Satellite Symposium ESGAR 2011
All along the colon:
multimodality imaging and staging
Chairman: Prof. T. Lauenstein
(Essen – Germany)
Sunday, May 22nd 2011
13:00 - 14:00
Venice Convention Centre, Lido, Italy
Sala Laguna, level 3
Introduction by the chairman
Prof.T. Lauenstein (Essen – Germany)
Potential of multimodality approach in colon imaging
Cross sectional imaging including computed tomography (CT) and magnetic
resonance tomography (MRI) is nowadays widely used in the field of gas-
trointestinal imaging. Both tumor and inflammatory disease of the bowel
can be accurately visualized by means of CT and MRI. In spite of the competition
with other diagnostic modalities including (capsule) endoscopy, there are
considerable advantages associated with cross sectional imaging. Not only
changes of the mucosa can be assessed, but all bowel layers and also
extraintestinal diseases can be evaluated. This is of particular interest in
inflammatory bowel disease for the depiction of fistulae and abscesses and
in malignant diseases for tumor staging and the visualization of lymph
nodes or hepatic metastases. The three presentations will provide an overview
over different clinical applications of CT and MRI for the assessment of
the small bowel, colon and rectum.
Bowel preparation in CT colonography for a better patient compliance
CT colonography is potentially the most accurate non-invasive method to detect colorectal polyps and
cancers. Many clinical studies evaluating CT colonography have demonstrated a success rate of 75 to 100% in
detecting colorectal polyps 1cm or more in diameter. CT colonography requires a clean, dry and
distended colon for optimal detection. Prior to the examination, a bowel preparation is required. The inconvenience
and discomfort of this procedure greatly reduce patient compliance.
The traditional bowel preparation for CT colonography, includes a low -residue diet, and a cathartic cleansing
(sodium phosphate or magnesium citrate and bisacodyl tablets) the day before the examination. However,
residual stool or fluid residue appear on CT hypodense, and may mimic polyps or hide colic lesions.
Fecal tagging (barium and/or iodine) administrated orally 24 hours prior to examination is used as stool
markers. Residual stool and fluid appear hyperdense on CT. Fecal tagging improves the detection of retained stool
and allows differentiation of stool from colonic polyp.
Electronic cleansing is an emerging technique for the removal of tagged fecal residue from CT colonographic
images. This technique seems to be helpful for radiologist, by improving interpretation time.
Association of low residue-diet, cathartic cleansing, and fecal tagging is essential to perform state-of the-art CT
colonography and is currently considered the clinical standard preparation. Disadvantages of the
cathartic preparation are related to side effects, impact on patient’s tolerance and acceptance of the
examination. This is the major barrier in colorectal cancer screening.
Recently, limited bowel preparation using low- fiber or clear diet combined with an ingestion of oral contrast
(barium or iodine) in divided doses has been proposed to increase patient compliance. Reduction or elimination
of catharsis with fecal tagging enhances the tolerability of CT colonography.
In the future, a taggingonly bowel preparation for CT colonography might be a challenge to enhance patient
compliance especially in colorectal cancer screening.
Marie-Ange Pierredon Foulongne MD
Imagerie Médicale, CHU Montpellier
MRI in locoregional assessment of rectum cancer
Rectal cancer is one of the most common malignant tumours. One concern after rectal cancer surgery
is the high local recurrent rate. In recent years mortality rates have decreased due to major changes in
therapeutic management, especially the operative procedure and the introduction of neoadjuvant
therapy. Neoadjuvant therapy followed by total mesorectal excision is now used as a standard for the
majority of patients with locally advanced rectal cancer in attempt to reduce the rate of local recurrence.
This presentation aims to illustrate the impact of MRI on the diagnosis and management of patients
with rectal cancer. It will provide an overview of the use of this technique at initial diagnosis and
MR preoperative imaging in staging the local extent of primary rectal cancer is important in order
to select subgroups of patients most likely to benefit from neoadjuvant therapy. The most relevant
aspects of local spread of rectal tumours will be discussed: T stage, circumferential resection margin
and N stage. Research on various MRI modalities that address nodal malignancy prediction will be
MR restaging of rectal cancer after concurrent chemotherapy and radiation therapy is challenging.
Awareness of therapeutic changes helps radiologists achieve appropriate restaging. The contribution
and limitations of MR after chemoradiation therapy will also be discussed.
Céline Savoye-Collet MD
Imagerie Médicale, CHU Charles Nicolle
The role of CT –Enteroclysis in peritoneal carcinomatosis.
Cytoreductive Surgery (CRS) combined with Perioperative Intraperitoneal Chemotherapy (PIC) has
resulted in improved long-term disease control rates in selected patients with peritoneal carcinomato-
sis (PC) of various origins, previously considered only for palliative treatment approaches. Disease in
the small bowel (SB) constitutes a sentinel, limiting criterion in the decision making process involved
CRS because enough SB needs to remain in place to allow for an adequate oral nutrition in the future.
Thus evaluation of SB is crucial component in the preoperative imaging assessment. Experience tells
us that even the most sophisticated CT technology usually underestimates actual SB involvement
revealed at surgical exploration. CT-Enteroclysis (CTE) may be indicated as complementary tool in the
diagnostic work-up evaluation of patients with PC candidates for an adequate CRS since it could map
in detail and accurately the extend of the disease in the SB and its mesentery. The use of scanners
with higher spatial resolution might increase our ability to detect smaller and thinner cancerous
implants. Further studies in larger cohorts are needed to establish CTE as initial work-up evaluation in
this specific group of patients since it combines diagnostic data from a conventional abdominal CT-
scan and simultaneously describes the extend of the disease in the SB and its mesentery
Nikos Courcoutsakis, MD, D(Med)Sci
• Dromain C, Abdom Imaging 2008; 87 Democritus University of Thrace,
• Jacquet P, J Am Coll Surg 1995;530 Alexandroupolis, Greece
• Gonzalez-Moreno S, Cancer J 2009
• Yan TD, et al. Ann Oncol 2007
• Yan TD, et al. Ann Surg Oncol 2007
• Yonemura Y, et al. Cancer Treat Res 2007
All along the colon:
multimodality imaging and staging
Chairman Prof. T. Lauenstein (Essen – Germany)
13:00 - 13:10 Introduction: potential of multimodality
approach in colon imaging
by the Chairman
13:10 - 13:25 CT enteroclysis in peritoneal carcinomatosis
Dr. N. Courcoutsakis (Alexandropoulis, Greece)
13:25 - 13:40 Bowel preparation in CT colonography for a better
Dr. M. A. Pierredon Foulongne (Montpellier, France)
13:40 – 13:55 MR Imaging in loco-regional assessment of rectum
Dr. C. Savoye Collet (Rouen, France)
13:55 – 14:00 Conclusion
Citron Marine - January 2011 - P 10 060 TX
by the Chairman