title: Barium enema "shoulder" sign: a useful predictor of pericolonic fat invasion in colorectal cancer.
abstract: OBJECTIVE
  We aimed to determine the presence of the "shoulder" sign in prediction of pericolonic fat invasion on double-contrast barium enema (DCBE) studies in colorectal cancer.
  
  
  METHODS
  Patients at our institution with apparent colorectal cancer were identified from a computer search of both radiological and surgical pathology records during a recent 30-month period. The presence of a shoulder sign was defined as a tumor margin having an abrupt transition from the intraluminal component to the adjacent normal mucosa, forming a shouldered edge on barium studies.
  
  
  RESULTS
  A total of 49 patients (53 lesions) for whom the DCBE studies and surgical pathology records were available for review were proven to have colorectal carcinomas. DCBE studies revealed that 45 patients with lesions (85%) presented with a "shoulder" sign. All of these lesions were correctly diagnosed as colorectal cancer. Of these, 89% had pericolonic fat invasion and 44% had regional lymph node metastases. Of lesions without a shoulder sign, 25% had pericolonic fat invasion and 25% had nodal metastases.
  
  
  CONCLUSIONS
  The presence of shoulder sign detected with barium enema can be a useful predictor of pericolonic fat invasion in colorectal cancer.
authors.affiliation: Department of Radiology, Taipei Medical University, Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC.
authors.forename: Shu-Chiang
authors.initials: SC
authors.lastname: Hsieh
authors.forename: Wing P
authors.initials: WP
authors.lastname: Chan
authors.forename: Chun
authors.initials: C
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D001707:Biopsy, Needle; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D004733:Enema; D005223:Fats / Q000032:analysis / Q000378:metabolism*; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D005223:Fats; D001466:Barium Sulfate