ENDORECTAL COLOR DOPPLER IMAGING OF PRIMARY AND RECURRENT RECTAL WALLTUMORS - PRELIMINARY EXPERIENCE

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.