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Wu Y, Cao H, Yang S, Liu C, Han Z. Progress of near-infrared-II fluorescence in precision diagnosis and treatment of colorectal cancer. Heliyon 2023; 9:e23209. [PMID: 38149207 PMCID: PMC10750080 DOI: 10.1016/j.heliyon.2023.e23209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Colorectal cancer is a malignant tumour with high incidence and mortality worldwide; therefore, improving the early diagnosis of colorectal cancer and implementing a targeted "individualized treatment" strategy is of great concern. NIR-II fluorescence imaging is a large-depth, high-resolution optical bioimaging tool. Around the NIR-II window, researchers have developed a variety of luminescent probes, imaging systems, and treatment methods with colorectal cancer targeting capabilities, which can be visualized and image-guided in clinical surgery. This article aims to overcome the difficulties in diagnosing and treating colorectal cancer. The present review summarizes the latest results on using NIR-II fluorescence for targeted colorectal cancer imaging, expounds on the application prospects of NIR-II optical imaging for colorectal cancer, and discusses the imaging-guided multifunctional diagnosis and treatment platforms.
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Affiliation(s)
- Yong Wu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Hongtao Cao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Shaoqing Yang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Chaohui Liu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Zhenguo Han
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
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Chang KJ, Kim DH, Lalani TK, Paroder V, Pickhardt PJ, Shaish H, Bates DDB. Radiologic T staging of colon cancer: renewed interest for clinical practice. Abdom Radiol (NY) 2023; 48:2874-2887. [PMID: 37277570 DOI: 10.1007/s00261-023-03904-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 06/07/2023]
Abstract
Radiologic imaging, especially MRI, has long been the mainstay for rectal cancer staging and patient selection for neoadjuvant therapy prior to surgical resection. In contrast, colonoscopy and CT have been the standard for colon cancer diagnosis and metastasis staging with T and N staging often performed at the time of surgical resection. With recent clinical trials exploring the expansion of the use of neoadjuvant therapy beyond the anorectum to the remainder of the colon, the current and future state of colon cancer treatment is evolving with a renewed interest in evaluating the role radiology may play in the primary T staging of colon cancer. The performance of CT, CT colonography, MRI, and FDG PET-CT for colon cancer staging will be reviewed. N staging will also be briefly discussed. It is expected that accurate radiologic T staging will significantly impact future clinical decisions regarding the neoadjuvant versus surgical management of colon cancer.
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Affiliation(s)
- Kevin J Chang
- Department of Radiology, Boston University Medical Center, Radiology- FGH 4001, 820 Harrison Ave, Boston, MA, 02118, USA.
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tasneem K Lalani
- Diagnostic Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Shi Y, Wang M, Zhang J, Xiang Z, Li C, Zhang J, Ma X. Tailoring the clinical management of colorectal cancer by 18F-FDG PET/CT. Front Oncol 2022; 12:1062704. [PMID: 36620584 PMCID: PMC9814158 DOI: 10.3389/fonc.2022.1062704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is among the most commonly diagnosed gastrointestinal malignancies worldwide. It is inadequate to handle in terms of staging and restaging only based on morphological imaging modalities and serum surrogate markers. And the correct and timely staging of CRC is imperative to prognosis and management. When compared to established sequential, multimodal conventional diagnostic methods, the molecular and functional imaging 18F-FDG PET/CT shows superiorities for tailoring appropriate treatment maneuvers to each patient. This review aims to summarize the utilities of 18F-FDG PET/CT in CRC, focusing on primary staging, follow-up assessment of tumor responses and diagnostic of recurrence. In addition, we also summarize the technical considerations of PET/CT and the conventional imaging modalities in those patients who are either newly diagnosed with CRC or has already been treated from this cancer.
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Affiliation(s)
- Yang Shi
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,State Key Laboratory for the Prevention and Treatment of Esophageal Cancer, Zhengzhou University, Zhengzhou, China,*Correspondence: Yang Shi, ; ; Jingjing Zhang, ; Xing Ma,
| | - Meiqi Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jiyu Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,State Key Laboratory for the Prevention and Treatment of Esophageal Cancer, Zhengzhou University, Zhengzhou, China
| | - Zheng Xiang
- Department of Pathology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, China
| | - Can Li
- Department of Administration, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jingjing Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,*Correspondence: Yang Shi, ; ; Jingjing Zhang, ; Xing Ma,
| | - Xing Ma
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China,*Correspondence: Yang Shi, ; ; Jingjing Zhang, ; Xing Ma,
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Komono A, Kajitani R, Matsumoto Y, Nagano H, Yoshimatsu G, Aisu N, Urakawa H, Hasegawa S. Preoperative T staging of advanced colorectal cancer by computed tomography colonography. Int J Colorectal Dis 2021; 36:2489-2496. [PMID: 34145484 DOI: 10.1007/s00384-021-03971-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Accurate preoperative T staging is important when determining the treatment strategy for advanced colorectal cancer. We have previously reported the usefulness of preoperative T staging based on the spatial relationship of tumors and "bordering vessels" by computed tomography colonography (CTC) with multiplanar reconstruction (MPR). The aims of this study were to evaluate the external validity of this method and to determine whether there is a difference in the accuracy of T staging between the mesenteric and antimesenteric sides. METHODS The study subjects were 110 patients with colorectal cancer who underwent preoperative CTC and surgical resection from June 2016 to March 2018. Preoperative T stage was determined by CTC based on the relationship between the tumor and the bordering vessels and compared with the pathological T stage. The influence of tumor location, namely, whether the tumor was on the antimesenteric or mesenteric side, on preoperative T staging was assessed in 78 patients with colorectal cancer. RESULTS Sensitivity, specificity, accuracy, positive, and negative predictive values were respectively, 65%, 91%, 83%, 76%, and 85% for T2 (n = 34); 76%, 82%, 81%, 50%, and 94% for T3 (n = 23); and 77%, 93%, 87%, 86%, and 88% for T4a disease (n = 39). Overall right answer rate was 83.3% (15/18) for the mesenteric side and 65% (39/60) for the antimesenteric side (n = 0.14). CONCLUSION Diagnostic criteria based on the bordering vessels seen on CTC images with MPR are useful for T staging of colorectal cancer. However, the accuracy differs between the antimesenteric and mesenteric sides.
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Affiliation(s)
- Akira Komono
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Department of Regenerative Medicine and Transplantation, Fukuoka University Hospital, Fukuoka, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroshi Urakawa
- Department of Diagnostic Radiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Kido H, Kato S, Funahashi K, Shibuya K, Sasaki Y, Urita Y, Hori M, Mizumura S. The metabolic parameters based on volume in PET/CT are associated with clinicopathological N stage of colorectal cancer and can predict prognosis. EJNMMI Res 2021; 11:87. [PMID: 34487264 PMCID: PMC8421476 DOI: 10.1186/s13550-021-00831-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background A combination of positron emission tomography and computed tomography (PET/CT) is an important modality for the diagnosis of carcinoma. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have been reported as metabolic parameters in PET/CT since the late 1990s, and they are expected to be useful in diagnosing diverse cancers and as prognostic biomarkers. We evaluated the potential of these parameters in the prognosis of colorectal cancer (CRC) by comparing them with conventional parameters, including the maximum standardized uptake value (SUVmax). We enrolled 84 patients who underwent surgery for CRC without distal metastasis between April 2015 and April 2019. SUVmax, MTV, and TLG were measured by 18F-fluorodeoxyglucose (FDG)-PET/CT. To find an optimal threshold value related to prognosis, the volume of interest in the primary carcinoma was measured at fixed relative and absolute thresholds based on SUVmax (30%, 40%, and 50%; 2.5, 3.0, and 3.5, respectively), tumor-to-liver standardized uptake ratios, TLR (1.0, 1.5, and 2.0), and SUV normalized to lean body mass, SUL (2.0, 2.5, and 3.0). After classifying the patients into two groups according to pathological N stage, the optimal threshold values of all metabolic parameters were compared between groups using a non-parametric comparison test. Result The most suitable thresholds for MTV were a SUVmax of 3.5 and a TLR 2.0. TLG with a SUVmax value of 40% showed the most significant difference. The MTV standard uptake ratio of 2.0 was significantly associated with pathological N stage. Conclusion Our results suggest that an MTV TLR 2.0 on PET/CT reflects pathological N stage in local patients with CRC.
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Affiliation(s)
- Hidenori Kido
- Department of Radiology, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan. .,Department of Oncology, School of Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of General Medicine and Emergency Care, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Shunsuke Kato
- Department of Oncology, School of Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kimihiko Funahashi
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Kazutoshi Shibuya
- Department of Pathology, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Yousuke Sasaki
- Department of General Medicine and Emergency Care, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Yoshihisa Urita
- Department of General Medicine and Emergency Care, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Masaaki Hori
- Department of Radiology, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Sunao Mizumura
- Department of Radiology, School of Medicine, Faculty of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
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Ihara K, Onoda H, Tanabe M, Kanki A, Ito K. Hemodynamic changes of abdominal organs after CT colonography with transrectal administration of CO2: evaluation with early-phase contrast-enhanced dynamic CT. Jpn J Radiol 2021; 39:900-906. [PMID: 33963466 PMCID: PMC8413186 DOI: 10.1007/s11604-021-01125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the hemodynamic changes in the liver, pancreas, gastric mucosa and abdominal vessels in early-phase dynamic contrast-enhanced (DCE) CT immediately after CT colonography (CTC) with carbon dioxide expansion. MATERIALS AND METHODS This study included 82 patients with DCE-CT after CTC (CTC group) and 77 patients without CTC (control group). Contrast enhancement values of the gastric mucosa, liver, pancreas, portal vein (PV), splenic vein (SpV), superior mesenteric vein (SMV), and inferior mesenteric vein (IMV) in early-phase CT were measured. The presence of hepatic pseudolesions were also recorded. RESULTS The mean contrast enhancement values of the gastric mucosa, pancreas and SpV in the CE-CTC group were significantly lower than those in the control group (p < 0.001, p < 0.001, p = 0.014). Conversely, the mean contrast enhancement values of the liver, PV, SMV and IMV in the CE-CTC group were significantly higher than those in the control group (p = 0.003, p = 0.013, p < 0.001, p < 0.001). Hypovascular hepatic pseudolesions were seen in early-phase CT in six patients after CTC, while they were not seen in the control group. CONCLUSIONS On DCE-CT performed immediately after CTC with carbon dioxide expansion, it is important to be aware of the imaging findings induced by visceral hemodynamic changes.
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Affiliation(s)
- Kenichiro Ihara
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Hideko Onoda
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Akihiko Kanki
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Liu Q, Li J, Xu L, Wang J, Zeng Z, Fu J, Huang X, Chu Y, Wang J, Zhang HY, Zeng F. Individualized Prediction of Colorectal Cancer Metastasis Using a Radiogenomics Approach. Front Oncol 2021; 11:620945. [PMID: 33996544 PMCID: PMC8113949 DOI: 10.3389/fonc.2021.620945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate whether incorporating the radiomics, genomics, and clinical features allows prediction of metastasis in colorectal cancer (CRC) and to develop a preoperative nomogram for predicting metastasis. Methods: We retrospectively analyzed radiomics features of computed tomography (CT) images in 134 patients (62 in the primary cohort, 28 in the validation cohort, and 44 in the independent-test cohort) clinicopathologically diagnosed with CRC at Dazhou Central Hospital from February 2018 to October 2019. Tumor tissues were collected from all patients for RNA sequencing, and clinical data were obtained from medical records. A total of 854 radiomics features were extracted from enhanced venous-phase CT of CRC. Least absolute shrinkage and selection operator regression analysis was utilized for data dimension reduction, feature screen, and radiomics signature development. Multivariable logistic regression analysis was performed to build a multiscale predicting model incorporating the radiomics, genomics, and clinical features. The receiver operating characteristic curve, calibration curve, and decision curve were conducted to evaluate the performance of the nomogram. Results: The radiomics signature based on 16 selected radiomics features showed good performance in metastasis assessment in both primary [area under the curve (AUC) = 0.945, 95% confidence interval (CI) 0.892–0.998] and validation cohorts (AUC = 0.754, 95% CI 0.570–0.938). The multiscale nomogram model contained radiomics features signatures, four-gene expression related to cell cycle pathway, and CA 19-9 level. The multiscale model showed good discrimination performance in the primary cohort (AUC = 0.981, 95% CI 0.953–1.000), the validation cohort (AUC = 0.822, 95% CI 0.635–1.000), and the independent-test cohort (AUC = 0.752, 95% CI 0.608–0.896) and good calibration. Decision curve analysis confirmed the clinical application value of the multiscale model. Conclusion: This study presented a multiscale model that incorporated the radiological eigenvalues, genomics features, and CA 19-9, which could be conveniently utilized to facilitate the individualized preoperatively assessing metastasis in CRC patients.
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Affiliation(s)
- Qin Liu
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, China
| | - Jie Li
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, China
| | - Lin Xu
- Department of Radiology, Dazhou Central Hospital, Dazhou, China
| | - Jiasi Wang
- Department of Clinical Laboratory, Dazhou Central Hospital, Dazhou, China
| | - Zhaoping Zeng
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, China
| | - Jiangping Fu
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, China
| | - Xuan Huang
- Department of Ophthalmology, Medical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanpeng Chu
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, China
| | - Jing Wang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong-Yu Zhang
- Hubei Key Laboratory of Agricultural Bioinformatics, College of Informatics, Huazhong Agricultural University, Wuhan, China
| | - Fanxin Zeng
- Department of Clinical Research Center, Dazhou Central Hospital, Dazhou, China.,School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Ge YX, Xu WB, Wang Z, Zhang JQ, Zhou XY, Duan SF, Hu SD, Fei BJ. Prognostic value of CT radiomics in evaluating lymphovascular invasion in rectal cancer: Diagnostic performance based on different volumes of interest. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:663-674. [PMID: 34024807 DOI: 10.3233/xst-210877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aims to evaluate diagnostic performance of radiomic analysis using computed tomography (CT) to identify lymphovascular invasion (LVI) in patients diagnosed with rectal cancer and assess diagnostic performance of different lesion segmentations. METHODS The study is applied to 169 pre-treatment CT images and the clinical features of patients with rectal cancer. Radiomic features are extracted from two different volumes of interest (VOIs) namely, gross tumor volume and peri-tumor tissue volume. The maximum relevance and the minimum redundancy, and the least absolute shrinkage selection operator based logistic regression analyses are performed to select the optimal feature subset on the training cohort. Then, Rad and Rad-clinical combined models for LVI prediction are built and compared. Finally, the models are externally validated. RESULTS Eighty-three patients had positive LVI on pathology, while 86 had negative LVI. An optimal multi-mode radiology nomogram for LVI estimation is established. The area under the receiver operating characteristic curves of the Rad and Rad-clinical combined model in the peri-tumor VOI group are significantly higher than those in the tumor VOI group (Rad: peri-tumor vs. tumor: 0.85 vs. 0.68; Rad-clinical: peri-tumor vs. tumor: 0.90 vs 0.82) in the validation cohort. Decision curve analysis shows that the peri-tumor-based Rad-clinical combined model has the best performance in identifying LVI than other models. CONCLUSIONS CT radiomics model based on peri-tumor volumes improves prediction performance of LVI in rectal cancer compared with the model based on tumor volumes.
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Affiliation(s)
- Yu-Xi Ge
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Wen-Bo Xu
- Wuxi Research Institute, Fudan University, Wuxi, Jiangsu, China
| | - Zi Wang
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jun-Qin Zhang
- Department of radiology, The First People's Hospital of Yuhang District, Hangzhou, Zhejiang Province, China
| | - Xin-Yi Zhou
- Department of Pathology, Affiliated Hospital of Jiangnan University, 200 Huihe Road, Wuxi, Jiangsu, China
| | | | - Shu-Dong Hu
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Bo-Jian Fei
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Xu H, Zhao W, Guo W, Cao S, Gao C, Song T, Yang L, Liu Y, Han Y, Zhang L, Wang K. Prediction Model Combining Clinical and MR Data for Diagnosis of Lymph Node Metastasis in Patients With Rectal Cancer. J Magn Reson Imaging 2020; 53:874-883. [PMID: 32978993 DOI: 10.1002/jmri.27369] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Determining the status of lymph node (LN) metastasis in rectal cancer patients preoperatively is crucial for the treatment option. However, the diagnostic accuracy of current imaging methods is low. PURPOSE To develop and test a model for predicting metastatic LNs of rectal cancer patients based on clinical data and MR images to improve the diagnosis of metastatic LNs. STUDY TYPE Retrospective. SUBJECTS In all, 341 patients with histologically confirmed rectal cancer were divided into one training set (120 cases) and three validation sets (69, 103, 49 cases). FIELD STRENGTH/SEQUENCE 3.0T, axial and sagittal T2 -weighted turbo spin echo and diffusion-weighted imaging (b = 0 s/mm2 , 800 s/mm2 ) ASSESSMENT: In the training dataset, univariate logistic regression was used to identify the clinical factors (age, gender, and tumor markers) and MR data that correlated with LN metastasis. Then we developed a prediction model with these factors by multiple logistic regression analysis. The accuracy of the model was verified using three validation sets and compared with the traditional MRI method. STATISTICAL TESTS Univariate and multivariate logistic regression. The area under the curve (AUC) value was used to quantify the diagnostic accuracy of the model. RESULTS Eight factors (CEA, CA199, ADCmean, mriT stage, mriN stage, CRM, EMVI, and differentiation degree) were significantly associated with LN metastasis in rectal cancer patients (P<0.1). In the training set (120) and the three validation sets (69, 103, 49), the AUC values of the model were much higher than the diagnosis by MR alone (training set, 0.902 vs. 0.580; first validation set, 0.789 vs. 0.743; second validation set, 0.774 vs. 0.573; third validation set, 0.761 vs. 0.524). DATA CONCLUSION For the diagnosis of metastatic LNs in rectal cancer patients, our proposed logistic regression model, combining clinical and MR data, demonstrated higher diagnostic efficiency than MRI alone. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Hanshan Xu
- PET-CT/MR Department, Harbin Medical University Cancer Hospital, Harbin City, China
| | - Wenyuan Zhao
- Bioinformatics Science and Technology College, Harbin Medical University, Harbin City, China
| | - Wenbing Guo
- Bioinformatics Science and Technology College, Harbin Medical University, Harbin City, China
| | - Shaodong Cao
- Radiology Department, Fourth Affiliated Hospital Harbin Medical University, Harbin City, China
| | - Chao Gao
- Radiology Department, Fourth Affiliated Hospital Harbin Medical University, Harbin City, China
| | - Tiantian Song
- PET-CT/MR Department, Harbin Medical University Cancer Hospital, Harbin City, China
| | - Liping Yang
- PET-CT/MR Department, Harbin Medical University Cancer Hospital, Harbin City, China
| | - Yanlong Liu
- Colorectal Surgery Department, Harbin Medical University Cancer Hospital, Harbin City, China
| | - Yu Han
- Gastroenterology and Oncology Department, Harbin Medical University Cancer Hospital, Harbin City, China
| | - Lingbo Zhang
- Head-neck and Oral Department, Second Affiliated Hospital of Harbin Medical University, Harbin City, China
| | - Kezheng Wang
- PET-CT/MR Department, Harbin Medical University Cancer Hospital, Harbin City, China
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10
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Zhang Y, He K, Guo Y, Liu X, Yang Q, Zhang C, Xie Y, Mu S, Guo Y, Fu Y, Zhang H. A Novel Multimodal Radiomics Model for Preoperative Prediction of Lymphovascular Invasion in Rectal Cancer. Front Oncol 2020; 10:457. [PMID: 32328460 PMCID: PMC7160379 DOI: 10.3389/fonc.2020.00457] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023] Open
Abstract
Objective: To explore a new predictive model of lymphatic vascular infiltration (LVI) in rectal cancer based on magnetic resonance (MR) and computed tomography (CT). Methods: A retrospective study was conducted on 94 patients with histologically confirmed rectal cancer, they were randomly divided into training cohort (n = 65) and validation cohort (n = 29). All patients underwent MR and CT examination within 2 weeks before treatment. On each slice of the tumor, we delineated the volume of interest on T2-weighted imaging, diffusion weighted imaging, and enhanced CT images, respectively. A total of 1,188 radiological features were extracted from each patient. Then, we used the student t-test or Mann–Whitney U-test, Spearman's rank correlation and least absolute shrinkage and selection operator (LASSO) algorithm to select the strongest features to establish a single and multimodal logic model for predicting LVI. Receiver operating characteristic (ROC) curves and calibration curves were plotted to determine how well they explored LVI prediction performance in the training and validation cohorts. Results: An optimal multi-mode radiology nomogram for LVI estimation was established, which had significant predictive power in training (AUC, 0.884; 95% CI, 0.803–0.964) and validation (AUC, 0.876; 95% CI, 0.721–1.000). Calibration curve and decision curve analysis showed that the multimodal radiomics model provides greater clinical benefits. Conclusion: Multimodal (MR/CT) radiomics models can serve as an effective visual prognostic tool for predicting LVI in rectal cancer. It demonstrated great potential of preoperative prediction to improve treatment decisions.
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Affiliation(s)
- Yiying Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Kan He
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yan Guo
- GE Healthcare, Shanghai, China
| | - Xiangchun Liu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Qi Yang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Chunyu Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yunming Xie
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Shengnan Mu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yu Guo
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yu Fu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
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Liang M, Cai Z, Zhang H, Huang C, Meng Y, Zhao L, Li D, Ma X, Zhao X. Machine Learning-based Analysis of Rectal Cancer MRI Radiomics for Prediction of Metachronous Liver Metastasis. Acad Radiol 2019; 26:1495-1504. [PMID: 30711405 DOI: 10.1016/j.acra.2018.12.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To use machine learning-based magnetic resonance imaging radiomics to predict metachronous liver metastases (MLM) in patients with rectal cancer. MATERIALS AND METHODS This study retrospectively analyzed 108 patients with rectal cancer (54 in MLM group and 54 in nonmetastases group). Feature selection were performed in the radiomic feature sets extracted from images of T2-weighted image (T2WI) and venous phase (VP) sequence respectively, and the combining feature set with 2058 radiomic features incorporating two sequences with the least absolute shrinkage and selection operator method. Five-fold cross-validation and two machine learning algorithms (support vector machine [SVM]; logistic regression [LR]) were utilized for predictive model constructing. The diagnostic performance of the models was evaluated by receiver operating characteristic curves with indicators of accuracy, sensitivity, specificity and area under the curve, and compared by DeLong test. RESULTS Five, 8, and 22 optimal features were selected from 1029 T2WI, 1029 VP, and 2058 combining features, respectively. Four-group models were constructed using the five T2WI features (ModelT2), the 8 VP features (ModelVP), the combined 13 optimal features (Modelcombined), and the 22 optimal features selected from 2058 features (Modeloptimal). In ModelVP, the LR was superior to the SVM algorithm (P = 0.0303). The Modeloptimal using LR algorithm showed the best prediction performance (P = 0.0019-0.0081) with accuracy, sensitivity, specificity, and area under the curve of 0.80, 0.83, 0.76, and 0.87, respectively. CONCLUSION Radiomics models based on baseline rectal magnetic resonance imaging has high potential for MLM prediction, especially the Modeloptimal using LR algorithm. Moreover, except for ModelVP, the LR was not superior to the SVM algorithm for model construction.
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Affiliation(s)
- Meng Liang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Zhengting Cai
- Huiying Medical Technology Co., Ltd., HaiDian District, Beijing City, 100192, People's Republic of China
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Chencui Huang
- Huiying Medical Technology Co., Ltd., HaiDian District, Beijing City, 100192, People's Republic of China
| | - Yankai Meng
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China; Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, People's Republic of China
| | - Li Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Dengfeng Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Xiaohong Ma
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
| | - Xinming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
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Mainenti PP, Stanzione A, Guarino S, Romeo V, Ugga L, Romano F, Storto G, Maurea S, Brunetti A. Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging. World J Gastroenterol 2019; 25:5233-5256. [PMID: 31558870 PMCID: PMC6761241 DOI: 10.3748/wjg.v25.i35.5233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians’ disposal for the diagnostic management of the disease, tomographic imaging (e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques, such as diffusion-weighted MRI and perfusion imaging, were designed for the “in vivo” evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone (e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes (e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition from purely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.
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Affiliation(s)
- Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples 80145, Italy
| | - Arnaldo Stanzione
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Salvatore Guarino
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Valeria Romeo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Lorenzo Ugga
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Federica Romano
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Giovanni Storto
- IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture 85028, Italy
| | - Simone Maurea
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Arturo Brunetti
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
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Komono A, Shida D, Iinuma G, Tsukamoto S, Sakamoto R, Moritani K, Miyake M, Kanemitsu Y. Preoperative T staging of colon cancer using CT colonography with multiplanar reconstruction: new diagnostic criteria based on "bordering vessels". Int J Colorectal Dis 2019; 34:641-648. [PMID: 30666406 DOI: 10.1007/s00384-019-03236-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Preoperative T staging of colon cancer, in particular, for distinguishing T3 from T2 and T4, has been a challenge. The aim of this study was to evaluate newly developed criteria for preoperative T staging of colorectal cancer using computed tomography colonography (CTC) with multiplanar reconstruction (MPR), based on the spatial relationship of tumors and "bordering vessels," that is, marginal vessels that are detectable by multi-detector row CT with MPR. METHODS A total of 172 patients with colon and upper rectal cancer who underwent preoperative CTC and surgery between August 2011 and September 2013 were included. Preoperative T staging using the new criteria was performed prospectively and compared with pathologic results. RESULTS Sensitivity, specificity, and accuracy of T staging by CTC using the new criteria were 63%, 80%, and 77% for T2 (n = 30); 72%, 94%, and 81% for T3 (n = 95); and 79%, 99%, and 97% for T4a (n = 14), respectively. Positive predictive value for T3 was 93%, indicating that a T3 diagnosis by CTC is precise. In addition, negative predictive value for pathological T4a was 98%, indicating that a "not T4a" diagnosis by CTC is also precise. CONCLUSIONS Our newly developed criteria are useful for preoperative T staging, particularly for distinguishing T3 from T2 and T4.
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Affiliation(s)
- Akira Komono
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Dai Shida
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
| | - Gen Iinuma
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Shunsuke Tsukamoto
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Ryohei Sakamoto
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Konosuke Moritani
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Mototaka Miyake
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
| | - Yukihide Kanemitsu
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan
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Hirata Y, Nozawa H, Murono K, Kawai K, Hata K, Tanaka T, Nishikawa T, Otani K, Sasaki K, Kaneko M. Over-diagnosis for preoperative T staging of colorectal cancer - A case series. Ann Med Surg (Lond) 2018; 32:10-13. [PMID: 30002822 PMCID: PMC6039894 DOI: 10.1016/j.amsu.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/15/2018] [Accepted: 06/05/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Recent progressive imaging technology such as multiplanar reconstruction on computed tomography (CT) and colonoscopy has made preoperative T staging of colorectal cancer (CRC) more accurate. Nevertheless, it is still difficult to make a correct diagnosis in some cases. The aim of this case study was to investigate the accuracy of T staging diagnosis in patients with CRC who underwent curative operations and to identify the causes of preoperative over-diagnosis. Method Medical charts of 1013 colorectal cancer patients who underwent a curative operation in the University of Tokyo Hospital between January 2011 and December 2016 were analyzed retrospectively. We defined a two-level or more difference between clinical and pathological T stages as over-diagnosis or under-diagnosis. Results Nine patients were over-diagnosed in T stage preoperatively. The rate of over-diagnosis was 0.9%. At least three main factors for over-diagnosis were identified: close-to-circumferential or obstructive lesion; a rough appearance in the adipose tissues around the tumor on CT; and a tumor with a depressed structure. Conclusions Clinical T stage is overestimated with a marked difference from pathological T stage in approximately 1% of CRC patients. Further progress in diagnostic modalities is required for more accurate staging. The rate of one-level over-diagnosis in T stage was 14.8%. The rate of two-levels or more over-diagnosis in T stage was 0.9%. At least three main factors for two-levels or more over-diagnosis were identified.
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Affiliation(s)
- Yugo Hirata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Nishikawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kensuke Otani
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Manabu Kaneko
- Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
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Bai RJ, Ren SH, Jiang HJ, Li JP, Liu XC, Xue LM. Accuracy of Multi-Slice Spiral Computed Tomography for Preoperative Tumor Node Metastasis (TNM) Staging of Colorectal Carcinoma. Med Sci Monit 2017; 23:3470-3479. [PMID: 28715364 PMCID: PMC5528007 DOI: 10.12659/msm.902649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background With the advances in imaging technologies, multi-slice spiral computed tomography (MSCT) has demonstrated superiority in the diagnosis and staging of colorectal carcinoma. In the current study, preoperative TNM staging of colorectal carcinoma by using MSCT was conducted and compared with the corresponding postoperative pathological examination findings, in order to evaluate the accuracy of preoperative MSCT for TNM staging. Material/Methods Combinations of biphasic or triphasic enhanced-phase MSCT scans were obtained for 76 patients with colorectal carcinoma, and the TNM stage was determined based on imaging reconstruction from various angles and perspectives to display the size, location, and affected range of tumors. The preoperative TNM stage was compared with the postoperative pathological stage, and the consistency between the 2 methods was tested by the κ test using SPSS 17.0 software. Results Among the different combinations of enhanced-phase MSCT scanning, triphasic MSCT imaging, comprising the arterial, portal venous, and delayed phases, showed the highest accuracy rates, at 81.6% (62/76), 82.89% (63/76), and 96.1% (73/76) for T, N, and M staging, respectively, with κ values of 0.72, 0.65, and 0.56, respectively, indicating consistency with the postoperative pathological staging. Conclusions Combined MSCT scanning comprising the arterial phase, portal venous phase, and delayed phase showed satisfying consistency with the postoperative pathological analysis results for TNM staging of colorectal carcinoma. Thus, MSCT is an important clinical value for improving the accuracy of TNM staging and for planning the appropriate colorectal cancer treatment.
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Affiliation(s)
- Rong-Jie Bai
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China (mainland)
| | - Shao-Hua Ren
- Department of Radiology, The First Hospital of Harbin, Harbin, Heilongjiang, China (mainland)
| | - Hui-Jie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Jin-Ping Li
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Xiao-Cheng Liu
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Li-Ming Xue
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
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Kanazawa H, Utano K, Kijima S, Sasaki T, Miyakura Y, Horie H, Lefor AK, Sugimoto H. Combined assessment using optical colonoscopy and computed tomographic colonography improves the determination of tumor location and invasion depth. Asian J Endosc Surg 2017; 10:28-34. [PMID: 27651020 DOI: 10.1111/ases.12313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/28/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION An accurate assessment of the depth of tumor invasion in patients with colon cancer is an important part of the preoperative evaluation. Whether computed tomographic colonography (CTC) or optical colonoscopy (OC) is better to accurately determine tumor location and invasion depth has not been definitively determined. The aim of this study was to determine the diagnostic accuracy of tumor localization and tumor invasion depth of colon cancer by preoperative OC alone or combined with CTC. METHODS Study participants include 143 patients who underwent both preoperative CTC using automated CO2 insufflation and OC from July 2012 to August 2013. RESULTS The accuracy of tumor localization was significantly better with CTC than with OC (OC, 90%; CTC, 98%; P < 0.05). No tumor in the descending colon was localized accurately via OC alone. The accuracy of tumor invasion depth was better with CTC plus OC than with OC alone (OC, 55%; CTC, 73%; P < 0.05). CONCLUSIONS OC combined with CTC provides a more accurate preoperative determination of tumor localization and invasion depth than OC alone.
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Affiliation(s)
- Hidenori Kanazawa
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | - Kenichi Utano
- Department of Coloproctology, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Shigeyoshi Kijima
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | - Takahiro Sasaki
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan.,Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | | | - Hideharu Sugimoto
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
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Kniery K, Nishtala M, Steele SR. Staging, prognosis, and survivorship in colon cancer. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Acuna SA, Elmi M, Shah PS, Coburn NG, Quereshy FA. Preoperative localization of colorectal cancer: a systematic review and meta-analysis. Surg Endosc 2016; 31:2366-2379. [PMID: 27699516 DOI: 10.1007/s00464-016-5236-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative colorectal tumor localization is crucial for appropriate resection and treatment planning. As the localization accuracy of conventional colonoscopy is considered to be low, several localization techniques have been developed. We systematically reviewed the tumor localization error rates of several preoperative endoscopic techniques and synthesized information on risk factors for localization errors and procedure-related adverse events. METHODS MEDLINE, EMBASE, the Cochrane Library, and the grey literature were searched. Studies were included if they reported tumor localization errors in patients with colorectal cancer undergoing resection with curative intent. Using random-effects models, pooled incidence of tumor localization errors were derived for conventional colonoscopy and colonoscopic tattooing. Due to the lack of comparative studies, a direct comparison of the pooled estimates was performed. Procedure-related adverse events, risk factors for localization errors, and the localization outcomes of other techniques such as colonoscopic clip placement, radioguided occult colonic lesion identification, and the use of magnetic endoscope imaging were also synthesized. RESULTS A total of 38 non-randomized controlled and observational studies were included in this review (2578 patients underwent conventional colonoscopy and 643 colonoscopic tattooing). The pooled incidence of localization errors with conventional colonoscopy was 15.4 % (95 % CI 12.0-18.7), whereas that of colonoscopic tattooing was 9.5 % (95 % CI 5.7-13.3), mean difference 5.9 % (95 % CI 0.65-11.14, p = 0.03). Adverse events secondary to tattooing were infrequent, and most were cases of ink spillage. Limited information was available for other localization techniques. CONCLUSION Conventional colonoscopy has a higher incidence of localization error compared to colonoscopic tattooing for localization of colorectal cancer. Colonoscopic tattooing is safe and leads to fewer tumor localization errors. Given the widespread adoption of laparoscopic resections for colorectal cancer, routine colonoscopic tattooing should be adopted. However, studies directly comparing different localization techniques are needed.
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Affiliation(s)
- Sergio A Acuna
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Maryam Elmi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Departments of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of General Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street Main Pavilion, Room 8-320, Toronto, ON, M5T 2S8, Canada.
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Diagnostic Accuracy of CT for Local Staging of Colon Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2016; 207:984-995. [PMID: 27490941 DOI: 10.2214/ajr.15.15785] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this article is to determine the accuracy of CT in the detection of tumor invasion beyond the bowel wall and nodal involvement of colon carcinomas. A literature search was performed to identify studies describing the accuracy of CT in the staging of colon carcinomas. Studies including rectal carcinomas that were inseparable from colon carcinomas were excluded. Publication bias was explored by using a Deeks funnel plot asymmetry test. A hierarchic summary ROC model was used to construct a summary ROC curve and to calculate summary estimates of sensitivity, specificity, and diagnostic odds ratios (ORs). CONCLUSION On the basis of a total of 13 studies, pooled sensitivity, specificity, and diagnostic ORs for detection of tumor invasion beyond the bowel wall (T3-T4) were 90% (95% CI, 83-95%), 69% (95% CI, 62-75%), and 20.6 (95% CI, 10.2-41.5), respectively. For detection of tumor invasion depth of 5 mm or greater (T3cd-T4), estimates from four studies were 77% (95% CI, 66-85%), 70% (95% CI, 53-83%), and 7.8 (95% CI, 4.2-14.2), respectively. For nodal involvement (N+), 16 studies were included with values of 71% (95% CI, 59-81%), 67% (95% CI, 46-83%), and 4.8 (95% CI, 2.5-9.4), respectively. Two studies using CT colonography were included with sensitivity and specificity of 97% (95% CI, 90-99%) and 81% (95% CI, 65-91%), respectively, for detecting T3-T4 tumors. CT has good sensitivity for the detection of T3-T4 tumors, and evidence suggests that CT colonography increases its accuracy. Discriminating between T1-T3ab and T3cd-T4 cancer is challenging, but data were limited. CT has a low accuracy in detecting nodal involvement.
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Mainenti PP, Romano F, Pizzuti L, Segreto S, Storto G, Mannelli L, Imbriaco M, Camera L, Maurea S. Non-invasive diagnostic imaging of colorectal liver metastases. World J Radiol 2015; 7:157-169. [PMID: 26217455 PMCID: PMC4506934 DOI: 10.4329/wjr.v7.i7.157] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/10/2015] [Accepted: 06/02/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the few malignant tumors in which synchronous or metachronous liver metastases [colorectal liver metastases (CRLMs)] may be treated with surgery. It has been demonstrated that resection of CRLMs improves the long-term prognosis. On the other hand, patients with un-resectable CRLMs may benefit from chemotherapy alone or in addition to liver-directed therapies. The choice of the most appropriate therapeutic management of CRLMs depends mostly on the diagnostic imaging. Nowadays, multiple non-invasive imaging modalities are available and those have a pivotal role in the workup of patients with CRLMs. Although extensive research has been performed with regards to the diagnostic performance of ultrasonography, computed tomography, positron emission tomography and magnetic resonance for the detection of CRLMs, the optimal imaging strategies for staging and follow up are still to be established. This largely due to the progressive technological and pharmacological advances which are constantly improving the accuracy of each imaging modality. This review describes the non-invasive imaging approaches of CRLMs reporting the technical features, the clinical indications, the advantages and the potential limitations of each modality, as well as including some information on the development of new imaging modalities, the role of new contrast media and the feasibility of using parametric image analysis as diagnostic marker of presence of CRLMs.
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Kijima S, Sasaki T, Nagata K, Utano K, Lefor AT, Sugimoto H. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol 2014; 20:16964-16975. [PMID: 25493009 PMCID: PMC4258565 DOI: 10.3748/wjg.v20.i45.16964] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/13/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging studies are a major component in the evaluation of patients for the screening, staging and surveillance of colorectal cancer. This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography (CT) colonography, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT colonography. CT colonography provides important information for the preoperative assessment of T staging. Wall deformities are associated with muscular or subserosal invasion. Lymph node metastases from colorectal cancer often present with calcifications. CT is superior to detect calcified metastases. Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery. T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure. N staging in patients with colorectal cancer is still challenging using any imaging modality. MRI is more accurate than CT for the evaluation of liver metastases. PET/CT colonography is valuable in the evaluation of extra-colonic and hepatic disease. PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically. PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely. However, there is no definite evidence to support the routine clinical use of PET/CT colonography.
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Evaluation of dual energy spectral CT in differentiating metastatic from non-metastatic lymph nodes in rectal cancer: Initial experience. Eur J Radiol 2014; 84:228-34. [PMID: 25497234 DOI: 10.1016/j.ejrad.2014.11.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the value of dual energy spectral CT (DEsCT) imaging in differentiating metastatic from non-metastatic lymph nodes in rectal cancer. METHODS Fifty-five patients with rectal cancer underwent the arterial phase (AP) and portal venous phase (PP) contrast-enhanced DEsCT imaging. The virtual monochromatic images and iodine-based material decomposition images derived from DEsCT imaging were interpreted for lymph nodes (LNs) measurement. The short axis diameter and the normalized iodine concentration (nIC) of metastatic and non-metastatic LNs were measured. The two-sample t test was used to compare the short axis diameters and nIC values of metastatic and non-metastatic LNs. ROC analysis was performed to assess the diagnostic performance. RESULTS One hundred and fifty two LNs including 92 non-metastatic LNs and 60 metastatic LNs were matched using the radiological-pathological correlation. The mean short axis diameter of metastatic LNs was significantly larger than that of the non-metastatic LNs (7.28±2.28mm vs. 4.90±1.64mm, P<0.001). The mean nIC value for metastatic LNs was significantly lower than that of non-metastatic LNs (0.24±0.08 vs. 0.34±0.21, P=0.001 in AP; 0.47±0.18 vs. 0.64±0.17, P<0.001 in PP). Combining nIC (PP) with the short axis diameter, the overall accuracy could be improved to 82.9%. CONCLUSIONS With the combination of nIC value in PP and conventional size criterion, dual energy spectral imaging may be used to differentiate metastatic from non-metastatic lymph nodes in rectal cancer.
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Shibasaki S, Takahashi N, Homma S, Nishida M, Shimokuni T, Yoshida T, Kawamura H, Oyama-Manabe N, Kudo K, Taketomi A. Use of transabdominal ultrasonography to preoperatively determine T-stage of proven colon cancers. ACTA ACUST UNITED AC 2014; 40:1441-50. [DOI: 10.1007/s00261-014-0296-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
AIM: To evaluate the value of computed tomography colonography (CTC) in the evaluation of colorectal cancer by comparing its performance with colonoscopy.
METHODS: Forty-one patients who were diagnosed with colorectal cancer by colonoscopic biopsy and underwent CTC and colonoscopy were included in the study. CTC and colonoscopy were compared for their performance in the evaluation of colorectal cancer.
RESULTS: The locations of tumors revealed by CTC and colonoscopy were consistent. However, colonoscopy had its limitation in determining the size of the tumor, and tumor size was measured by colonoscopy in 54% (23/43) of cases , in contrast to 95% (41/43) of cases by CTC. There was no statistical significance in the pathological type revealed by the two techniques (P = 0.621). Colonoscopy failed to evaluate the condition outside the intestinal tract and the proximal colon in cases with colon obstruction, resulting in incomplete examination. The grade of subjective tolerability was significantly lower for colonoscopy than for CTC (P = 0.000).
CONCLUSION: CTC can evaluate colorectal cancer effectively, although it cannot replace colonoscopy entirely. CTC can be chosen as a preferred means for patients who cannot tolerate colonoscopy as well as patients who have incomplete colonoscopy examination.
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Preoperative staging of colorectal cancer: accuracy of single portal venous phase multidetector computed tomography. Clin Imaging 2013; 37:1048-53. [PMID: 24055146 DOI: 10.1016/j.clinimag.2013.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/26/2013] [Accepted: 08/01/2013] [Indexed: 12/17/2022]
Abstract
In this study, we aimed to investigate the accuracy of single portal venous phase multidetector computed tomography (MDCT) in preoperative staging of colorectal cancer. MDCT, surgery, and pathological results of 159 patients with pathologically proven colorectal adenocarcinoma were evaluated retrospectively. In T staging, the accuracy was 96% for ≤ T2 tumors, 92% for T3 tumors, and 96% for T4 tumors. In N staging, the accuracy was 68% for N0 tumors, 74% for N1 tumors, and 71% for N2 tumors. In conclusion, the accuracy of single portal venous phase MDCT is reasonably high in T staging, but it is not sufficiently high enough in N staging.
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The second ESGAR consensus statement on CT colonography. Eur Radiol 2012; 23:720-9. [PMID: 22983280 PMCID: PMC3563960 DOI: 10.1007/s00330-012-2632-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 03/18/2012] [Accepted: 04/01/2012] [Indexed: 12/14/2022]
Abstract
Objective To update quality standards for CT colonography based on consensus among opinion leaders within the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Material and methods A multinational European panel of nine members of the ESGAR CT colonography Working Group (representing six EU countries) used a modified Delphi process to rate their level of agreement on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval. Results The panel elaborated 86 statements. In the final round the panelists achieved complete consensus in 71 of 86 statements (82 %). Categories including the highest proportion of statements with excellent Cronbach's internal reliability were colon distension, scan parameters, use of intravenous contrast agents, general guidelines on patient preparation, role of CAD and lesion measurement. Lower internal reliability was achieved for the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading, and reporting. Conclusion The recommendations of the consensus should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating. Key Points • Computed tomographic colonography is the optimal radiological method of assessing the colon • This article reviews ESGAR quality standards for CT colonography • This article is aimed to provide CT-colonography guidelines for practising radiologists • The recommendations should help radiologists who are starting/updating their CTC services
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Mainenti PP, Iodice D, Segreto S, Storto G, Magliulo M, Palma GDD, Salvatore M, Pace L. Colorectal cancer and 18FDG-PET/CT: What about adding the T to the N parameter in loco-regional staging? World J Gastroenterol 2011; 17:1427-33. [PMID: 21472100 PMCID: PMC3070015 DOI: 10.3748/wjg.v17.i11.1427] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 10/16/2010] [Accepted: 10/23/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate whether FDG-positron emission tomography (PET)/computed tomography (CT) may be an accurate technique in the assessment of the T stage in patients with colorectal cancer.
METHODS: Thirty four consecutive patients (20 men and 14 women; mean age: 63 years) with a histologically proven diagnosis of colorectal adenocarcinoma and scheduled for surgery in our hospital were enrolled in this study. All patients underwent FDG-PET/CT preoperatively. The primary tumor site and extent were evaluated on PET/CT images. Colorectal wall invasion was analysed according to a modified T classification that considers only three stages (≤ T2, T3, T4). Assessment of accuracy was carried out using 95% confidence intervals for T.
RESULTS: Thirty five/37 (94.6%) adenocarcinomas were identified and correctly located on PET/CT images. PET/CT correctly staged the T of 33/35 lesions identified showing an accuracy of 94.3% (95% CI: 87%-100%). All T1, T3 and T4 lesions were correctly staged, while two T2 neoplasms were overstated as T3.
CONCLUSION: Our data suggest that FDG-PET/CT may be an accurate modality for identifying primary tumor and defining its local extent in patients with colorectal cancer.
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Computed tomographic colonography in preoperative evaluation of colorectal tumors: a prospective study. Surg Endosc 2011; 25:2344-9. [PMID: 21416185 PMCID: PMC3116126 DOI: 10.1007/s00464-010-1566-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 12/22/2010] [Indexed: 12/18/2022]
Abstract
Background This study aimed to assess the usefulness of computed tomographic colonography (CTC) in preoperative evaluation of colorectal tumors and the entire bowel including endoscopically inaccessible regions. Methods Colonoscopy and CTC were performed for 49 patients. The tumor and the entire colon were assessed, and the results were compared with colonoscopy. The extraluminal findings of CTC were compared with contrast-enhanced computed tomography (CT) of the abdomen and the pelvis in 33 patients. All these patients had undergone surgery. A comparison of results for tumor node metastasis classification between CTC, CT, and histopathology was performed. Results Exploration of the entire colon was possible for 89.8% of the patients using CTC and 49.0% of the patients using colonoscopy. Bowel cleansing was assessed as worse with CTC. In the evaluation of tumor location and morphologic type, CTC was congruent with colonoscopy. Colonoscopy enabled approximate tumor size and volume to be evaluated for only 59.2% (29/49) and 30.6% (15/49) of patients, respectively, whereas CTC enabled evaluation of all 48 (100.0%) visualized tumors. Wall thickening, outer contour, and suspected infiltration of surrounding tissues and organs are impossible to determine with colonoscopy but can be determined with CTC. Using CTC, two additional tumors were found proximate to occlusive masses in endoscopically inaccessible regions. Conclusion Computed tomographic colonography is a useful method for diagnosing colorectal tumors. It allows the clinician to diagnose tumor, determine local tumor progression, and detect synchronous lesions in the large bowel including endoscopically inaccessible regions.
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Computed Tomography colonography in Preoperative Evaluation of colorectal cancer. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kobayashi Y, Fujita S, Yamaguchi T, Yamamoto S, Akasu T, Moriya Y. Optimum lymph node dissection in clinical T1 and clinical T2 colorectal cancer. Dis Colon Rectum 2009; 52:942-9. [PMID: 19502860 DOI: 10.1007/dcr.0b013e3181a4f85d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE On the basis of a retrospective review, we aimed to clarify the optimum extent of lymph node dissection in patients with cT1 and cT2 colorectal cancer. METHODS We reviewed medical records of 487 patients with cT1 and 351 patients with cT2 colorectal tumors, who had undergone curative surgery. RESULTS In patients with cT1 tumors, results of pathologic examination showed either no lymph node metastasis or metastasis within the paracolic or pararectal region in 284 (98.3 percent) of 289 patients with colon tumors and 195 (98.5 percent) of 198 with rectal tumors. Of 459 patients without clinically evident metastasis, only one patient with a poorly differentiated adenocarcinoma had metastasis beyond the paracolic area. In 28 patients with cT1 tumors and clinically diagnosed node metastasis, pathologic examination showed that node involvement did not extend beyond the named vessel in 26. Among patients with cT2tumors, 97.5 percent of patients with colon tumors and 95.9 percent with rectal tumors had no or limited metastasis. Of 276 without clinically evident metastasis, none had node metastasis at the roots of the named vessels; of 75 with clinically evident metastasis, none had pathologic extension beyond the roots of the named vessels. CONCLUSIONS In cT1 patients with cN-negative colorectal cancers, paracolorectal lymph node dissection may be optimal; in those with cN positivity, the regional nodes along the named vessels should be dissected. In cT2 patients who are cN-negative, dissection of the regional nodes may be optimal. For those with cN positivity, dissection at the roots of the named vessels should be considered.
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Affiliation(s)
- Yutaka Kobayashi
- Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
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Use of modified multidetector CT colonography for the evaluation of acute and subacute colon obstruction caused by colorectal cancer: a feasibility study. Dis Colon Rectum 2009; 52:489-95. [PMID: 19333051 DOI: 10.1007/dcr.0b013e318197d789] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate the feasibility of using CT colonography with a modified procedural protocol for diagnosis and cancer staging in patients with suspected acute or subacute colon obstruction caused by colorectal cancer. METHODS Following colonic cleansing with lukewarm water enemas, thin-collimation CT colonography was performed on 47 patients (15 women and 32 men, mean age, 68 years) in the precontrast prone position and in the supine position after the intravenous administration of a contrast agent. The surgical and pathologic findings served as a reference standard. RESULTS In 44 of 47 patients, colon distention was caused by obstruction, and pathologic examination confirmed colorectal cancer in 41 of these 44 patients. CT colonography correctly located all tumors and successfully identified noncancerous causes of colon distention in five patients. The overall accuracy of staging was 97.6 percent for the T category, 73.2 percent for N, and 100 percent for M. Two synchronous colorectal cancers were correctly identified. CONCLUSIONS When appropriate protocol modifications regarding colon cleansing and air insufflation are made to take the clinical situation into account, CT colonography is a technically feasible, accurate, and well-tolerated method for tumor evaluation and cancer staging in patients with acute and subacute colon obstruction.
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Zhou SA, Brahme A. Development of phase-contrast X-ray imaging techniques and potential medical applications. Phys Med 2008; 24:129-48. [PMID: 18602852 DOI: 10.1016/j.ejmp.2008.05.006] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 05/22/2008] [Accepted: 05/23/2008] [Indexed: 11/18/2022] Open
Affiliation(s)
- Shu-Ang Zhou
- Karolinska Institute, Department of Oncology-Pathology, Division of Medical Radiation Physics, Stockholm, Sweden.
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3-T MRI of rectal carcinoma: preoperative diagnosis, staging, and planning of sphincter-sparing surgery. AJR Am J Roentgenol 2008; 190:1271-8. [PMID: 18430843 DOI: 10.2214/ajr.07.2505] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the accuracy of 3-T MRI in the preoperative diagnosis, staging, and planning of surgical management of rectal carcinoma. SUBJECTS AND METHODS Thirty-eight patients (23 men, 15 women) with clinically suspected rectal carcinoma underwent 3-T MRI. Coronal, axial, and sagittal T2-weighted sequences with and without fat suppression; axial T1-weighted spin-echo sequences; axial T1-weighted gradient-echo sequences with and without fat suppression; oblique 2D MR hydrography; and 3D fat-suppressed dynamic contrast-enhanced MRI were performed. Image quality with these sequences was evaluated by three radiologists experienced in body MRI. The significance of difference in results with the sequences was tested. The manner in which MRI staging and feasibility of sphincter-sparing surgery agreed with operative and pathologic findings was evaluated with kappa statistics. RESULTS Rectal carcinoma was identified on MRI and confirmed histologically in all 38 patients. MRI findings were correctly predictive of T category in 35 cases (accuracy, 92.1%). In 31 (96.9%) of 32 resectable cases,sphincter-sparing surgical approaches were accurately chosen on the basis of MRI findings. Among the 11 sequences, 3D fat-suppressed dynamic contrast-enhanced MRI best delineated tumor margins. Coronal and axial T2-weighted images also well depicted tumor margins with minimal artifact. T2-weighted images were superior to unenhanced T1-weighted images. CONCLUSION MRI of rectal cancer at 3 T is accurate for prediction of T category and the feasibility of sphincter-sparing surgery. The best images were obtained with coronal, sagittal, and axial T2-weighted sequences and 3D fat-suppressed dynamic contrast-enhanced MRI.
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Abstract
At present, several modalities exist for the preoperative staging of rectal lesions, including computed tomography (CT), body coil or endorectal coil magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) done by rigid or flexible probes, and positron emission tomography (PET). Staging accuracy for CT ranges from 53% to 94% for T-stage accuracy and from 54% to 70% for N-stage accuracy. Improved CT accuracy is observed at higher disease stages. Body coil MRI has shown T- and N-stage accuracy ranging from 59% to 95% and 39% to 95%, respectively. Endorectal coil MRI has shown improved T- and N-stage accuracy, with rates of 66% to 91% and 72% to 79%, respectively. The development of phased-array MRI, combining high spatial resolution with a larger field of view, offers promise to improve on these rates. EUS, considered the current gold standard, has shown T-stage accuracy ranging from 75% to 95%, with N-stage accuracy ranging from 65% to 80%. Flexible EUS probes have the advantage of being able to access and sample iliac nodes. Recent studies also suggest that three-dimensional EUS may provide greater accuracy than conventional two-dimensional EUS. Limited studies exist on the use of PET in primary tumor staging. PET may upstage disease in 8% to 24% of patients and has also been used in posttreatment restaging and surveillance. Postradiation edema, necrosis, and fibrosis seem to decrease restaging accuracy in all modalities. This article reviews the current literature about the staging accuracy of the various modalities and suggests a staging algorithm for rectal cancer.
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Affiliation(s)
- V Raman Muthusamy
- H H Chao Comprehensive Digestive Disease Center, Chao Family Comprehensive Cancer Center, Department of Medicine, University of California, Irvine Medical Center, Orange, CA 92868, USA
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