Endorectal Ultrasonography Research Articles

Epidermal growth factor receptor and rectal cancer: In regard to Kim et al. (Int J Radiat Oncol Biol Phys 2006;66:195–200)

We read with great interest the article by Kim et al. (1) about the role of the epidermal growth factor receptor (EGFR) in the tumor response after neoadjuvant treatment of locally advanced rectal cancer. We have some comments and reservations concerning certain aspects of the article. First, only 30 patients (16%) underwent endorectal ultrasonography. The pretreatment clinical TNM stage was thus determined mainly by computed tomography (CT). Endoluminal ultrasonography is now recognized as the most accurate modality compared with CT and magnetic resonance imaging (MRI) for the evaluation of local invasion of rectal cancer (2) and should be considered the standard medical examination for parietal infiltration evaluation before treatment.

Preoperative Staging of Rectal Cancer: Comparison of 3-T High-Field MRI and Endorectal Sonography

The aim of this study was to compare phased-array 3-T MRI and endorectal sonography in the preoperative staging of rectal cancer. During an 8-month period, 24 patients with rectal cancer underwent both 3-T MRI performed with phased-array coils and 7.5- to 10-MHz endorectal sonography in the 3 weeks before surgical resection. Three radiologists independently reviewed the MR and endorectal sonographic images. The histopathologic findings in resected specimens were used to evaluate the sensitivities and specificities of these techniques for invasion of the muscularis propria and perirectal tissue and for lymph node involvement. Receiver operating characteristic (ROC) analysis was used to compare the diagnostic accuracies of the techniques. For muscularis propria invasion, the mean sensitivities of both MRI and endorectal sonography were 100%, and the mean specificities were 66.7% and 61.1%, respectively. The differences in the mean sensitivities and specificities were not statistically significant (p > 0.05 in each case). For perirectal tissue invasion, MRI and endorectal sonography had comparable sensitivities and specificities (91.1% vs 100%, 92.6% vs 81.5%; p > 0.05 in each case). They also had similar sensitivities and specificities for lymph node involvement (63.6% vs 57.6%, 92.3% vs 82.1%; p > 0.05 in each case). ROC curves for muscularis propria invasion and lymph node involvement showed no differences in diagnostic accuracy. The mean area under the ROC curve for endorectal sonography (A(Z) = 0.996) for perirectal tissue invasion, however, showed higher accuracy than that of MRI (A(Z) = 0.938, p = 0.028). The sensitivity, specificity, and accuracy of 3-T MRI were similar to those of endorectal sonography for muscularis propria invasion and lymph node involvement, but for perirectal tissue invasion, 3-T MRI was less accurate than endorectal sonography.

Bilan pré opératoire des cancers du rectum en IRM pelvienne haute résolution avec antenne en réseau phasé

The main problem associated with rectal cancer treatment is tumor recurrence. Randomized controlled studies have shown that adjuvant preoperative radiation therapy is effective for reducing local recurrence. These studies have also demonstrated that there are groups of rectal cancer patients with differing degrees of risk for local recurrence. At one end of the spectrum is the low-risk group: patients with superficial rectal cancer, who can be treated with surgery alone. At the other end is the high-risk group: patients with a close or involved resection margin at total mesorectal excision, the very advanced tumors that require a longer course of chemotherapy and radiation therapy, and extensive surgery. Paramount for this selection and differentiated treatment is a reliable preoperative test that can be used to distinguish these groups of patients. In this review article, we will discuss the role of high-resolution phased array MRI among the other imaging modalities such as endorectal MRI, endorectal US, and CT. We will also discuss and illustrate MR imaging results in terms of T stage, circumferential resection margin, locally advanced rectal cancer, and N stage.

2183: Rectal Adenocarcinoma in Patients Aged 80 Years or More Towards Conservative Treatment

In elderly patient conservative treatment of rectal cancer is a goal of prime importance, not only to increase sphincter saving procedure, but also to avoid as much as possible radical open surgery which is in this population associated with a non negligeable risk of postoperative death and morbidity. Such a conservative approach has been promoted in our institute and we present a preliminary analysis of our Results. Between 2001 and 2005, 29 patients presenting primary adenocarcinoma without distant metastasis and aged 80 years or more, have been treated in CAL. A conservative radiotherapy treatment with curative intent was given in 10 patients (5 men, 5 women). Staging performed with endorectal ultrasonography showed T2 = 7pts, T3 = 3. All patients were treated with contact x ray (mean dose = 100 Gy/4 fractions). External beam radiotherapy with 45 Gy was performed in 7 patients. Concurrent chemotherapy (Capecitabine) in 2 patients. One patient underwent local excision. Median follow-up time was 2 years (1–4 years). Primary local control was achieved in 8 patients. Good anorectal function was preserved in all the patients. None required palliative stoma. All treatments were ambulatory without severe toxicity. One patient had a local recurrence with moderate symptoms. Six patients are alive without symptoms (1–4 years). Three died from intercurrent disease, none from rectal cancer. Elderly patients with rectal cancer deserve a specific approach with a comprehensive geriatric evaluation. Open surgery is often associated with mortality and morbidity or poor anorectal function after LAR. Curative radiotherapy especially combining external RT and endocavitary contact x ray (+ chemotherapy) should play an increasing role to obtain a good balance between survival and quality of life in this group of population which is increasing regularly. Specific end points as time without symptom or stoma should be more often utilized in this group of population to assess relevance of management.

Endorectal ultrasonography in rectal cancer: a preliminary Barbadian experience

Preoperative staging of rectal cancer assists in surgical decision making regarding the suitability of curative local excision as well as in the selective use of preoperative adjuvant radiation and chemoradiation, both of which have been shown to reduce the incidence of loco-regional cancer recurrence substantially. Most colorectal units employ endorectal ultrasound (ERUS) in the assessment to define tumour depth (T) and nodal (N) status. The preliminary Barbadian experience of 40 such cases showing an accuracy for T stage of 85% and for N stage of 50% in keeping with international reports is presented The interpretation and limitations of this technology are presented

The use of a dedicated rectosigmoidoscope for ultrasound staging of tumours of the upper and middle third of the rectum

Tumours of the upper rectum, and many in the middle third, are not accessible to endorectal ultrasound staging because of the difficulty in reaching all sites of the rectum with a rigid probe. The aim of this prospective study was to assess whether using a dedicated rectosigmoidoscope, endorectal ultrasonography (ERUS) can accurately stage any rectal lesion irrespective of its distance from the anal verge. A total of 173 consecutive patients with a primary rectal tumour were included. A rotating, high multifrequency (5.0-10 MHz) endoprobe was introduced through a dedicated rectosigmoidoscope and advanced above the lesion. A computer allowed for three-dimensional (3D) reconstruction of 2D images. Treatment was selected on the basis of 3D-ERUS findings. ERUS staging was correlated with pathological staging. The depth of invasion was correctly determined by 3D-ERUS in 78.2% of tumours of the lower rectum, 76.4% of tumours extending between the lower and middle third of the rectum, 80.9% of tumours of the middle third of the rectum, 78.5% of tumours extending between the middle and upper third of the rectum and 78.9% of tumours of the upper rectum. The accuracy for the absence of lymph node metastases was 81.2% for tumours of the lower rectum, 78.5% for tumours extending between the lower and middle third of the rectum, 85.7% for tumours of the middle third of the rectum, 83.3% for tumours extending between the middle and upper third of the rectum and 78.5% for tumours of the upper rectum. Analysis showed that there was no difference between the various tumour sites. Our findings indicate that using a dedicated proctosigmoidoscope, tumours of the upper and middle third of the rectum are equally accessible to ultrasonographic evaluation. The distance of the tumour from the anal verge does not influence the accuracy of examinations considered adequate by the operator.

A Pathologic Complete Response of Rectal Cancer to Preoperative Combined-Modality Therapy Results in Improved Oncological Outcome Compared With Those Who Achieve No Downstaging on the Basis of Preoperative Endorectal Ultrasonography

Preoperative combined-modality therapy (CMT) is the preferred treatment for locally advanced rectal cancer (endorectal ultrasonography [ERUS] T3-4, N1, or clinically bulky) and achieves a pathologic complete response (pCR) in 4% to 33% of patients. However, the prognostic significance of pCR remains unclear. A prospectively collected database was queried to identify 200 patients with locally advanced disease treated from 1992 to 2002. The pCR group was defined as having no evidence of viable tumor on pathologic analysis. The no-downstaging group was defined as no difference between the pre-CMT ERUS stage and the pathologic stage. Those achieving some downstaging but not pCR were excluded. Patients were treated with CMT (5040 cGy of radiation and 5-fluorouracil-based chemotherapy) followed by surgery, and 51 (85%) in the pCR group and 129 (92%) in the no-downstaging group (P = .1) received postoperative chemotherapy. Recurrence-free survival (RFS) and overall survival (OS) were determined by using the Kaplan-Meier method. The median follow-up was 38.6 months (range, 18.2-124.9 months). The pCR (n = 60) and control (n = 140) groups were similar in age (P = .6), sex (P = .4), distance of the tumor from the anal verge (P = .3), pre-CMT ERUS stage (P = .2), and comorbidities (P = .2). The 5-year RFS was 96% and 54% in the pCR and control groups, respectively (P < .00001); the 5-year OS was 90% and 68% (P = .009). Sphincter-preservation rates were higher in the pCR group (P = .01). Rectal cancer patients with pCR after preoperative CMT have improved RFS, OS, and sphincter preservation compared with patients without downstaging. Because pCR seems to be associated with better outcome, an understanding of the factors governing the response to CMT should be pursued.

Transvaginal Sonography as an Adjunct to Endorectal Sonography in the Staging of Rectal Cancer in Women

The purpose of this study was to evaluate the contribution of transvaginal sonography (TVS) in the staging of rectal cancer in women. Sixty women with rectal tumors underwent TVS. Forty-five of the 60 women also underwent endorectal sonography. Forty-nine of the women had rectal carcinoma; nine, tubulovillous adenoma; and two, gastrointestinal stromal tumor confirmed at surgical pathologic examination (n = 41) and biopsy before chemoradiation therapy (n = 19). Four of the 49 rectal carcinomas were T1; seven, T2; 35, T3; and three, T4. Images from TVS and endorectal sonography were shown independently to two blinded reviewers, who staged the tumors and assessed examination adequacy for tumor presence, size, and depth and nodal status. Staging results with TVS were compared with those obtained with endorectal sonography and histopathologic examination. All tumors were seen with TVS. In 30 of the 49 rectal carcinomas confirmed at surgical pathologic examination TVS tumor staging was accurate in 25 (83.3%) of the cases. Two (6.7%) of the 30 tumors were understaged, and 3 (10%) were overstaged. All tumors selected for chemoradiation (n = 19) were correctly staged T3. Endorectal sonography was suboptimal for tumors that were stenotic (n = 3), large (n = 2), high at the rectosigmoid junction (n = 4), or low at the anal canal (n = 3). In these 12 cases, TVS successfully depicted the lesion, and the images gave enough information for prediction of stage. In interpretation of the images of 45 patients who underwent both TVS and endorectal sonography, the blinded reviewers had good agreement and comparable accuracy for staging in adequate examinations with each technique. Four of the nine villous adenomas were overstaged as T1 on TVS. Gastrointestinal stromal tumors manifested as intramural vascular masses. TVS is an excellent adjunct to endorectal sonography in the staging of rectal cancer in women. It helps resolve the findings after endorectal sonography has been unsuccessful because the tumors are stenotic or in a high or low position.

CT3N0 rectal cancer: Potential overtreatment with preoperative chemoradiation (CRT) is warranted

3568 Background: Although CRT has emerged as the preferred treatment for T3 and/or lymph node (LN) positive rectal cancer, Sauer et al (NEJM 2004) demonstrated that 18% of patients deemed suitable for preop CRT via endorectal ultrasound (ERUS) were overstaged and therefore received unnecessary preoperative CRT. Since data also suggest that LN negative rectal cancer s/p TME may not need adjuvant therapy, it is reasonable to consider the omission of radiotherapy for the cT3N0 subset. We therefore determined the accuracy of pre-CRT ERUS/MRI staging in order to explore the validity of a non-radiation approach for cT3N0 disease. Methods: 188 ERUS/MRI staged T3N0 rectal cancer patients from 6 insitutions in the US, Europe and Asia received preoperative CRT (5-FU based and 45–52.5 Gy) followed by radical resection. Rates of pathologic complete response (pCR) and mesorectal LN involvement were determined. Results: Tumors were located a median of 5 centimeters from the anal verge. Sphincter-preserving surgery was performed in 135 (81%) patients. Overall pCR was 19%. Median number of LN sampled was 9 (range 0–38). Rate of positive LN was significantly associated with T-stage: pT0: 3%, pT1: 7%, pT2: 20%, pT3–4: 36%(p=0.001). 41 patients (22%) had pathologically positive mesorectal LN. There was no significant difference in rate of positive LN between those staged by ERUS and MRI(25% vs 16%, p=0.19). Conclusions: Accuracy of preoperative ERUS/MRI for identifying mid to distal T3N0 rectal cancer is limited, as 22% will have undetected mesorectal LN involvement despite CRT. Therefore, ERUS/MRI staged T3N0 patients should continue to receive preoperative CRT. Although 19% are overstaged and therefore overtreated, our data suggest that an even larger number would be understaged and require postoperative CRT, which is associated with inferior local control, higher toxicity, and poor functional outcome. No significant financial relationships to disclose.

Sphincter preserving surgery after preoperative treatment for ultra-low rectal carcinoma. A French multicenter prospective trial: GRECCAR 1

3527 Background: GRECCAR 1 is a phase III randomised multicenter trial which compared two preoperative treatments for low rectal carcinoma which should be classicaly treated by abdominoperineal resection (Eligibility: distance between the tumor [T] and the levator ani [LA] less than 2 cm). Methods: Between 2001 and 2005, 207 patients with rectal adenocarcinomas were included in 13 French centers. The average distance between the tumor and the levator ani was 0.8 cm. 72% of the tumors were classified T3 with 60% of N1 on pre treatment endorectal ultrasonography. The mean lenght of the tumors was 5 cm on colonoscopy. Preoperative treatment randomisation was made between high dose radiation (HDR: 45 + 18 Gy: 106 patients) and radio-chemotherapy (RTCT: 45 Gy + 5FU continuous infusion: 101 patients). All surgeons performed homogeous technique for intersphincteric resection. Results: Conservative rate was 83% (HDR) and 86% (RTCT) (p: 0.64) with 84% (140/168) of intersphincteric resection. Conservative rate did not differ according to the distance T-LA: 0 cm: 84% / 1–2 cm: 84% and 3 cm: 91%. No post operative mortality was noticed with a 15% post operative morbidity rate, same in the two arms. Sterilized specimen rate was respectively 7% and 12.5% (p: 0.29), the mean inferior safety margin and radial margin was 1 cm and 4 mm, same in the two groups as the 90% R0 resection rate. On specimen, nodal involvement rate was 5.6% for pT0–1, 29% for pT2 and 56% for pT3–4. No difference was seen for down-staging between the two groups (p: 0.59). With a 22 months follow up, we noticed 92% rate of stoma closure in the conservative group. Seven patients had a local recurrence and 25 metastases with 12 patient’s death. Conclusions: GRECCAR 1 is the first prospective randomized trial which shows an 85% rate of sphincter conservative surgery due to down staging induced by preoperative tretament. No significant difference was seen between HDR and RTCT with a trend for more morbidity in the first group. Intersphincteric resection is a safe technical procedure in order to preserv the striated sphincter with sufficient lateral and inferior margins. No significant financial relationships to disclose.

Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging

Background This study was performed to verify reports of the decreased accuracy of endorectal ultrasonography (EUS) in preoperative staging of rectal cancer, and to compare the efficacy of 3-dimensional (3D) EUS with that of 2-dimensional (2D) EUS and computed tomography (CT). Methods Eighty-six consecutive rectal cancer patients undergoing curative surgery were evaluated by 2D EUS, 3D EUS, and CT scan. Results The accuracy in T-staging was 78% for 3D EUS, 69% for 2D EUS, and 57% for CT ( P < .001–.002), whereas the accuracy in evaluating lymph node metastases was 65%, 56%, and 53%, respectively ( P < .001–.006). Examiner errors were the most frequent cause of misinterpretation, occurring in 47% of 2D EUS examinations and in 65% of 3D EUS examinations. By eliminating examiner errors, the accuracy rates in T-staging and lymph node evaluation could be improved to 88% and 76%, respectively, for 2D EUS, and to 91% and 90%, respectively, for 3D EUS. Conical protrusions along the deep tumor border on 3D images were correlated closely with infiltration grade, advanced T-stage, and lymph node metastasis. Conclusions We found that 3D EUS showed greater accuracy than 2D EUS or CT in rectal cancer staging and lymph node metastases. Concrete 3D images based on tumor biology appear to provide more accurate information on tumor progression.

PREOPERATIVE LOCO‐REGIONAL IMAGING IN RECTAL CANCER

Preoperative staging of rectal cancer can influence the choice of surgery and the use of neoadjuvant therapy. This review evaluates the use of endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) in the local staging of rectal cancer. Staging for distant metastases is beyond the scope of this review. A MEDLINE search for published work in English between 1984-2004 was carried out by entering the key words of ERUS, MRI and preoperative imaging and rectal cancer. Initially, 867 articles were retrieved. Abstracts were reviewed and papers selected according to the inclusion criteria of a minimum of 50 patients and papers published in English. Papers focusing on preoperative chemoradiotherapy and distal metastases were excluded. Thirty-one papers were included in the systematic review. The examination techniques and images obtained are discussed and the respective accuracy is reviewed. ERUS and MRI have complementary roles in the assessment of tumour depth. Ultrasound has an overall accuracy of 82% (T1, 2, 40-100%; T3, 4, 25-100%) and is particularly useful for early localized rectal cancers. MRI has an accuracy of 76% (T1, 2, 29-80%; T3, 4, 0-100%) and is useful in more advanced disease by providing clearer definition of the mesorectum and mesorectal fascia. Both methods have similar accuracy in the assessment of nodal metastases. Ultrasound is more operator dependent and accuracies improve with experience, but it is more portable and accessible than MRI. Improvements in technology and increased operator experience have led to more accurate preoperative staging. ERUS and MRI are complementary and are most accurate for early localized cancers and more advanced cancers, respectively.

Endorectal Ultrasonography in Predicting Rectal Wall Infiltration in Patients With Deep Pelvic Endometriosis: A Modern Tool for an Ancient Disease

This study evaluated the validity of endorectal ultrasonography in predicting rectal infiltration in patients with deep pelvic endometriosis. Patients were recruited consecutively in the Department of Surgical Gynecology of Diaconesses Hospital from April 1996 to July 2003. Inclusion criteria were the suspicion of deep pelvic endometriosis on the basis of outpatient history and/or clinical symptoms with a mass palpable on bimanual examination that might infiltrate the rectal wall. There were no exclusion criteria. Endorectal ultrasonography was performed by the same investigator with a 7.5-MHz to 10-MHz rigid probe, producing a 360 degrees view of the rectal wall and adjacent areas. We used surgical and histopathologic findings as the "gold standard" to evaluate the validity of endorectal ultrasonography. This study was based on 37 patients (mean age, 35.8 (range, 26-46) years) who underwent surgery. The time between endorectal ultrasonography and surgery ranged from 4 to 529 (mean, 88.7) days. Eight patients had endometriosis nodules penetrating the rectal wall. Endorectal ultrasonography showed sensitivity, specificity, a positive predictive value, and a negative predictive value of 87.5, 97, 87.5, and 97 percent, respectively, in the diagnosis of infiltration of the rectal wall by endometriosis. Endorectal ultrasonography is a reliable technique for visualizing rectal infiltration in patients with deep pelvic endometriosis. It should be more widely used by gynecologists because knowing about rectal infiltration before surgery is fundamental to defining the best possible surgical approach.

The role and value of endorectal ultrasonography in diagnosing T1 rectal tumors

Rectal carcinoma in 50% to 60% of cases is localized in the rectum and, if diagnosed early can be locally excised. The authors evaluated the diagnostic accuracy of the preoperative endorectal ultrasonography (ERUS) in the staging of rectal tumors and the usefulness of the method to assess patients’ suitability for local excision. In the retrospective analysis, we analyzed 29 patients with rectal cancer. The depth of invasion into the rectal wall was assessed by ERUS and all patients were qualified for tumor excision with transanal endoscopic microsurgery (TEM). We analyzed overall accuracy of ERUS and the effectiveness of treatment. In the analyzed group, diagnostic accuracy of ERUS in assessing T1 carcinomas was 89.2%, sensitivity 92.3% and specificity 50%. Local excision with TEM was deemed to be curative in 86.2% patients with rectal tumors detected by ERUS. ERUS is an accurate method of preoperative assessment of T1 and T2 carcinomas and its diagnostic accuracy is sufficient to qualify patients for anal-saving operations. (E-mail: mskulig@cyf-kr.edu.pl)

Three-Dimensional Endorectal Ultrasound Using a New Freehand Software Program: Results in 35 Patients with Rectal Cancer

This paper describes experience in the staging of rectal cancer using a new software program for three-dimensional endoscopic ultrasonography (EUS) that works without electromagnetic sensors and can be used even with electronic radial or linear rectal probes. From May 2003 to March 2004, 35 three-dimensional endorectal ultrasound (ERUS) examinations were carried out using this program. The indication for ERUS was local staging of rectal cancer in all cases. The three-dimensional software imaging program forms part of a new ultrasound scanning system (Hitachi 6500 or 8000) and allows reconstruction of the two-dimensional EUS images in six different scans. Thirty-five rectal cancers were assessed using two-dimensional and three-dimensional EUS. Using two-dimensional imaging, it was not possible to assess precisely the degree of involvement of the mesorectum (more or less than 50%). No differences were evident with three-dimensional EUS for superficial tumors (T1 and T2N0), but in six of 15 patients classified as having T3N0 lesions, three-dimensional EUS revealed malignant lymph nodes, a finding that was confirmed surgically in five of the six cases. Three-dimensional EUS also made it possible to assess the degree of infiltration of the mesorectum precisely in all cases, demonstrating complete invasion of the mesorectum in eight cases. These findings were confirmed in all cases by the surgical data. Two-dimensional EUS correctly assessed 25 of the 35 rectal tumors (71.4%) in relation to the T and N classifications, and three-dimensional EUS increased this figure to 31 correct evaluations out of 35 (88.6%). Three-dimensional ERUS is easy to carry out using this new software program. There is no need for an external sensor mounted at the tip of the probe, and manipulation of the rectal probe is facilitated. Three-dimensional ERUS can be carried out using linear and radial electronic probes with the same ultrasound equipment. Three-dimensional ERUS allows more precise staging of lesions and better definition of the mesorectal margins, and this has a direct impact on therapeutic decision-making in patients with rectal cancer.

Anorectal ultrasound for neoplastic and inflammatory lesions

Accurate staging of rectal and anal carcinoma is crucial for planning surgery and indicating adjuvant therapy. Although, computed tomography and magnetic resonance imaging are very sensitive in detecting metastatic disease, the local staging of rectal cancer with these techniques has been disappointing. Endorectal ultrasound (ERUS) and anal endosonography (AE) remain the most accurate methods for staging rectal and anal cancer. Anal endosonography is also of value in evaluating perianal sepsis: it can assist the surgeon in planning the surgical strategy by delineating the anatomy of fistula tracts, and can aid in puncturing abscesses in the operating room. Continued research and development has made the instrumentation for ERUS and AE more accurate and user-friendly. New techniques that have contributed significantly to the evolution of ERUS include three-dimensional ERUS, high-frequency miniprobes, transrectal ultrasound-guided biopsy techniques and hydrogen peroxide-enhanced endosonography. Further improvements can be expected from contrast enhancement with microbubbles and colour Doppler imaging. In this new millennium, new developments in ERUS and anal endosonography, such as tri-dimensional ERUS and anal endosonography and radial electronic probing, widen the role of ERUS in the staging of rectal and anal carcinoma, as well as for perianal inflammatory conditions.

Les thérapeutiques et la surveillance dans le cancer de la prostate et leurs implications sur l’imagerie

Multiple treatments are proposed to cure prostate carcinoma. Radical prostatectomy is the classical option for localized tumor. However radiotherapy can be proposed in such circumstances with the argument of a less invasive procedure with similar results. High Intensity Focalised Ultrasound (HIFU) is a new technique available for similar staging of the carcinoma with good results. Follow up is based on biological evaluation of PSA. Imaging studies are required only in cases of abnormal level. Endorectal Ultrasonography with biopsies is useful after radical surgery. Indications for MRI study is mainly to differentiate a localized from a general recurrence.

Imagerie de la prostate normale, de l’hyperplasie bénigne et de la pathologie inflammatoire

According to Mc Neal, the prostate gland is characterized by three major glandular compartments: the transition zone, the central zone and the peripheral zone. This zonal anatomy can be identified with endorectal sonography and with MRI. With the later, both endorectal or external surface coils can be used. Internal structure of seminal vesicles and vas deferens is better analyzed with MRI than with sonography. Relationship between these elements is important to know, as well as areas of weakness of the prostatic capsule, mainly in the evaluation of cancer extraprostatic extension. Sonography plays a major role in diagnosis, pre-therapeutic evaluation and follow-up of patients with benign prostatic hyperplasia. The role of imaging in inflammatory disorders is more questionable.

Staging of rectal cancer by endorectal ultrasonography

Endorectal ultrasonography is valuable method for accurate local staging of rectal cancer. Precise evaluation of tumor stage is essential for optimal therapy planning in patients with rectal cancer. Furthermore, it has great influence on the resectability and the risk of recurrence following resection. Endorectal ultrasonography has become the most common diagnostic tool for locally staging rectal cancer due to its advantages over magnetic resonance imaging (MRI) and computer tomography (CT). Among these diagnostic modalities ERUS has been known to be most accurate. Moreover, endorectal ultrasonography is inexpensive and quick diagnostic procedure associated with minimal discomfort to the patient. However, the use of CT, MRI, and more recently magnetic resonance imaging with endorectal coil often remains necessary. These modalities may be useful supplements in patients with suspected T4 lesion, when endorectal ultrasonography is technically unsuccessful and in cases of diagnostic dilemma. Major improvements in diagnostic and staging of rectal cancer have led to stage-oriented surgery, planning of therapy individually for each patient, reduce of local recurrences, and better overall survival. This article reviews the current use of endorectal ultrasonography in preoperative staging of rectal cancer as the most practical and accurate diagnostic modality for preoperative locoregional staging of rectal cancer at this time.

Endorectal ultrasound (ERUS) in pelvic disorders

Endorectal ultrasound (ERUS) imaging is a complex process using electronic devices to control ultrasound waves and produce images of anatomic structures. It is a simple, cheep and well-tolerated procedure that provides excellent images of rectal and anal canal wall and pelvic floor muscles together with surrounding organs and tissues. The direct imaging of anal canal and pelvic floor muscles with surrounding tissues allows one to identify sphincter defects, anorectal abscesses and fistulas as well as great variety of benign and malignant pathology of the pelvis. Basically, techniques for ERUS are very similar, but there are some slight modifications regarding equipment, indications, and localization of pathologic process. We describe the technique, indications, results and pitfalls of ERUS with the Bruel and Kjaer type 1850 endosonic probe with 7 and 10 MHz transducers in benign pelvic disorders.