Role of Multidetector Computed Tomography in the Assessment of Malignant Large-Bowel Lesions

Abstract

Abstract Background and Objective: Intestinal disease can be examined with computed tomography (CT), which also allows for an assessment of extraintestinal pathology. In addition, CT enhances diagnostic specificity (SP) and offers an exceptional evaluation of the perienteric anomalies that typically accompany bowel disorders. The preoperative grading accuracy was found unappealing, varying between 48% and 77%. The bowel wall thickening among individuals with colorectal cancer is classified as benign or malignant depending on the extent of thickening, symmetrical and asymmetrical thickening, focal, segmental, or diffuse involvement, and related perienteric anomalies. The current study used a cohort of patients with colorectal cancers. The study aimed to find out sensitivity (SN) and SP of multidetector CT (MDCT) in detecting malignant pathologies of the large bowel by comparing the MDCT diagnosis with findings of histopathological examination. Materials and Methods: The study was an observational study, done from December 2019 to December 2021 in the Department of Radiodiagnosis, MES Medical College, Perinthalmanna, Kerala. The patients included were clinically and radiologically indicative of bowel lesions, who were referred with clinical suspicion of large-bowel diseases. The 16-slice Philips ACCESS MDCT scanner was used for MDCT. Oral, rectal, and IV contrast were used after plain CT imaging. Results: The study consisted of 63 patients, of which 53 lesions were found to be malignant on MDCT. However, only 51 patients had cancer verified by histology. Histopathology indicated that the two instances, which the MDCT had identified as malignant, were actually inflammatory. Therefore, for the diagnosis of malignant tumors, MDCT had a SN of 98.10%, SP of 81.80%, a positive predictive value of 96.20%, and a negative predictive value of 90.00% in the present study. On histology, a case that was first identified as benign on MDCT turned out to be malignant. Benign abnormalities on CT showed broad intestinal involvement and modest, symmetric wall thickening. The CT characteristics of malignant tumors included localized intestinal involvement and pronounced asymmetric wall thickening. Conclusion: MDCT has shown to be a trustworthy method for the purpose of evaluating and discriminating benign from malignant colon and rectum tumors. In addition to merely identifying a tumor, MDCT also offers additional information on any perienteric anomalies that may be present around the lesion, the presence of lymph node enlargement, invasion of adjacent viscera, the existence of intestinal obstruction, and metastatic tumors.