Pitfalls in diagnosing colon cancer on abdominal CT.

AIM: To assess the frequency of undetected colon cancer on conventional abdominal CT and to evaluate the imaging features that are characteristic of those cancers. MATERIALS AND METHODS: The present study included consecutive patients diagnosed with colorectal cancer at colonoscopy (2006-2015) who also underwent abdominal computed tomography (CT) performed for various reasons within a year prior to the colonoscopy. The frequency of undetected lesions was evaluated for the original CT interpretations ("original readers"). Two radiologists ("study readers"), blinded to the tumour location, independently performed interpretations oriented for colon cancer detection. The study readers analysed the imaging features of detected tumours (tumour shape, length, maximal wall thickness, free fluid, fat stranding, vascular engorgement, stenosis, and lymphadenopathy). Imaging features of the cancers undetected by the original readers were evaluated. RESULTS: The study included 127 patients. The original readers' frequency of undetected cancer was 25/127 (19.7%). Each study reader could not identify the cancer in 8/127 (6.3%) patients. Imaging features associated with undetected cancers by the original readers included the absence of fat stranding (p=0.007, p=0.003), absence of vascular engorgement (p<0.0001, p<0.0001) and absence of lymphadenopathy (p=0.005, p=0.004). Undetected tumours were shorter than those detected (original reader: 33.2±11.9 versus 51.4±18.2 mm; study reader: 32.5±9.6 versus 61.3±23.4 mm; p<0.001). CONCLUSION: Colon cancer is undetected in 20% of abdominal CT examinations in patients subsequently proven to have colon cancer at colonoscopy. The absence of fat stranding, vascular engorgement, or lymphadenopathy, and an average tumour length of 3.3 cm are contributing factors for failure of detection. Radiologists' training should emphasis these findings as it may improve cancer detection, and clinicians should be aware of the limitations of abdominal CT.

Triribbed-functionalized clathrochelate iron(II) dioximates as a new and promising tool to obtain polynucleating and polynuclear compounds with improved properties.

Template condensation on iron(II) ion of dichloroglyoxime (H2C12Gm) with (C6H5O)3, n-C4H9B(O-n-C4H9)2, and BF3.O(C2H5)2 in CH3NO2 afforded reactive clathrochelate precursors Fe(C12Gm)3(BC6H5)2 (2), Fe(C12Gm)3(B-n-C4H9)2 (3), and Fe(C12Gm)3(BF)2 (4). A series of triribbed-functionalized clathrochelate dioximates have been synthesized. Reaction of 2 with C6H5SH/K2CO3 and CH3SH/t-C4H9OK in 1,4-dioxane and THF afforded Fe((C6H5S)2Gm)3(BC6H5)2 (5) and Fe((CH3S)2Gm)3(BC6H5)2 (6). Reaction of 3 with C6H5OK in THF afforded Fe((C6H5O)2Gm)3(B-n-C4H9)2 (7). Condensation of 3 with bis(2-(o-oxyphenoxy))diethyl ether in THF afforded di- and tricrown etheric Fe(CwGm)2(C12Gm)(Bn-C4H9)2 (8) and Fe(CwGm)3(B-n-C4H9)2 (9) clathrochelates. Condensation of 3 with 3,5-dithiaoctane-1,8-dithiol/Cs2CO3 in DMF afforded the thiocrown etheric Fe((12anS4)Gm)3(BC6H5)2 complex (10). Reaction of 2 with n-butylamine in DMF resulted in the tetrasubstituted Fe((n-C4H9NH)2Gm)2(C12Gm)(BC6H5)2 clathrochelate (11). The clathrochelates obtained have been characterized both on the basis of elemental analysis, FAB and PD mass spectrometry, IR, UV-vis, 57Fe Mössbauer, and NMR spectroscopies and crystallographically (compounds 3, 4, 6, 7, and 11). An encapsulated iron(II) ion in a distorted trigonal-prismatic environment of six nitrogen atoms of the macrobicyclic ligand was found to be in a low-spin state. The cyclic voltammograms for the complexes 2-11 show irreversible oxidation waves assignable to Fe3+/Fe2+ couples. The correlation of E1/2 for these couples with Hammet sigma para constants for substituents in dioximate fragments has been demonstrated.