Importance of preoperative rectal ultrasound and CT in rectal tumors

INTRODUCTION:
The reason of high mortality of colorectal carcinoma is above all the fact, that majority of diseases are detected in progressive stage. Radical change in this unfavorable mortality rate can be achieved only by targeted search for early stages of the disease. Early diagnostics consists in rectoscopy and colonoscopy. Regarding X-ray methods it is X-ray irigography. Regarding CT examinations it is CT irigography, virtual colonoscopy. Another examination can be USG examination of abdomen and endosonographic examination of rectum.

MATERIALS AND METHODS:
: In the period from June 2006 to December 2010, in 60 patients out of the total number 106 examined patients, tumorous affection of rectum CT examination of pelvis and abdomen separately or pelvis and abdomen at one session was made in 3186 patients. In 115 patients we discovered malign tumorous illness of colon. Metastatic affection in the form of distant metastases was proven n 63 patients. 403 patients had CT irigography examination. In 77 out of them we diagnosed colon carcinoma. CT colonoscopy did not discover in our group of 30 patients examined the presence of colon carcinoma.

RESULTS:
In the group of 60 patients who were diagnosed rectal carcinoma, in 29 patients expansive infiltrative affection was evaluated in endorectal sonography, histologically confirmed in 28 patients – 96,5 %, expansive affection in 41 patients with histological verification in 100 %. With CT we diagnosed 52 expansive tumorous processes, histologically confirmed in 47 patients – 90,38 %. In 63 patients expansive infiltrative process was evaluated, histologically confirmed in 52 patients 82,53 %. In total of 115 examinations there was conformance with histological examination in 99 patients – 86,08 %. In CT irigography we diagnosed colon tumour in 77 patients. Expansive growth was evaluated in 40 patients, histologicaly confirmed in 37 patients – 92,5 %. Expansive infiltrative expansion was evaluated in 37 patients, with histological verification in 9 patients – 78,3 %. In total we marked conformance of CT irigography with histological examination in 85,71 examinations. In CT virtual colonoscopy we did not diagnose any case of malign colon affection.

CONCLUSION:
Early diagnostics of primary colorectal carcinoma is the only possibility how to improve the prognosis of the patients. Endorectal sonography should serve as a complement to other examination methods. It assesses the principal expansion of the tumour in the rectal wall, infiltration in the surroundings. MSCT of abdomen and pelvis brings excellent results and the surgeon can evaluate in selecting the appropriate type of operation. The benefits f this methodology is high in assessing the local finding as well as in assessing the presence of metastases in parenchyma organs or lymphatic nods. CT irigography better evaluated intestinal wall, its thickness, bordering or infiltration to the surroundings. A part of the examination is also evaluation of the state of the organs of abdominal cavity, pelvis, LU. Virtual colonoscopy is an excellent screening method to search for polyps of colorectum, which are considered pre-cancerosis.

KEY WORDS:
colorectal carcinoma, endorectal sonography, Multi-slice CT, CT irigography, CT virtual colonoscopy