We investigated the feasibility of using ultrasound colonography (USC) to visualize the healthy colon and rectum and detect colorectal polyps. Eight healthy volunteers underwent USC after standard bowel preparation. The feasibility and image quality of USC in different segments were evaluated. Then, USC was conducted on eight patients with known colonic neoplasms using colonoscopy as the reference standard. For volunteers, USC examinations were successfully performed on four (50.0%) ascending, three (37.5%) transverse and eight (100%) descending colons, as well as all sigmoid colons and rectums. One of four (25.0%) ascending, two of eight (25.0%) descending and all sigmoid colons and rectums were well visualized and free of artifacts. For patients, colonoscopy revealed that eight patients had 17 neoplasms in the distal sigmoid colon and rectum, which included 3 lesions ≤5 mm, 3 lesions 6-9 mm and 11 lesions ≥10 mm. USC visualized 12 of 17 (70.6%) neoplasms. Lesion detection by USC was 0% (0/3), 33.3% (1/3) and 100% (11/11) for neoplasms ≤5, 6-9 mm and ≥10 mm in size. USC can visualize the sigmoid colon and rectum well and detect distal sigmoid and rectal neoplasms ≥10 mm in diameter.

Hydrocolonic ultrasound (HUS) is a low-cost imaging modality as compared with standard colonoscopy. However, HUS is not popular in the clinical setting due to its somewhat complicated technique of examination and inability to visualize the rectum. We developed a technique to overcome these limitations.

Ten patients with cancer-suggestive symptoms and 70 asymptomatic patients were included in this study. All patients underwent HUS, with the technique described herein, before colonoscopy on the same day. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

There were 30 men and 50 women with a mean age of 60.9 ± 7.3 (SD) years. Thirteen polyps with a size ≥0.6 cm (four lesions size 0.6 to 0.9 cm and nine lesions size ≥1 cm) were detected by colonoscopy. The detection rate of lesions by HUS was 25% for polyps size 0.6-0.9 cm and 89% for lesions size ≥1 cm in size. Three lesions were missed in the sigmoid colon, one in the transverse colon, and one in the rectum.

HUS is a low-cost and noninvasive procedure for colorectal study. This technique has the potential to be used for the detection of colorectal cancer and polyps.

Bowel sonography has become accepted as a useful tool in several gastrointestinal disorders. Filling of the gut with echo-poor liquids has been proposed to achieve a detailed evaluation of the bowel. This article refers to a review made concerning the benefits and limits of hydrosonography of the gastrointestinal tract.

The use of a luminal contrast agent in bowel sonography may improve results but should be adopted on a case-by-case basis, according to the clinical context and the experience of the sonologist.

To assess the accuracy of intraoperative ultrasound (IOUS) as a localizing technique for colorectal resections, and its impact on surgical management.

Twenty-five patients (15 men and 10 women; mean age, 74.4 years) with early cancers (p T1), or polyps, not amenable to endoscopic removal were selected. IOUS was used as a sole method of intraoperative localization. Its performance was evaluated through review of preoperative colonoscopy reports, intraoperative findings, histopathology reports, and clinical follow-up.

The lesions were situated in the cecum (n = 5), ascending colon (n = 3), transverse colon (n = 4), descending colon (n = 7), and rectum (n = 6). IOUS technique allowed correct localization in 24 of 25 patients, visualization of the bowel wall, and its penetration by malignant tumors. In rectal lesions, IOUS showed clearly the tumor and its margin, which facilitated performance sphincter-sparing procedure.

In patients with small polyps and early cancers of colon and rectum, IOUS may be effectively used as a sole method of intraoperative localization and provide additional information that may alter decision making with regard to surgical technique.

This study examined the sensitivity of routine abdominal ultrasound scanning in the detection of colonic malignancy.

A case control prospective study included 101 patients hospitalized at the Department of Gastroenterology and Liver Diseases of Zemun Clinical Hospital over a four-year period. Since the complaints pointed to colonic malignancy, the patients underwent routine golden standard diagnostic procedures. These patients were referred to an experienced abdominal ultrasound operator who searched for some characteristic signs of colonic malignancy. All of the participants were surgically treated after the completion of relevant procedures for diagnosing colonic malignancy. SPSS for Windows 10.0 was used for data analysis.

The sensitivity of an abdominal ultrasound scan in the detection and location of pathological changes pointed to colonic malignancy was different- 76% and 84% respectively. This method was very reliable in detecting right-sided colonic carcinoma (100%). Some specific ultrasonographic signs of colonic carcinoma were observed at the advanced stages of disease.

The routine abdominal ultrasonography can be used for the screening of colonic malignancy owing to its high sensitivity, particularly in advanced disease, but solely in conjunction with other methods. Finally, abdominal ultrasonography cannot be a definitive diagnostic tool for colonic carcinoma.

To assess the ability of transabdominal ultrasound to detect adult colonic polyps and to describe their ultrasonographic appearance.

Total colonoscopy was carried out for 729 consecutive patients over a 39-month period. Ultrasonographic examination of the abdomen was followed by specific examination of the colon. Colorectal ultrasound was carried out for patients with colonic polyps of the protruded type (exclusive of advanced cancers and polyps of the flat or depressed types), and cleansing liquid was administered preparatory to colonoscopic examination. In examining colonic polyps we wanted to determine the sensitivity and specificity of ultrasound for detecting colonic polyps, and the presence of power-Doppler flow signals, location, morphologic classification, and size of the polyps.

Ultrasound identified no colonic polyps less than 10 mm in diameter in any of the 729 patients. Of the 732 deternimation (three patients had two polyps greater than 10 mm in diameter), ultrasound yielded a positive diagnosis in 16 cases, false-positive in four cases, false-negative in 40 cases, and negative in 672 cases. Sensitivity of the technique was 28.6% and specificity was 99.4% for detection of polyps greater than 10 mm in diameter. Doppler signals were detected in all positive cases. Most polyps that were false-negatives on ultrasound examination occurred in the rectum and sigmoid colon. Sensitivity increased with tumor size, and was as high as 82% (9/11) for polyps exceeding 25 mm in diameter. Fifty-seven percent of pedunculated polyps (type Ip) but no sessile polyps (type Is) were found using ultrasound.

Colorectal ultrasound detected adult colonic polyps greater than 10 mm in diameter 16 of the 56 in present 729 patients, suggesting that this method may be of limited value in screening for colonic polyps.

Radiologic evaluation of small bowel is usually done by barium examination, which involves considerable radiation exposure. A new sonographic method, sonoenteroclysis, is a promising technique for diagnosing small intestinal disorders. In this study the applicability, performance, and diagnostic yield of sonoenteroclysis were assessed and the results of this novel method were compared with those of barium enteroclysis.

Forty-five consecutive patients with suspected small bowel disorder were studied. All patients underwent abdominal ultrasound before and after infusion of an isotonic nonabsorbable electrolyte solution containing polyethylene glycol through a nasojejunal tube (modified Billbao Dotter tube), and images at various levels were obtained. Small bowel wall thickness, luminal narrowing, intestinal dilatation, peristalsis, and extraintestinal complications were noted. It was followed by barium enteroclysis and findings were recorded. Findings of sonoenteroclysis were compared with those of barium enteroclysis.

Satisfactory distention of the intestinal lumen was obtained with sequential visualization of jejunoileal loops in 34.4 +/- 18.4 min. Of 45 patients, 10 showed normal small bowel on sonoenteroclysis and barium enteroclysis. These 10 patients served as controls. Sonoenteroclysis displayed normal diameters smaller than 3.0 and 2.0 cm for the jejunum and ileum, respectively. Bowel wall thickness was 1.7 to 3.0 mm and all five layers of bowel wall could be well appreciated. Valvulae conniventes were clearly visualized with a fold thickness between 1.4 and 2.0 mm. The remaining 35 patients showed abnormalities in the form of strictures, matted bowel loops, dilated loops, thickened folds, deformed ileocecal junction, mass lesions, etc., on sonoenteroclysis and barium enteroclysis. In addition, sonoenteroclysis showed thickened bowel wall with loss of stratification. Extraintestinal findings such as enlarged lymph nodes and ascites were also disclosed at the time of sonography. These were diagnosed subsequently as cases of tuberculosis (n = 23), celiac disease (n = 6), adenocarcinoma (n = 2), leiomyoma (n = 2), Immunoproliferative small intestinal disease (n = 1), and segmental enteritis (n = 1).

The diagnostic accuracy of sonoenteroclysis for detecting small bowel lesions is comparable to that of barium enteroclysis. This new, widely available, inexpensive, and undemanding technique can be used as an initial investigation in the evaluation of patients with small bowel disorders.

Small colonic polyps are difficult to palpate and thus difficult to localize during surgery. Preoperative injection of dyes and "on-the-table colonoscopy" are some of the methods used to allow the surgeon to find the polyps. The aim of the present study was to evaluate the value of intraoperative ultrasound as a tool that may allow detection of small colonic polyps during surgery.

The study population consisted of nine consecutive patients referred to surgery for polyps of the large bowel that were not amenable to endoscopic removal. At surgery, the colon was filled with saline and than scanned by linear ultrasound probe. In 8 out of 9 patients, intraoperative ultrasound successfully detected all polyps, even those smaller than 0.5 cm. In one patient with two polyps, one in the right colon was easily localized, but a second flat, 0.4-cm tubular adenoma at the splenic flexure was missed. In three patients, intraoperative ultrasound showed penetration into the muscular coat. These polyps were found on pathology to be invasive cancer.

Intraoperative ultrasound makes it possible for surgeons to easily localize small nonpalpable polyps of the large bowel. Furthermore, it can determine the aggressive potential of these lesions with great accuracy.

To compare the accuracy of hydrocolonic sonography (HUS) in determining the depth of invasion (T stage) in colon and rectal cancer.

A total of 1 000-2 000 mL of saline was instilled per rectum using a system for barium enemas, and then ultrasonography was conducted by a SSA-270A (Toshiba Co, Japan) sonolayer unit with a 3.75 MHz for 17 patients with colon cancer and 13 patients with rectal cancer before operation. After operation, T stage in HUS was compared with postoperative histological findings.

Overall, the accuracy of T stage was 70%. It was 88% in colon cancer and 46% in rectal cancer. In evaluating nodal state, the accuracy of HUS was low in both colon (71%) and rectal cancers (46%) compared with conventional CT or MRI. The overall accuracy of N staging was 60%.

HUS is valuable to evaluate the depth of invasion in colon cancer, but is less valuable in rectal cancer. Because HUS is low-cost, noninvasive, and readily available at any place, this technique seems to be useful to determine the preoperative staging in colon cancer, but not in rectal cancer.

The purpose of our study was to compare the usefulness of hydrocolonic sonography and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)--labeled leukocyte scintigraphy in the examination of patients with inflammatory bowel disease, using precise sonographic criteria of bowel involvement.

Sixty-eight consecutive patients with active inflammatory bowel disease (34 ulcerative colitis and 34 Crohn's disease), 12 with inactive inflammatory bowel disease, and 10 control subjects were prospectively studied. Patients with active disease underwent clinical assessment, hydrocolonic sonography, scintigraphy, and colonoscopy within 72 hr, whereas patients with inactive disease and control subjects underwent clinical examination and hydrocolonic sonography.

Involvement of a colonic segment by active inflammatory bowel disease was best defined by mucosal thickness greater than 1.5 mm, bowel wall thickness greater than 4 mm, mucosal irregularity, or the absence of haustra; and involvement of the terminal ileum by bowel wall thickness greater than 4 mm. Using these criteria, hydrocolonic sonography had 100% sensitivity for identifying patients with active inflammatory bowel disease and a greater overall accuracy (87%) than scintigraphy (77%) in the assessment of disease extension. In addition, strong correlation was shown between a hydrocolonic sonography activity index and clinical and endoscopic activity indexes.

This prospective study provides precise sonographic criteria for the definition of bowel involvement by active inflammatory bowel disease. Hydrocolonic sonography has a greater accuracy than scintigraphy for assessing disease extension and activity. Therefore, hydrocolonic sonography should be considered a first-choice technique to complete the study of inflammatory bowel disease after confirmation of the diagnosis by histology.

To assess magnetic resonance (MR) colonography as a method for detection of colorectal masses, with conventional colonoscopy as the reference standard.

MR colonography was performed in 132 patients referred for colonoscopy because of the possible presence of a mass. After rectal filling with a gadopentetate dimeglumine and water enema, T1-weighted three-dimensional gradient-echo MR studies were acquired with the patient in the prone and supine positions. Water-sensitive single-shot fast spin-echo MR images were also obtained. Surface-rendered virtual endoscopic endoluminal views, orthogonal sections in three planes, and water-sensitive MR images were interactively assessed for presence of colorectal masses by two radiologists.

MR colonography was well tolerated without sedation or analgesia. MR image quality was sufficient for diagnosis in 127 (96%) patients. Most small (</=5-mm-diameter) masses were overlooked at MR colonography, but 19 of 31 6-10-mm lesions and 26 of 27 large (>10-mm) lesions were correctly identified. For these large masses, MR colonography had a sensitivity of 93%, specificity of 99%, positive predictive value of 92%, and negative predictive value of 98% for detection of masses.

MR colonography is a promising modality for help in detecting colorectal mass lesions larger than 10 mm in diameter.

A more differentiated therapy regimen concept for gastric cancer requires more precise pre-operative diagnostic imaging. There are several methods for pre-operative locoregional tumor staging in gastric cancer: percutaneous abdominal ultrasound with hydrotechnique (HUS), endoluminal ultrasound in the stomach (EUS), computed tomography (CT), and magnetic resonance imaging (MRI). The advantages and indications for each method are described and an overview of the medical literature is given. The results in the literature are compared to our own findings, which were obtained in prospective studies comparing the four different imaging methods. On the basis of our experience and the literature, we conclude that the indication for the different diagnostic imaging methods primarily depends on the type of therapy concept followed in the respective surgical department. Endoscopy with biopsy remains the primary diagnostic procedure. Endosonography (EUS) is another diagnostic procedure, which can be performed simultaneously with endoscopy. Only special questions or reasons warrant the use of other imaging methods.

Barium enema and colonoscopy are commonly used for the investigation of suspected colonic cancer. These techniques are relatively invasive and both the investigation and the preceding bowel preparation are demanding, particularly in the elderly. A prospective, blinded trial was conducted to compare ultrasound (US) and CT with colonoscopy. CT and colonoscopy were performed on 50 patients with symptoms suggesting colonic cancer. Both radiological investigations were performed prior to the bowel preparation for colonoscopy. US was performed without any preparation and oral contrast medium was the only preparation used for CT. Colonoscopy detected six cancers, all of which were diagnosed by both US and CT. In addition, US and CT diagnosed a further cancer not seen on colonoscopy due to an incomplete study. US had a sensitivity and specificity of 100% and CT a sensitivity of 100% and a specificity of 84%. US and CT were poor at diagnosing polyps. If the detection of polyps greater than 2 cm is included then US sensitivity falls to 67% and CT sensitivity falls to 89% and specificity rises to 88%. In conclusion, both US and CT are possible alternatives to colonoscopy in the investigation of symptomatic patients with suspected colonic cancer. The use of these techniques could markedly reduce the need for colonoscopy in this patient population with attendant cost savings. Non-invasive imaging has particular advantages in the elderly who cope poorly with both the bowel preparation and the procedure.

Colonic cancer is normally diagnosed by barium enema or colonoscopy. Neither investigation is ideal, especially in the elderly patient. This study investigates the potential role of abdominal ultrasonography in the diagnosis of colorectal carcinoma.

Fifty-four patients with known or suspected colonic carcinoma were referred for abdominal ultrasonography. A single radiologist performed scans on these patients and the site of any colonic mass or wall thickening considered to be consistent with a colonic carcinoma was reported. All carcinomas were confirmed by histology on tissue obtained at colonoscopy or surgery against which the ultrasonographic diagnosis was compared. Colonic masses detected in patients undergoing routine abdominal ultrasonography for abdominal symptoms were also reported.

Forty-five of the 54 patients referred had colonic carcinoma and abdominal ultrasonography detected 43 of the tumours and correctly identified the site of 41. The sensitivity, specificity and accuracy of abdominal ultrasonography in the detection of colonic tumours considered to be consistent with a colonic carcinoma was 96, 67 and 91 per cent respectively. Seven tumours were identified in patients referred before any other investigation had been carried out.

Abdominal ultrasonography may detect a colonic mass or wall thickening consistent with a colonic carcinoma with a high degree of accuracy and may be useful when barium enema or colonoscopy is not possible.

In the past few years, knowledge of the clinical, biologic, and molecular genetic characteristics of colorectal cancer has greatly increased. Although the most cost-effective approach remains to be identified, screening for colorectal cancer can decrease mortality due to this disease by detecting cancers at earlier stages and allowing the removal of adenomas, thus preventing the subsequent development of cancer. Molecular studies that have helped define the genetic basis for this disease hold great promise for the development of better and more powerful methods to identify populations at risk. Individually, these technological, clinical, and basic-science advances are exciting; together, they promise to move us closer to the goal of substantially reducing mortality due to colorectal cancer.