RPS 1001b - Colon cancer: techniques for detection and staging

Purpose:

CT colonographs (CTCs) are often used as an alternative investigation for colorectal malignancies (CRCs) for patients who are deemed too frail for colonoscopy. We hope to investigate if CTCs performed for this cohort of patients changes their management outcome.

Methods and materials:

All CTCs performed from 01/06/14 to 30/06/18 with the keywords 'frail', 'unfit', or 'dementia', and patients coming from nursing homes, were identified. Patients where colonoscopy was attempted previously were excluded. As a control group (non-frail), 100 random CTCs were selected from 01/01/18 to 30/06/18. The CTC quality and findings were collected and categorised. For patients with suspected CRC or polyps, subsequent management and colonoscopy, surgical and pathology report (if applicable) were analysed. The correlation of CTC findings was recorded and any complications from subsequent intervention were also recorded. The Chi-square test was used to test for significance of differences between the groups.

Results:

57 patients met the inclusion criteria. The population group median age was 83 years old vs 67 years old. 46.6% of the study group's examinations were suboptimal quality (p<0.005). None of the suspected CRC and polyps <6mm in the study group had a subsequent intervention. Patients with polyps >6mm, 33.3% from the study group versus 83.3%, had an intervention. There was statistical significance in the number of CRC, polyps >6mm, and intervention rate of patients with suspected CRC.

Conclusion:

For patients too frail to undergo colonoscopy, CTCs rarely changes their management outcome and a contrast-enhanced abdominopelvic CT examination may be sufficient to identify CRCs and facilitate potential future palliative intervention.

Limitations:

Reliance on the accuracy of the provided clinical history to identify the study population and subjective assessment of the clinician to assess the patient's frailty.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To investigate the frequency of the redundant sigmoid colon on computed tomography images by using Kantor’s criteria and to compare the results with the literature. We also aimed to emphasise the clinical importance of redundancy and to increase the awareness of radiologists for this condition.

Methods and materials:

This retrospective study was performed with 500 patients who underwent CT scans in Turhal State Hospital from August to October 2017. Axial views were evaluated to detect the presence of the redundant sigmoid colon. The thickness of the rectus abdominis muscle, psoas muscle, subcutaneous fat, anteroposterior diameter of abdomen, and the transverse diameter between each anterior superior iliac spinae were measured. The presence of colonic diverticulae was also noted.

Results:

The redundant sigmoid colon was detected in 93 patients with a frequency of 18.6%. Age and sex were not significantly different between both groups. The transverse diameter between each anterior superior iliac spinae was significantly shorter in patients with a redundant sigmoid colon.

Conclusion:

Kantor’s criteria is a useful method for evaluating the redundancy of the sigmoid colon on axial CT images. The frequency of the redundant sigmoid colon is nearly 20% and this condition is important since it is a major risk factor for volvulus, it causes incomplete optic colonoscopies, and is associated with irritable bowel syndrome.

Limitations:

Limitations of design and number of patients.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To investigate feasibility and patient tolerance of a reduced bowel preparation for CT colonography (CTC).

Methods and materials:

Asymptomatic and symptomatic patients were enrolled in this multicentric randomised trial. All patients were randomly assigned (1:1 ratio, blocks of ten) to receive a reduced (52.5 g of Macrogol dissolved in 500 mL of water, RBP) or full (105 g of Macrogol in 1000 mL, FBP) bowel preparation and faecal tagging. Five readers performed a blinded subjective image analysis by means of 4-point Likert-scales from 0 (highest score) to 3 (worst score). Endpoints were the quality of large bowel cleansing and tolerance to the assigned bowel preparation regimen.

Results:

78 patients were randomly allocated to treatments (44 in FBP-group, 34 in RBP-group). Both groups resulted in optimal colon cleansing. Homogeneity of fluid tagging (median score 0 vs 0, p=0.075), volume of residual stools (median score 0 vs 0, p=0.082), and colonic distension (median score 0 vs 0, p=0.073) were similar for both groups. RBP resulted in better patient tolerance.

Conclusion:

Reduced bowel preparation may provide better tolerance for patients undergoing CTC without affecting colon cleansing and image quality.

Limitations:

The main limitation of our study is that the diagnostic accuracy has not been evaluated.

Ethics committee approval

The study protocol was approved by the Institutional Review Board of our Institution and written informed consent was obtained from all patients.

Funding:

No funding was received for this work.