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World J Gastroenterol. Dec 14, 2013; 19(46): 8502-8514
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8502
Colorectal cancer: Current imaging methods and future perspectives for the diagnosis, staging and therapeutic response evaluation
Maka Kekelidze, Luigia D’Errico, Michele Pansini, Anthony Tyndall, Joachim Hohmann
Maka Kekelidze, Luigia D’Errico, Michele Pansini, Anthony Tyndall, Joachim Hohmann, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
Author contributions: Kekelidze M and Hohmann J designed and wrote the paper; D’Errico L contributed to the metastatic spreading part; Pansini M provided the images and contributed to posttreatment part; Tyndall A contributed to colonoscopy part; all authors revised the text for important intellectual content.
Correspondence to: Maka Kekelidze, MD, PhD, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland. maka.kekelidze@usb.ch
Telephone: +41-61-3286567 Fax: +41-61-2655471
Received: September 30, 2013
Revised: November 6, 2013
Accepted: November 18, 2013
Published online: December 14, 2013
Processing time: 78 Days and 10.3 Hours
Abstract

In the last 10 years the mortality rate of colorectal cancer (CRC) has decreased by more than 20% due to the rising developments in diagnostic techniques and optimization of surgical, neoadjuvant and palliative therapies. Diagnostic methods currently used in the evaluation of CRC are heterogeneous and can vary within the countries and the institutions. This article aims to discuss in depth currently applied imaging modalities such as virtual computed tomography colonoscopy, endorectal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of CRC. Special focus is put on the potential of recent diagnostic developments as diffusion weighted imaging MRI, MRI biomarkers (dynamic enhanced MRI), positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG-PET) combined with computed tomography (PET/CT) and new hepatobiliary MRI contrast agents. The precise role, advantage and disadvantages of these modalities are evaluated controversially in local staging, metastatic spread and treatment monitoring of CRC. Finally, the authors will touch upon the future perspectives in functional imaging evaluating the role of integrated FDG-PET/CT with perfusion CT, MRI spectroscopy of primary CRC and hepatic transit time analysis using contrast enhanced ultrasound and MRI in the detection of liver metastases. Validation of these newer imaging techniques may lead to significant improvements in the management of patients with colorectal cancer.

Keywords: Colorectal cancer; Imaging; Staging; Computed tomography; Magnetic resonance imaging; Diffusion weighted imaging; Contrast enhanced ultrasound

Core tip: This state-of-the-art review article covers current and future contribution of various imaging modalities in the diagnosis of colorectal cancer. Primary local staging, metastatic spread, restaging and posttreatment response evaluation are discussed in depth using emerging techniques such as virtual computed tomography (CT) colonoscopy, endorectal ultrasound and positron emission tomography/CT. The role and indications of more recently developed techniques as magnetic resonance imaging (MRI) with diffusion weighted images and hepatobiliary contrast materials are evaluated. The challenges and evolving role of functional imaging with MRI spectroscopy and hepatic transit time analysis using MRI and contrast enhanced ultrasound in the detection of liver metastases are also covered.