TC rectal pathology: Findings at CT-colonography

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Lesión lobulada dependiente de la pared lateral del recto (flecha blanca). El suave tapizado de su superficie por el contraste oral refleja su aspecto frondoso. b) Correspondencia con visión 3D. El resultado anatomopatológico fue de adenoma velloso." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Martínez-Sapiña Llanas, S.A. Otero Muinelo, C. Crespo García" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Martínez-Sapiña Llanas" ] 1 => array:2 [ "nombre" => "S.A." "apellidos" => "Otero Muinelo" ] 2 => array:2 [ "nombre" => "C." 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Direction of the compression exerted from the pelvis to the cephalic trabecular system, or main compression group in the femoral head (A). Direction of the tension exerted from the pelvis to the cervicocephalic trabecular system, or main tension group (B). Perpendicular to the force lines applied on the acetabular roof (A′) and femoral head (B′)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O.J. Alí-Morell, F. Zurita-Ortega, I. Davó-Jiménez, S. Segura-Biedma" "autores" => array:4 [ 0 => array:2 [ "nombre" => "O.J." "apellidos" => "Alí-Morell" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Zurita-Ortega" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Davó-Jiménez" ] 3 => array:2 [ "nombre" => "S." 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Axial slice with bone window (a) and sagittal reformatting with soft tissue algorithm (b and c) in a 26-year-old woman with facial trauma after a recent traffic accident. She had multiple fractures in her left maxillary sinus and orbit, with multi-fragmented fracture in her orbital roof, revealing one fragment (arrow) in the optic foramen that caused an irreversible lesion of the optic nerve despite urgent treatment. Orbital trauma. Axial slice (d) and sagittal reformatting (e) of CT scan performed on an 80-year-old woman after falling down the stairs, with periorbital hematoma and limitation of ocular motility. Thickening and fraying of retrobulbar and perineural fat compatible with hematoma, which was immediately drained." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.C. Vela Marín, P. Seral Moral, C. Bernal Lafuente, B. Izquierdo Hernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.C." "apellidos" => "Vela Marín" ] 1 => array:2 [ "nombre" => "P." 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Martínez-Sapiña Llanas, S.A. Otero Muinelo, C. Crespo García" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Martínez-Sapiña Llanas" ] 1 => array:4 [ "nombre" => "S.A." "apellidos" => "Otero Muinelo" "email" => array:1 [ 0 => "susana.otero.muinelo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Crespo García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patología del recto: hallazgos en la colonografía-TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 603 "Ancho" => 1800 "Tamanyo" => 130344 ] ] "descripcion" => array:1 [ "en" => "Actinic proctitis. CTC in one patient with cervical carcinoma treated with radiation therapy after incomplete optical colonoscopy due to impassable stenosis. (a) CT image reconstruction in the coronal plane that reveals protrusions (arrows) and stenoses (not shown). (b) The 3D image shows one of the polypoid lesions that looks ulcerative in the optical colonoscopy (c)." ] ] ] "textoCompleto" => "IntroductionRectal pathology is varied and prevalent and, although the most serious lesion is the carcinoma, in most cases the lesion is usually benign. The optical colonoscopy (OC) is the standard imaging modality for its study since it entirely evaluates the rectum in most cases. Nonetheless, the OC procedure is an invasive imaging modality with associated risks such as perforation, bleeding, and complications following sedation.<a class="elsevierStyleCrossRef" href="#bib0105">1</a> Whenever the OC is contraindicated (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) or is incomplete (10–15% of the times<a class="elsevierStyleCrossRef" href="#bib0110">2</a>), the computed tomography-colonography (CTC).<a class="elsevierStyleCrossRefs" href="#bib0105">1,2</a> is indicated. In other occasions, the CTC is conducted as the first imaging modality for the screening of colorectal cancer.<a class="elsevierStyleCrossRefs" href="#bib0115">3–7</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The CTC is a quick, non-invasive emerging imaging modality developed for the screening of colorectal cancer and approved by the American Cancer Society back in 2008.<a class="elsevierStyleCrossRef" href="#bib0140">8</a> It is usually implemented as an alternative to the incomplete or contraindicated OC and is considered the most suitable radiological imaging modality for the screening of colorectal cancer and polyps. Its diagnostic performance for the detection of cancer is similar to that of the OC, and clearly superior to the barium enema.<a class="elsevierStyleCrossRef" href="#bib0110">2</a>The CTC allows us to perform easy, well-tolerated, and almost risk-free<a class="elsevierStyleCrossRef" href="#bib0110">2</a> 2D and 3D examinations of the colon, and it is also capable of showing extracolonic findings<a class="elsevierStyleCrossRefs" href="#bib0145">9,10</a> using low doses and no IV contrast. The CTC has different indications (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>),<a class="elsevierStyleCrossRefs" href="#bib0115">3,11</a> and very few contraindications (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<a class="elsevierStyleCrossRef" href="#bib0160">12</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The assessment of the anorectal region using the CTC is especially problematic due to a wide range of unique pathologies in this area, the presence of a rectal balloon catheter, the possible artifacts, and the particular funicular morphology of the anal canal, which all may lead to false positive findings or conceal serious pathologies.<a class="elsevierStyleCrossRefs" href="#bib0165">13–15</a> The rectum is the most common location of hidden cancers in the CTC.<a class="elsevierStyleCrossRef" href="#bib0180">16</a>The goal of this article is to get to know the rectal pathology, its semiology in the CTC and its management.Technical considerationsConducting one CTC requires one 8-row multidetector CT machine,<a class="elsevierStyleCrossRef" href="#bib0185">17</a> the adequate preparation and distension of the colon, and specific software.<a class="elsevierStyleCrossRef" href="#bib0105">1</a>The preparation of the colon (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) is essential here, since the residual fecal matter can simulate or hide lesions, and an inadequate distension won’t let us assess the colonic wall or surface.<a class="elsevierStyleCrossRefs" href="#bib0115">3,15,17,18</a><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>One moderately inflated balloon catheter is inserted into the rectum after an optional, although recommended, digital examination. Distension can be manual, using ambient air, or preferably automatic with CO2. The whole process starts in the right lateral decubitus position and different series are acquired both in the supine decubitus and prone positions<a class="elsevierStyleCrossRefs" href="#bib0160">12–17</a> without IV contrast. It is advisable to partially deflate the balloon in its helix in the prone position so that no adjacent lesions are blocked.<a class="elsevierStyleCrossRef" href="#bib0160">12</a> If a segment is found that remains persistently collapsed, then a third helix should be acquired in the lateral decubitus position.<a class="elsevierStyleCrossRefs" href="#bib0185">17,18</a>If available, protocols with a low-dose of radiation<a class="elsevierStyleCrossRef" href="#bib0185">17</a> and iterative reconstruction are used.In the presence of a known tumor, the staging process with the use of contrast in one of the series is optional.The analysis of the images obtained allows 2D (axial images and multiplanar reconstructions) and 3D (endoluminal views with anterograde and retrograde navigation) visualizations.<a class="elsevierStyleCrossRef" href="#bib0180">16</a> Post-processing tools are virtual dissection, virtual biopsy or translucency, second readings, and the electronic subtraction of fluid and feces.<elsevierMultimedia ident="tb0005"></elsevierMultimedia>Rectal pathologyRectal pathology includes processes of very different origin: congenital, acquired, tumors, inflammatory, vascular, or artifactual. Although the most severe lesions are carcinomas and lymphomas, we may find a wide variety of benign lesions in the rectum.PolypsThey are homogeneous attenuation structures of soft tissues that originate in the mucosa and project toward the lumen. They may be found anywhere in the colon and are common in the rectum, where the rectal catheter can end up masking them.<a class="elsevierStyleCrossRef" href="#bib0165">13</a>They are classified based on their morphology and size (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>),<a class="elsevierStyleCrossRef" href="#bib0185">17</a> being this the criterion that stratifies its malignant potential.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>The goal of the CTC is to detect advanced adenomas: polyps ≥10mm, villous component >25, or high-grade dysplasia. Size should be assessed in both helixes through 2D and 3D visualizations,<a class="elsevierStyleCrossRef" href="#bib0165">13</a> and also in the plane that better shows its actual dimension.<a class="elsevierStyleCrossRef" href="#bib0180">16</a>Rectal polyps can be single or multiple polyps, be part of polyposis syndromes, and coexist with other conditions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>For screening purposes, polyps ≥6mm identified through the CTC should appear in the radiological report, being the endoscopic polypectomy the recommended procedure here.<a class="elsevierStyleCrossRef" href="#bib0110">2</a> CTC monitoring is an alternative in patients where the polypectomy is risky and with one or two polyps of intermediate size. Polyps ≥10mm should undergo endoscopic polypectomy procedures.<a class="elsevierStyleCrossRef" href="#bib0110">2</a> Polyps <5mm are difficult to detect on the CTC, grow slowly and have a low malignancy risk; however, the European Society of Gastrointestinal and Abdominal Radiology recommends reporting polyps >3mm when they have been safely detected.<a class="elsevierStyleCrossRef" href="#bib0110">2</a><elsevierMultimedia ident="tb0010"></elsevierMultimedia>Villous tumorsThey are rare in the rectum and represent 5% of all colorectal neoplasms. They are large in size, and have a lobular appearance on the CTC, which is consistent with the dense appearance seen on the OC. They have a higher risk of degeneration (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The diagnosis should be confirmed through OC and biopsy.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Malignant neoplasmsOf variable morphology, they may present as small or big size stenosing or polypoid lesions. The most difficult cancers to detect are the small ones, since they can remain kind of hidden by the balloon catheter and look like polypoid focal thickenings (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), which is why it is advisable to slightly deflate the balloon in its helix in the decubitus prone position. Between 1.5% and 6% of all colonic neoplasms associate synchronic lesions (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The CTC is especially useful if the distal lesion is oclusive.<a class="elsevierStyleCrossRefs" href="#bib0105">1,9,19</a><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>One rectal lesion suspicious of malignancy on the CTC should be biopsized with CO.<a class="elsevierStyleCrossRef" href="#bib0110">2</a><elsevierMultimedia ident="tb0015"></elsevierMultimedia>Submucosal lesionsThere is a wide variety of benign and malignant conditions (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). They originate in deep areas (intramural or extramural), protrude toward the intestinal lumen, make up obtuse angles with the wall and displace the folds without interrupting them.<a class="elsevierStyleCrossRef" href="#bib0160">12</a><elsevierMultimedia ident="tbl0030"></elsevierMultimedia>The most common of all are lipomas that can be easily identified by their fat density. When it comes to malignant lesions, the primary rectal lymphoma is relatively rare compared to the small intestine gastric lymphoma. Almost all of them are non-Hodgkin lymphomas type B associated with immunosuppression and bowel inflammatory disease. On the OC they appear as one big polilobulated or multifocal single mass (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>The CTC assessment of alleged submucosal lesions found on the OC is useful to be able to distinguish an intramural process from an extramural extrinsic compression, identify its true nature, and study the spread of the disease<a class="elsevierStyleCrossRefs" href="#bib0165">13,14</a> (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).<elsevierMultimedia ident="fig0030"></elsevierMultimedia>Management can vary. Fat density characterizes lipomas and is diagnostic on the 2D images. In other submucosal lesions, other imaging modalities (MRI, transrectal ultrasound…) may help us characterize these lesions.We should remember that the CTC allows us to distinguish intramural from extramural submucosal lesions, identify their true nature, and study the spread of the disease.Vascular lesions<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Internal hemorrhoids: it is the most common rectal pathology. It consists of the dilation of the veins of the superior plexus that are covered by the mucosa<a class="elsevierStyleCrossRef" href="#bib0165">13</a> over the dentate line.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> They have a typical appearance on the CTC, of anorectal location, and on circumferential disposition around the catheter, giving the appearance of one submucosal lesion, or a wrinkled appearance of the mucosa around the rectal tube. When hemorrhoids become thrombosed they may look like a tumor.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> The rectal touch, instead of the OC, may help confirm the diagnosis.</li><li class="elsevierStyleListItem" id="lsti0010">•Rectal varices: they are less common than internal hemorrhoids, associate portal hypertension, and have a winding and tubular morphology (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>). Diagnosis is achieved through the OC.<elsevierMultimedia ident="fig0035"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015">•Venous malformations: they are rare. They may be part of the blue rubber bleb nevus syndrome or appear in isolation on the CTC simulating one polyp. On the OC they show a characteristic blue color. On the MRI, their hyperintensity on the T2-weighted sequences and their spread into the mesorectal fat are specific characteristics.<a class="elsevierStyleCrossRef" href="#bib0200">20</a></li></ul>Papillary hypertrophyThey are focal fibrous protrusions on the dentate line.<a class="elsevierStyleCrossRef" href="#bib0165">13</a> They may look like polyps, but their location in the anorectal junction is patognomonic, and almost always in contact with the catheter (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>). The OC is diagnostic.<elsevierMultimedia ident="fig0040"></elsevierMultimedia>Inflammatory conditionsThe rectum is affected in the ulcerative colitis and Chron's disease whenever there is associated perianal disease.<a class="elsevierStyleCrossRef" href="#bib0165">13</a> The radiation therapy-related iatrogenia in the pelvis affects the rectum in the form of actinic proctitis. These conditions appear as one diffuse, circumferential thickening of the wall of the rectum that causes variable stenoses, with important frequencies, but with signs of benignity. The patient's personal history facilitates the diagnosis (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>).<elsevierMultimedia ident="fig0045"></elsevierMultimedia>The CTC outside the acute episode allows us to assess the degree of stenosis and plan the course of treatment.The solitary rectal ulcer consists of an intense inflammatory reaction around an ulcer that conditions one mass effect that can be interpreted as a malignant tumor in a patient with rectorrhagy and painful defectation.<a class="elsevierStyleCrossRef" href="#bib0165">13</a> Both the OC and the biopsy are indicated to achieve the diagnosis.Postoperative changesThe surgical clips placed on colorectal anastomoses usually appear on the 3D images as irregularities of the mucosa that can be taken for tumor relapses. The 2D images are key here since they reveal their metallic density (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>).<elsevierMultimedia ident="fig0050"></elsevierMultimedia>Rectocolonic anastomoses are a common cause of incomplete OCs, but they rarely cause significant stenoses.The signs of recurrence of neoplastic disease are irregularity, wall thickening, and distortion of the mucosal pattern compared to common postoperative findings such as small size inflammatory polyps located in the anastomotic line.<a class="elsevierStyleCrossRef" href="#bib0145">9</a>In the presence of suspicious images and suspicion of relapse, we should try to biopsize with the OC, or else, with a surgical biopsy in cases of impassable stenoses.Pseudolesions and artifactsWith an optimal fecal marking and colonic distention,<a class="elsevierStyleCrossRef" href="#bib0165">13</a> most artifacts are easily recognizable:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">•The rectal catheter: constant finding in the anorectal region.<a class="elsevierStyleCrossRefs" href="#bib0165">13,14</a> Its tip can have a polypoid appearance on the 3D views, or cause compression on an adjacent rectal fold. Both the partial balloon deflating in the decubitus prone position<a class="elsevierStyleCrossRef" href="#bib0170">14</a> and the verification of its presence on the 2D images (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a>) are of great help.<elsevierMultimedia ident="fig0055"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0025">•Stained feces: they may appear as polyps or masses based on their size on the 3D endoluminal images,<a class="elsevierStyleCrossRef" href="#bib0170">14</a> but they can be easily identified on the 2D images after contrast staining.<a class="elsevierStyleCrossRefs" href="#bib0165">13,17</a></li><li class="elsevierStyleListItem" id="lsti0030">•Unstained feces: they can be a problem if they are small.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> Internal air foci and supine-to-prone position changes are characteristic here.<a class="elsevierStyleCrossRefs" href="#bib0165">13,17</a></li><li class="elsevierStyleListItem" id="lsti0035">•Fecalomas: they are common in the rectal ampulla. The 3D endoluminal image shows one lobulated irregular mass that simulates a tumor or cancer. The 2D image is diagnostic and shows the heterogeneous composition that is typical of unstained feces.</li></ul>Other lesionsThe condyloma acuminatum can present as a polypoid lesion, although it is rare. The diagnosis of anorectal lesions is achieved through anoscopy examination or rectal touch.The diverticula are exceptional in the rectum. They look exactly the same in all colonic locations, and their finding does not require follow-up or diagnostic confirmation.ConclusionAlthough rectal lesions can go misdiagnosed on the CTC because it is particularly difficult to assess this anatomical region, and even though it is not the modality of choice for the study of rectal pathologies, it is indicated in cases of incomplete or contraindicated OCs. For this reason, it is essential to know the rectal pathology and its semiology on the CTC, have an excellent command while performing the technique when it comes to preparation and distension, conduct moderate balloon insufflations, and careful 2D and 3D navigations.Authors<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040">1.Manager of the integrity of the study: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0045">2.Study idea: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0050">3.Study design: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0055">4.Data mining: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0060">5.Data analysis and interpretation: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0065">6.Statistical analyses N/A.</li><li class="elsevierStyleListItem" id="lsti0070">7.Reference: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0075">8.Writing: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0080">9.Critical review of the manuscript with intellectually relevant remarks: MJMSL, SAOM and CCG.</li><li class="elsevierStyleListItem" id="lsti0085">10.Approval of final version: MJMSL, SAOM and CCG.</li></ul>Ethical responsibilitiesProtection of people and animalsThe authors declare that no experiments with human beings or animals have been performed while conducting this investigation.Data confidentialityThe authors declare that they have followed their center protocols on the publication of data from patients.Right to privacy and informed consentThe authors confirm that in this article there are no data from patients.Conflict of interestThe authors declare no conflict of interest associated with this article whatsoever." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1022330" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec980505" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1022331" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec980504" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Technical considerations" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Rectal pathology" "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Polyps" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Villous tumors" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Malignant neoplasms" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Submucosal lesions" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Vascular lesions" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Papillary hypertrophy" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Inflammatory conditions" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Postoperative changes" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Pseudolesions and artifacts" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Other lesions" ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Authors" ] 9 => array:3 [ "identificador" => "sec0080" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0090" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0095" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-03-28" "fechaAceptado" => "2017-10-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec980505" "palabras" => array:5 [ 0 => "CT-colonography" 1 => "Pathology" 2 => "Rectum" 3 => "Cancer" 4 => "Technique" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec980504" "palabras" => array:5 [ 0 => "Colonografía-TC" 1 => "Patología" 2 => "Recto" 3 => "Cáncer" 4 => "Técnica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo review the spectrum of benign and malignant rectal diseases, their findings on CT colonography, and their management. ConclusionAlthough CT colonography is not the first choice for the study of rectal disease, it is indicated in cases where optical colonoscopy is contraindicated or cannot be completed. Rectal lesions can go undetected because this anatomic area is difficult to evaluate; for this reason, it is essential to ensure optimal preparation and distension, moderate balloon insufflation, and careful 2D and 3D navigation with knowledge of the spectrum of rectal disease and its CT colonography signs." "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoRevisar el espectro de la patología rectal benigna y maligna, sus hallazgos en la colonografía-TC (CTC) y su manejo. ConclusiónAunque la CTC no es la herramienta de primera elección para el estudio de la patología rectal, está indicada en casos de colonoscopia óptica incompleta o contraindicada. Las lesiones rectales pueden pasar desapercibidas por la dificultad que representa la valoración de esta área anatómica, y por ello es necesaria una excelente preparación y distensión, la insuflación moderada del balón y una navegación cuidadosa en 2D y 3D con conocimiento del espectro de la patología rectal y su semiología en CTC." "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Martínez-Sapiña Llanas MJ, Otero Muinelo SA, Crespo García C. Patología del recto: hallazgos en la colonografía-TC. Radiología. 2018;60:208–216." ] ] "multimedia" => array:20 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 846 "Ancho" => 950 "Tamanyo" => 81390 ] ] "descripcion" => array:1 [ "en" => "Rectal polyps. Coexistence of different polypoid lesions in the rectum: pedunculated polyp (white arrow), sessile polyp (arrowhead), rectal balloon (asterisk)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 561 "Ancho" => 1400 "Tamanyo" => 116802 ] ] "descripcion" => array:1 [ "en" => "Villous tumor. (a) Axial CT image. Lobulated lesion based on the lateral wall of the rectum (white arrow). The soft cover of its surface after the administration of oral contrast shows its dense appearance. (b) Match with 3D view. The anatomopathological finding was villous adenoma." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 599 "Ancho" => 1800 "Tamanyo" => 127667 ] ] "descripcion" => array:1 [ "en" => "Carcinoma. (a) This axial CTC image corresponds to one patient studied due to anemia and shows one flat mural lesion in the rectum discretely protruding toward the lumen (arrow) that turned out to be an adenocarcinoma in the cylinder biopsy. (b) 3D virtual colonoscopy. (c) Optical colonoscopy." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 503 "Ancho" => 1800 "Tamanyo" => 106583 ] ] "descripcion" => array:1 [ "en" => "Synchronic neoplasms. CTC of a seventy-five-year-old woman after an incomplete optical colonoscopy due to occlusive stenosing lesion in her rectum. (a) Axial CT image. Lesion inside the distal rectum (arrow) corresponding with one polypoid elevated lesion (b, 3D endoluminal view) consistent with one carcinoma. The CTC was good for the detection of another lesion of malignant appearance in the sigma (c). Note the beam hardening artifact caused by the metallic prosthetic material in both hips (a), which makes the assessment of the rectum even more difficult." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 634 "Ancho" => 1800 "Tamanyo" => 118107 ] ] "descripcion" => array:1 [ "en" => "Lymphoma. (a) CT image reconstruction in the sagittal plane. Diffuse thickening of the wall of the rectum and sigma (black arrows). (b) Virtual luminogram. Loss of distension in the damaged segments (arrowheads). Note the loss of haustration of the descending colon (hollow arrows) relative to ulcerative colitis in chronic stage. (c) Virtual colonoscopy. Stenotic appearance of submucosal masses in intestinal lymphoma." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 611 "Ancho" => 1800 "Tamanyo" => 121699 ] ] "descripcion" => array:1 [ "en" => "Extramural submucosal lesion. Sixty-eight-year-old woman with abdominal pain. (a) CTC, virtual luminogram. Repletion defect in the lateral wall of the rectum (thick arrow) that looks like an extrinsic compression on the 3D endoluminal image (thick arrow in b). (c) The axial CT image shows one extramural submucosal fluid density lesion (white arrow) exerting that extrinsic compression and consistent with a developing cyst. The thin arrows in (a) and (b) point at the rectal balloon." ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 549 "Ancho" => 1800 "Tamanyo" => 131513 ] ] "descripcion" => array:1 [ "en" => "Rectal varicose vein. Eighty-year-old male with anemia and rectorrhagy. (a) Axial CTC image. Parietal lesion in his rectum of soft tissue density (white arrow). (b) 3D CTC. The black arrow shows the tubular and winding morphology of the lesion objectified in (a). Rectal catheter (asterisk). (c) Rectal varicose veins as seen on the optical colonoscopy (arrow)." ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1589 "Ancho" => 1396 "Tamanyo" => 218386 ] ] "descripcion" => array:1 [ "en" => "Hypertrophied anal papilla. Fifty-seven-year-old-woman. CTC after incomplete optical colonoscopy. (a) 2D image on the axial plane. Lesion in the rectal lumen stained in its periphery after the administration of oral contrast (white arrow). (b) 3D endoluminal view. The arrow points at the same lesion in contact with the rectal balloon (asterisk) and close to the anorectal junction (c) The optical colonoscopy confirms it is consistent with one hypertrophied anal papilla (white arrow)." ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 603 "Ancho" => 1800 "Tamanyo" => 130344 ] ] "descripcion" => array:1 [ "en" => "Actinic proctitis. CTC in one patient with cervical carcinoma treated with radiation therapy after incomplete optical colonoscopy due to impassable stenosis. (a) CT image reconstruction in the coronal plane that reveals protrusions (arrows) and stenoses (not shown). (b) The 3D image shows one of the polypoid lesions that looks ulcerative in the optical colonoscopy (c)." ] ] 9 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 578 "Ancho" => 1800 "Tamanyo" => 118544 ] ] "descripcion" => array:1 [ "en" => "Surgical material. (a) The 3D image shows a significant mucosal irregularity inside one rectal valve (black arrow). The CTC image on the axial plane (b) shows material of metallic density (white arrow), and eventually tumor pathology is ruled out after the OC confirms the presence of surgical clips (c)." ] ] 10 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 611 "Ancho" => 1800 "Tamanyo" => 136455 ] ] "descripcion" => array:1 [ "en" => "Rectal balloon catheter. (a) The distal end of the rectal catheter (black arrow) can compress the rectal valves (arrowhead) and create an image of submucosal extrinsic compression. (b) 3D image. Appearance of the catheter protrusion over the rectal valve. (c) The position of the balloon catheter needs to be confirmed on the multiplanar reconstructions." ] ] 11 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Absolute contraindications \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Severe pulmonary or heart disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Diathesis, bleeding, or treatment with anticoagulants \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Risks due to sedation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Patient refusing to undergo the procedure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Relative contraindications \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Prior history of incomplete optical colonoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Advanced age \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Weak patient and with mobility issues \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737433.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Contraindications of the optical colonoscopy procedure." ] ] 12 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Contraindicated optical colonoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Incomplete optical colonoscopy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Patient refusal to undergo the optical colonoscopy procedure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Assessment of diverticular disease (after the acute phase) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Assessment of patients with colonic stoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Other indications: •Screening of colorectal cancer •Controls after colorectal cancer surgery or polypectomy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737435.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Indications of the CT-colonography." ] ] 13 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Acute bowel inflammatory disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Acute diverticulitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Recent surgery (<3 months) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Inguinal hernia with colonic content \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737434.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Contraindications of the CT-colonography." ] ] 14 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Diet without fiber three (3) days prior to the examination \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Complete diet with liquid food supplement (Isosource®) one (1) day prior to the examination \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Oral iodinated contrast (diatriazoate): 3 doses of 7cc diluted in water two (2) days prior to the examination, and 5 doses of 7 cc diluted in water one (1) day prior to the examination \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Microenema of local action (Micralax®) first time in the morning of the examination day; immediately prior to the CTC, evacuation of the rectal ampulla \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Take 2l of water a day as a complement to the whole preparation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Optional: prescription of intramuscular bowel muscle relaxants (Buscopan®) one (1) hour prior to the test; they are contraindicated in cases of glaucoma, prostatic hypertrophy, heart disease, severe myasthenia gravis, or porphyria \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737438.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Colonic preparation for the CT-colonography." ] ] 15 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Based on their morphology \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Based on their size \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Sessile: wide base of implantation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">•Tiny: <6mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Pedunculated: with stalk or pedicle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">•Intermediate: 6–9mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Flat: protrude <3mm over the mucosa; carpet lesions are flat lesions >3cm in size that usually affect the caecum and the rectum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">•Large: ≥10mm \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737437.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Classification of colonic polyps." ] ] 16 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Of intramural origin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Of extramural origin \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Leiomyoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">•Endometriosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Lipoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">•Developmental retrorectal cystic lesions: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Neuroendocrine tumor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">–Retrorectal cystic hamartoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Gastrointestinal stromal tumor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">–Rectal duplication \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Schwannoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">–Epidermoid cyst \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">–Dermoid cyst \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Melanoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">•Rectal invasion by other tumors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Other primary tumors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">•Metastasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737436.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Submucosal lesions." ] ] 17 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "We should remember that for the adequate assessment of the rectal region, an excellent colonic preparation and distension are needed. The balloon should be moderately deflated in its helix in the decubitus prone position." ] ] 18 => array:5 [ "identificador" => "tb0010" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "We should remember that the target lesion of the CTC is the advanced adenoma: polyp ≥10mm, villous component >25%, or high-grade dysplasia. There is a direct correlation between size and malignancy risk." ] ] 19 => array:5 [ "identificador" => "tb0015" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "We should remember that the biggest problem when it comes to the anorectal region is misdiagnosing low malignant lesions hidden by the balloon catheter or darkened by the artifacts." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optical colonoscopy and virtual colonoscopy: the current role of each technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. 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Radiology through images

Patología del recto: hallazgos en la colonografía-TC

M.J. Martínez-Sapiña Llanas, S.A. Otero Muinelo

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susana.otero.muinelo@gmail.com

Corresponding author.

, C. Crespo García

Servicio de Radiodiagnóstico, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain

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    "cabecera" => "<span class="elsevierStyleTextfn">Radiology through images</span>"
    "titulo" => "TC rectal pathology&#58; Findings at CT-colonography"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Actinic proctitis&#46; CTC in one patient with cervical carcinoma treated with radiation therapy after incomplete optical colonoscopy due to impassable stenosis&#46; &#40;a&#41; CT image reconstruction in the coronal plane that reveals protrusions &#40;arrows&#41; and stenoses &#40;not shown&#41;&#46; &#40;b&#41; The 3D image shows one of the polypoid lesions that looks ulcerative in the optical colonoscopy &#40;c&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rectal pathology is varied and prevalent and&#44; although the most serious lesion is the carcinoma&#44; in most cases the lesion is usually benign&#46; The optical colonoscopy &#40;OC&#41; is the standard imaging modality for its study since it entirely evaluates the rectum in most cases&#46; Nonetheless&#44; the OC procedure is an invasive imaging modality with associated risks such as perforation&#44; bleeding&#44; and complications following sedation&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Whenever the OC is contraindicated &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; or is incomplete &#40;10&#8211;15&#37; of the times<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a>&#41;&#44; the computed tomography-colonography &#40;CTC&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;2</span></a> is indicated&#46; In other occasions&#44; the CTC is conducted as the first imaging modality for the screening of colorectal cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#8211;7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The CTC is a quick&#44; non-invasive emerging imaging modality developed for the screening of colorectal cancer and approved by the American Cancer Society back in 2008&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> It is usually implemented as an alternative to the incomplete or contraindicated OC and is considered the most suitable radiological imaging modality for the screening of colorectal cancer and polyps&#46; Its diagnostic performance for the detection of cancer is similar to that of the OC&#44; and clearly superior to the barium enema&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The CTC allows us to perform easy&#44; well-tolerated&#44; and almost risk-free<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> 2D and 3D examinations of the colon&#44; and it is also capable of showing extracolonic findings<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;10</span></a> using low doses and no IV contrast&#46; The CTC has different indications &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;11</span></a> and very few contraindications &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The assessment of the anorectal region using the CTC is especially problematic due to a wide range of unique pathologies in this area&#44; the presence of a rectal balloon catheter&#44; the possible artifacts&#44; and the particular funicular morphology of the anal canal&#44; which all may lead to false positive findings or conceal serious pathologies&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#8211;15</span></a> The rectum is the most common location of hidden cancers in the CTC&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The goal of this article is to get to know the rectal pathology&#44; its semiology in the CTC and its management&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Technical considerations</span><p id="par0040" class="elsevierStylePara elsevierViewall">Conducting one CTC requires one 8-row multidetector CT machine&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> the adequate preparation and distension of the colon&#44; and specific software&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The preparation of the colon &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41; is essential here&#44; since the residual fecal matter can simulate or hide lesions&#44; and an inadequate distension won&#8217;t let us assess the colonic wall or surface&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;15&#44;17&#44;18</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">One moderately inflated balloon catheter is inserted into the rectum after an optional&#44; although recommended&#44; digital examination&#46; Distension can be manual&#44; using ambient air&#44; or preferably automatic with CO<span class="elsevierStyleInf">2</span>&#46; The whole process starts in the right lateral decubitus position and different series are acquired both in the supine decubitus and prone positions<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12&#8211;17</span></a> without IV contrast&#46; It is advisable to partially deflate the balloon in its helix in the prone position so that no adjacent lesions are blocked&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> If a segment is found that remains persistently collapsed&#44; then a third helix should be acquired in the lateral decubitus position&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">If available&#44; protocols with a low-dose of radiation<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> and iterative reconstruction are used&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the presence of a known tumor&#44; the staging process with the use of contrast in one of the series is optional&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The analysis of the images obtained allows 2D &#40;axial images and multiplanar reconstructions&#41; and 3D &#40;endoluminal views with anterograde and retrograde navigation&#41; visualizations&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> Post-processing tools are virtual dissection&#44; virtual biopsy or translucency&#44; second readings&#44; and the electronic subtraction of fluid and feces&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Rectal pathology</span><p id="par0090" class="elsevierStylePara elsevierViewall">Rectal pathology includes processes of very different origin&#58; congenital&#44; acquired&#44; tumors&#44; inflammatory&#44; vascular&#44; or artifactual&#46; Although the most severe lesions are carcinomas and lymphomas&#44; we may find a wide variety of benign lesions in the rectum&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Polyps</span><p id="par0095" class="elsevierStylePara elsevierViewall">They are homogeneous attenuation structures of soft tissues that originate in the mucosa and project toward the lumen&#46; They may be found anywhere in the colon and are common in the rectum&#44; where the rectal catheter can end up masking them&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">They are classified based on their morphology and size &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> being this the criterion that stratifies its malignant potential&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The goal of the CTC is to detect advanced adenomas&#58; polyps &#8805;10<span class="elsevierStyleHsp" style=""></span>mm&#44; villous component &#62;25&#44; or high-grade dysplasia&#46; Size should be assessed in both helixes through 2D and 3D visualizations&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> and also in the plane that better shows its actual dimension&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Rectal polyps can be single or multiple polyps&#44; be part of polyposis syndromes&#44; and coexist with other conditions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">For screening purposes&#44; polyps &#8805;6<span class="elsevierStyleHsp" style=""></span>mm identified through the CTC should appear in the radiological report&#44; being the endoscopic polypectomy the recommended procedure here&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> CTC monitoring is an alternative in patients where the polypectomy is risky and with one or two polyps of intermediate size&#46; Polyps &#8805;10<span class="elsevierStyleHsp" style=""></span>mm should undergo endoscopic polypectomy procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Polyps &#60;5<span class="elsevierStyleHsp" style=""></span>mm are difficult to detect on the CTC&#44; grow slowly and have a low malignancy risk&#59; however&#44; the European Society of Gastrointestinal and Abdominal Radiology recommends reporting polyps &#62;3<span class="elsevierStyleHsp" style=""></span>mm when they have been safely detected&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a><elsevierMultimedia ident="tb0010"></elsevierMultimedia></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Villous tumors</span><p id="par0130" class="elsevierStylePara elsevierViewall">They are rare in the rectum and represent 5&#37; of all colorectal neoplasms&#46; They are large in size&#44; and have a lobular appearance on the CTC&#44; which is consistent with the dense appearance seen on the OC&#46; They have a higher risk of degeneration &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The diagnosis should be confirmed through OC and biopsy&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Malignant neoplasms</span><p id="par0135" class="elsevierStylePara elsevierViewall">Of variable morphology&#44; they may present as small or big size stenosing or polypoid lesions&#46; The most difficult cancers to detect are the small ones&#44; since they can remain kind of hidden by the balloon catheter and look like polypoid focal thickenings &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; which is why it is advisable to slightly deflate the balloon in its helix in the decubitus prone position&#46; Between 1&#46;5&#37; and 6&#37; of all colonic neoplasms associate synchronic lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; The CTC is especially useful if the distal lesion is oclusive&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;9&#44;19</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">One rectal lesion suspicious of malignancy on the CTC should be biopsized with CO&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a><elsevierMultimedia ident="tb0015"></elsevierMultimedia></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Submucosal lesions</span><p id="par0155" class="elsevierStylePara elsevierViewall">There is a wide variety of benign and malignant conditions &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; They originate in deep areas &#40;intramural or extramural&#41;&#44; protrude toward the intestinal lumen&#44; make up obtuse angles with the wall and displace the folds without interrupting them&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">The most common of all are lipomas that can be easily identified by their fat density&#46; When it comes to malignant lesions&#44; the primary rectal lymphoma is relatively rare compared to the small intestine gastric lymphoma&#46; Almost all of them are non-Hodgkin lymphomas type B associated with immunosuppression and bowel inflammatory disease&#46; On the OC they appear as one big polilobulated or multifocal single mass &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The CTC assessment of alleged submucosal lesions found on the OC is useful to be able to distinguish an intramural process from an extramural extrinsic compression&#44; identify its true nature&#44; and study the spread of the disease<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#44;14</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Management can vary&#46; Fat density characterizes lipomas and is diagnostic on the 2D images&#46; In other submucosal lesions&#44; other imaging modalities &#40;MRI&#44; transrectal ultrasound&#8230;&#41; may help us characterize these lesions&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We should remember that</span> the CTC allows us to distinguish intramural from extramural submucosal lesions&#44; identify their true nature&#44; and study the spread of the disease&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Vascular lesions</span><p id="par0185" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Internal hemorrhoids&#58; it is the most common rectal pathology&#46; It consists of the dilation of the veins of the superior plexus that are covered by the mucosa<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> over the dentate line&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> They have a typical appearance on the CTC&#44; of anorectal location&#44; and on circumferential disposition around the catheter&#44; giving the appearance of one submucosal lesion&#44; or a wrinkled appearance of the mucosa around the rectal tube&#46; When hemorrhoids become thrombosed they may look like a tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> The rectal touch&#44; instead of the OC&#44; may help confirm the diagnosis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Rectal varices&#58; they are less common than internal hemorrhoids&#44; associate portal hypertension&#44; and have a winding and tubular morphology &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; Diagnosis is achieved through the OC&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Venous malformations&#58; they are rare&#46; They may be part of the blue rubber bleb nevus syndrome or appear in isolation on the CTC simulating one polyp&#46; On the OC they show a characteristic blue color&#46; On the MRI&#44; their hyperintensity on the T2-weighted sequences and their spread into the mesorectal fat are specific characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Papillary hypertrophy</span><p id="par0205" class="elsevierStylePara elsevierViewall">They are focal fibrous protrusions on the dentate line&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> They may look like polyps&#44; but their location in the anorectal junction is patognomonic&#44; and almost always in contact with the catheter &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46; The OC is diagnostic&#46;</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Inflammatory conditions</span><p id="par0215" class="elsevierStylePara elsevierViewall">The rectum is affected in the ulcerative colitis and Chron&#39;s disease whenever there is associated perianal disease&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> The radiation therapy-related iatrogenia in the pelvis affects the rectum in the form of actinic proctitis&#46; These conditions appear as one diffuse&#44; circumferential thickening of the wall of the rectum that causes variable stenoses&#44; with important frequencies&#44; but with signs of benignity&#46; The patient&#39;s personal history facilitates the diagnosis &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">The CTC outside the acute episode allows us to assess the degree of stenosis and plan the course of treatment&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The solitary rectal ulcer consists of an intense inflammatory reaction around an ulcer that conditions one mass effect that can be interpreted as a malignant tumor in a patient with rectorrhagy and painful defectation&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Both the OC and the biopsy are indicated to achieve the diagnosis&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Postoperative changes</span><p id="par0235" class="elsevierStylePara elsevierViewall">The surgical clips placed on colorectal anastomoses usually appear on the 3D images as irregularities of the mucosa that can be taken for tumor relapses&#46; The 2D images are key here since they reveal their metallic density &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46;</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">Rectocolonic anastomoses are a common cause of incomplete OCs&#44; but they rarely cause significant stenoses&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The signs of recurrence of neoplastic disease are irregularity&#44; wall thickening&#44; and distortion of the mucosal pattern compared to common postoperative findings such as small size inflammatory polyps located in the anastomotic line&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">In the presence of suspicious images and suspicion of relapse&#44; we should try to biopsize with the OC&#44; or else&#44; with a surgical biopsy in cases of impassable stenoses&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Pseudolesions and artifacts</span><p id="par0270" class="elsevierStylePara elsevierViewall">With an optimal fecal marking and colonic distention&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> most artifacts are easily recognizable&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0275" class="elsevierStylePara elsevierViewall">The rectal catheter&#58; constant finding in the anorectal region&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#44;14</span></a> Its tip can have a polypoid appearance on the 3D views&#44; or cause compression on an adjacent rectal fold&#46; Both the partial balloon deflating in the decubitus prone position<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> and the verification of its presence on the 2D images &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 11</a>&#41; are of great help&#46;</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Stained feces&#58; they may appear as polyps or masses based on their size on the 3D endoluminal images&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> but they can be easily identified on the 2D images after contrast staining&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#44;17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Unstained feces&#58; they can be a problem if they are small&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> Internal air foci and supine-to-prone position changes are characteristic here&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#44;17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Fecalomas&#58; they are common in the rectal ampulla&#46; The 3<span class="elsevierStyleHsp" style=""></span>D endoluminal image shows one lobulated irregular mass that simulates a tumor or cancer&#46; The 2D image is diagnostic and shows the heterogeneous composition that is typical of unstained feces&#46;</p></li></ul></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Other lesions</span><p id="par0295" class="elsevierStylePara elsevierViewall">The condyloma acuminatum can present as a polypoid lesion&#44; although it is rare&#46; The diagnosis of anorectal lesions is achieved through anoscopy examination or rectal touch&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">The diverticula are exceptional in the rectum&#46; They look exactly the same in all colonic locations&#44; and their finding does not require follow-up or diagnostic confirmation&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0305" class="elsevierStylePara elsevierViewall">Although rectal lesions can go misdiagnosed on the CTC because it is particularly difficult to assess this anatomical region&#44; and even though it is not the modality of choice for the study of rectal pathologies&#44; it is indicated in cases of incomplete or contraindicated OCs&#46; For this reason&#44; it is essential to know the rectal pathology and its semiology on the CTC&#44; have an excellent command while performing the technique when it comes to preparation and distension&#44; conduct moderate balloon insufflations&#44; and careful 2D and 3D navigations&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Authors</span><p id="par0310" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">1&#46;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">2&#46;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Study idea&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">3&#46;</span><p id="par0325" class="elsevierStylePara elsevierViewall">Study design&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">4&#46;</span><p id="par0330" class="elsevierStylePara elsevierViewall">Data mining&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">5&#46;</span><p id="par0335" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">6&#46;</span><p id="par0340" class="elsevierStylePara elsevierViewall">Statistical analyses N&#47;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">7&#46;</span><p id="par0345" class="elsevierStylePara elsevierViewall">Reference&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">8&#46;</span><p id="par0350" class="elsevierStylePara elsevierViewall">Writing&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">9&#46;</span><p id="par0355" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks&#58; MJMSL&#44; SAOM and CCG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">10&#46;</span><p id="par0360" class="elsevierStylePara elsevierViewall">Approval of final version&#58; MJMSL&#44; SAOM and CCG&#46;</p></li></ul></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical responsibilities</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of people and animals</span><p id="par0365" class="elsevierStylePara elsevierViewall">The authors declare that no experiments with human beings or animals have been performed while conducting this investigation&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Data confidentiality</span><p id="par0375" class="elsevierStylePara elsevierViewall">The authors declare that they have followed their center protocols on the publication of data from patients&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0380" class="elsevierStylePara elsevierViewall">The authors confirm that in this article there are no data from patients&#46;</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of interest</span><p id="par0385" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest associated with this article whatsoever&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Technical considerations"
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          "titulo" => "Rectal pathology"
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            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Polyps"
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            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Villous tumors"
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              "titulo" => "Malignant neoplasms"
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              "titulo" => "Submucosal lesions"
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              "titulo" => "Vascular lesions"
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              "titulo" => "Papillary hypertrophy"
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              "titulo" => "Pseudolesions and artifacts"
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              "titulo" => "Other lesions"
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    "fechaRecibido" => "2017-03-28"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To review the spectrum of benign and malignant rectal diseases&#44; their findings on CT colonography&#44; and their management&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Although CT colonography is not the first choice for the study of rectal disease&#44; it is indicated in cases where optical colonoscopy is contraindicated or cannot be completed&#46; Rectal lesions can go undetected because this anatomic area is difficult to evaluate&#59; for this reason&#44; it is essential to ensure optimal preparation and distension&#44; moderate balloon insufflation&#44; and careful 2D and 3D navigation with knowledge of the spectrum of rectal disease and its CT colonography signs&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Objetivo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Revisar el espectro de la patolog&#237;a rectal benigna y maligna&#44; sus hallazgos en la colonograf&#237;a-TC &#40;CTC&#41; y su manejo&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Aunque la CTC no es la herramienta de primera elecci&#243;n para el estudio de la patolog&#237;a rectal&#44; est&#225; indicada en casos de colonoscopia &#243;ptica incompleta o contraindicada&#46; Las lesiones rectales pueden pasar desapercibidas por la dificultad que representa la valoraci&#243;n de esta &#225;rea anat&#243;mica&#44; y por ello es necesaria una excelente preparaci&#243;n y distensi&#243;n&#44; la insuflaci&#243;n moderada del bal&#243;n y una navegaci&#243;n cuidadosa en 2D y 3D con conocimiento del espectro de la patolog&#237;a rectal y su semiolog&#237;a en CTC&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez-Sapi&#241;a Llanas MJ&#44; Otero Muinelo SA&#44; Crespo Garc&#237;a C&#46; Patolog&#237;a del recto&#58; hallazgos en la colonograf&#237;a-TC&#46; Radiolog&#237;a&#46; 2018&#59;60&#58;208&#8211;216&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Rectal polyps&#46; Coexistence of different polypoid lesions in the rectum&#58; pedunculated polyp &#40;white arrow&#41;&#44; sessile polyp &#40;arrowhead&#41;&#44; rectal balloon &#40;asterisk&#41;&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Villous tumor&#46; &#40;a&#41; Axial CT image&#46; Lobulated lesion based on the lateral wall of the rectum &#40;white arrow&#41;&#46; The soft cover of its surface after the administration of oral contrast shows its dense appearance&#46; &#40;b&#41; Match with 3D view&#46; The anatomopathological finding was villous adenoma&#46;</p>"
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        "etiqueta" => "Figure 3"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Carcinoma&#46; &#40;a&#41; This axial CTC image corresponds to one patient studied due to anemia and shows one flat mural lesion in the rectum discretely protruding toward the lumen &#40;arrow&#41; that turned out to be an adenocarcinoma in the cylinder biopsy&#46; &#40;b&#41; 3D virtual colonoscopy&#46; &#40;c&#41; Optical colonoscopy&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Synchronic neoplasms&#46; CTC of a seventy-five-year-old woman after an incomplete optical colonoscopy due to occlusive stenosing lesion in her rectum&#46; &#40;a&#41; Axial CT image&#46; Lesion inside the distal rectum &#40;arrow&#41; corresponding with one polypoid elevated lesion &#40;b&#44; 3D endoluminal view&#41; consistent with one carcinoma&#46; The CTC was good for the detection of another lesion of malignant appearance in the sigma &#40;c&#41;&#46; Note the beam hardening artifact caused by the metallic prosthetic material in both hips &#40;a&#41;&#44; which makes the assessment of the rectum even more difficult&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lymphoma&#46; &#40;a&#41; CT image reconstruction in the sagittal plane&#46; Diffuse thickening of the wall of the rectum and sigma &#40;black arrows&#41;&#46; &#40;b&#41; Virtual luminogram&#46; Loss of distension in the damaged segments &#40;arrowheads&#41;&#46; Note the loss of haustration of the descending colon &#40;hollow arrows&#41; relative to ulcerative colitis in chronic stage&#46; &#40;c&#41; Virtual colonoscopy&#46; Stenotic appearance of submucosal masses in intestinal lymphoma&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
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            "imagen" => "gr6.jpeg"
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            "Tamanyo" => 121699
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Extramural submucosal lesion&#46; Sixty-eight-year-old woman with abdominal pain&#46; &#40;a&#41; CTC&#44; virtual luminogram&#46; Repletion defect in the lateral wall of the rectum &#40;thick arrow&#41; that looks like an extrinsic compression on the 3D endoluminal image &#40;thick arrow in b&#41;&#46; &#40;c&#41; The axial CT image shows one extramural submucosal fluid density lesion &#40;white arrow&#41; exerting that extrinsic compression and consistent with a developing cyst&#46; The thin arrows in &#40;a&#41; and &#40;b&#41; point at the rectal balloon&#46;</p>"
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        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr7.jpeg"
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            "Tamanyo" => 131513
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Rectal varicose vein&#46; Eighty-year-old male with anemia and rectorrhagy&#46; &#40;a&#41; Axial CTC image&#46; Parietal lesion in his rectum of soft tissue density &#40;white arrow&#41;&#46; &#40;b&#41; 3D CTC&#46; The black arrow shows the tubular and winding morphology of the lesion objectified in &#40;a&#41;&#46; Rectal catheter &#40;asterisk&#41;&#46; &#40;c&#41; Rectal varicose veins as seen on the optical colonoscopy &#40;arrow&#41;&#46;</p>"
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        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr8.jpeg"
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            "Tamanyo" => 218386
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Hypertrophied anal papilla&#46; Fifty-seven-year-old-woman&#46; CTC after incomplete optical colonoscopy&#46; &#40;a&#41; 2D image on the axial plane&#46; Lesion in the rectal lumen stained in its periphery after the administration of oral contrast &#40;white arrow&#41;&#46; &#40;b&#41; 3D endoluminal view&#46; The arrow points at the same lesion in contact with the rectal balloon &#40;asterisk&#41; and close to the anorectal junction &#40;c&#41; The optical colonoscopy confirms it is consistent with one hypertrophied anal papilla &#40;white arrow&#41;&#46;</p>"
        ]
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        "etiqueta" => "Figure 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr9.jpeg"
            "Alto" => 603
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            "Tamanyo" => 130344
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Actinic proctitis&#46; CTC in one patient with cervical carcinoma treated with radiation therapy after incomplete optical colonoscopy due to impassable stenosis&#46; &#40;a&#41; CT image reconstruction in the coronal plane that reveals protrusions &#40;arrows&#41; and stenoses &#40;not shown&#41;&#46; &#40;b&#41; The 3D image shows one of the polypoid lesions that looks ulcerative in the optical colonoscopy &#40;c&#41;&#46;</p>"
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        "etiqueta" => "Figure 10"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Surgical material&#46; &#40;a&#41; The 3D image shows a significant mucosal irregularity inside one rectal valve &#40;black arrow&#41;&#46; The CTC image on the axial plane &#40;b&#41; shows material of metallic density &#40;white arrow&#41;&#44; and eventually tumor pathology is ruled out after the OC confirms the presence of surgical clips &#40;c&#41;&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Rectal balloon catheter&#46; &#40;a&#41; The distal end of the rectal catheter &#40;black arrow&#41; can compress the rectal valves &#40;arrowhead&#41; and create an image of submucosal extrinsic compression&#46; &#40;b&#41; 3D image&#46; Appearance of the catheter protrusion over the rectal valve&#46; &#40;c&#41; The position of the balloon catheter needs to be confirmed on the multiplanar reconstructions&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Absolute contraindications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Severe pulmonary or heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Diathesis&#44; bleeding&#44; or treatment with anticoagulants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Risks due to sedation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Patient refusing to undergo the procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Relative contraindications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Prior history of incomplete optical colonoscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Advanced age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Weak patient and with mobility issues&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1737433.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Contraindications of the optical colonoscopy procedure&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
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          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Contraindicated optical colonoscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Incomplete optical colonoscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Patient refusal to undergo the optical colonoscopy procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Assessment of diverticular disease &#40;after the acute phase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Assessment of patients with colonic stoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Other indications&#58;<br>&#8226;<span class="elsevierStyleHsp" style=""></span>Screening of colorectal cancer<br>&#8226;<span class="elsevierStyleHsp" style=""></span>Controls after colorectal cancer surgery or polypectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1737435.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Indications of the CT-colonography&#46;</p>"
        ]
      ]
      13 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Acute bowel inflammatory disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Acute diverticulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Recent surgery &#40;&#60;3 months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Inguinal hernia with colonic content&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1737434.png"
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            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Contraindications of the CT-colonography&#46;</p>"
        ]
      ]
      14 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Diet without fiber three &#40;3&#41; days prior to the examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Complete diet with liquid food supplement &#40;Isosource&#174;&#41; one &#40;1&#41; day prior to the examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Oral iodinated contrast &#40;diatriazoate&#41;&#58; 3 doses of 7<span class="elsevierStyleHsp" style=""></span>cc diluted in water two &#40;2&#41; days prior to the examination&#44; and 5 doses of 7 cc diluted in water one &#40;1&#41; day prior to the examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Microenema of local action &#40;Micralax<span class="elsevierStyleSup">&#174;</span>&#41; first time in the morning of the examination day&#59; immediately prior to the CTC&#44; evacuation of the rectal ampulla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Take 2<span class="elsevierStyleHsp" style=""></span>l of water a day as a complement to the whole preparation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Optional&#58; prescription of intramuscular bowel muscle relaxants &#40;Buscopan<span class="elsevierStyleSup">&#174;</span>&#41; one &#40;1&#41; hour prior to the test&#59; they are contraindicated in cases of glaucoma&#44; prostatic hypertrophy&#44; heart disease&#44; severe myasthenia gravis&#44; or porphyria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1737438.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Colonic preparation for the CT-colonography&#46;</p>"
        ]
      ]
      15 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Based on their morphology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Based on their size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Sessile&#58; wide base of implantation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Tiny&#58; &#60;6<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Pedunculated&#58; with stalk or pedicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Intermediate&#58; 6&#8211;9<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Flat&#58; protrude &#60;3<span class="elsevierStyleHsp" style=""></span>mm over the mucosa&#59; carpet lesions are flat lesions &#62;3<span class="elsevierStyleHsp" style=""></span>cm in size that usually affect the caecum and the rectum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Large&#58; &#8805;10<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1737437.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Classification of colonic polyps&#46;</p>"
        ]
      ]
      16 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Of intramural origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Of extramural origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Leiomyoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Endometriosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Lipoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Developmental retrorectal cystic lesions&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Neuroendocrine tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;<span class="elsevierStyleHsp" style=""></span>Retrorectal cystic hamartoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Gastrointestinal stromal tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;<span class="elsevierStyleHsp" style=""></span>Rectal duplication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Schwannoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;<span class="elsevierStyleHsp" style=""></span>Epidermoid cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;<span class="elsevierStyleHsp" style=""></span>Dermoid cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Rectal invasion by other tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Other primary tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Metastasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1737436.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Submucosal lesions&#46;</p>"
        ]
      ]
      17 => array:5 [
        "identificador" => "tb0005"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We should remember that</span> for the adequate assessment of the rectal region&#44; an excellent colonic preparation and distension are needed&#46; The balloon should be moderately deflated in its helix in the decubitus prone position&#46;</p></span>"
        ]
      ]
      18 => array:5 [
        "identificador" => "tb0010"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We should remember that</span> the target lesion of the CTC is the advanced adenoma&#58; polyp &#8805;10<span class="elsevierStyleHsp" style=""></span>mm&#44; villous component &#62;25&#37;&#44; or high-grade dysplasia&#46; There is a direct correlation between size and malignancy risk&#46;</p></span>"
        ]
      ]
      19 => array:5 [
        "identificador" => "tb0015"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">We should remember that</span> the biggest problem when it comes to the anorectal region is misdiagnosing low malignant lesions hidden by the balloon catheter or darkened by the artifacts&#46;</p></span>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2018.03.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	1	0	1
2024 January	3	0	3
2023 December	2	3	5
2023 September	1	0	1
2023 June	1	2	3
2023 March	1	2	3
2023 January	2	1	3
2021 January	1	0	1
2020 September	1	0	1
2019 May	2	2	4
2018 June	1	0	1
2018 May	0	1	1

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