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Imaging in the Diagnosis, Staging, and Follow-Up of Colorectal Cancer

¹ All authors: Department of Diagnostic Radiology, Box 57, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.

View larger version (129K): [in a new window]   Fig. 1A. —50-year-old man with pedunculated polyp. Spot radiograph obtained during barium enema shows polyp.

View larger version (84K): [in a new window]   Fig. 1B. —50-year-old man with pedunculated polyp. Photograph of gross specimen obtained for pathology.

View larger version (103K): [in a new window]   Fig. 2A. —59-year-old woman with colon cancer. Radiograph obtained during double-contrast barium enema shows apple-core lesion (arrowheads) in sigmoid colon. Note small filling defect (arrow) in descending colon.

View larger version (95K): [in a new window]   Fig. 2B. —59-year-old woman with colon cancer. Spot radiograph of filling defect in descending colon reveals polyp (arrow).

View larger version (73K): [in a new window]   Fig. 3. —Diagram of adenoma—carcinoma sequence shows development of colon cancer and corresponding primary tumor (T) stage.

View larger version (95K): [in a new window]   Fig. 4. —Drawing shows routes of lymphatic drainage from malignant tumors arising in different areas of colon.

View larger version (120K): [in a new window]   Fig. 5A. —68-year-old man with cecal cancer. Axial CT scan of abdomen shows mass in cecum (black arrow) and adjacent lymphadenopathy (white arrow).

View larger version (123K): [in a new window]   Fig. 5B. —68-year-old man with cecal cancer. Axial CT scan of abdomen shows lymphadenopathy (arrow) followed to root of mesentery.

View larger version (125K): [in a new window]   Fig. 6A. —60-year-old man with colon cancer at hepatic flexure. Axial CT scan of abdomen shows mass (M) at hepatic flexure and lymphadenopathy (arrow) anterior to superior mesenteric vessels (asterisks).

View larger version (159K): [in a new window]   Fig. 6B. —60-year-old man with colon cancer at hepatic flexure. Axial CT scan of abdomen shows lymphadenopathy (arrow) followed along gastrocolic trunk (GC) anterior to superior mesenteric vessels (asterisks).

View larger version (168K): [in a new window]   Fig. 7A. —45-year-old man with colon cancer involving transverse colon. Axial CT scan of abdomen shows primary tumor (black arrow) with adjacent lymphadenopathy (white arrow).

View larger version (151K): [in a new window]   Fig. 7B. —45-year-old man with colon cancer involving transverse colon. Axial CT scan of abdomen shows lymphadenopathy (arrow) followed along middle colic vessels (asterisk) in transverse mesocolon.

View larger version (133K): [in a new window]   Fig. 8. —50-year-old man with rectal cancer (T) shown on endorectal sonogram. Note tumor does not penetrate hypoechoic muscularis mucosa (arrowheads) or submucosa.

View larger version (155K): [in a new window]   Fig. 9. —55-year-old man with rectal cancer (T). Endorectal sonogram shows that tumor penetrates through all layers to hyperechoic perirectal fat (F).

View larger version (176K): [in a new window]   Fig. 10. —46-year-old woman with sigmoid colon cancer. Thin-section axial CT scan of pelvis shows extension of tumor into pericolonic fat (arrowheads) and adjacent nodes (arrow).

View larger version (102K): [in a new window]   Fig. 11. —53-year-old man with colon cancer and liver metastasis (arrow) shown on axial CT scan of abdomen.

View larger version (116K): [in a new window]   Fig. 12. —48-year-old man with colon cancer. Axial CT scan of abdomen shows calcified liver metastases (arrow) and calcification (arrowheads) in primary tumor in descending colon.

View larger version (122K): [in a new window]   Fig. 13A. —45-year-old man with colon cancer. Axial T1-weighted (A) and axial T2-weighted (B) MR images of abdomen show liver metastasis (arrow).

View larger version (113K): [in a new window]   Fig. 13B. —45-year-old man with colon cancer. Axial T1-weighted (A) and axial T2-weighted (B) MR images of abdomen show liver metastasis (arrow).

View larger version (87K): [in a new window]   Fig. 13C. —45-year-old man with colon cancer. Sagittal gadolinium-enhanced T1-weighted MR image of abdomen shows peripheral enhancement of liver metastasis (arrow).

View larger version (142K): [in a new window]   Fig. 14A. —60-year-old man with colon cancer and liver metastasis. Axial T2-weighted MR image of abdomen shows poorly defined lesion (arrow) in left lobe of liver.

View larger version (134K): [in a new window]   Fig. 14B. —60-year-old man with colon cancer and liver metastasis. Axial T2-weighted MR image of abdomen after ferumoxide administration shows increased liver-to-lesion (arrow) contrast compared with A.

View larger version (130K): [in a new window]   Fig. 15A. —67-year-old woman who presented with signs and symptoms of bowel obstruction after having undergone right hemicolectomy for colon cancer. Radiograph obtained during barium enema shows complete obstruction at anastomosis (arrow).

View larger version (98K): [in a new window]   Fig. 15B. —67-year-old woman who presented with signs and symptoms of bowel obstruction after having undergone right hemicolectomy for colon cancer. Axial CT scan of abdomen shows recurrent mass (arrow) is causing small-bowel obstruction.

View larger version (144K): [in a new window]   Fig. 16. —57-year-old man who had undergone low anterior resection for colorectal cancer. Follow-up axial CT scan of pelvis shows anastomotic recurrence (arrow).

View larger version (173K): [in a new window]   Fig. 17A. —49-year-old man who presented with anastomotic leak after having undergone low anterior resection for colorectal cancer. Axial CT scans of pelvis (A) and from barium enema (B) show presacral collection (arrows), posterior to rectum (R), communicating with rectosigmoid anastomosis (arrowheads).

View larger version (120K): [in a new window]   Fig. 17B. —49-year-old man who presented with anastomotic leak after having undergone low anterior resection for colorectal cancer. Axial CT scans of pelvis (A) and from barium enema (B) show presacral collection (arrows), posterior to rectum (R), communicating with rectosigmoid anastomosis (arrowheads).

View larger version (91K): [in a new window]   Fig. 18A. —70-year-old man who underwent right hemicolectomy for colon cancer. Positron emission tomogram (PET) shows uptake (arrow) in mid abdomen.

View larger version (138K): [in a new window]   Fig. 18B. —70-year-old man who underwent right hemicolectomy for colon cancer. Axial CT scan of abdomen shows adenopathy (arrow) in middle colic nodal group anterior to superior mesenteric vessels (asterisks), corresponding to findings on A, and subsequently proven to be recurrent disease.

View larger version (154K): [in a new window]   Fig. 19A. —71-year-old man who presented for routine follow-up after having undergone left hemicolectomy for colon cancer. Axial CT scan of abdomen shows linear soft tissue (arrow) along Gerota's fascia.

View larger version (102K): [in a new window]   Fig. 19B. —71-year-old man who presented for routine follow-up after having undergone left hemicolectomy for colon cancer. Positron emission tomogram shows increased uptake (arrow) corresponding to lesion revealed on A. Lesion was subsequently biopsied and proven to be recurrent disease.

View larger version (85K): [in a new window]   Fig. 20A. —40-year-old man who presented with rising level of carcino-embryonic antigen after having undergone low anterior resection for rectosigmoid cancer. SPECT image shows uptake of radiolabeled anti-CEA monoclonal antibody (arrow) in left side of pelvis.

View larger version (117K): [in a new window]   Fig. 20B. —40-year-old man who presented with rising level of carcino-embryonic antigen after having undergone low anterior resection for rectosigmoid cancer. Unenhanced axial CT scan of pelvis shows normal findings.

View larger version (176K): [in a new window]   Fig. 20C. —40-year-old man who presented with rising level of carcino-embryonic antigen after having undergone low anterior resection for rectosigmoid cancer. Axial (C) and coronal (D) T2-weighted MR images of pelvis show mass (arrow) adjacent to prostate.

View larger version (161K): [in a new window]   Fig. 20D. —40-year-old man who presented with rising level of carcino-embryonic antigen after having undergone low anterior resection for rectosigmoid cancer. Axial (C) and coronal (D) T2-weighted MR images of pelvis show mass (arrow) adjacent to prostate.

View larger version (117K): [in a new window]   Fig. 21A. —58-year-old woman with breast cancer who presented for routine colon screening. Two-dimensional axial CT scan (A) and three-dimensional CT scan with endoluminal-perspective volume rendering (B) of colon show 1-cm polyp (arrow) in rectum.

View larger version (124K): [in a new window]   Fig. 21B. —58-year-old woman with breast cancer who presented for routine colon screening. Two-dimensional axial CT scan (A) and three-dimensional CT scan with endoluminal-perspective volume rendering (B) of colon show 1-cm polyp (arrow) in rectum.

View larger version (139K): [in a new window]   Fig. 21C. —58-year-old woman with breast cancer who presented for routine colon screening. Photograph obtained at colonoscopy reveals same polyp (arrow) as that shown in A and B and proven to be tubulovillous adenoma with foci of high-grade dysplasia.

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