title: Contrast-enhanced computed tomography colonography in preoperative distinction between T1-T2 and T3-T4 staging of colon cancer.
abstract: OBJECTIVE
  To predict the T stage of nonrectal colon cancer using contrast-enhanced computed tomography colonography.
  
  
  METHODS
  Sixty-one patients with 67 nonrectal colon cancers consecutively underwent contrast-enhanced computed tomography colonography after an incomplete colonoscopy. Two readers evaluated wall deformity and perilesional fat abnormality on three-dimensional double contrast enema-like views and multiplanar reconstructions. Pathology was used as the standard of reference. McNemar, Fisher, and Cohen κ statistics were used.
  
  
  RESULTS
  At pathologic examination, we found the following stages: T1 (n = 5), T2 (n = 10), T3 (n = 41), T4a (n = 6), and T4b (n = 5). Intraobserver and interobserver reproducibilities were almost perfect for wall deformity (κ = 1.00 and κ = 0.88, respectively), substantial for perilesional fat abnormality (κ = 0.79 and κ = 0.74, respectively). Using the results of the more experienced reader, accuracy of wall deformity ≥50% (apple-core) alone for T ≥ 3 was 62 of 67 (0.93, 95% confidence interval [CI] 0.83-0.97) and that of perilesional fat abnormality alone was 37 of 67 (0.55, 95% CI 0.43-0.67) (P < .001). Predictive value for ≥ T3 of the association wall deformity ≥50% with perilesional fat abnormality was 22 of 22 (1.00, 95% CI 0.85-1.00), higher, but not significantly, than that of wall deformity ≥50% with normal perilesional fat 29 of 33 (0.88, 95% CI 0.72-0.97) (P = .148, Fisher exact test).
  
  
  CONCLUSIONS
  The presence of apple-core wall deformity, regardless of perilesional fat abnormality, is highly predictive of stage T3 or higher.
authors.affiliation: Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, via A. Di Rudinì, 8 - 20142 Milan, Italy. nicola.flor@unimi.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Flor
authors.forename: Miriam
authors.initials: M
authors.lastname: Mezzanzanica
authors.forename: Paolo
authors.initials: P
authors.lastname: Rigamonti
authors.forename: Elena Guerini
authors.initials: EG
authors.lastname: Rocco
authors.forename: Silvano
authors.initials: S
authors.lastname: Bosari
authors.forename: Andrea Pisani
authors.initials: AP
authors.lastname: Ceretti
authors.forename: Simone
authors.initials: S
authors.lastname: Soldi
authors.forename: Mauro
authors.initials: M
authors.lastname: Peri
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Cornalba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol