Advertisement

European Radiology

, Volume 16, Issue 10, pp 2284–2291 | Cite as

The diagnostic value of multiplanar reconstruction on MDCT colonography for the preoperative staging of colorectal cancer

  • Kwang Nam Jin
  • Jeong Min LeeEmail author
  • Se Hyung Kim
  • Kyung-Sook Shin
  • Jae Young Lee
  • Joon Koo Han
  • Byung Ihn Choi
Gastrointestinal

Abstract

The purpose of this study was to determine whether multiplanar reconstruction (MPR) images can improve the accuracy of MDCT-based colorectal cancer preoperative staging by receiver-operating characteristic (ROC) analysis. Fifty-five patients with colorectal cancer underwent contrast-enhanced CT colonography using an 8- or 16-row scanner. Two separate interval reviews of the axial MDCT datasets with/without MPR images (coronal and sagittal) were performed independently by two radiologists blinded to both the colonoscopic and histopathologic results. At each review session, the radiologists were asked to determine the colorectal cancer TNM stage within the context of differentiating ≤T3 from T4, N0 from ≥N1 and M0 from M1 using a five-point confidence scale. The radiologists’ performance for staging the colorectal cancer using axial CT datasets with/without MPR images was evaluated using ROC analysis. Sensitivities, specificities and interobserver agreement were assessed. When MPR images were added, significant improvement was achieved by both radiologists for differentiating N0 from ≥N1 in terms of both AZ (0.651 to 0.769; 0.573 to 0.713) and specificity (26.7 to 69.2%; 23.1 to 76.9%) (P<0.05). For T staging, ROC analysis failed to show a significant improvement in terms of differentiating ≤T3 from T4 for either radiologist (P>0.05), but a significant improvement in the specificity (70 to 90%; 80 to 92%) was achieved by one radiologist (P<0.05). In terms of the M staging, a significant improvement in the Az (0.844 to 0.996) was observed for the combined interpretation of the axial and MPR images by one radiologist (P<0.05). Furthermore, substantial or almost perfect interobserver agreement was achieved for all TNM stagings for the combined interpretations (κ=0.641–0.866), whereas only fair to substantial agreement was achieved for the axial images alone (κ=0.337-0.707). In conclusion, the combined interpretation of the axial and MPR MDCT images significantly improved the local staging of colorectal cancer compared with assessments based on axial images alone.

Keywords

Colorectal cancer Preoperative staging CT colonography Multiplanar reconstruction 

References

  1. 1.
    Freeny PC, Marks WM, Ryan JA, Bolen JW (1986) Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence. Radiology 158:347–353PubMedGoogle Scholar
  2. 2.
    Gazelle GS, Gaa J, Saini S, Shellito P (1995) Staging of colon carcinoma using water enema CT. J Comput Assist Tomogr 19:87–91PubMedCrossRefGoogle Scholar
  3. 3.
    Balthazar EJ, Megibow AJ, Hulnick D, Naidich DP (1998) Carcinoma of the colon: detection and preoperative staging by CT. Am J Roentgenol 150:301–306Google Scholar
  4. 4.
    Filippone A, Ambrosini R, Fuschi M, Marinelli T, Genovesi D, Bonomo L (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography-initial experience. Radiology 231:83–90PubMedCrossRefGoogle Scholar
  5. 5.
    Hu H, He HD, Foley WD, Fow SH (2000) Four multidetector-row helical CT: image quality and volume coverage speed. Radiology 215:55–62PubMedGoogle Scholar
  6. 6.
    Blum A, Walter F, Ludig T, Zhu X, Roland J (2000) Multislice CT: principles and new CT-scan applications. J Radiol 81:1597–1614PubMedGoogle Scholar
  7. 7.
    Prokop M, Schaefer-Prokop C, Galanski M (1997) Spiral CT angiography of the abdomen. Abdom Imaging 22:143–153PubMedCrossRefGoogle Scholar
  8. 8.
    Kulinna C, Eibel R, Matzek W, Bonel H, Aust D, Strauss T, Reiser M, Scheidler J (2004) Staging of rectal cancer: diagnostic potential of multiplanar reconstructions with MDCT. Am J Roentgenol 183:421–427Google Scholar
  9. 9.
    Chung DJ, Huh KC, Choi WJ, Kim JK (2005) CT colonography using 16-MDCT in the evaluation of colorectal cancer. Am J Roentgenol 184:98–103Google Scholar
  10. 10.
    Gryspeerdt S, Lefere P, Herman M, Deman R, Rutgeerts L, Ghillebert G, Baert F, Baekelandt M, Van Holsbeeck B (2005) CT colonography with fecal tagging after incomplete colonoscopy. Eur Radiol 15:1192–1202PubMedCrossRefGoogle Scholar
  11. 11.
    Obuchowski NA (2003) Receiver operating characteristic curves and their use in radiology. Radiology 229:3–8PubMedCrossRefGoogle Scholar
  12. 12.
    Obuchowski NA (2005) ROC analysis. Am J Roentgenol 184:364–372Google Scholar
  13. 13.
    Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New YorkGoogle Scholar
  14. 14.
    Thompson WM, Halvorsen RA, Foster WL Jr, Roberts L, Gibbons R (1986) Preoperative and postoperative CT staging of rectosigmoid carcinoma. Am J Roentgenol 146:703–710Google Scholar
  15. 15.
    Ng CS, Doyle TC, Courtney HM, Campbell GA, Freeman AH, Dixon AK (2004) Extracolonic findings in patients undergoing abdomino-pelvic CT for suspected colorectal carcinoma in the frail and disabled patient. Clin Radiol 59:421–430PubMedCrossRefGoogle Scholar
  16. 16.
    Valls C, Lopez E, Guma A, Gil M, Sanchez A, Andia E, Serra J, Moreno V, Figueras J (1998) Helical CT versus CT arterial portography in the detection of hepatic metastasis of colorectal carcinoma. Am J Roentgenol 170:1341–1347Google Scholar
  17. 17.
    Landis JR, Koch GG (1997) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  18. 18.
    Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227:800–811PubMedCrossRefGoogle Scholar
  19. 19.
    Bauer TW, Spitz FR (1998) Adjuvant and neoadjuvant chemoradiation therapy for primary colorectal cancer. Surg Oncol 7:175–1781PubMedCrossRefGoogle Scholar
  20. 20.
    O’Connell MJ (2004) Current status of adjuvant therapy for colorectal cancer. Oncology (Huntingt) 18:751–758Google Scholar
  21. 21.
    Wheeler JM, Dodds E, Warren BF, Cunningham C, George BD, Jones AC, Mortensen NJ (2004) Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade. Dis Colon Rectum 47:2025–2031PubMedCrossRefGoogle Scholar
  22. 22.
    Chau I, Chan S, Cunningham D (2003) Overview of preoperative and postoperative therapy for colorectal cancer: the European and United States perspectives. Clin Colorectal Cancer 3:19–33PubMedCrossRefGoogle Scholar
  23. 23.
    Paraskeva PA, Aziz O, Darzi A (2005) Laparoscopic surgery for colon cancer. Surg Clin North Am 85:49–60PubMedCrossRefGoogle Scholar
  24. 24.
    Kieran JA, Curet MJ (2004) Laparoscopic colon resection for colon cancer. J Surg Res 117:79–91PubMedCrossRefGoogle Scholar
  25. 25.
    Neri E, Giusti P, Battolla L, Vagli P, Boraschi P, Lencioni R, Caramella D, Bartolozzi C (2002) Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology 223:615–619PubMedCrossRefGoogle Scholar
  26. 26.
    Macari M, Berman P, Dicker M, Milano A, Megibow AJ (1999) Usefulness of CT colonography in patients with incomplete colonoscopy. Am J Roentgenol 173:561–564Google Scholar
  27. 27.
    Luboldt W, Kroll M, Wetter A, Toussaint TL, Hoepffner N, Holzer K, Kluge A, Vogl TJ (2004) Phase- and size-adjusted CT cut-off for differentiating neoplastic lesions from normal colon in contrast-enhanced CT colonography. Eur Radiol 14:2228–2235PubMedCrossRefGoogle Scholar
  28. 28.
    Juchems MS, Fleiter TR, Pauls S, Schmidt SA, Brambs HJ, Aschoff AJ (2006) CT colonography: comparison of a colon dissection display versus 3D endoluminal view for the detection of polyps. Eur Radiol 16(1):68–72PubMedCrossRefGoogle Scholar
  29. 29.
    Morrin MM, Farrell RJ, Raptopoulos V, McGee JB, Bleday R, Kruskal JB (2000) Role of virtual computed tomographic colonography in patients with colorectal cancers and obstructing colorectal lesions. Dis Colon Rectum 43:303–311PubMedCrossRefGoogle Scholar
  30. 30.
    Nauta R, Stablein DM, Holyoke ED (1989) Survival of patients with stage B2 colon carcinoma. The Gastrointestinal Tumor Study Group experience. Arch Surg 124:180–182PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Kwang Nam Jin
    • 1
  • Jeong Min Lee
    • 1
    • 2
    Email author
  • Se Hyung Kim
    • 1
  • Kyung-Sook Shin
    • 3
  • Jae Young Lee
    • 1
  • Joon Koo Han
    • 1
    • 2
  • Byung Ihn Choi
    • 1
    • 2
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Institute of Radiation Medicine, Department of RadiologySeoul National University College of MedicineSeoulSouth Korea
  3. 3.Chungnam National University Hospital, Department of RadiologySeoul National University College of MedicineSeoulSouth Korea

Personalised recommendations