Gs. Sudakoff et al., ENDORECTAL COLOR DOPPLER IMAGING OF PRIMARY AND RECURRENT RECTAL WALLTUMORS - PRELIMINARY EXPERIENCE, American journal of roentgenology, 166(1), 1996, pp. 55-61
OBJECTIVE, The purpose of our study was to assess whether color Dopple
r imaging is a useful adjunct to endorectal sonography in evaluating r
ectal wall neoplasms and in distinguishing recurrent or residual tumor
from postoperative changes, MATERIALS AND METHODS, Thirty-two patient
s underwent endorectal sonography with color Doppler imaging for one o
f two indications: evaluation and staging of a suspected primary recta
l wall cancer, or distinguishing tumor recurrence from postoperative s
carring in patients with previously resected lesions. Rectal wall lesi
ons were evaluated for hypervascularity, and their corresponding flow
patterns were graded from 0 to 4. Local tumor staging with endorectal
sonography and color Doppler imaging was performed before the results
of pathological staging were available. RESULTS, Ninety-five percent o
f patients with malignant rectal wall tumors demonstrated hypervascula
rity during color Doppler imaging. In 61% of patients with rectal canc
ers, prominent perirectal vessels were identified supplying the tumor
and were never identified in patients with benign lesions. Endorectal
sonography alone correctly identified perirectal fat invasion with a 1
00% sensitivity and an 83% specificity, Color Doppler imaging during e
ndorectal sonography correctly identified perirectal fat invasion with
a sensitivity of 91% and a specificity of 83%, Of the 8 patients with
previously resected lesions (five adenomas and three cancers), two pa
tients had recurrent tumor, and both of these demonstrated grade 3 abn
ormality, Six patients with biopsy-proven fibrosis only had grades of
0 or 1. CONCLUSIONS. Both benign and malignant rectal wall tumors demo
nstrate abnormal intratumoral hypervascularity when seen with color Do
ppler imaging, Advanced rectal cancers (T3 or greater) are also associ
ated with abnormal perirectal vascularity. Color Doppler imaging durin
g endorectal sonography does not appear to improve discrimination of b
enign from T2 (or less) rectal wall cancers, nor does it appear to imp
rove the ability to locally stage rectal wall cancers during endorecta
l sonography, However, endorectal sonography with color Doppler imagin
g may add significant information in distinguishing recurrent tumor fr
om postsurgical scarring.