Solitary metastases from colorectal carcinoma in the absence of hepatic or pulmonary metastases are rare. These can have a diverse imaging appearance, particularly after chemotherapy. It is important identify patients with solitary skeletal metastases, as they have a better prognosis than those with multiple skeletal or visceral metastases. We describe an unusual case of a solitary metastasis to the femur in a case of colon carcinoma that went undiagnosed and later presented with imaging features of osteogenic sarcoma.
Adult ; Bone Neoplasms/diagnosis/radiography/secondary ; Carcinoma/*diagnosis/pathology/radiography ; Colorectal Neoplasms/*diagnosis/pathology/radiography ; Female ; Femur/radiography ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Tomography, X-Ray Computed

PURPOSE: This study was performed to evaluate the effectiveness of conventional chest radiography and abdominal CT for early detection of pulmonary metastases after curative surgery for colorectal cancer. METHODS: We retrospectively reviewed 138 cases of pulmonary metastases from a group of colorectal-cancer patients, who were recruited from 1994 to 2002 at Samsung Medical Center, Sungkyunkwan University School of Medicine, and who had been surgically treated with a curative resection. RESULTS: The detection rates for pulmonary metastases were 34.1% by conventional chest radiography, 50.0% by abdominal CT, and 15.9% by other means. For stage I and II tumors, conventional chest radiography was superior to abdominal CT (45.7% vs. 34.3%, P<0.05) for detecting pulmonary metastases. On the contrary, for stage III tumors, abdominal CT was superior to conventional chest radiography (55.3% vs. 30.1%, P<0.05). Compared with stage I and II, pulmonary metastases in stage III had a tendency to be more numerous, bilateral, and extra-pulmonary. They also had a low detection rate by conventional chest radiography and a higher detection rate by abdominal CT, and they were associated with poor survival. CONCLUSIONS: Conventional chest radiography is no more useful in detecting early pulmonary metastases after curative colorectal surgery than abdominal CT, especially for stage III tumors. We propose the use of routine chest CT or extended abdominal CT for screening of occult lung metastases in stage III colorectal cancer patients.
Colorectal Neoplasms* ; Colorectal Surgery ; Humans ; Lung ; Mass Screening ; Neoplasm Metastasis* ; Radiography ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Physical activity (PA) is associated with a reduced risk of colorectal cancer. Thus, we examined the colon transit time (CTT) according to the physical activity level (PAL) in Korean adults. METHODS: The study subjects were 49 adults: 24 males and 25 females. The subjects used an accelerometer for 7 consecutive days to measure the 1-week PAL. The subjects took a capsule containing 20 radio-opaque markers for 3 days. On the fourth day, a supine abdominal radiography was performed. According to the total activity count of all study subjects, the upper 25%, middle 50% and lower 25% were classified into the high (H), moderate (M) and low (L) physical activity (PA) groups, respectively. RESULTS: The total CTT was significantly longer in the female (25.8 hours) than in the male subjects (7.4 hours) (P = 0.002). In regard to difference on PAL, although there was no significant difference among the male subjects, the right CTT in the female subjects was significantly shorter in H group than in M group (P = 0.048), and the recto-sigmoid CTT was significantly shorter in H group than in L group (P = 0.023). Furthermore, there were significant differences in total CTT between L and M groups (P = 0.022), M and H groups (P = 0.026) and between L and H groups (P = 0.002). CONCLUSIONS: The female, but not male, subjects showed that moderate and high PAL assisted colon transit.
Adult ; Colon ; Colorectal Neoplasms ; Female ; Humans ; Male ; Motor Activity ; Radiography, Abdominal

No abstract available.
Adult ; Colonography, Computed Tomographic ; Colorectal Neoplasms/*radiography ; Female ; Humans ; Male ; Middle Aged

PURPOSE: To evaluate the usefulness of flexible covered stent in the treatment of acute colorectalobstruction secondary to colorectal carcinoma. MATERIALS AND METHODS: Flexible covered stents were placed in 11patients with clinical and radiologic signs of acute colonic obstruction secondary to colorectal carcinoma. Thepurposes of stent insertion were pre-operative bowel preparation in seven patients and palliative treatment infour. A fistula was present in two;in one this was between the proximal jejunum and colon, and the other wasrectovaginal. The usefulness of stent insertion for the purpose of preoperative bowel preparation was evaluatedaccording to the feasability and status of bowel preparation, as decided by the operator. Palliative treatment forthe relief of symptoms of acute bowel obstruction was evaluated according to the number and amount of defecation,bowel dilatation in simple abdomen radiography, and the presence of complications. RESULT: Bowel preparation forthe purpose of preoperative bowel cleansing was easy in seven patients;the fecal materials remaining in the colonpresented no problems during surgery. In one of four patients palliative treatment involved a colostomy;this wasdue to recurrent stent obstruction by fecal materials after three months, and in two other patients there wasstent obstruction after two and five months, respectively. The stent in one of four patients who underwentpalliative treatment was removed because of stent migration three days after insertion;the stents in two patientswith fistulas covered the fistulas successfully. Complications after stent insertion were anal pain in threepatients, anal bleeding in three and stent migration in one. CONCLUSION: The flexible covered stent was aneffective device for the relief of acute colonic obstruction secondary to malignant rectosigmoid neoplasia. Itallowed for single-stage operation and covered the fistula. We believe however that for further evaluation of theusefulness of this type of stent in long-term palliative treatment, a larger-scale study is needed.
Abdomen ; Colon ; Colorectal Neoplasms ; Dilatation ; Fistula ; Hemorrhage ; Humans ; Jejunum ; Palliative Care ; Radiography ; Stents*

OBJECTIVE: We wanted to evaluate the usefulness of the computer-aided detection (CAD) system for detecting pulmonary nodules in real clinical practice by using the CT images. MATERIALS AND METHODS: Our Institutional Review Board approved our retrospective study with a waiver of informed consent. This study included 166 CT examinations that were performed for the evaluation of pulmonary metastasis in 166 patients with colorectal cancer. All the CT examinations were interpreted by radiologists and they were also evaluated by the CAD system. All the nodules detected by the CAD system were evaluated with regard to whether or not they were true nodules, and they were classified into micronodules (MN, diameter < 4 mm) and significant nodules (SN, 4 < or = diameter < or = 10 mm). The radiologic reports and CAD results were compared. RESULTS: The CAD system helped detect 426 nodules; 115 (27%) of the 426 nodules were classified as true nodules and 35 (30%) of the 115 nodules were SNs, and 83 (72%) of the 115 were not mentioned in the radiologists' reports and three (4%) of the 83 nodules were non-calcified SNs. One of three non-calcified SNs was confirmed as a metastatic nodule. According to the radiologists' reports, 60 true nodules were detected, and 28 of the 60 were not detected by the CAD system. CONCLUSION: Although the CAD system missed many SNs that are detected by radiologists, it helps detect additional nodules that are missed by the radiologists in real clinical practice. Therefore, the CAD system can be useful to support a radiologist's detection performance.
Colorectal Neoplasms/*pathology ; *Diagnosis, Computer-Assisted ; Female ; Humans ; Lung Neoplasms/*radiography/secondary ; Male ; Middle Aged ; Retrospective Studies ; Solitary Pulmonary Nodule/*radiography/secondary ; *Tomography, X-Ray Computed

DBJECTIVE: To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression. MATERIALS AND METHODS: Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used. RESULTS: Thirty of 31 attempted placements in 26 patients were successful, with a technical success rate of 96.8% (30/31) and a clinical success rate of 80.0% (24/30). After clinically successful stent placement, bowel decompression occurred within 1-4 (mean, 1.58+/-0.9) days. Five of six clinical failures involved stent migration and one stent did not expand after successful placement. In the preoperative group, 11 stents, one of which migrated, were placed in ten patients, in all of whom bowel preparation was successful. In the palliative group, 19 stents were placed in 15 patients. The mean period of patency was 96.25+/-105.12 days: 146.25+/-112.93 for type-A, 78.82+/-112.26 for type-B, and 94.25+/-84.21 for type-C. Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%). The migration rate was significantly higher in the type-B group than in other groups (p=0.038). CONCLUSION: Newly designed covered and non-covered metallic stents of a larger diameter are effective for the treatment of colorectal obstruction. The migration rate of covered stents with flaring is higher than that of other types. For evaluation of the ideal stent configuration for the relief of colorectal obstruction, a clinical study involving a larger patient group is warranted.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/radiography/*therapy ; Colorectal Neoplasms/*complications ; Equipment Design ; Female ; Human ; Intestinal Obstruction/radiography/*therapy ; Male ; Middle Age ; Palliative Care ; Rectal Diseases/radiography/*therapy ; *Stents ; Support, Non-U.S. Gov't

Objective: We wanted to evaluate usefulness of uncovered stent in comparison with covered stent for the palliative treatment of malignant colorectal obstruction. Materials and Methods: Covered (n = 52, type 1 and type 2) and uncovered (n = 22, type 3) stents were placed in 74 patients with malignant colorectal obstruction. Stent insertion was performed for palliative treatment in 37 patients (covered stent: n = 23 and uncovered stent: n = 14). In the palliative group, the data on the success of the procedure, the stent patency and the complications between the two groups (covered versus uncovered stents) were compared. Results: The technical success rate was 89% (33/37). Symptomatic improvement was achieved in 86% (18/21) of the covered stent group and in 92% (11/12) of the uncovered stent group patients. The period of follow-up ranged from three to 319 days (mean period: 116+/-85 days). The mean period of stent patency was 157+/-33 days in the covered stent group and 165+/-25 days in the uncovered stent group. In the covered stent group, stent migration (n = 11), stent fracture (n = 2) and poor expansion of the stent (n = 2) were noted. In the uncovered stent group, tumor ingrowth into the stents (n = 3) was noted. Conclusion: Self-expanding metallic stents are effective for relieving malignant colorectal obstruction. The rate of complications is lower in the uncovered stent group than in the covered stent group.
Treatment Outcome ; Tomography, X-Ray Computed ; *Stents ; *Radiography, Interventional ; Palliative Care ; Middle Aged ; Male ; Intestinal Obstruction/*etiology/radiography/*therapy ; Humans ; Female ; Equipment Design ; Colorectal Neoplasms/*complications/radiography/*therapy ; Aged, 80 and over ; Aged ; Adult

BACKGROUNDThe continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline. Colorectal cancer multidisciplinary team (MDT) working model is recommended by UK and other countries, but there is little information on the impact of MDT working on management of colorectal cancer in China. The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT.

METHODSA total of 595 consecutive colorectal cancer patients were referred to the Department of Gastroenterological Surgery, the pre-MDT cohort include 297 patients, recruited from January 1999 to November 2002, and the MDT cohort had 298 patients enrolled from December 2002 to September 2006. Information recorded included: TNM stage from histological reports, degree of differentiation, the number of examined lymph nodes and CT TNM staging performed or not, and its accuracy, including local and distant recurrence.

RESULTSThe number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group. CT TNM staging was more accurate in the MDT group compared to the pre-MDT group (P = 0.044). The rate of tumor recurrence in the MDT group was lower than pre-MDT group (log-rank test, P < 0.001). Multivariate analysis revealed that age (P = 0.001), management after inception of the MDT (P = 0.002), degree of differentiation (P = 0.003), number of examined lymph nodes (P = 0.002), and TNM stage (P = 0.000) were important factors that independently influence overall survival.

CONCLUSIONSThe inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients. MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis, evidence-based decision making, and optimal treatment planning.

Aged ; Colorectal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Disease Management ; Female ; Humans ; Interdisciplinary Communication ; Male ; Middle Aged ; Neoplasm Staging ; Radiography ; Treatment Outcome

Colorectal carcinoma is a common lethal disease with signs and symptoms that may be nonspecific. Computed tomography (CT) of the abdomen and pelvis with or without contrast is frequently performed for various general abdominal complaints, but unlike CT colonography, the large bowel may not be optimally prepared for evaluation. As such, careful and diligent assessment of the non-prepared colon in all CT images of the abdomen and pelvis is important, as it ensures that incidental colorectal malignancy is not missed, especially in older patients. This article gives an overview of multidetector CT imaging signs and subtle clues to aid in the diagnosis of colorectal carcinoma, as well as their pitfalls.
Colonic Polyps ; pathology ; Colonography, Computed Tomographic ; Colorectal Neoplasms ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Humans ; Incidental Findings ; Pelvis ; diagnostic imaging ; Radiography, Abdominal ; Tomography, X-Ray Computed