Hemodynamic changes of abdominal organs after CT colonography with transrectal administration of CO2: evaluation with early-phase contrast-enhanced dynamic CT

Kenichiro Ihara,Masahiro Tanabe,Katsuyoshi Ito,Akihiko Kanki,Hideko Onoda

doi:10.1007/s11604-021-01125-5

Kenichiro Ihara, Masahiro Tanabe + Show 3 more

Open Access

https://doi.org/10.1007/s11604-021-01125-5

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Abstract

PurposeTo evaluate the hemodynamic changes in the liver, pancreas, gastric mucosa and abdominal vessels in early-phase dynamic contrast-enhanced (DCE) CT immediately after CT colonography (CTC) with carbon dioxide expansion.Materials and methodsThis study included 82 patients with DCE-CT after CTC (CTC group) and 77 patients without CTC (control group). Contrast enhancement values of the gastric mucosa, liver, pancreas, portal vein (PV), splenic vein (SpV), superior mesenteric vein (SMV), and inferior mesenteric vein (IMV) in early-phase CT were measured. The presence of hepatic pseudolesions were also recorded.ResultsThe mean contrast enhancement values of the gastric mucosa, pancreas and SpV in the CE-CTC group were significantly lower than those in the control group (p < 0.001, p < 0.001, p = 0.014). Conversely, the mean contrast enhancement values of the liver, PV, SMV and IMV in the CE-CTC group were significantly higher than those in the control group (p = 0.003, p = 0.013, p < 0.001, p < 0.001). Hypovascular hepatic pseudolesions were seen in early-phase CT in six patients after CTC, while they were not seen in the control group.ConclusionsOn DCE-CT performed immediately after CTC with carbon dioxide expansion, it is important to be aware of the imaging findings induced by visceral hemodynamic changes.

Highlights

Computed tomography (CT) colonography (CTC) has been widely used as a minimally invasive, reliable diagnostic technique for colorectal cancer [1,2,3,4,5]
Hepatic pseudolesions were seen as hypo-attenuating areas on early-phase CT in six patients (7%) of the CECTC group at the posterior edge of the left medial segment (n = 5) or the surrounding gallbladder fossa (n = 1) (Fig. 4) while they were not seen at all in the control group (p = 0.016)
The mean contrast enhancement CT values of superior mesenteric vein (SMV) and inferior mesenteric vein (IMV) were significantly higher in the CE-CT colonography (CTC) group than in the control group, suggesting an increased venous return from the large intestine

Summary

Introduction

Computed tomography (CT) colonography (CTC) has been widely used as a minimally invasive, reliable diagnostic technique for colorectal cancer [1,2,3,4,5]. CTC allows for the detection of colorectal cancers and polyps with high sensitivity, determination of local progression for staging, and depiction of synchronous lesions in the colon, even in patients with endoscopic inaccessibility. In patients with colorectal cancer, the preoperative detection of metastases is extremely important for deciding on the therapeutic strategy. Positive or negative extra-colonic findings can be as valuable as colonic findings in the management of patients with colorectal cancer [6, 7]. The combination of CTC and dynamic contrastenhanced (DCE) CT of the body performed immediately after CTC is considered efficient for the further investigation of both colonic and extra-colonic findings

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