Purpose:
The purpose of this study was to retrospectively assess the detectability and
enhancement pattern of rectal carcinoid tumors on contrast-enhanced computed
tomography colonography (CE-CTC). Methods: The study sample consisted of 12
lesions in nine patients of rectal carcinoid tumors. To evaluate the
detectability, two radiologists reviewed axial and 3D images including air enema
(AE), virtual endoscopy (VE), and virtual colon dissection (VCD). To determine
the contrast enhancement pattern of the tumors, the CT attenuation value of
each lesion was measured in three phases. Results: Four of the 12 lesions (33%)
were detected on axial images in patients in both the prone and supine
positions, the sizes of which were 6 mm or larger. Seven lesions (58%),
including the four lesions mentioned above, were detected on 3D images
including AE and VE in patients in the prone position, the sizes of which were
5 mm or larger. The ranges of CT attenuation values of the lesions at 40 s, 70
s and 240 s were 112 - 147, 116 - 140 and 82 - 97 HU, respectively. Conclusion:
Rectal carcinoid tumors are challenging to detect on CE-CTC. They demonstrated
enhancement at the early phase and washout at the delayed phase on CE-CTC.
References
[1]
Bosman, F.T. (2010) WHO Classification of Tumours of the Digestive System. World Health Organization Classification of Tumours, 4th Edition, International Agency for Research on Cancer, Lyon.
[2]
Godwin, J.D., 2nd (1975) Carcinoid Tumors. An Analysis of 2837 Cases. Cancer, 36, 560-569. http://dx.doi.org/10.1002/1097-0142(197508) 36:2<560::AID-CNCR2820360235>3.0.CO;2-4
[3]
Teleky, B., Herbst, F., Langle, F., Neuhold, N. and Niederle, B. (1992) The Prognosis of Rectal Carcinoid Tumours. International Journal of Colorectal Disease, 7, 11-14. http://dx.doi.org/10.1007/BF01647653
[4]
Modlin, I.M., Lye, K.D. and Kidd, M. (2003) A 5-Decade Analysis of 13,715 Carcinoid Tumors. Cancer, 97, 934-959. http://dx.doi.org/10.1002/cncr.11105
[5]
Fahy, B.N., Tang, L.H., Klimstra, D., Wong, W.D., Guillem, J.G., Paty, P.B., Temple, L.K., Shia, J. and Weiser, M.R. (2007) Carcinoid of the Rectum Risk Stratification (CaRRs): A Strategy for Preoperative Outcome Assessment. Annals of Surgical Oncology, 14, 1735-1743. http://dx.doi.org/10.1245/s10434-006-9311-6
[6]
Koura, A.N., Giacco, G.G., Curley, S.A., Skibber, J.M., Feig, B.W. and Ellis, L.M. (1997) Carcinoid Tumors of the Rectum: Effect of Size, Histopathology, and Surgical Treatment on Metastasis Free Survival. Cancer, 79, 1294-1298. http://dx.doi.org/10.1002/(SICI)1097-0142(19970401) 79:7<1294::AID-CNCR4>3.0.CO;2-H
[7]
Soga, J. (2005) Early-Stage Carcinoids of the Gastrointestinal Tract: An Analysis of 1914 Reported Cases. Cancer, 103, 1587-1595. http://dx.doi.org/10.1002/cncr.20939
[8]
Mashimo, Y., Matsuda, T., Uraoka, T., Saito, Y., Sano, Y., Fu, K., Kozu, T., Ono, A., Fujii, T. and Saito, D. (2008) Endoscopic Submucosal Resection with a Ligation Device Is an Effective and Safe Treatment for Carcinoid Tumors in the Lower Rectum. Journal of Gastroenterology and Hepatology, 23, 218-221. http://dx.doi.org/10.1111/j.1440-1746.2008.05313.x
[9]
Park, H.W., Byeon, J.S., Park, Y.S., Yang, D.H., Yoon, S.M., Kim, K.J., Ye, B.D., Myung, S.J., Yang, S.K. and Kim, J.H. (2010) Endoscopic Submucosal Dissection for Treatment of Rectal Carcinoid Tumors. Gastrointestinal Endoscopy, 72, 143-149. http://dx.doi.org/10.1016/j.gie.2010.01.040
[10]
Elsayes, K.M., Menias, C.O., Bowerson, M., Osman, O.M., Alkharouby, A.M. and Hillen, T.J. (2011) Imaging of Carcinoid Tumors: Spectrum of Findings with Pathologic and Clinical Correlation. Journal of Computer Assisted Tomography, 35, 72-80. http://dx.doi.org/10.1097/RCT.0b013e3181fd2044
[11]
Pickhardt, P.J., Kim, D.H., Menias, C.O., Gopal, D.V., Arluk, G.M. and Heise, C.P. (2007) Evaluation of Submucosal Lesions of the Large Intestine: Part 2. Nonneoplastic Causes. Radiographics, 27, 1693-1703. http://dx.doi.org/10.1148/rg.276075028
[12]
Salerno, G., Sinnatamby, C., Branagan, G., Daniels, I.R., Heald, R.J. and Moran, B.J. (2006) Defining the Rectum: Surgically, Radiologically and Anatomically. Colorectal Disease, 8, 5-9. http://dx.doi.org/10.1111/j.1463-1318.2006.01062.x
[13]
Hoppe, H., Quattropani, C., Spreng, A., Mattich, J., Netzer, P. and Dinkel, H.P. (2004) Virtual Colon Dissection with CT Colonography Compared with Axial Interpretation and Conventional Colonoscopy: Preliminary Results. American Journal of Roentgenology, 182, 1151-1158. http://dx.doi.org/10.2214/ajr.182.5.1821151
[14]
Macari, M., Bini, E.J., Jacobs, S.L., Lui, Y.W., Laks, S., Milano, A. and Babb, J. (2004) Significance of Missed Polyps at CT Colonography. American Journal of Roentgenology, 183, 127-134. http://dx.doi.org/10.2214/ajr.183.1.1830127
[15]
Morrin, M.M., Farrell, R.J., Keogan, M.T., Kruskal, J.B., Yam, C.S. and Raptopoulos, V. (2002) CT Colonography: Colonic Distention Improved by Dual Positioning But Not Intravenous Glucagon. European Radiology, 12, 525-530. http://dx.doi.org/10.1007/s003300100954
[16]
Taylor, S.A., Halligan, S., Goh, V., Morley, S., Bassett, P., Atkin, W. and Bartram, C.I. (2003) Optimizing Colonic Distention for Multi-Detector Row CT Colonography: Effect of Hyoscine Butylbromide and Rectal Balloon Catheter. Radiology, 229, 99-108. http://dx.doi.org/10.1148/radiol.2291021151
[17]
Lee, S.S., Park, S.H., Kim, J.K., Kim, N., Lee, J., Park, B.J., Kim, Y.J., Lee, M.W., Kim, A.Y. and Ha, H.K. (2009) Panoramic Endoluminal Display with Minimal Image Distortion Using Circumferential Radial Ray-Casting for Primary Three-Dimensional Interpretation of CT Colonography. European Radiology, 19, 1951-1959. http://dx.doi.org/10.1007/s00330-009-1362-1
[18]
Veyrie, N., Pierre-Kahn, N., Hugol, D., Servajean, S., Berger, N., Bethoux, J.P. and Bouillot, J.L. (2004) Carcinoid Tumor from the Small Bowel. Annales de Chirurgie, 129, 607-610. http://dx.doi.org/10.1016/j.anchir.2004.09.012
[19]
Oto, A., Gelebek, V., Oguz, B.S., Sivri, B., Deger, A., Akhan, O. and Besim, A. (2003) CT Attenuation of Colorectal Polypoid Lesions: Evaluation of Contrast Enhancement in CT Colonography. European Radiology, 13, 1657-1663. http://dx.doi.org/10.1007/s00330-002-1770-y
[20]
Kobayashi, K., Katsumata, T., Yoshizawa, S., Sada, M., Igarashi, M., Saigenji, K. and Otani, Y. (2005) Indications of Endoscopic Polypectomy for Rectal Carcinoid Tumors and Clinical Usefulness of Endoscopic Ultrasonography. Diseases of the Colon & Rectum, 48, 285-291. http://dx.doi.org/10.1007/s10350-004-0765-y
[21]
Yoshikane, H., Tsukamoto, Y., Niwa, Y., Goto, H., Hase, S., Mizutani, K. and Nakamura, T. (1993) Carcinoid Tumors of the Gastrointestinal Tract: Evaluation with Endoscopic Ultrasonography. Gastrointestinal Endoscopy, 39, 375-383. http://dx.doi.org/10.1016/S0016-5107(93)70109-1
