Preoperative Assessment of Rectal Cancer: Value of Two-Phase Dynamic CT

PURPOSE: The purpose of this study was to evaluate the utility of two-phase dynamic CT, early and equilibrium pahse, in the preoperative staging of rectal cancers. MATERIALS AND METHODS: We performed incremental dynamic CT after rectal infusion of water in 34 patients with pathologically proved rectal cancers. Two-phase dynamic CT findings were prospectively analyzed and correlated with surgical and histopathologic findings. A total of 150ml of nonionic contrast medium was intravenously administered with a power injector at a flow rate of 5ml/sec for 30 sec, and two-phase images were obtained at 30 sec(early phase) and 2 min (equilibrium phase) after bolus injection. Local tumor staging and regional lymph node were classified by TNM staging. RESULTS: All 34 rectal cancers showed a moderate to marked enhancement in the early phase and a homogeneous and prolonged enhancement of the entire lesion in the equilibrium phase. T-staging of primary tumors were 85.3%(29/34) in early phase and 70.6%(24/34) in equilibrium phase. The accuracy in determining the perirectal fat invasion of rectal cancer was 92%(23/25) in early phase, and 72%(18/25) in equilibrium phase. The sensitivity & specificity of the regional lymph node metastasis were 63.6% and 79.1% in early phase, and 54.5% and 65.2% in equilibrium phase, respectively. CONCLUSION: Early phase dynamic CT was more accurate for the preoperative staging of rectal cancer than that at equilibrium phase.

Percutaneous Balloon Dilatation of Benign Biliary Strictures and Stone Extraction of Residual Intrahepatic Stones

PURPOSE: The residual intrahepatic stones with biliary strictures are difficult to remove percutaneously via T-tube tract after surgery in patients with recurrent pyogenic cholangitis. We evaluated the effectiveness of percutaneous balloon dilatation of benign biliary strictures. MATERIALS AND METHODS: The balloon dilatations with 6-12mm angioplasty balloon catheter and stone extractions were performed via a T-tube tract after surgical treatment in 15 patients with recurrent pyogenic cholangitis. The balloons were inflated for 3-4minutes under 5 atm. until disappearance of waist of the stricture site, from one to seven session. After balloon dilatation, residual stones were extracted with saline irrigation or stone basket. RESULTS: Among total 42 strictures, the balloon dilatation was succesful in 27 strictures(64.3%), partially successful in 12 strictures(28.6%), and failed in three strictures(7.1%). Single or central biliary strictures were dilated easily rather than multiple ductal strictures. Of 26 sites with residual intrahepatic stones, stone extraction was complete in 17 sites(65.4%), incomplete in seven sites(26.9%) due to impacted or large stone and acute ductal angulation, and failed in two sites(7.7%). CONCLUSION: Percutaneous balloon dilatation of benign biliary strictures is an effective procedure for extraction of residual intrahepatic stones associated with recurrent pyogenic cholangitis.

Sonourethrography in the Evaluation of Anterior Urethral Strictures

PURPOSE: To determine the reliability of sonourethrog raphy (SUG) in the evaluation of male anterior urethral strictures. MATERIALS AND METHODS: Both SUG with retrograde saline infusion and retrograde urethrography (RUG) were performed in 5 young normal volunteers and 20 patients with symptoms of impaired urine flow. Those findings were compared with urethroscopic and operative findings in all patients. RESULTS: SUG was more accurate in the evaluation of the stricture length and degree than RUG in 7 patients with anterior urethral strictures, when compared with their subsequent open urethroplasty findings. Only SUG could classify the degree of spongiofibrosis surrounding the strictures in 15 patients. So, SUG was diagnostically as efficacious as or, superior to, RUG in all 20 patients. CONCLUSION: SUG can be used as one of complementary and reliable tools for diagnosis, evaluation and follow-up of anterior urethral strictures.