全结肠无神经节细胞症X线误诊分析：附10例报告

目的：通过回顾性分析，找出全结肠无神经节细胞症（ＴＣＡ）的误诊原因，以减少误诊。材料与方法：将本院１９８０￣１９９５年经手术病理证实的１０例ＴＣＡ患儿与正常新生儿进行对照分析。结果：ＴＣＡ结肠长度明显短于正常组；管径可小于正常（６７％），正常（２２％），轻度扩大（１１％）；结肠弯曲减少或变浅，边缘可不整齐有奇特收缩切迹（３３％），或光滑整齐（４４％），或光滑整齐与小段痉挛收缩相间存在（２３％）；钡     

Radiological findings in total colon aganglionosis and allied disorders

OBJECTIVE: The aim of this study was to review the radiological findings of three cases of total colon aganglionosis (TCA), hypoganglionosis, and immature ganglionosis, and to compare the differences in diagnosis and follow-up of these three disease entities. MATERIALS AND METHODS: Three neonates with neonatal onset of abdominal distension with vomiting were investigated, and the cases were diagnosed as TCA, hypoganglionosis, and immature ganglionosis, respectively. Radiological examination of each neonate was performed during the neonatal period and at follow-up. RESULTS: A plain abdominal radiograph showed massive abdominal bowel gas and multiple air-fluid levels in all cases. Barium enema findings including no transition zone, normal rectosigmoid index, reflux of barium into a dilated ileum, and retention of barium on delayed film were observed in all three cases. In aganglionosis and hypoganglionosis, a normal-sized colon, irregular contraction, shortening of the colon, and lack of redundancy were observed. In immature ganglionosis, microcolon was present but there was no shortening of the colon or loss of redundancy. Barium studies following ileostomy during childhood revealed no efficient peristalsis after the neonatal period in patients with aganglionosis and hypoganglionosis. Conversely, the patient with immature ganglionosis showed maturity of colonic function on barium studies after infancy. CONCLUSION: The clinical and radiological findings of TCA and allied disorders are similar in neonates. Sequential contrast intestinal studies could reveal peristalsis of the colon wall, suggesting maturity of the ganglion cells.     

Diverticulosis in total colonic aganglionosis

Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction.     

Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon

PURPOSE: To evaluate the use of preoperative virtual colonoscopy to examine the proximal colon in patients with distal occlusive carcinomas, defined as cancers that cannot be traversed endoscopically. MATERIALS AND METHODS: Twenty-nine patients with occlusive colorectal carcinomas underwent preoperative virtual colonoscopy with use of a standard protocol. Patients with acute bowel obstruction were excluded. Results of virtual colonoscopy were compared with the findings of preoperative colonoscopy, preoperative barium enema examination, intraoperative colon palpation, histopathologic outcome, and postoperative colonoscopy and barium enema examination, where possible. RESULTS: Virtual colonoscopy helped identify all 29 occlusive carcinomas and demonstrated two cancers and 24 polyps in the proximal colon. Both synchronous cancers were confirmed intraoperatively and resected. Postoperative conventional colonoscopy in 12 patients confirmed 16 polyps identified at virtual colonoscopy and demonstrated two subcentimeter polyps missed at virtual colonoscopy. Postoperative barium enema examination was performed in two patients and helped confirm two polyps identified at virtual colonoscopy. Virtual colonoscopy successfully demonstrated the proximal colon in 26 of 29 patients examined compared with preoperative barium enema examination, which failed to adequately demonstrate the proximal colon in any patient examined. CONCLUSION: Virtual colonoscopy is a feasible and useful method for evaluating the entire colon before surgery in patients with occlusive carcinomas.     

Colonic stenoses: use of oral barium when retrograde flow is completely obstructed on barium enema studies

Forty patients with complete obstruction to retrograde barium flow on barium enema examinations, without clinical or radiographic evidence of obstruction, were studied further with orally administered barium in the same session. All patients had undergone aborted double-contrast barium enema studies and had received antispasmodics intramuscularly before the examination. The authors describe the technique, as well as the clinical and radiologic findings, that allows the safe ingestion of oral barium in patients with stenotic lesions of the colon. In all patients, oral barium passed through the small bowel and the stenotic site in an average of 148 minutes, with no complications. In seven patients, there were synchronous lesions in the colon and small bowel, and the findings were determined better with oral barium studies in 19 patients. If a barium enema study is done and retrograde passage of barium is obstructed by a lesion in the left side of the colon, additional diagnostic information can be obtained by giving the patients oral barium. This practice is safe if precise criteria are applied.     

Double-contrast barium enema examination technique

This review article presents the principles for performing a safe, comfortable, and accurate double-contrast barium enema examination. The procedure is a flexible examination in which the fluoroscopist interacts with the patient, the controls of the fluoroscope, and the image on the television monitor. During a double-contrast examination, images of the colon are created by manipulating the patient, the barium pool, and the amount of air insufflated into the rectum. Fluoroscopy is essential for guiding the radiologist to obtain spot images with adequate technical factors. The fluoroscopist analyzes the luminal contour, the barium-coated mucosal surface en face, and the barium pool to detect abnormalities in the colon. With careful technique, a high-quality examination can be performed in most patients.     

Pneumomediastinum after double-contrast barium enema examination: a sign of colonic perforation

Pneumomediastinum as an iatrogenic complication of a diagnostic procedure is rare [1-7]. We report a case of pneumomediastinum following a double-contrast barium enema examination. With the increasing use of double-contrast barium studies, pneumomediastinum may be an important sign of rupture of the colon during this examination.     

Determination of renal arterial stenosis severity: comparison of pressure gradient and vessel diameter

PURPOSE: To evaluate radiologic findings of peripheral T-cell lymphoma (PTCL) of the colon at double-contrast barium enema examination. MATERIALS AND METHODS: Double-contrast barium enema findings in six patients with pathologically proved PTCL of the colon were retrospectively evaluated and compared with colonoscopic and histopathologic findings. RESULTS: There was a diffuse involvement of almost all segments of the colon in four patients and a focal segmental involvement in two. Frequent findings at double-contrast barium enema examination included geographic ulcerations (n = 6), aphthous ulcerations (n = 4), pseudopolyps (n = 4), circumferential luminal narrowing (n = 4), and ileocecal deformity (n = 4). CONCLUSION: PTCL of the colon manifested as either a diffuse or a focal segmental lesion and showed extensive mucosal ulceration at double-contrast barium enema examination. These findings are similar to those of inflammatory bowel disease and are different from those of colorectal lymphoma with the B-cell phenotype.     

Accuracy of double-contrast barium enema in diagnosing colorectal polyps and cancer

CRC is a common malignancy, and reduced mortality can be achieved through detection and treatment of early cancers and by removal of colonic adenomas. Although current screening recommendations, especially in the average-risk individual, typically promote the use of FOBT and FS, a substantial minority of colonic cancers and many colonic adenomas are not detected by these methods. Modalities that examine the entire colon, such as the barium enema and colonoscopy, can detect most clinically important colorectal neoplasms; however, their additional costs and potential risks have limited their use as initial screening examinations. But recent changes in governmental policies regarding reimbursement for CRC screening and increasing emphasis on total colon examinations have altered these recommendations.

This review on the accuracy of the DCBE has emphasized the detection of colonic polyps and cancers and has updated the changing role of this examination in screening patients at variable risk for CRC. The efficacy of the barium enema depends on many factors that radiologists must understand and control to perform accurate examinations. Current recommendations for CRC screening and approved reimbursement of the barium enema for that purpose provide a new impetus to radiologists to maintain and improve their skills in performing and interpreting this radiologic examination. The barium enema may have a future in the new millennium.     

Diagnostic yield of barium enema examination after incomplete colonoscopy

PURPOSE: To determine the diagnostic yield of barium enema examination for neoplastic lesions larger than 1 cm in diameter in the nonvisualized portion of the colon after incomplete colonoscopy. MATERIALS AND METHODS: A review of computerized gastroenterology and radiology databases identified 355 patients who underwent incomplete colonoscopy; 158 (44.5%) underwent subsequent barium enema examination (125 double-contrast and 33 single-contrast barium enema examinations). The radiographic reports were reviewed and compared with the endoscopic reports by one author to identify neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy. Six such lesions were found. In all six cases, the images from the barium enema examinations were reviewed together by two authors to determine the size, location, and morphologic features (polypoid, ulcerated, or annular) of the lesions. Medical, endoscopic, and surgical records were subsequently reviewed by one author to determine whether these represented true- or false-positive radiographic findings. RESULTS: Barium enema examination depicted six possible lesions in the nonvisualized colon after incomplete colonoscopy; five were found to be true-positive radiographic findings, and one was found to be a false-positive finding. The five true-positive findings included two annular lesions (both adenocarcinomas) and three polypoid lesions (all tubulovillous adenomas, with high-grade dysplasia in one). Thus, neoplastic lesions larger than 1 cm were found on barium enema images in the nonvisualized colon in five (3.2%) of 158 patients after incomplete colonoscopy. CONCLUSION: Barium enema examination had a diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy.     

Barium filling for glucagon-resistant spasm on double-contrast barium enema examinations

Severe glucagon-resistant spasm on double-contrast barium enema (DCE) examinations may occasionally lead to a nondiagnostic examination or erroneously suggest colonic disease. In such cases, this glucagon-resistant spasm may be overcome by refilling the colon with single-contrast barium immediately after completion of the DCE examination.     

Double-contrast barium enema technique

During a double-contrast barium enema the radiologist interacts with the patient, the controls of the fluoroscope, and the image on the television monitor. The radiologist paints an image of the colon; the barium is the paint, the colon is the canvas. The radiologist manipulates the barium pool, the air column, and the patient to create images. Although the radiologist may have a plan going into the examination, the game plan is altered by the patient's ability to tolerate and perform the study, the length of the colon, and pathology encountered. If the radiologist understands the goals to be achieved, the studied can be tailored to fit what is happening in the fluoroscopic suite.     

Usefulness of CT colonography in the preoperative evaluation of patients with distal occlusive colorectal carcinoma

PURPOSE: To evaluate the role of preoperative virtual colonoscopy to study the proximal colon in patients with distal occlusive carcinomas, diagnosed by conventional colonoscopy. MATERIAL AND METHODS: We examined 19 patients aged 46 to 83 years (13 men and 6 women) with distal occlusive colorectal carcinomas diagnosed by conventional colonoscopy, who were preoperatively studied with virtual colonoscopy. Patients with acute bowel obstruction were excluded. Results were compared with the findings of preoperative conventional colonoscopy and barium enema examination, intraoperative colon palpation, histopathologic outcome, postoperative conventional colonoscopy and barium enema examination. RESULTS: Virtual colonoscopy identified all 19 distal occlusive colon carcinomas and 22 synchronous lesions, 2 cancers (prevalence 10,6%) and 20 polyps (prevalence 68,4%). Both synchronous cancers were confirmed intraoperatively by direct palpation. Postoperative conventional colonoscopy, which was performed in 18 patients, confirmed the presence of 15 polyps in 12 patients. Three subcentimeter polyps were removed during conventional colonoscopy and were missed at virtual colonoscopy. Two polyps shown by virtual colonoscopy were not found at conventional colonoscopy. Postoperative barium enema was performed in three patients and confirmed three polyps identified at virtual colonoscopy. Preoperative barium enema was performed in five patients and failed to adequately demonstrate the proximal colon. Virtual colonoscopy showed a sensitivity of 87% and a specificity of 75%. CONCLUSIONS: Virtual CT colonoscopy can be considered an important diagnostic technique to evaluate preoperatively the proximal colon in patients with distal occlusive carcinomas,as it gives better results than barium enema or conventional colonoscopy, as well as being well tolerated and less invasive.     

Chronic ulcerative colitis and colon cancer: can radiographic appearance predict survival patterns?

Twenty-four patients with chronic ulcerative colitis and colon carcinoma who underwent barium enema examination prior to the diagnosis of cancer were studied in an attempt to correlate the radiographic appearance of the tumors with their biologic behavior, as well as to assess the accuracy of the barium enema in detection. Of the radiographically detected tumors, 65% displayed an annular infiltrative appearance, with the prime radiographic manifestation being relative nondistensibility of the involved segment. The remaining tumors had various appearances more typical of noncolitic colon cancer. Patients with infiltrative lesions had a much poorer prognosis than those with noninfiltrative lesions. Of 33 gross tumors described pathologically and/or surgically, only 70% were correctly detected by barium enema. It is suggested that periodic barium enema examinations are an unreliable means of following patients with ulcerative colitis if malignant degeneration is to be detected at an early and curative stage. Prophylactic proctocolectomy may be the best therapeutic approach.     

Acute gastrointestinal hemorrhage: the changing role of barium examinations.

The emergency evaluation of a patient with acute life-threatening gastrointestinal hemorrhage requires the coordinated efforts of medical, surgical, and radiologic personnel. In most patients with an acute upper gastrointestinal hemorrhage, endoscopy represents the primary diagnostic procedure. Arteriography may follow, depending on the identification of the lesion at endoscopy or the need for therapy through the vascular catheter. Arteriography should precede endoscopy when bleeding is massive or the clinical situation suggests that therapy by a catheter must be instituted on a more urgent basis. When personnel are available to perform endoscopy and arteriography, the barium examination of the upper gastrointestinal tract is best postponed for a few days until the patient can be stabilized completely. In the patient with massive red rectal bleeding and a negative nasogastric aspirate, the arteriogram is clearly the procedure of choice for the emergency diagnostic evaluation. Bleeding diverticular and vascular ectatic lesions can be diagnosed only by arteriography and treatment can usually begin immediately by a catheter infusion of vasopressin. Colonoscopic and barium enema examinations of the acutely bleeding patient are not reliable. In addition, the presence of barium in the colon interferes with arteriography for a number of hours. The barium examination of the colon should be performed at some time during the hospitalization to exclude other possible bleeding lesions and to provide a better overall anatomic assessment of the colon. Both the retrograde and antegrade small bowel enemas are useful in detecting obscure small bowel bleeding lesions that occasionally present as a massive lower gastrointestinal hemorrhage.     

Do magnesium ions influence barium mucosal coating of the large bowel?

The aim of the present study was to verify whether the presence of magnesium in the colon lumen at the time of the double-contrast barium enema (DCBE) examination changes the quality of barium mucosal coating. The two members of 38 pairs of patients undergoing DCBE with a standardised technique were randomly subjected to bowel preparation with sennosides and magnesium sulphate, or sennosides and sodium sulphate. Mucosal coating, residual fluid and colon cleansing were assessed independently by three radiologists. The null hypothesis was tested by means of Wilcoxon's signed-rank test. Barium mucosal coating was judged to be better in the members to whom magnesium sulphate was administered (p = 0.0007). There was no difference in the amount of residual fluids (p = 0.3198). Colon cleansing was judged to be better in the members to whom sodium sulphate was administered (p = 0.0166). These results demonstrate, in a simple way, that magnesium ions increase barium coating of the colon mucosa in vivo. The underlying mechanisms (increase in viscosity of barium suspension through water subtraction owing to the hydrophilism of magnesium ions, or interactions with the polysaccharide additives) need further investigation. A first clinical application could be the integration of magnesium ions in a newly designed isotonic electrolyte solution containing polyethylene glycol for the oral colon wash-out. Received: 7 July 1998; Revision received: 24 September 1998; Accepted: 29 September 1998     

Gastrointestinal complications of pancreatitis

Supine and upright films of the abdomen are usually the first imaging procedures in the evaluation of patients with suspected acute pancreatitis and may document calcific pancreatitis, inflammatory masses, abscesses, or obstruction. Appropriate barium or water-soluble contrast examination of the upper GI tract may provide an accurate indication of upper GI tract obstruction as well as document gastric varices that may occur as a complication of pancreatitis. Appropriate contrast examinations of the colon are important in documenting the extent of inflammatory changes of the colon, which may include perforation and necrosis. Accurate and expeditious documentation of these colonic complications is important in planning appropriate surgical therapy.     

Imaging of the colon

The highlight of articles published on radiologic examination of the colon is the increasing indication for use of the barium enema for screening for colorectal carcinoma. Radiologic screening for colorectal cancer promises to be more effective than mammograptive screening and more cost-effective than alternative means, such as colonoscopy. Important work on defocography suggests that measurements of anorectal angle and pelvic floor descent are nondiagnostic, and that rectal-wall changes are the important findings. Findings on CT scanning continue to be investigated in diseases, such as diverticulitis and tuberculosis, that affect both the colonic mucosa and pericolonic tissues. An important new trend is the use of sonography to investigate the colon for the presence of neoplasms.     

Colon cancer at barium enema examination and colonoscopy: a study from the county of Hordaland, Norway

PURPOSE: To evaluate the efficacy of barium enema examination as routinely performed in the detection of colon cancer in the inhabitants of a well-defined and circumscribed geographic region. MATERIALS AND METHODS: The study comprised 571 patients with histopathologically verified colon cancer during 1990-1993 from the county of Hordaland. The barium enema examination results were reviewed retrospectively. RESULTS: The correct diagnosis was reached in 351 cases (sensitivity, 90.9%) in 386 tumor locations on the basis of the results of 381 barium enema examinations. Cancer or an important precancerous lesion was overlooked in 26 cases (6.7%), and the examination was not feasible in nine cases (2.3%). The correct diagnosis was reached in 172 cases (sensitivity, 80.0%) in patients with 215 tumor locations on the basis of the results of 213 colonoscopies. Cancer or an important precancerous lesion was overlooked in 13 cases (6.0%). The examination was technically not successful (i.e., the affected area was not reached with the scope) in 30 cases (13.9%). CONCLUSION: Barium enema examination is valuable in the diagnosis of colon cancer and compares favorably with colonoscopy. The main reason for missed radiologic diagnosis is failure to observe important lesions visible on the radiographs.     

Small cell carcinoma of the colon: barium study and CT findings

Extrapulmonary small cell carcinoma is a rare neoplasm. It is an aggressive malignant tumour characterized by rapid local progression and early metastasis. We report a case of small cell carcinoma arising in the transverse colon in a 34-year-old man who presented with epigastric pain. On CT, a poorly enhancing bulky mass encircling the transverse colon with extensive regional lymph node metastases was observed. A segmental annular narrowing with thick interhaustral folds of the transverse colon was found by barium enema examination. This is the first report of barium study and CT findings of extrapulmonary small cell carcinoma of the colon.