Comparative Study between Gastro g rafin Enema and Air Enema CT: Evaluation of the Diagnostic Accuracy of Lesion Detection and Staging of Colorectal Cancer

PURPOSE: We compared the use of diluted gastrografin enema- and air enema CT for the evaluation of the diagnostic accuracy of preoperative lesion detection and the staging of colorectal carcinoma. MATERIALS AND METHODS: Forty-two patients (43 lesions) with colorectal carcinoma, diagnosed by barium enema and/or colonoscopy, underwent preoperative diluted (2.5%) gastrografin enema CT, and in another 26 patients (27 lesions) with colorectal carcinoma, air enema CT was performed. The presence or absence of lesion, its spread (T), and peritumoral lymph node (N) were analyzed. All patients underwent surgery and pathologic confirmation was obtained. RESULTS: Gastrografin enema CT and air enema CT demonstrated the primary tumor in 97.7% (42 of 43) and 96.3% of cases (26 of 27), respectively. A comparison of gastrografin enema CT and the pathologic results showed that the disease was correctly staged as T2 in five of six cases, as T3 in 28 of 31, and as T4 in two of five. Using air enema CT, the disease was correctly staged as T2 in three of three cases, as T3 in 17 of 21, and as T4 in one of two. Overall, carcinoma was correctly staged by gastrografin enema CT in 83% of cases (35 of 42) and by air enema CT in 81% (21 of 26). Nodal involvement was accurately detected in 64% of cases (27 of 42) using gastrografin enema CT and in 69% (18 of 26) using air enema CT. CONCLUSIONS: These findings suggest that the use of gastrografin enema or air enema CT does not significantly affect the diagnostic outcome.

Comparative Study between Gastro g rafin Enema and Air Enema CT: Evaluation of the Diagnostic Accuracy of Lesion Detection and Staging of Colorectal Cancer

PURPOSE: We compared the use of diluted gastrografin enema- and air enema CT for the evaluation of the diagnostic accuracy of preoperative lesion detection and the staging of colorectal carcinoma. MATERIALS AND METHODS: Forty-two patients (43 lesions) with colorectal carcinoma, diagnosed by barium enema and/or colonoscopy, underwent preoperative diluted (2.5%) gastrografin enema CT, and in another 26 patients (27 lesions) with colorectal carcinoma, air enema CT was performed. The presence or absence of lesion, its spread (T), and peritumoral lymph node (N) were analyzed. All patients underwent surgery and pathologic confirmation was obtained. RESULTS: Gastrografin enema CT and air enema CT demonstrated the primary tumor in 97.7% (42 of 43) and 96.3% of cases (26 of 27), respectively. A comparison of gastrografin enema CT and the pathologic results showed that the disease was correctly staged as T2 in five of six cases, as T3 in 28 of 31, and as T4 in two of five. Using air enema CT, the disease was correctly staged as T2 in three of three cases, as T3 in 17 of 21, and as T4 in one of two. Overall, carcinoma was correctly staged by gastrografin enema CT in 83% of cases (35 of 42) and by air enema CT in 81% (21 of 26). Nodal involvement was accurately detected in 64% of cases (27 of 42) using gastrografin enema CT and in 69% (18 of 26) using air enema CT. CONCLUSIONS: These findings suggest that the use of gastrografin enema or air enema CT does not significantly affect the diagnostic outcome.

Diagnostic Value of Immediate CT after Chemoembolization in Patients with Hepatocellular Carcinoma: Comparison with 2-3 Week Delayed CT

PURPOSE: Lipiodol CT is a important modality for the diagnosis of hepatocellular carcinoma and compared is usually performed at 2-3 week after Lipiodol injection. Therefore, we assessed and the diagnostic value and merits of immediate CT after chemoembolization from there of 2-3 week delayed Lipiodol CT. MATERIALS AND METHODS: Thirty three cases of chemoembolization which were performed both immediate CT after chemoembolization and 2-3 week delayed Lipiodol CT were reviewed retrospectively. They were divided into four grades according to pattern of lipiodol uptake by three radiologists. The diagnostic value of immediate Lipiiodol CT was compared to delayed Lipiodol CT. RESULTS: Grade 0 was two cases(3.0%) and Grade 1 was seven cases(21.2%). In the cases of Grade 2(23/33, 69.7%) tumor uptake could be dishng wished from parenchymal uptake of Lipiodol by its density and pattern. Tumor uptake showed dense and homogeneous pattern, but parenchymal uptake revealed less dense and hepatoram-like wedge shaped pattern. Lipiodol uptake of tumor in Grade 3(1/24, 3.0%) was equal to that in delayed Lipiodrl CT. Grade 3 and 2(72.7%) of the immediate Lipiodol CT were not inferior to delayed Lipiodol CT in its diagnostic value. CONCLUSION: The immediate Lipiodol CT could make rapid establishment of treatment plan and are expected to be more convenient than delayed CT for the patients.

Radiologic Intervention of Esophagobronchial Fistula in Adults: Effeativeness of Oirect Fistula Occlusion and Pre-surgical Wire Insertion

PURPOSE: To assess the role and efficacy of radiologic intervention in the adult patients with esophagobronchial fistula. MATERIALS AND METHODS: Radiologic intervertion was performed in 4 patients with esophagobronchial fistula. We tried direct occlusion of fistula tract by glue(histoacylate 0.4cc + lipiodol 0.3cc) and coil in 2 patients and performed presurgical wire insertion by using 8F curved catheter via esophageal opening of fistula tract. The latter procedure was carled out to detect the fistula tract easily at operation. RESULTS: Direct occlusions of fistula tract by glue and coil were performed only to fail in 2 patients. Pre-surgical wire incertion by using 8F curred catheter under guidance of fluroscopy in 3 patients were helpful in detecting fistula tract at operation. CONCLUSION: Direct occlusion of the fistulous tract in esophagobronchial fistulas was ineffective. However, presur- gical wire insertion by using cured catheter under fluroscopy guidance is helpful to detect the fistula tract easily at operation.

An Experimental Study on Mixing of Chemoembolic Material for Hepatocellular Carcinoma

PURPOSE: The chemoembolization with Lipiodol and doxorubicin hydrochloride is used in patients with hepatocellular carcinoma. What condition is the ideal emulsion of Lipiodol and doxorubicin for excellent anticancer effect? METHOD AND MATERIALS: Microscopic evaluation was performed on the emulsions, which were varied with different specific gravities of doxorubicin solutions, degrees in mixing of the emulsion, and amount of Lipiodol. RESULT: 1. Maximal amount of doxorubicin solution was contained in Lipiodol droplets and the release of doxorubicin from the droplets were delayed, when specific gravity of doxorubicin was equal to that of Lipiodol (SG, 1.28). 2. The optimal therapertic ratio of Lipiodol and doxorubicin was 3:2 at least, as in the emulsion less than 3:2, unmixed free forms of doxorubicin solution were increased. 3. The emulsion mixed by pumping 50--100 times had smaller Lipiodol droplets and contained larger amount of doxorubicin solution in the droplets than by pumping 20 times. CONCLUSION: We recommend the emulsion with specific gravity of doxorubicin equal to Lipiodol (SG. 1.28), the ratio of Lipiodol and doxorubicin closo to 3:2, and the mixture prepased with puming 50--100 times.