title: Accuracy of water-enema multidetector computed tomography (WE-MDCT) in colon cancer staging: a prospective study.
abstract: OBJECTIVE
  To assess the accuracy of water-enema multidetector computed tomography (WE-MDCT) in extra-rectal colon cancer staging.
  
  
  METHODS
  Fifty-three patients (mean age 70 years) with extra-rectal colon cancer proven by colonoscopy and biopsy were prospectively evaluated by preoperative WE-MDCT. CT scans were both intraluminal (water enema or WE) and intravenous (iodinated) contrast enhanced (CE). All patients underwent surgery. Tumors were classified with the TNM staging system. Noted CT features were: tumor size and location; tumor form and edges; spread to the pericolic fat or neighboring organs; thickening of retroperitoneal fascia; number, size, and enhancement of the peritumoral lymph nodes. Tumors were classified on CT into 3 T-stage groups: T1/T2, T3, and T4. Lymph nodes were classified by their density after injection [positive over 100 Hounsfield units (HU)].
  
  
  RESULTS
  Tumor localization to the specific colon segment was correct in all the cases. The agreement between WE-MDCT staging and histopathology staging was good (k = 0.64). An irregular and bowl-shaped aspect of the external edges of tumor provided excellent sensitivity for T3/T4 inclusion (Se 97.7%, NPV 85.7%). Thickening of a fascia or the abdominal wall provided good specificity for T4 stage (Sp 88.1%, NPV 94.9%). Enhancement over 100 HU of at least one peritumoral lymph node was the best criterion of N+ staging (Sp 67.7%, NPV 87.5%).
  
  
  CONCLUSIONS
  WE-MDCT permits good staging of colon cancer based on objective features.
authors.affiliation: Department of Radiology, University Hospital of Angers, LUNAM University, Angers, France.
authors.forename: E
authors.initials: E
authors.lastname: Sibileau
authors.forename: Catherine
authors.initials: C
authors.lastname: Ridereau-Zins
authors.forename: D
authors.initials: D
authors.lastname: Vanel
authors.forename: A H
authors.initials: AH
authors.lastname: Pavageau
authors.forename: S
authors.initials: S
authors.lastname: Bertrais
authors.forename: E
authors.initials: E
authors.lastname: Metivier-Cesbron
authors.forename: A
authors.initials: A
authors.lastname: Venara
authors.forename: C
authors.initials: C
authors.lastname: Aubé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D004733:Enema / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D012680:Sensitivity and Specificity; D014867:Water
chemical_list: D003287:Contrast Media; D014867:Water; C093233:iobitridol; D007472:Iohexol