Multi‑slice spiral CT evaluation of chronic radiation colitis and rectitis

Xiao,Jing; Li,Qing‑Dong

doi:10.3892/etm.2020.9069

Multi‑slice spiral CT evaluation of chronic radiation colitis and rectitis

Authors:
- Jing Xiao
- Qing‑Dong Li
View Affiliations

Affiliations: Key Laboratory for Biorheological Science and Technology of the Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing 400044, P.R. China
Published online on: July 29, 2020 https://doi.org/10.3892/etm.2020.9069
Pages: 3033-3040
Copyright: © Xiao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present study was to retrospectively analyse the multi‑slice spiral CT (MSCT) findings of radiation colitis and rectitis (RC&R). A total of 23 cases of RC&R detected by helical CT were included. The CT findings and clinical and endoscopy data of the patients were reviewed. The primary tumours included cancers of the cervix (n=17), rectum (n=4), ovaries (n=1) and bladder (n=1). The total dose of radiation per patient was 46‑60 Gy (mean, 49.7 Gy) delivered over 5 weeks. The CT manifestations included different degrees of increased thickness of the intestinal wall (n=20, 87.0%), with a maximum thickness of 16.6 mm. On enhanced CT, the target sign was observed (n=16, 69.9%), with an obviously enhanced mucosa and/or serosa and the following changes observed: Oedema and increased density of the mesentery (n=15, 65.2%); increased density of the subcutaneous fat, and blurred and oedematous pelvic wall muscles (n=4, 17.4%), with the obturator internus and levator ani muscles being most commonly affected; narrowed intestinal lumen (n=3, 13.0%); and a small amount of ascitic fluid (n=2, 8.7%) located in the paracolic sulci and bladder or Douglas pouch. The 23 patients underwent colonoscopy and were diagnosed with RC&R. The major manifestations included telangiectasia and mucosal hyperaemia (n=21, 91.3%). MSCT of chronic RC&R (CRC&R) was associated with certain characteristic findings, which, combined with a medical history of radiotherapy and the clinical manifestations, may prove to be of value in the diagnosis of CRC&R.

View Figures

View References

1	Kennedy GD and Heise CP: Radiation colitis and proctitis. Clin Colon Rectal Surg. 20:64–72. 2007.PubMed/NCBI View Article : Google Scholar
2	Shadad AK, Sullivan FJ, Martin JD and Egan LJ: Gastrointestinal radiation injury: Prevention and treatment. World J Gastroenterol. 19:199–208. 2013.PubMed/NCBI View Article : Google Scholar
3	Li YS: Radiation pelvicopathy: A comprehensive and interdisciplinary approach. J Med Postgrad. 29:449–452. 2016.
4	Regimbeau JM, Panis Y, Gouzi JL and Fagniez PL: French University Association for Surgical Research: Operative and long term results after surgery for chronic radiation enteritis. Am J Surg. 182:237–242. 2001.PubMed/NCBI View Article : Google Scholar
5	Zhang XH, Gao MY, Zhou XH, et al: MRI diagnosis of radiation enteritis in patients with gynecological pelvic malignancies after radiotherapy. Chin J Med Imaging Technol. 28:1695–1698. 2012.
6	Chen S, Harisinghani MG and Wittenberg J: Small bowel CT fat density target sign in chronic radiation enteritis. Australas Radiol. 47:450–452. 2003.PubMed/NCBI View Article : Google Scholar
7	Harb AH, Abou Fadel C and Sharara AI: Radiation enteritis. Curr Gastroenterol Rep. 16(383)2014.PubMed/NCBI View Article : Google Scholar
8	Zimmerer T, Böcker U, Wenz F and Singer MV: Medical prevention and treatment of acute and chronic radiation induced enteritis-is there any proven therapy? A short review. Z Gastroenterol. 46:441–448. 2008.PubMed/NCBI View Article : Google Scholar
9	DeVita VT, Hellman S and Rosenberg SA (eds): Cancer: Rrinciples and practice of oncology. Philadelphia, New York, Lippincott Williams and Wilkins Press. pp1527–1528. 2008.
10	Denham JW, O'Brien PC, Dunstan RH, Johansen J, See A, Hamilton CS, Bydder S and Wright S: Is there more than one late radiation proctitis syndrome? Radiother Oncol. 51:43–53. 1999.
11	Dorr W and Hendry JH: Consequential late effects in normal tissues. Radiother Oncol. 61:223–231. 2001.PubMed/NCBI View Article : Google Scholar
12	Huang Y, Guo F, Yao D, Li Y and Li J: Surgery for chronic radiation enteritis: Outcome and risk factors. J Surg Res. 204:335–343. 2016.PubMed/NCBI View Article : Google Scholar
13	Theis VS, Sripadam R, Ramani V and Lal S: Chronic radiation enteritis. Clin Oncol (R Coll Radiol). 22:70–83. 2010.PubMed/NCBI View Article : Google Scholar
14	Iraha S, Ogawa K, Moromizato H, Shiraishi M, Nagai Y, Samura H, Toita T, Kakinohana Y, Adachi G, Tamaki W, et al: Radiation enterocolitis requiring surgery in patients with gynecological malignancies. Int J Radiat Oncol Biol Phys. 68:1088–1093. 2007.PubMed/NCBI View Article : Google Scholar
15	Krol R, Smeenk RJ, van Lin EN and Hopman WP: Impact of late anorectal dysfunction on quality of life after pelvic radiotherapy. Int J Colorectal Dis. 28:519–526. 2013.PubMed/NCBI View Article : Google Scholar
16	Haddad MC, Khouzami RA, Saad HA and Azzi MC: Imaging fifindings of radiation enteritis. J Med Liban. 52:55–57. 2004.PubMed/NCBI
17	Smith DH and DeCosse JJ: Reliation damage to the small intestine. World J Surg. 10:189–194. 1986.PubMed/NCBI View Article : Google Scholar
18	Chater C, Saudemont A and Zerbib P: Chronic radiation enteritis. J Visc Surg. 156:175–176. 2019.PubMed/NCBI View Article : Google Scholar
19	Zhang SY and LI YS: Diagnosis of chronic radiation enteritis. J Med Postgrad. 25:654–657. 2012.
20	Wu XR, Liu XL, Katz S and Shen B: Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis. Inflamm Bowel Dis. 21:703–715. 2015.PubMed/NCBI View Article : Google Scholar
21	Raman SP, Horton KM and Fishman EK: MDCT and CT angiography evaluation of rectal bleeding: The role of volume visualization. AJR Am J Roentgenol. 201:589–597. 2013.PubMed/NCBI View Article : Google Scholar
22	Chen K, Yin F and Chen HT: Evaluation of clinical use of CT virtual colonoscopy. China Prac Med. 4:115–116. 2009.
23	Kalaoselvan R, Theis VS, Dibb M, Teubner A, Anderson ID, Shaffer JL, Carlson GL and Lal S: Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre. Eur J Clin Nutr. 68:166–170. 2014.PubMed/NCBI View Article : Google Scholar
24	Kasuya G, Ogawa K, Iraha S, Nagai Y, Shiraishi M, Hirakawa M, Samura H, Toita T, Kakinohana Y, Kudaka W, et al: Severe late complications in patients with uterine cancer treated with postoperative radiotherapy. Anticancer Res. 31:3527–3533. 2011.PubMed/NCBI
25	Chen MC, Chiang FF, Hsu TW, Chen JB, Chao TH, Ma HF and Wang HM: Clinical experience in 89 consecutive cases of chronic radiation enterocolitis. J Chin Med Assoc. 74:69–74. 2011.PubMed/NCBI View Article : Google Scholar
26	Seastedt KP, Trencheva K, Michelassi F, Alsaleh D, Milsom JW, Sonoda T, Lee SW and Nandakumar G: Accuracy of CT enterography and magnetic resonance enterography imaging to detect lesions preoperatively in patients undergoing surgery for Crohn's disease. Dis Colon Rectum. 57:1364–1370. 2014.PubMed/NCBI View Article : Google Scholar
27	Cox VL, Tahvildari AM, Johnson B, Wei W and Jeffrey RB: Bowel obstruction complicated by ischemia: Analysis of CT findings. Abdom Radiol (NY). 43:3227–3232. 2018.PubMed/NCBI View Article : Google Scholar