Many unexpected abdominal findings on staging computed tomography in patients with colorectal cancer

Computed tomography (CT) was proven to be superior to preoperative abdominal ultrasound in the preoperative setting for detection of hepatic metastases from colorectal cancer (CRC). The higher sensitivity of CT has resulted in a number of unexpected abdominal findings of varying importance; an issue that was previously studied in relation to CT colonography, but not in relation to staging CT with intravenous contrast in CRC patients. The aim of the present study was to evaluate the number and significance of such unexpected findings on staging CTs in CRC patients.

The study comprises a retrospective analysis of 247 consecutive patients who underwent colorectal cancer surgery at Roskilde Hospital, Denmark, in 2009. A preoperative abdominal staging CT was performed in 245 of these patients. All CT scans and patient records were reviewed by the authors. The unexpected CT findings were classified as being of high, moderate or low clinical importance according to whether they required treatment relatively promptly, later or did not require treatment at all, respectively.

Overall, 114 patients (47%) had unexpected findings. Nineteen of the 137 findings (14%) or 8% in all patients were considered to be of high importance. Three per cent of all patients had abdominal aortic aneurysms, 2% had CRC metastases to the adrenal glands, 2% primary kidney tumours and 1% gynaecologic tumours. Twenty per cent of the patients had findings of moderate importance and 29% findings of low importance.

Staging CT in CRC patients showed nearly 8% of unexpected abdominal findings of high clinical importance requiring relatively prompt treatment.

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