Preoperative Evaluation of Synchronous Colorectal Cancer Using MR Colonography
Received 24 November 2008; accepted 24 January 2009. published online 20 April 2009.
Rationale and Objectives
It is well known that synchronous cancers (incidence, 2%–11%) and polyps (incidence, 12%–58%) occur in patients with colorectal cancer. Magnetic resonance colonography (MRC) seems like the obvious choice as a diagnostic tool in preoperative evaluation, because it is noninvasive, and most of the colon can be evaluated. Furthermore, it has higher patient acceptance, and no sedation or radiation is used. The purpose of this study was to determine the feasibility of performing MRC preoperatively in an everyday clinical situation in a group of patients who were not offered a full conventional colonoscopy or in whom full conventional colonoscopy was not possible.
Materials and Methods
In a 13-month period, 47 patients diagnosed with rectal or sigmoid colon cancer scheduled for operation were included in the study. MRC was performed with bowel purgation either the night before surgery or as ambulatory MRC the week before surgery.
Results
Full MRC was performed in 98% of the patients. In four patients, 12 synchronous lesions (one cancer, two plaques of carcinosis, and nine adenomas) were found. One flat adenoma and five small polyps were missed by MRC and perioperative palpation but found on postoperative colonoscopy. The findings resulted in altered operative strategies in three patients.
Conclusion
This study shows the feasibility and potential gain of preoperative MRC in patients with sigmoid colon cancer or rectal cancer.
Department of Diagnostic Radiology and the Department of Surgical Gastroenterology D, Copenhagen University Hospital Herlev, Herlev Ringvej, DK-2730 Herlev, Denmark; and the Department of Diagnostic Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
ABSTRACT