Spiral CT of Colon Cancer: Imaging Features and Role in Management1
Karen M. Horton, MD ,
Ross A. Abrams, MD and
Elliot K. Fishman, MD
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).
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Figure 1. Colon cancer in a 74-year-old man. Contrast material-enhanced spiral CT scan shows luminal narrowing and marked wall thickening involving the right side of the transverse colon (arrow). There is adjacent stranding of the serosa and mesenteric fat, a finding compatible with local tumor extension.
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Figure 2. Adenocarcinoma in a 64-year-old woman with right lower quadrant pain. Contrast-enhanced CT scan shows marked circumferential thickening of the cecum (curved arrows). The wall has a low-attenuation component (straight arrow), which is due to necrosis. There is also stranding of the pericolic fat, a finding suggestive of tumor invasion through the wall. Adenocarcinoma was confirmed at endoscopy.
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Figure 3. Adenocarcinoma in an 89-year-old woman with severe abdominal pain. Spiral CT scan obtained with oral contrast material shows segmental circumferential thickening of the hepatic flexure (arrows) with ascites. Adenocarcinoma was confirmed at colonoscopy and biopsy.
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Figure 4. Adenocarcinoma in a 77-year-old woman with lower abdominal pain. Spiral CT scan obtained with oral contrast material shows air distention of the rectosigmoid and focal eccentric wall thickening (arrow). Although this appearance could be due to diverticulitis or colon cancer, the lack of pericolic inflammation or fluid favors colon cancer. Colonoscopy and biopsy were recommended, and adenocarcinoma was diagnosed.
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Figure 5. Rectal cancer in a 65-year-old man with rectal bleeding. Spiral CT scan obtained with rectal contrast material shows an eccentric rectal cancer (black arrow) as well as adjacent nodes (white arrows).
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Figure 6. Diverticulitis in a 42-year-old man with pain and heme-positive stools. CT scan obtained with oral contrast material shows focal, masslike thickening of the sigmoid colon (straight arrows) with adjacent stranding of the pericolic fat. On the basis of the CT appearance and clinical history, colon cancer was suspected. At endoscopy, diverticulitis was diagnosed. In retrospect, the presence of minimal adjacent mesenteric fluid (curved arrow) favored diverticulitis.
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Figure 7. Bowel obstruction in a 66-year-old man with a family history of colon cancer. Coronal 3D image obtained with intravenous contrast material and after air distention of the colon shows a focal applecore lesion in the descending colon (arrow). L = lung, S = stomach.
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Figure 8a. Intussusception due to colon cancer in a 66-year-old woman. Contrast-enhanced spiral CT scans show a large ileocolic intussusception in the transverse (a) and longitudinal (b) planes. A colon cancer was found to be the lead point at endoscopy.
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Figure 8b. Intussusception due to colon cancer in a 66-year-old woman. Contrast-enhanced spiral CT scans show a large ileocolic intussusception in the transverse (a) and longitudinal (b) planes. A colon cancer was found to be the lead point at endoscopy.
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Figure 9. Colonic perforation in a 57-year-old woman with a history of stage IV cervical carcinoma who presented with pain and sepsis. On plain radiographs of the abdomen obtained earlier the same day (not shown), there was mottled air in the right side of the pelvis, a finding suggestive of abscess. Emergent nonenhanced CT scan shows extensive mottled extraluminal air in the right side of the pelvis. At surgery, a perforating cecal cancer was discovered.
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Figure 10. Tumor invasion in a 71-year-old woman with a palpable abdominal mass. Contrast-enhanced CT scan shows a large, circumferential soft-tissue mass in the cecum, a finding compatible with carcinoma. The mass extends to involve the anterior abdominal wall (arrow), an appearance compatible with tumor invasion. Tumor invasion was confirmed at surgery.
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Figure 11. Tumor invasion in a 72-year-old woman with sigmoid cancer. Contrast-enhanced CT scan shows a mass in the sigmoid colon (arrow) with infiltration of the surrounding fat and extension into the presacral space.
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Figure 12. Tumor invasion in a 40-year-old man with gastrointestinal hemorrhage. Coronal oblique 3D image obtained with intravenous contrast material and water used as an oral contrast material shows a large mass in the left upper quadrant (solid arrows). The mass is ulcerated, and there is a direct connection (open arrow) between the mass and the stomach (S). At surgery, an adenocarcinoma with a gastrocolic fistula was found.
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Figure 13. Enlarged lymph nodes in a 43-year-old man with metastatic colon cancer. Contrast-enhanced spiral CT scan shows multiple hepatic metastases as well as enlarged portacaval and aortocaval nodes (arrows).
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Figure 14. Hepatic metastases in a 53-year-old woman with colon cancer. Contrast-enhanced spiral CT scan shows multiple low-attenuation hepatic metastases.
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Figure 15. Hepatic metastases in a 64-year-old woman with metastatic colon cancer. Contrast-enhanced spiral CT scan shows metastatic disease involving the liver, predominantly the right lobe (arrows). The metastases are partially calcified.
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Figure 16. Pulmonary metastases in a 47-year-old man with colon cancer. Spiral CT scan shows numerous metastases in the lungs.
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Figure 17. Peritoneal metastases in a 59-year-old man with colon cancer. Contrast-enhanced spiral CT scan shows metastatic implants involving the liver edge with scalloping of the liver. In addition, peritoneal implants are seen in the left side of the abdomen.
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Figure 18. Tumor recurrence in a 53-year-old woman 3 months after local resection of a cancer of the transverse colon. Contrast-enhanced spiral CT scan shows a local recurrence at the surgical site (arrow). A diverting ileostomy is also present.
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Figure 19. Tumor recurrence in a 59-year-old man 4 months after resection of colon cancer. Contrast-enhanced spiral CT scan shows a large, heterogeneous mass (arrowhead) involving the left anterior aspect of the abdomen adjacent to the ostomy site (arrow). The mass also invades the anterior abdominal wall. This appearance is compatible with recurrence at the surgical site, which was confirmed at surgery.
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Copyright © 2000 by the Radiological Society of North America.
