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Differentiation of cancerous and inflammatory colorectal perforations using multi-detector computed tomography

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Abstract

Purpose

To determine reliable CT features to distinguish cancerous from inflammatory colorectal perforations.

Materials and methods

A total of 43 patients with surgically and pathologically confirmed colorectal perforation caused by either colorectal cancer (n =27) or an inflammatory conditions (n = 16) were identified. Two radiologists independently assessed the contrast-enhanced CT features for locations of perforation, mural configurations, soft-tissue alterations, lymphadenopathy, and metastases. Intergroup comparisons for univariate analysis were performed using Fisher’s exact test or chi-square test for categorical data and Mann–Whitney test for numeric data. Stepwise logistic regression analysis was conducted with features that were found significant under the univariate analysis. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and kappa test.

Results

Maximal mural thickness >1.39 cm (sensitivity, 100%; specificity, 68.75%), luminal mass or shoulder formation (sensitivity, 88.89%; specificity, 68.75%), absence of diverticula (sensitivity, 96.30%; specificity, 50.00%), irregular mural thickening (sensitivity, 92.59%; specificity, 81.25%), lymphadenopathy (sensitivity, 40.74%; specificity, 93.75%), and metastases (sensitivity, 25.93%; specificity, 100%) were significantly frequent in cancerous perforations. The maximal mural thickness (P = 0.0493, odds ratio = 439.83) and irregular mural thickening (P = 0.0343, odds ratio = 4.69) were identified as the highly distinguished identifiers.

Conclusions

The CT manifestations of cancerous and inflammatory colorectal perforations overlap. Definitive diagnosis is not always possible with imaging alone. The maximal mural thickness >1.39 cm and irregular configuration of the thickened bowel wall were the two highly statistically significant CT features that may help order the difference between the two entities.

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References

  1. Lee IK, Sung NY, Lee YS, et al. (2007) The survival rate and prognostic factors in 26 perforated colorectal cancer patients. Int J Colorectal Dis 22(5):467–473

    Article  PubMed  Google Scholar 

  2. Ogawa M, Watanabe M, Eto K, et al. (2009) Clinicopathological features of perforated colorectal cancer. Anticancer Res 29(5):1681–1684

    PubMed  Google Scholar 

  3. Mandava N, Kumar S, Pizzi WF, Aprile IJ (1996) Perforated colorectal carcinomas. Am J Surg 172(3):236–238

    Article  CAS  PubMed  Google Scholar 

  4. Chen HS, Sheen-Chen SM (2000) Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery 127(4):370–376

    Article  CAS  PubMed  Google Scholar 

  5. Steinberg SM, Barkin JS, Kaplan RS, Stablein DM (1986) Prognostic indicators of colon tumors. The Gastrointestinal Tumor Study Group experience. Cancer 57(9):1866–1870

    Article  CAS  PubMed  Google Scholar 

  6. Kaiser AM, Jiang JK, Lake JP, et al. (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100(4):910–917

    Article  PubMed  Google Scholar 

  7. Berg DF, Bahadursingh AM, Kaminski DL, Longo WE (2002) Acute surgical emergencies in inflammatory bowel disease. Am J Surg 184(1):45–51

    Article  PubMed  Google Scholar 

  8. Wu CH, Huang CC, Wang LJ, et al. (2012) Value of CT in the discrimination of fatal from non-fatal stercoral colitis. Korean J Radiol 13(3):283–289

    Article  PubMed  PubMed Central  Google Scholar 

  9. Oguro S, Funabiki T, Hosoda K, et al. (2010) 64-Slice multidetector computed tomography evaluation of gastrointestinal tract perforation site: detectability of direct findings in upper and lower GI tract. Eur Radiol 20(6):1396–1403

    Article  PubMed  Google Scholar 

  10. Thornton E, Mendiratta-Lala M, Siewert B, Eisenberg RL (2011) Patterns of fat stranding. AJR Am J Roentgenol 197(1):W1–14

    Article  PubMed  Google Scholar 

  11. Padidar AM, Jeffrey RB Jr, Mindelzun RE, Dolph JF (1994) Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis. AJR Am J Roentgenol 163(1):81–83

    Article  CAS  PubMed  Google Scholar 

  12. Chintapalli KN, Chopra S, Ghiatas AA, et al. (1999) Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 210(2):429–435

    Article  CAS  PubMed  Google Scholar 

  13. Anderson EM, Betts M, Slater A (2011) The value of true axial imaging for CT staging of colonic cancer. Eur Radiol 21(6):1286–1292

    Article  PubMed  Google Scholar 

  14. Lips LM, Cremers PT, Pickhardt PJ, et al. (2015) Sigmoid cancer versus chronic diverticular disease: differentiating features at CT colonography. Radiology 275(1):127–135

    Article  PubMed  Google Scholar 

  15. Kircher MF, Rhea JT, Kihiczak D, Novelline RA (2002) Frequency, sensitivity, and specificity of individual signs of diverticulitis on thin-section helical CT with colonic contrast material: experience with 312 cases. AJR Am J Roentgenol 178(6):1313–1318

    Article  PubMed  Google Scholar 

  16. Naqvi J, Hosmane S, Lapsia S (2015) Revisiting the potential signs of colorectal cancer on contrast-enhanced computed tomography without bowel preparation. Abdom Imaging 40(8):2993–3001

    Article  PubMed  Google Scholar 

  17. Macari M, Balthazar EJ (2001) CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 176(5):1105–1116

    Article  CAS  PubMed  Google Scholar 

  18. Wittenberg J, Harisinghani MG, Jhaveri K, Varghese J, Mueller PR (2002) Algorithmic approach to CT diagnosis of the abnormal bowel wall. Radiographics 22(5):1093–1107

    Article  PubMed  Google Scholar 

  19. Balthazar EJ (1991) CT of the gastrointestinal tract: principles and interpretation. AJR Am J Roentgenol 156(1):23–32

    Article  CAS  PubMed  Google Scholar 

  20. Horton KM, Abrams RA, Fishman EK (2000) Spiral CT of colon cancer: imaging features and role in management. Radiographics 20(2):419–430

    Article  CAS  PubMed  Google Scholar 

  21. Hainaux B, Agneessens E, Bertinotti R, et al. (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR Am J Roentgenol 187(5):1179–1183

    Article  PubMed  Google Scholar 

  22. Ghekiere O, Lesnik A, Millet I, et al. (2007) Direct visualization of perforation sites in patients with a non-traumatic free pneumoperitoneum: added diagnostic value of thin transverse slices and coronal and sagittal reformations for multi-detector CT. Eur Radiol 17(9):2302–2309

    Article  PubMed  Google Scholar 

  23. Kim SW, Shin HC, Kim IY, Kim YT, Kim CJ (2010) CT findings of colonic complications associated with colon cancer. Korean J Radiol 11(2):211–221

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kim SW, Kim HC, Yang DM (2012) Perforated tumours in the gastrointestinal tract: CT findings and clinical implications. Br J Radiol 85(1017):1307–1313

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Welch JP, Donaldson GA (1974) Perforative carcinoma of colon and rectum. Ann Surg 180(5):734–740

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kelley WE Jr, Brown PW, Lawrence W Jr, Terz JJ (1981) Penetrating, obstructing, and perforating carcinomas of the colon and rectum. Arch Surg 116(4):381–384

    Article  PubMed  Google Scholar 

  27. Ripolles T, Martinez-Perez MJ, Gomez Valencia DP, Vizuete J, Martin G (2015) Sigmoid stenosis caused by diverticulitis vs. carcinoma: usefulness of sonographic features for their differentiation in the emergency setting. Abdom Imaging 40(7):2219–2231

    Article  PubMed  Google Scholar 

  28. Shen SH, Chen JD, Tiu CM, et al. (2005) Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting. J Chin Med Assoc 68(9):411–418

    Article  PubMed  Google Scholar 

  29. Jang HJ, Lim HK, Lee SJ, et al. (2000) Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR Am J Roentgenol 174(5):1397–1402

    Article  CAS  PubMed  Google Scholar 

  30. Sheiman L, Levine MS, Levin AA, et al. (2008) Chronic diverticulitis: clinical, radiographic, and pathologic findings. AJR Am J Roentgenol 191(2):522–528

    Article  PubMed  Google Scholar 

  31. Greenbaum EI, Freedman S (1973) Neoplasia of the colon over a long segment. Clin Radiol 24(4):416–426

    Article  CAS  PubMed  Google Scholar 

  32. Sheth AA, Longo W, Floch MH (2008) Diverticular disease and diverticulitis. Am J Gastroenterol 103(6):1550–1556

    Article  PubMed  Google Scholar 

  33. Law WL, Lo CY, Chu KW (2001) Emergency surgery for colonic diverticulitis: differences between right-sided and left-sided lesions. Int J Colorectal Dis 16(5):280–284

    Article  CAS  PubMed  Google Scholar 

  34. Khalil HA, Yoo J (2014) Colorectal emergencies: perforated diverticulitis (operative and nonoperative management). J Gastrointest Surg 18(4):865–868

    Article  PubMed  Google Scholar 

  35. Markham NI, Li AK (1992) Diverticulitis of the right colon–experience from Hong Kong. Gut 33(4):547–549

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This study was partly funded by the Chinese National Natural Science Foundation (Grant 81401373). The authors thank Dr. Wei He, department of pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, for her help with pathological consultation.

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Authors and Affiliations

  1. Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People’s Republic of China

    Xu Hua Gong, Zhi Guo Zhuang, Jiong Zhu, Qi Feng, Jian Rong Xu & Li Jun Qian

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  1. Xu Hua Gong
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  2. Zhi Guo Zhuang
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  3. Jiong Zhu
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  4. Qi Feng
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Corresponding author

Correspondence to Li Jun Qian.

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Funding

This study was partly funded by the Chinese National Natural Science Foundation (Grant 81401373).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by our institutional review board. For this type of study formal consent is not required.

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Informed consents were waived ​by the ethical commission of our institution.

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Gong, X.H., Zhuang, Z.G., Zhu, J. et al. Differentiation of cancerous and inflammatory colorectal perforations using multi-detector computed tomography. Abdom Radiol 42, 2233–2242 (2017). https://doi.org/10.1007/s00261-017-1134-3

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  • DOI: https://doi.org/10.1007/s00261-017-1134-3

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