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Spiral CT of Colon Cancer: Imaging Features and Role in Management¹

¹ From the Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St, Baltimore, MD 21287 (K.M.H., E.K.F.); and the Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore (R.A.A.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received March 3, 1999; revision requested April 21 and received May 14; accepted May 17. Address reprint requests to E.K.F. (e-mail: efishman@jhmi.edu).

Colorectal cancer is a common malignancy that results in significant morbidity and mortality. Abdominal computed tomography (CT) is valuable in planning surgery for colon cancer because it can demonstrate regional extension of tumor as well as adenopathy and distant metastases. At CT, colorectal cancer typically appears as a discrete soft-tissue mass that narrows the colonic lumen. Colorectal cancer can also manifest as focal colonic wall thickening and luminal narrowing. Complications of primary colonic malignancies such as obstruction, perforation, and fistula can be readily visualized with CT. At CT, local extension of tumor appears as an extracolic mass or simply as thickening and infiltration of pericolic fat. Extracolic spread is also suggested by loss of fat planes between the colon and adjacent organs. The liver is the predominant organ to be involved with metastases from colorectal cancer. At CT, hepatic metastases usually appear as hypoattenuating masses, which are best visualized during the portal venous phase of liver enhancement. Other common sites of metastases from colon cancer include the lungs, adrenal glands, and bones. Use of CT is critical for identifying recurrences, evaluating anatomic relationships, documenting "normal" postoperative anatomy, and confirming the absence of new lesions during and after therapy.

Index Terms: Colon, CT, 75.12115 • Colon, neoplasms, 75.32 • Intestinal neoplasms, CT, 75.12115, 75.32 • Intestinal neoplasms, diagnosis, 75.32 • Intestinal neoplasms, staging, 75.32

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