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Accuracy of CT prediction of poor prognostic features in colonic cancer

¹ Departments of Colorectal Surgery, Radiology and Histopathology, Mayday University Hospital, London Road, Croydon, CR7 7YE, ² Royal Marsden Hospital, Departments of Radiology and Statistics, Downs Road, Sutton, Surrey, SM2 5PT, UK

View larger version (121K): [in this window] [in a new window]   Figure 1. (a) Axial CT at the level of the ascending colon demonstrating the retroperitoneal surgical resection margin (solid white arrows) and the peritoneum (white dashed arrows). (b) Axial CT at the level of the descending colon demonstrating similar features.

View larger version (114K): [in this window] [in a new window]   Figure 2. (a) Axial CT demonstration of complete investment of the transverse colon by peritoneum (white dashed arrows). (b) Axial CT demonstration of complete investment of the sigmoid colon by peritoneum (white dashed arrows).

View larger version (51K): [in this window] [in a new window]   Figure 3. Percentage agreement and 95% confidence intervals for CT staging in both observers versus histopathological staging.

View larger version (110K): [in this window] [in a new window]   Figure 4. Axial CT image demonstrating a T1 tumour with intraluminal projection of the lesion(open arrow) but no distortion of the bowel wall layers (arrow).

View larger version (83K): [in this window] [in a new window]   Figure 5. (a) Axial CT image through the mid-ascending colon showing the primary tumour as a circumferential soft tissue density mass. The scan depicts peritumoral stranding posteriorly, suggestive of T3 disease (white arrows). (b) Axial CT image of tumour at the level of mid-sigmoid. The primary tumour is demonstrated as a segment of thickened sigmoid colon with enhancing soft tissue density and nodularity into pericolic fat, in keeping with a T3 tumour (white arrow).

View larger version (178K): [in this window] [in a new window]   Figure 6. Axial CT image at the level of the caecum. The primary tumour is demonstrated as a bulky annular mass infiltrating through the bowel wall circumferentially. Anterior spread through peritonealized colon indicates T4 disease(white arrow).

View larger version (127K): [in this window] [in a new window]   Figure 7. (a) Axial CT image of enlarged lymph nodes consistent with N1 disease. (b) Axial CT image of multiple enlarged lymph nodes which proved to be N2 disease.

View larger version (56K): [in this window] [in a new window]   Figure 8. (a,b) Two examples of axial CT images at the level of the caecum. The ileocolic vessels are markedly thickened and irregular and show nodular enhancement (white arrows). This equates to tumour invasion within vessels.

View larger version (84K): [in this window] [in a new window]   Figure 9. (a) Axial CT image of a descending colon tumour, the posterior margin of which (dashed arrows) is clear of the retroperitoneal surgical resection margin (white arrows). (b) An axial pathological specimen of the same patient with the posterior margin of the tumour (dashed arrows) more than 1 cm from the RSM (solid arrows). (c) Histological demonstration of the negative RSM.

View larger version (93K): [in this window] [in a new window]   Figure 10. (a) Axial CT at the level of the ascending colon. A large ascending colon tumour with extension of tumour to within 1 mm of the retroperitoneal surgical margin — this can be seen as a blurring of the plane between the tumour and the posterior fascia (white arrows). (b) Axial CT at the level of the ascending colon. Extension of tumour to the retroperitoneal surgical margin can be seen as a tumour abutting the posterior fascia (white arrows).