NetForum uses cookies to ensure that we give you the best experience on our website. If you continue to use the site, we'll assume that you are happy to receive these cookies on the NetForum website. Read about our cookies.
NetForum Community
Learn. Share. Optimize.
Log in | Sign up now | Submit content | Contact
Go to similar content

Splenic flexure apple core lesion

Case Study
Buxton, Heather CT Clinical Applications - Australasia

Clinical history

Limited Colonoscopy due to the discovery of a sigmoid stricture. CT Colonoscopy was requested to further evaluate beyond the lesion and for staging. Age 74.

Image scan parameters

A low dose technique was not performed as staging was requested.

  • 64 x 0.625
  • 1.5 mm thickness
  • 0.75 mm increment
  • Rotation time: 0.75 second
  • Acquisition time: 10 seconds
  • Patient size - Large
  • 120 kV
  • 386 mAs with DOM
  • 0.891 pitch
  • B filter

 

 

Virtual Colonoscopy Technique:

The default layout for the Filet view is with a Rectangular aspect. If a stricture is present, it may be useful for the demonstration of the lesion to turn off the Rectangular aspect and view the segment of colon in its true geometry. This is done under Features.

Default configuration of Filet Apple core geometry is not appreciated.Turn off Rectangle Under Features, turn off Rectangle. Also turn off Auto to manually zoom the image.Filet showing apple core lesion With Rectangle turned off, the Filet view shows the true geometry of the lumen.
Default configuration of Filet
Turn off Rectangle
Filet showing apple core lesion
Apple core geometry is not appreciated.
Under Features, turn off Rectangle. Also turn off Auto to manually zoom the image.
With Rectangle turned off, the Filet view shows the true geometry of the lumen.

 

Virtual Colonoscopy Technique:

The Endo view is very useful for looking at the proximal and distal ends of any stricture. A smooth tapering approach to the stricture is less indicative of the pressure of a tumour than the irregular appearance of the images below.

Endo view on approach Endo view reverse direction After you have nagivated through past the lesion, click on the reverse icon to look back at the lesion.Reverse viewer icon
Endo view on approach
Endo view reverse direction
Reverse viewer icon
After you have nagivated through past the lesion, click on the reverse icon to look back at the lesion.

 

Virtual Colonoscopy Technique:

As you pass through the centre of any stricture, view the cross sectional 2-D images on a soft tissue window to appreciate the presence of wall thickening.

Wall thickening Wall thickening at the proximal end of the strictureWall thickening Wall thickening at the centre of the strictureStricture without thickening Sigmoid stricture showing diverticular disease and no mass present
Wall thickening
Wall thickening
Stricture without thickening
Wall thickening at the proximal end of the stricture
Wall thickening at the centre of the stricture
Sigmoid stricture showing diverticular disease and no mass present
Liver Lesions
Liver Lesions

Diagnosis

Multiple metastatic deposits are seen within the liver. There is no significant mesenteric lymphadenopathy.

 

The CT colonography demonstrates an apple core type lesion near the splenic flexure. This extends over a distance of 35 mm. I note this area could not be examined at colonoscopy. The fat planes about the colon here are smooth with no significant stranding.

 

There is stricturing of the sigmoid colon. Diverticulosis is present. The area of stricturing is long segment and the appearance is more consistent with an inflammatory stricture from the diverticulosis and on prone imaging there is some distension of this segment of sigmoid. No other significant bowel wall abnormality is seen.

Clinical significance

This study demonstrates the advantages of CTC in the case of limited colonoscopy. The initial stricture found during colonoscopy in the Sigmoid Colon was diagnosed by CTC as inflammatory in nature. The CTC progressed further to find a neoplastic stricture in the Splenic Flexure. The CTC also demonstrated liver metastatic disease but no mesenteric lymphadenopathy.

 

Evaluating beyond a stricture and oncology staging are two valuable advantages of CTC.



This content has been made possible by NetForum Community.
Share this on: Share your link in twitter Share your link in facebook Share your link on LinkedIn Print Rate this article: Log in to vote

 
Rating:
Votes:
0
Views:
1992
Added:
Sep 22, 2008

Rate this:
Log in to vote
 

Case Study
Brilliance 64-channel
abdomen, Body, Bowel, Brilliance v2.0, colon, lesion, liver, Virtual Colonoscopy
 

Clinical News
Best Practices
Case Studies
Publications and Abstracts
White Papers
Web seminars and Presentations
ExamCards
Protocols
Application Tips and FAQ
Training
Try an Application
Business News
Case Studies
White Papers
Web Seminars and Presentations
Utilization Services
Contributing Professionals
Contributing Institutions
Become a Contributor