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Colon Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: A Systematic Review with Meta-Analysis. Cancers (Basel) 2020; 12:cancers12113367. [PMID: 33202936 PMCID: PMC7697096 DOI: 10.3390/cancers12113367] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Following incomplete colonoscopy (IC) patients often undergo computed tomography colonography (CTC), but colon capsule endoscopy (CCE) may be an alternative. We compared the completion rate, sensitivity and diagnostic yield for polyp detection from CCE and CTC following IC. A systematic literature search resulted in twenty-six studies. Extracted data included inter alia, complete/incomplete investigations and polyp findings. Pooled estimates of completion rates of CCE and CTC and complete colonic view rates (CCE reaching the most proximal point of IC) of CCE were calculated. Per patient diagnostic yields of CCE and CTC were calculated stratified by polyp sizes. CCE completion rate and complete colonic view rate were 76% (CI 95% 68-84%) and 90% (CI 95% 83-95%). CTC completion rate was 98% (CI 95% 96-100%). Diagnostic yields of CTC and CCE were 10% (CI 95% 7-15%) and 37% (CI 95% 30-43%) for any size, 13% (CI 95% 9-18%) and 21% (CI 95% 12-32%) for >5-mm and 4% (CI 95% 2-7%) and 9% (CI 95% 3-17%) for >9-mm polyps. No study performed a reference standard follow-up after CCE/CTC in individuals without findings, rendering sensitivity calculations unfeasible. The increased diagnostic yield of CCE could outweigh its slightly lower complete colonic view rate compared to the superior CTC completion rate. Hence, CCE following IC appears feasible for an introduction to clinical practice. Therefore, randomized studies investigating CCE and/or CTC following incomplete colonoscopy with a golden standard reference for the entire population enabling estimates for sensitivity and specificity are needed.
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Clinical Value of CT Colonography Versus Preoperative Colonoscopy in the Surgical Management of Occlusive Colorectal Cancer. AJR Am J Roentgenol 2017; 210:333-340. [PMID: 29261351 DOI: 10.2214/ajr.17.18144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE CT colonography (CTC) has been recognized as a complementary approach to evaluating the entire colon after incomplete colonoscopy (IC) in patients with occlusive colorectal cancer (CRC). The objective of this study is to evaluate changes in preoperative surgical planning after CTC is performed for patients with occlusive CRC and IC in an oncologic hospital. MATERIALS AND METHODS This retrospective study included 65 consecutive patients with occlusive CRC who underwent CTC after IC at our institution from February 2000 to April 2016. CTC examinations and radiology reports were reviewed by an abdominal radiologist. Clinical information was obtained from a review of the electronic medical record. RESULTS CTC contributed to a change in the initial surgical plan of the surgeon for 14 of 65 patients (21.5%). In these 14 patients, CTC detected five synchronous proximal colon polyps (35.7%), five synchronous proximal cancers (35.7%), two imprecise CRC locations (14.3%), one case of proximal colon ischemia (7.1%), and one instance of tumor infiltration of the urinary bladder (7.1%). All CTC findings were confirmed at surgery, and all proximal colon polyps were subsequently confirmed to be advanced adenomas. CONCLUSION The preoperative CTC findings optimized the surgical management plan for 21.5% of patients with occlusive CRC and IC.
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Ito D, Teruya M, Hata S, Kobayashi K, Kaminishi M. Transverse carcinoma after Miles operation: a case in which preoperative evaluation was assisted by computed tomographic colonography. World J Surg Oncol 2016; 14:118. [PMID: 27094762 PMCID: PMC4837561 DOI: 10.1186/s12957-016-0872-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/12/2016] [Indexed: 01/18/2023] Open
Abstract
Background There were only few case reports in which CTC was performed in patients with colostomy. Case Presentation A 68-year-old man was admitted with right abdominal pain and bloody stool that had been present for 2 weeks prior to admission. His medical history included abdominoperineal rectal resection with permanent sigmoid stoma (Miles operation). Colonoscopy showed a sub-occlusive tumor in the transverse colon but provided no information about the proximal colon. Thus, computed tomographic colonography (CTC) was planned to assist our examination of the proximal colon under sigmoid colostomy. CTC revealed the apple core sign in the hepatic flexure, without any evident tumor in the proximal colon. Therefore, we performed transverse colectomy and lymph node dissection, preserving a part of the ascending colon and Bauhin valve. Conclusion CTC examination can be an effective means of preoperatively evaluating the proximal colon in patients with occlusive tumor. Further, CTC examination was technically feasible through a sigmoid stoma.
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Affiliation(s)
- Daisuke Ito
- Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1, Hanakoganei, Kodaira, Tokyo, 187-8510, Japan.
| | - Masanori Teruya
- Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1, Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Shojiro Hata
- Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1, Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Kaoru Kobayashi
- Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1, Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Michio Kaminishi
- Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1, Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
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Sachdeva R, Tsai SD, El Zein MH, Tieu AA, Abdelgelil A, Besharati S, Khashab MA, Kalloo AN, Kumbhari V. Predictors of incomplete optical colonoscopy using computed tomographic colonography. Saudi J Gastroenterol 2016; 22:43-9. [PMID: 26831606 PMCID: PMC4763528 DOI: 10.4103/1319-3767.173758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS Optical colonoscopy (OC) is the primary modality for investigation of colonic pathology. Although there is data on demographic factors for incomplete OC, paucity of data exists for anatomic variables that are associated with an incomplete OC. These anatomic variables can be visualized using computed tomographic colonography (CTC). We aim to retrospectively identify variables associated with incomplete OC using CTC and develop a scoring method to predict the outcome of OC. PATIENTS AND METHODS In this case-control study, 70 cases ( with incomplete OC) and 70 controls (with complete OC) were identified. CTC images of cases and controls were independently reviewed by a single CTC radiologist. Demographic and anatomical parameters were recorded. Data was examined using descriptive linear statistics and multivariate logistic regression model. RESULTS On analysis, female gender (80% vs 58.6% P = 0.007), prior abdominal/pelvic surgeries (51.4% vs 14.3% P < 0.001), colonic length (187.6 ± 30.0 cm vs 163.8 ± 27.2 cm P < 0.001), and number of flexures (11.4 ± 3.1 vs 8.4 ± 2.9 P < 0.001) increased the risk for incomplete OC. No significant association was observed for increasing age (P = 0.881) and history of severe diverticulosis (P = 0.867) with incomplete OC. A scoring system to predict the outcome of OC is proposed based on CTC findings. CONCLUSION Female gender, prior surgery, and increasing colonic length and tortuosity were associated with incomplete OC, whereas increasing age and history of severe diverticulosis were not. These factors may be used in the future to predict those patients who are at risk of incomplete OC.
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Affiliation(s)
- Reetika Sachdeva
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Salina D. Tsai
- Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mohamad H. El Zein
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Alan A. Tieu
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Ahmed Abdelgelil
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Sepideh Besharati
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A. Khashab
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Anthony N. Kalloo
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA,Address for correspondence: Dr. Vivek Kumbhari, Johns Hopkins Hospital, 1800 Orleans St, Suite 2058 B, Baltimore - 21205, Maryland, USA. E-mail:
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Neri E, Mantarro A, Faggioni L, Scalise P, Bemi P, Pancrazi F, D'Ippolito G, Bartolozzi C. CT colonography with rectal iodine tagging: Feasibility and comparison with oral tagging in a colorectal cancer screening population. Eur J Radiol 2015; 84:1701-7. [PMID: 26032131 DOI: 10.1016/j.ejrad.2015.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate feasibility, diagnostic performance, patient acceptance, and overall examination time of CT colonography (CTC) performed through rectal administration of iodinated contrast material. MATERIALS AND METHODS Six-hundred asymptomatic subjects (male:female=270:330; mean 63 years) undergoing CTC for colorectal cancer screening on an individual basis were consecutively enrolled in the study. Out of them, 503 patients (group 1) underwent CTC with rectal tagging, of which 55 had a total of 77 colonic lesions. The remaining 97 patients (group 2) were randomly selected to receive CTC with oral tagging of which 15 had a total of 20 colonic lesions. CTC findings were compared with optical colonoscopy, and per-segment image quality was visually assessed using a semi-quantitative score (1=poor, 2=adequate, 3=excellent). In 70/600 patients (11.7%), CTC was performed twice with both types of tagging over a 5-year follow-up cancer screening program. In this subgroup, patient acceptance was rated via phone interview two weeks after CTC using a semi-quantitative scale (1=poor, 2=fair, 3=average, 4=good, 5=excellent). RESULTS Mean per-polyp sensitivity, specificity, positive and negative predictive values of CTC with rectal vs oral tagging were 96.1% (CI95% 85.4÷99.3%) vs 89.4% (CI95% 65.4÷98.1%), 95.3% (CI95% 90.7÷97.8%) vs 95.8% (CI95% 87.6÷98.9%), 86.0% (CI95% 73.6÷93.3) vs 85.0% (CI95% 61.1÷96.0%), and 98.8% (CI95% 95.3÷99.8%) vs 97.2% (CI95% 89.4÷99.5%), respectively (p>0.05). Polyp detection rates were not statistically different between groups 1 and 2 (p>0.05). Overall examination time was significantly shorter with rectal than with oral tagging (18.3±3.5 vs 215.6±10.3 minutes, respectively; p<0.0001). CONCLUSIONS Rectal iodine tagging can be an effective alternative to oral tagging for CTC with the advantages of greater patient acceptance and lower overall examination time.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Annalisa Mantarro
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Paola Scalise
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Pietro Bemi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Francesca Pancrazi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Giuseppe D'Ippolito
- Federal University of São Paulo - Sena Madureira 1500 - Vila Mariana, UNIFESP, São Paulo, SP, Brazil
| | - Carlo Bartolozzi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Meric K, Bakal N, Aydin S, Yesil A, Tekesin K, Simsek M. Fecal tag CT colonography with a limited 2-day bowel preparation following incomplete colonoscopy. Jpn J Radiol 2015; 33:329-35. [PMID: 25895857 DOI: 10.1007/s11604-015-0421-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/08/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to assess the feasibility and patient tolerance of a 2-day limited fecal tag bowel preparation in computed tomographic colonography (CTC) performed for incomplete conventional colonoscopy (CC) patients. MATERIALS AND METHODS Seventy-five patients who underwent a CTC examination fbecause of incomplete CC were included. A low-residue diet was given for 2 days before CTC. Fecal tagging (FT) was done using a barium sulfate suspension. The quality of the preparation, success of tagging and patient experience with the bowel preparation were investigated. RESULTS Four hundred fifty bowel segments were evaluated. The number of solid stool balls of 6-9 mm size was 284; the corresponding figure was 93 for solid stool balls ≥ 10 mm. Residual fluid was present in about one-third of the segments. The fecal tagging efficacy for ≥ 6 mm residual stool balls was 92 %. Overall, 16 (21.3 %) patients presented with colonic lesions at CTC. Three out of four colonic mass lesions had not been diagnosed with CC. Most patients reported mild discomfort. CONCLUSION FT-CTC performed after a limited 2-day bowel preparation seems to be a technically feasible, safe and acceptable procedure that allows a complete a colonic study in incomplete CC patients.
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Affiliation(s)
- Kaan Meric
- Department of Radiology, Haydarpaşa Numune Training and Research Hospital, Tibbiye Caddesi No: 40, 34668, Uskudar, Istanbul, Turkey,
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Singh K, Narula AK, Thukral CL, Singh NR, Singh A, Kaur H. Role of CT Colonography in Colonic Lesions and Its Correlation with Conventional Colonoscopic Findings. J Clin Diagn Res 2015; 9:TC14-8. [PMID: 26023619 DOI: 10.7860/jcdr/2015/12686.5853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 03/09/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Preoperative evaluation in patients with colorectal carcinoma is essential for a correct therapeutic plan. Conventional colonoscopy has certain limitations including its inability to detect synchronous lesions in case of distal obstructive mass and inaccurate tumour localization. CT colonography combines cross sectional imaging with virtual colonoscopic images and offers a comprehensive preoperative evaluation in patients with colorectal carcinoma including detection of synchronous lesions with accurate segmental localization and loco regional staging. AIM The objective was to determine the role of CT colonography in various colonic lesions and to correlate the findings with conventional colonoscopy and histopathological findings. SETTINGS AND DESIGN This prospective study included 50 patients with clinical symptoms suspicious of colonic pathology. MATERIALS AND METHODS All the patients underwent both CT colonography and conventional colonoscopy on the same day. CT colonography was performed in supine and prone position. Considering histopathological and/or surgical findings as gold standard, sensitivity and specificity of both the modalities were calculated. RESULTS Conventional colonoscopy missed two synchronous lesions proximal to occlusive mass and one lesion proximal to the anastomotic site; all were detected with CT colonography. One carpet lesion in rectum and one case of mild ulcerative colitis were missed by CT colonography. Sensitivity and specificity for detection of colorectal cancer were 97.56% and 100%, resp. with PPV and NPV of 100% and 93.75%, for CT colonography and 92.68% and 100%, respectively with PPV and NPV of 100% and 83.3% for conventional colonoscopy. Sensitivity for correct detection of acute and chronic ulcerative colitis of CT colonography was 66.6 % and 100 %, resp. CONCLUSION CT colonography has higher sensitivity than conventional colonoscopy for detection of colorectal carcinoma, including its ability to detect abnormalities proximal to obstructing lesion, accurate segmental localization of lesions and staging. However, some limitations of CT colonography were difficulty in detection of flat lesions and lack of information about hyperemia and superficial mucosal erosion, where conventional colonoscopy scored over CT colonography.
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Affiliation(s)
- Kunwarpal Singh
- Assistant Professor, Department of Radiodiagnosis, Sri Guru Ram Das Institute of Medical Sciences and Research , Vallah, Amritsar, India
| | - Aparna Kaur Narula
- Post Graduate, Department of Radiodiagnosis, Sri Guru Ram Das Institute of Medical Sciences and Research , Vallah, Amritsar, India
| | - Chuni Lal Thukral
- Professor and Head, Department of Radiodiagnosis, Sri Guru Ram Das Institute of Medical Sciences and Research , Vallah, Amritsar, India
| | - Neeti Rajan Singh
- Professor, Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research , Vallah, Amritsar, India
| | - Amandeep Singh
- Assistant Professor, Department of Radiodiagnosis, Sri Guru Ram Das Institute of Medical Sciences and Research , Vallah, Amritsar, India
| | - Harmeet Kaur
- Senior Resident, Department of Radiodiagnosis, Sri Guru Ram Das Institute of Medical Sciences and Research , Vallah, Amritsar, India
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Spada C, Hassan C, Barbaro B, Iafrate F, Cesaro P, Petruzziello L, Minelli Grazioli L, Senore C, Brizi G, Costamagna I, Alvaro G, Iannitti M, Salsano M, Ciolina M, Laghi A, Bonomo L, Costamagna G. Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial. Gut 2015; 64:272-81. [PMID: 24964317 DOI: 10.1136/gutjnl-2013-306550] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In case of incomplete colonoscopy, several radiologic methods have traditionally been used, but more recently, capsule endoscopy was also shown to be accurate. Aim of this study was to compare colon capsule endoscopy (CCE) and CT colonography (CTC) in a prospective cohort of patients with incomplete colonoscopy. DESIGN Consecutive patients with a previous incomplete colonoscopy underwent CCE and CTC followed by colonoscopy in case of positive findings on either test (polyps/mass lesions ≥6 mm). Clinical follow-up was performed in the other cases to rule out missed cancer. CTC was performed after colon capsule excretion or 10-12 h postingestion. Since the gold standard colonoscopy was performed only in positive cases, diagnostic yield and positive predictive values of CCE and CTC were used as study end-points. RESULTS 100 patients were enrolled. CCE and CTC were able to achieve complete colonic evaluation in 98% of cases. In a per-patient analysis for polyps ≥6 mm, CCE detected 24 patients (24.5%) and CTC 12 patients (12.2%). The relative sensitivity of CCE compared to CTC was 2.0 (95% CI 1.34 to 2.98), indicating a significant increase in sensitivity for lesions ≥6 mm. Of larger polyps (≥10 mm), these values were 5.1% for CCE and 3.1% for CTC (relative sensitivity: 1.67 (95% CI 0.69 to 4.00)). Positive predictive values for polyps ≥6 mm and ≥10 mm were 96% and 85.7%, and 83.3% and 100% for CCE and CTC, respectively. No missed cancer occurred at clinical follow-up of a mean of 20 months. CONCLUSIONS CCE and CTC were of comparable efficacy in completing colon evaluation after incomplete colonoscopy; the overall diagnostic yield of colon capsule was superior to CTC. TRIAL REGISTRATION NUMBER NCT01525940.
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Affiliation(s)
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Brunella Barbaro
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | - Franco Iafrate
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Paola Cesaro
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | | | | | - Carlo Senore
- Epidemiologia dei Tumori II, AOU S Giovanni Battista-CPO Piemonte Torino, Torino, Italy
| | - Gabriella Brizi
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | | | - Giuseppe Alvaro
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | - Marcella Iannitti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Marco Salsano
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
| | - Maria Ciolina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy
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Abstract
BACKGROUND Computed tomography-colonography is a diagnostic modality that can be used when the colon is not completely intubated during colonoscopy. It may have the additional advantage that information on extracolonic lesions can be obtained. OBJECTIVE The aim of this study was to investigate the yield of CT-colonography of relevant intra- and extracolonic findings in patients after incomplete colonoscopy. DESIGN This was an observational, retrospective study. DATA SOURCES Data were be obtained from standardized radiology and endoscopy reports and electronic medical records. STUDY SELECTION In total, 136 consecutive CT-colonographies performed after incomplete colonoscopy were evaluated. MAIN OUTCOME MEASURES All intra- and extracolonic findings on CT-colonography were recorded and interpreted for clinical relevance, and it was determined whether further diagnostic and/or therapeutic workup was indicated. RESULTS Major indications for colonoscopy included iron-deficiency anemia (25.7%), hematochezia (20.6%), change in bowel habits (18.4%), and colorectal cancer screening or surveillance (11.0%). Major reasons for incomplete colonoscopy were a fixed colon (34.6%) and strong angulation of the sigmoid colon (17.6%). Introduction of the colonoscope was limited to the left-sided colon in 53.7% of cases. Incomplete colonoscopy detected colorectal cancer in 12 (8.8%) patients and adenomatous polyps in 27 (19.9%) patients. CT-colonography after incomplete colonoscopy additionally revealed 19 polyps in 15 (11.0%) and a nonsynchronous colorectal cancer in 4 (2.9%) patients. CT-colonography also detected extracolonic findings with clinical consequences in 8 (5.9%) patients, including fistulizing diverticulitis (n = 3), gastric tumor (n = 2), liver abscess (n = 1), osteomyelitis (n = 1), and an infected embolus in both renal arteries (n = 1). LIMITATIONS This study was limited by the lack of confirmation of intraluminal CT-colonography findings in a subset of patients. CONCLUSIONS Computed tomography-colonography can be of added value in patients with incomplete colonoscopy, because it revealed 27 relevant additional (both intra- and extracolonic) lesions in 19.1% of patients. In cases where CT-colonography detected colorectal cancer after incomplete colonoscopy, it can also be used for staging purposes.
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Incomplete colonoscopy: maximizing completion rates of gastroenterologists. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 26:589-92. [PMID: 22993727 DOI: 10.1155/2012/353457] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear. OBJECTIVES To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure. METHODS All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul's Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively. RESULTS A total of 90 patients (29 males) with a mean (± SD) age of 58 ± 13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture). CONCLUSION Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.
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The second ESGAR consensus statement on CT colonography. Eur Radiol 2012; 23:720-9. [PMID: 22983280 PMCID: PMC3563960 DOI: 10.1007/s00330-012-2632-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 03/18/2012] [Accepted: 04/01/2012] [Indexed: 12/14/2022]
Abstract
Objective To update quality standards for CT colonography based on consensus among opinion leaders within the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Material and methods A multinational European panel of nine members of the ESGAR CT colonography Working Group (representing six EU countries) used a modified Delphi process to rate their level of agreement on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval. Results The panel elaborated 86 statements. In the final round the panelists achieved complete consensus in 71 of 86 statements (82 %). Categories including the highest proportion of statements with excellent Cronbach's internal reliability were colon distension, scan parameters, use of intravenous contrast agents, general guidelines on patient preparation, role of CAD and lesion measurement. Lower internal reliability was achieved for the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading, and reporting. Conclusion The recommendations of the consensus should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating. Key Points • Computed tomographic colonography is the optimal radiological method of assessing the colon • This article reviews ESGAR quality standards for CT colonography • This article is aimed to provide CT-colonography guidelines for practising radiologists • The recommendations should help radiologists who are starting/updating their CTC services
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Neri E, Faggioni L, Vagli P, Cerri F, Picano E, Angeli S, Cini L, Bartolozzi C. Patients' preferences about follow-up of medium size polyps detected at screening CT colonography. ACTA ACUST UNITED AC 2012; 36:713-7. [PMID: 21161217 DOI: 10.1007/s00261-010-9671-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate patients' preferences regarding follow-up of medium size polyps detected at screening CT colonography (CTC). METHODS AND MATERIALS 193 C-RADS2 asymptomatic patients were asked to fill in a form explaining the indications, technique and potential complications of CTC, and were invited to choose their preferred examination technique (CTC or optical colonoscopy: OC) and their follow-up interval by repeated consultations at 3-month intervals. The follow-up interval for CTC and OC was recorded. RESULTS 87/193 C-RADS2 patients (45.1%) accepted follow-up. Average time interval for follow-up was comparable between CTC and OC (9.00 ± 4.24 vs. 9.00 ± 4.39 months, respectively; P = 0.7188). No patients chose to undergo a 3-year follow-up with either CTC or OC. Most patients elected to have follow-up with either CTC or OC before 18 months rather than later (P = 0.0004). CONCLUSIONS A substantial fraction of C-RADS2 patients prefer to undergo immediate OC and polyp removal rather than follow-up, and the majority of those accepting follow-up are willing to wait for less than 18 months. Such findings may suggest a revision of the proposed C-RADS2 category.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
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Sali L, Falchini M, Della Monica P, Regge D, Bonanomi AG, Castiglione G, Grazzini G, Zappa M, Mungai F, Volpe C, Mascalchi M. CT colonography before colonoscopy in subjects with positive faecal occult blood test. Preliminary experience. Radiol Med 2010; 115:1267-78. [PMID: 20680499 DOI: 10.1007/s11547-010-0569-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/06/2009] [Indexed: 01/22/2023]
Abstract
PURPOSE We report a preliminary evaluation of the performance of computed tomography colonography (CTC) systematically obtained before optical colonoscopy (OC) in subjects with positive faecal occult blood test (FOBT) within a population-based screening programme for colorectal cancer (CRC). MATERIALS AND METHODS Seventy-nine subjects with positive FOBT from a regional screening programme were invited to perform same day CTC and OC. CTC was performed with standard bowel preparation. OC with segmental unblinding was the reference standard. A per-patient per-adenoma analysis was performed. RESULTS Forty-nine of 79 subjects (62%) with positive FOBT adhered to the study and completed both examinations. Twenty-two (44.9%) of the 49 had a cancer or an adenoma ≥6 mm. Per-patient sensitivity, specificity, negative predictive value and positive predictive value for cancer or adenoma ≥6 mm were 95.5% (95%CI:77.2%-99.9%), 51.9% (95%CI:32.0%-71.3%), 93.3% (95%CI:68.1%-99.8%) and 61.8% (95%CI:43.6%-77.8%). CONCLUSIONS In the setting of a FOBT-based screening programme for CRC, CTC showed a high sensitivity, but relatively low specificity and positive predictive value, for cancer and adenoma ≥6 mm. Probably performing CTC without faecal tagging as second line test after a positive FOBT is not a cost-effective strategy.
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Affiliation(s)
- L Sali
- Radiodiagnostic Section--Department of Clinical Physiopathology, University of Florence, Viale G.B. Morgagni 85, Florence, Italy.
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Current techniques in the performance, interpretation, and reporting of CT colonography. Gastrointest Endosc Clin N Am 2010; 20:169-92. [PMID: 20451809 DOI: 10.1016/j.giec.2010.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The technical objective of computed tomographic colonography (CTC) is to acquire high-quality computed tomography images of the cleansed, well-distended colon for polyp detection. In this article the authors provide an overview of the technical components of CTC, from preparation of the patient to acquisition of the imaging data and basic methods of interpretation. In each section, the best evidence for current practices and recommendations is reviewed. Each of the technical components must be optimized to achieve high sensitivity in polyp detection.
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Nagata K, Singh AK, Sangwaiya MJ, Näppi J, Zalis ME, Cai W, Yoshida H. Comparative evaluation of the fecal-tagging quality in CT colonography: barium vs. iodinated oral contrast agent. Acad Radiol 2009; 16:1393-9. [PMID: 19596591 DOI: 10.1016/j.acra.2009.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 05/12/2009] [Accepted: 05/18/2009] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this evaluation was to compare the tagging quality of a barium-based regimen with that of iodine-based regimens for computed tomographic (CT) colonography. MATERIALS AND METHODS Tagging quality was assessed retrospectively in three different types of fecal-tagging CT colonographic cases: 24 barium-based cases, 22 nonionic iodine-based cases, and 24 ionic iodine-based cases. For the purpose of evaluation, the large intestine was divided into six segments, and the tagging homogeneity of a total of 420 segments (70 patients) was graded by three blinded readers from 0 (heterogeneous) to 4 (homogeneous). RESULTS For barium-based cases, the average score for the three readers was 2.4, whereas it was 3.4 for nonionic iodine and 3.6 for ionic iodine. The percentages of segments that were assigned scores of 4 (excellent tagging [100%]) were 11.6%, 61.9%, and 72.9% for the barium-based, nonionic iodine-based, and ionic iodine-based regimens, respectively. The homogeneity scores of iodine-based fecal-tagging regimens were significantly higher than those of the barium-based fecal-tagging regimen (P < .001). The CT attenuation values of tagging in the cases were also assessed: the minimum and maximum values were significantly higher for the iodine-based regimens than for the barium-based regimen (P < .001). CONCLUSIONS The iodine-based fecal-tagging regimens provide significantly greater homogeneity in oral-tagging fecal material than the barium-based fecal-tagging regimen. Iodine-based fecal-tagging regimens can provide an appropriate method for use in nonlaxative or minimum-laxative CT colonography.
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Affiliation(s)
- Koichi Nagata
- 3D Imaging Laboratory, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 25 New Chardon Street, Suite 400C, Boston, MA 02114, USA.
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Campanella D, Morra L, Delsanto S, Tartaglia V, Asnaghi R, Bert A, Neri E, Regge D. Comparison of three different iodine-based bowel regimens for CT colonography. Eur Radiol 2009; 20:348-58. [PMID: 19711082 DOI: 10.1007/s00330-009-1553-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 07/13/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to compare the computed tomographic colonography (CTC) image quality and patient acceptance of three iodine-based faecal tagging bowel preparations in 60 patients undergoing the following regimens: a 2-day regimen of meal-time administration of iodine and phospho-soda (GFPH); a 2-day regimen of meal-time mild laxative, followed by iodine administered 2 h before CTC (SD); and a 2-day regimen of meal-time administration of iodine (GF). METHODS Two independent radiologists assessed tagging quality; quantitative measures included the tagged stool density, and computer-aided detection (CAD) false-positive rate. RESULTS The GFPH and SD regimens provided better subjective quality than GF (p < 0.001). The latter regimen resulted in a higher proportion of insufficiently tagged segments: the measured average stool density was less than 200 HU in 10.7% in all segments vs 3.6% for SD and <0.5% for GFPH, respectively. Insufficient tagging occurred mostly in the ascending colon and the caecum. The CAD false-positive rate increased following the trend: GFPH < SD < GF (p = 0.00012). GFPH was worse tolerated than SD (p < 0.05). CONCLUSIONS Considering preparation quality alone, GFPH was the best regimen, but SD provided the best balance between bowel preparation quality and patient acceptability.
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Affiliation(s)
- Delia Campanella
- Radiology Unit, Institute for Cancer Research and Treatment, Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
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CT colonography with minimal bowel preparation: evaluation of tagging quality, patient acceptance and diagnostic accuracy in two iodine-based preparation schemes. Eur Radiol 2009; 20:367-76. [PMID: 19707769 PMCID: PMC2814044 DOI: 10.1007/s00330-009-1570-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 07/01/2009] [Accepted: 07/22/2009] [Indexed: 01/11/2023]
Abstract
Purpose The aim of this study was to compare a 1-day with a 2-day iodine bowel preparation for CT colonography in a positive faecal occult blood test (FOBT) screening population. Materials and methods One hundred consecutive patients underwent CT colonography and colonoscopy with segmental unblinding. The first 50 patients (group 1) ingested 7*50 ml iodinated contrast starting 2 days before CT colonography. The latter 50 patients (group 2) ingested 4*50 ml iodinated contrast starting 1 day before CT colonography. Per colonic segment measurements of residual stool attenuation and homogeneity were performed, and a subjective evaluation of tagging quality (grade 1–5) was done. Independently, two reviewers performed polyp and carcinoma detection. Results The tagging density was 638 and 618 HU (p = 0.458) and homogeneity 91 and 86 HU for groups 1 and 2, respectively (p = 0.145). The tagging quality was graded 5 (excellent) in 90% of all segments in group 1 and 91% in group 2 (p = 0.749). Mean per-polyp sensitivity for lesions ≥10 mm was 86% in group 1 and 97% in group 2 (p = 0.355). Patient burden from diarrhoea significantly decreased for patients in group 2. Conclusions One-day preparation with meglumine ioxithalamate results in an improved patient acceptability compared with 2-day preparation and has a comparable, excellent image quality and good diagnostic performance.
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Abstract
CT colonography (CTC), also termed virtual colonoscopy, is increasingly accepted at sites throughout the world as a new effective tool for the diagnosis and screening of colorectal carcinoma. This article presents information of related issues of bowel cleansing, stool and fluid tagging, bowel distention and multidetector CT scanning parameters. The author presents discussion of interpretation of CTC, appropriate applications of CTC and potential complications.
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Affiliation(s)
- Judy Yee
- University of California, San Francisco, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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de Vries AH, Liedenbaum MH, Bipat S, Truyen R, Serlie IWO, Cohen RH, van Elderen SGC, Heutinck A, Kesselring O, de Monyé W, te Strake L, Wiersma T, Stoker J. Primary uncleansed 2D versus primary electronically cleansed 3D in limited bowel preparation CT-colonography. Is there a difference for novices and experienced readers? Eur Radiol 2009; 19:1939-50. [PMID: 19301011 PMCID: PMC2705716 DOI: 10.1007/s00330-009-1360-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 01/01/2009] [Accepted: 01/26/2009] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to compare a primary uncleansed 2D and a primary electronically cleansed 3D reading strategy in CTC in limited prepped patients. Seventy-two patients received a low-fibre diet with oral iodine before CT-colonography. Six novices and two experienced observers reviewed both cleansed and uncleansed examinations in randomized order. Mean per-polyp sensitivity was compared between the methods by using generalized estimating equations. Mean per-patient sensitivity, and specificity were compared using the McNemar test. Results were stratified for experience (experienced observers versus novice observers). Mean per-polyp sensitivity for polyps 6 mm or larger was significantly higher for novices using cleansed 3D (65%; 95%CI 57–73%) compared with uncleansed 2D (51%; 95%CI 44–59%). For experienced observers there was no significant difference. Mean per-patient sensitivity for polyps 6 mm or larger was significantly higher for novices as well: respectively 75% (95%CI 70–80%) versus 64% (95%CI 59–70%). For experienced observers there was no statistically significant difference. Specificity for both novices and experienced observers was not significantly different. For novices primary electronically cleansed 3D is better for polyp detection than primary uncleansed 2D.
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Affiliation(s)
- Ayso H de Vries
- Department of Radiology Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Singh AK, Hiroyuki Y, Sahani DV. Advanced Postprocessing and the Emerging Role of Computer-Aided Detection. Radiol Clin North Am 2009; 47:59-77. [DOI: 10.1016/j.rcl.2008.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kim MJ, Park SH, Lee SS, Byeon JS, Choi EK, Kim JH, Kim YN, Kim AY, Ha HK. Efficacy of barium-based fecal tagging for CT colonography: a comparison between the use of high and low density barium suspensions in a Korean population - a preliminary study. Korean J Radiol 2009; 10:25-33. [PMID: 19182500 PMCID: PMC2647168 DOI: 10.3348/kjr.2009.10.1.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 11/11/2008] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This preliminarily study was designed to determine and to compare the efficacy of two commercially available barium-based fecal tagging agents for CT colonography (CTC) (high-density [40% w/v] and low-density [4.6% w/v] barium suspensions) in a population in Korea. MATERIALS AND METHODS In a population with an identified with an average-risk for colorectal cancer, 15 adults were administered three doses of 20 ml 40% w/v barium for fecal tagging (group I) and 15 adults were administered three doses of 200 ml 4.6% w/v barium (group II) for fecal tagging. Excluding five patients in group I and one patient in group II that left the study, ten patients in group I and 14 patients in group II were finally included in the analysis. Two experienced readers evaluated the CTC images in consensus regarding the degree of tagging of stool pieces 6 mm or larger. Stool pieces were confirmed with the use of standardized CTC criteria or the absence of matched lesions as seen on colonoscopy. The rates of complete fecal tagging were analyzed on a per-lesion and a per-segment basis and were compared between the patients in the two groups. RESULTS Per-lesion rates of complete fecal tagging were 52% (22 of 42; 95% CI, 37.7-66.6%) in group I and 78% (28 of 36; 95% CI, 61.7-88.5%) in group II. The difference between the two groups did not reach statistical significance (p = 0.285). The per-segment rates of complete tagging were 33% (6 of 18; 95% CI, 16.1%-56.4%) in group I and 60% (9 of 15; 95% CI, 35.7%-80.3%) in group II; again, the difference between the two groups did not reach statistical significance (p = 0.171). CONCLUSION Barium-based fecal tagging using both the 40% w/v and the 4.6% w/v barium suspensions showed moderate tagging efficacy. The preliminary comparison did not demonstrate a statistically significant difference in the tagging efficacy between the use of the two tagging agents, despite the tendency toward better tagging with the use of the 4.6% w/v barium suspension.
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Affiliation(s)
- Min Ju Kim
- Department of Radiology and Research Institute of Radiology and Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
- National Cancer Center, Gyeonggi-do 410-769, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology and Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology and Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Jeong-Sik Byeon
- Department of Radiology and Research Institute of Radiology and Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Eugene K. Choi
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jung Hoon Kim
- Department of Radiology, Asan Medical Center, Seoul 138-736, Korea
| | - Yeoung Nam Kim
- Department of Radiology, Asan Medical Center, Seoul 138-736, Korea
| | - Ah Young Kim
- Department of Radiology and Research Institute of Radiology and Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
| | - Hyun Kwon Ha
- Department of Radiology and Research Institute of Radiology and Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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Sali L, Falchini M, Bonanomi AG, Castiglione G, Ciatto S, Mantellini P, Mungai F, Menchi I, Villari N, Mascalchi M. CT colonography after incomplete colonoscopy in subjects with positive faecal occult blood test. World J Gastroenterol 2008; 14:4499-504. [PMID: 18680229 PMCID: PMC2731276 DOI: 10.3748/wjg.14.4499] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To report our experience with computed tomography colonography (CTC) systematically performed in subjects with positive faecal occult blood test (FOBT) and an incomplete colonoscopy in the setting of a population-based screening for colorectal cancer (CRC).
METHODS: From April 2006 to April 2007, 43 290 individuals (age range 50-70) who adhered to the regional screening program for the prevention of CRC underwent immunochemical FOBT. FOBT was positive in 1882 subjects (4.3%). 1463 (77.7%) of these subjects underwent colonoscopy, 903 performed in a single center. Of 903 colonoscopies 65 (7.2%) were incomplete. Forty-two of these subjects underwent CTC. CTC was performed with a 16-MDCT scanner after standard bowel prep (polyethylene glycole) in both supine and prone position. Subjects whose CTC showed polyps or masses were referred to the endoscopist for repeat colonoscopy under sedation or underwent surgery. Per-lesion and per-segment positive predictive values (PPV) were calculated.
RESULTS: Twenty-one (50%) of 42 CTCs showed polyps or masses. Fifty-five of these subjects underwent a repeat colonoscopy, whereas 2 subjects underwent surgery for colonic masses of indeterminate nature. Four subjects refused further examinations. CTC correctly identified 2 colonic masses and 20 polyps. PPV for masses or polyps greater than 9 mm was of 87.5%. Per-lesion and per-segment PPV were, respectively, 83.3% and 83.3% for polyps greater or equal to 10 mm, and 77.8% and 85.7% for polyps of 6-9 mm.
CONCLUSION: In the context of a screening program for CRC based on FOBT, CTC shows high per-segment and per-lesion PPV for colonic masses and polyps greater than 9 mm. Therefore, CTC has the potential to become a useful technique for evaluation of the non visualized part of the colon after incomplete colonoscopy.
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Juchems MS, Ernst AS, Brambs HJ, Aschoff AJ. Computer-aided detection in computer tomography colonography: a review. ACTA ACUST UNITED AC 2008; 2:487-95. [DOI: 10.1517/17530059.2.5.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Iafrate F, Hassan C, Zullo A, Stagnitti A, Ferrari R, Spagnuolo A, Laghi A. CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly. Eur Radiol 2008; 18:1385-95. [PMID: 18351357 DOI: 10.1007/s00330-008-0892-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 12/13/2007] [Accepted: 01/31/2008] [Indexed: 12/18/2022]
Abstract
We prospectively assessed the feasibility and acceptance of computerized tomographic colonography (CTC) without bowel cathartic preparation in elderly patients after incomplete colonoscopy. A total of 136 patients underwent CTC without cathartic preparation. The time delay between conventional colonoscopy and CTC ranged between 3 and 20 days, depending on the clinical situation. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. CTCs were interpreted using a primary two-dimensional (2D) approach and 3D images for further characterization. Patients were interviewed before and 2 weeks after CTC to assess preparation acceptance. CTC was feasible and technically successful in all the 136 patients. Fecal tagging was judged as excellent in 113 (83%) patients and sufficient in 23 (17%). Average CT image interpretation time was 14.8 min. Six (4.4%) cases of colorectal cancer and nine (6.6%) large polyps were detected, as well as 23 (11.3%) extracolonic findings of high clinical importance. No major side effect occurred, although 25% patients reported minor side effects, especially diarrhea. Overall, 76/98 patients replied that they would be willing to repeat the test if necessary. CTC without cathartic preparation is a technically feasible and safe procedure to complete a colonic study in the elderly, prompting its use in clinical practice.
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Affiliation(s)
- F Iafrate
- Department of Radiological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy.
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Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol 2008; 190:374-85. [PMID: 18212223 DOI: 10.2214/ajr.07.2099] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of our study was to perform a meta-analysis comparing the performance of double-contrast barium enema (DCBE) with CT colonography (CTC) for the detection of colorectal polyps > or = 6 mm using endoscopy as the gold standard. MATERIALS AND METHODS Prospective DCBE and CTC studies were identified. Percentages of polyps and of patients with polyps > or = 10 mm and 6-9 mm were abstracted. The performance of DCBE versus CTC was determined by separately evaluating each technique's performance versus that of endoscopy, and contrasting the techniques. The I-squared statistic and Fisher's exact test were used for heterogeneity, the Cochran-Mantel-Haenszel and the Kruskal-Wallis tests for correlation, and the A(z) test for comparing pooled weighted estimates of performance. RESULTS Eleven studies of DCBE (5,995 patients, 1,548 polyps) and 30 studies of CTC (6,573 patients, 2,348 polyps) fulfilled inclusion criteria. For polyps > or = 10 mm, a 0.121-per-patient sensitivity difference favored CTC (p < 0.0001; DCBE, 0.702 [95% CI, 0.687-0.715]; CTC, 0.823 [0.809-0.836]). For polyps > or = 10 mm, a 0.031-per-polyp sensitivity difference favored CTC (p < 0.0001; DCBE, 0.715 [0.703-0.726]; CTC, 0.746 [0.735-0.757]). For polyps > or = 10 mm, a specificity difference of 0.104 favored CTC (p = 0.001; DCBE, 0.850 [0.847-0.855]; CTC, 0.954 [0.952-0.955]). DCBE was also significantly less sensitive for 6- to 9-mm polyps (p < 0.001). CONCLUSION DCBE has statistically lower sensitivity and specificity than CTC for detecting colorectal polyps > or = 6 mm.
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CT Colonography for Incomplete or Contraindicated Optical Colonoscopy in Older Patients. AJR Am J Roentgenol 2008; 190:145-50. [DOI: 10.2214/ajr.07.2633] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hartmann D, Riemann JF. Colorectal Polyps. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Aschoff AJ, Ernst AS, Brambs HJ, Juchems MS. CT colonography: an update. Eur Radiol 2007; 18:429-37. [PMID: 17899101 DOI: 10.1007/s00330-007-0764-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 07/25/2007] [Accepted: 08/24/2007] [Indexed: 12/19/2022]
Abstract
Computed tomographic (CT) colonography (CTC)--also known as "virtual colonoscopy"--was first described more than a decade ago. As advancements in scanner technology and three-dimensional (3D) postprocessing helped develop this method to mature into a potential option in screening for colorectal cancer, the fundamentals of the examination remained the same. It is a minimally invasive, CT-based procedure that simulates conventional colonoscopy using 2D and 3D computerized reconstructions. The primary aim of CTC is the detection of colorectal polyps and carcinomas. However, studies reveal a wide performance variety in regard to polyp detection, especially for smaller polyps. This article reviews the available literature, discusses established indications as well as open issues and highlights potential future developments of CTC.
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Affiliation(s)
- Andrik J Aschoff
- Diagnostic and Interventional Radiology, University Hospitals of Ulm, Steinhoevelstr. 9, 89070, Ulm, Germany.
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Langhorst J, Kühle CA, Ajaj W, Nüfer M, Barkhausen J, Michalsen A, Dobos GJ, Lauenstein TC. MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: diagnostic accuracy and patient acceptance. Inflamm Bowel Dis 2007; 13:1001-8. [PMID: 17352384 DOI: 10.1002/ibd.20140] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The purpose of this pilot study was to assess the diagnostic accuracy of MR colonography (MRC) without bowel cleansing regarding its ability to quantify inflammatory bowel disease (IBD). In addition, patient acceptance was compared with conventional colonoscopy (CC). METHODS In all, 29 patients with IBD (17 ulcerative colitis; 12 Crohn's disease) were included. While CC was performed after bowel cleansing as the gold standard, MRC was based on a fecal tagging technique and performed 48-72 hours prior to CC. The presence of inflammation in each of 7 ileocolonic segments was rated for every procedure. Patients evaluated both modalities and dedicated aspects of the examination according to a 10-point-scale (1 = good, 10 = poor acceptance). Furthermore, preferences for future examinations were investigated. RESULTS Inflammatory segments were found by means of CC in 23 and by MRC in 14 patients. Overall sensitivity and specificity of MRC in a segment-based detection were 32% and 88%, respectively. Concerning severely inflamed segments, sensitivity increased to 53% for MRC. Overall acceptance of CC was significantly higher compared to MRC (mean value (mv) for MRT = 6.0; CC = 4.1; P = 0.003). For MRC, the placement of the rectal tube (mv = 7.3), and for CC bowel purgation (mv = 6.5), were rated as the most unpleasant. A total of 67% of patients voted for CC as the favorable tool for future examinations. CONCLUSIONS The presented data indicate that 'fecal tagging MRC' is not suitable for an adequate quantification of inflammatory diseases of the large bowel. Furthermore, overall acceptance of endoscopic colonoscopy was superior to MRC.
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Affiliation(s)
- Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Germany.
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Abstract
Published results to date have indicated a good per patient sensitivity of computed tomographic colonography (CTC) for colorectal cancer and for polyps measuring 10 mm or more together with a very good specificity. Sensitivity and specificity for polyps in the range of 6-10 mm are moderate. These results, however, can be achieved only with meticulous attention to technique including adequate colonic distention, and acquisition of supine and prone thin-section computed tomographic (CT) images. Moreover, there is a significant learning curve involved in the interpretation of CTC studies, with performance statistics improving with operator experience. Radiologists must be comfortable in reporting directly from workstation monitors and have access to and be familiar with software for multiplanar and endoluminal reconstructions. In addition to maximize polyp detection and minimize false positive results, reporting radiologists must have a working knowledge of normal colorectal anatomy and pathology on CTC and be familiar with potential pitfalls in interpretation. Besides the description of several possible causes for perceptive errors, also a literature search of perceptive errors in CTC is included in this paper.
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Affiliation(s)
- C Y Nio
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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van Gelder RE, Florie J, Nio CY, Jensch S, de Jager SW, Vos FM, Venema HW, Bartelsman JF, Reitsma JB, Bossuyt PMM, Laméris JS, Stoker J. A comparison of primary two- and three-dimensional methods to review CT colonography. Eur Radiol 2006; 17:1181-92. [PMID: 17119975 DOI: 10.1007/s00330-006-0487-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Revised: 08/28/2006] [Accepted: 09/28/2006] [Indexed: 11/29/2022]
Abstract
The aim of our study was to compare primary three-dimensional (3D) and primary two-dimensional (2D) review methods for CT colonography with regard to polyp detection and perceptive errors. CT colonography studies of 77 patients were read twice by three reviewers, first with a primary 3D method and then with a primary 2D method. Mean numbers of true and false positives, patient sensitivity and specificity and perceptive errors were calculated with colonoscopy as a reference standard. A perceptive error was made if a polyp was not detected by all reviewers. Mean sensitivity for large (> or = 10 mm) polyps for primary 3D and 2D review was 81% (14.7/18) and 70%(12.7/18), respectively (p-values > or = 0.25). Mean numbers of large false positives for primary 3D and 2D were 8.3 and 5.3, respectively. With primary 3D and 2D review 1 and 6 perceptive errors, respectively, were made in 18 large polyps (p = 0.06). For medium-sized (6-9 mm) polyps these values were for primary 3D and 2D, respectively: mean sensitivity: 67%(11.3/17) and 61%(10.3/17; p-values > or = 0.45), number of false positives: 33.3 and 15.6, and perceptive errors : 4 and 6 (p = 0.53). No significant differences were found in the detection of large and medium-sized polyps between primary 3D and 2D review.
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Affiliation(s)
- Rogier E van Gelder
- Department of Radiology, Academic Medical Center of the University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Dachman AH, Dawson DO, Lefere P, Yoshida H, Khan NU, Cipriani N, Rubin DT. Comparison of routine and unprepped CT colonography augmented by low fiber diet and stool tagging: a pilot study. ACTA ACUST UNITED AC 2006; 32:96-104. [PMID: 16969601 DOI: 10.1007/s00261-006-9044-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 05/15/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND We performed a pilot study examining the feasibility of a new unprepped CT colonography (CTC) strategy: low fiber diet and tagging (unprepped) vs. low fiber diet, tagging and a magnesium citrate cleansing preparation (prepped). Prior reports of tagging were limited in that the residual stool was neither measured and stratified by size nor did prior reports subjectively evaluate the ease of interpretation by a reader experienced in interpreting CTC examinations. METHODS Prospective randomized to unprepped n = 14 and prepped n = 14. Colonic segments were subjectively evaluated for residual stool that would potentially interfere with interpretation. Scores were given in the following categories: percentage of residual stool that was touching or nearly touching mucosa, the largest piece of retained stool, effectiveness of tagging, height of residual fluid, degree of distention, ease of interpretation, and reading time. RESULTS Ease of the CT read (scale where 4 = optimal read) averaged 1.3 for the unprepped group and 2.3 for the prepped group. The mean read time averaged 17.5 min for unprepped and 17.9 min for prepped. The degree of distention (scale where 4 = well distended) averaged 3.7 for unprepped and 3.6 for prepped. Supine and prone images combined, the unprepped group had 160 segments with stool; prepped group had 58 segments. The amount of stool covering the mucosa in all segments averaged 1.6 (33%-66% coverage) in the unprepped group and 0.35 (<33% mucosal coverage) in the prepped group. The mean size of the largest piece of stool was 33.67 mm for unprepped and 4.01 mm for prepped. Percentage of tagged stool was not significantly different between the groups (range of 94-98%). The height of residual fluid averaged 8.37 mm for unprepped and 13.4 mm for prepped. Three polyps in three patients were found during optical colonoscopy (OC) in the unprepped group (5, 6, and 10 mm), none of which were prospectively detected at CTC. Three polyps in three patients were detected during OC in the prepped group (5, 10, and 15 mm), two of which were prospectively detected at CTC. Two false-positive lesions were observed at CTC in one patient in the prepped group. CONCLUSION There was more stool in the unprepped group and while this factor did not slow down the reading time, it made the examination subjectively harder to interpret and likely caused the three polyps in this group to be missed. We conclude that a truly unprepped strategy that leaves significant residual stool, even if well tagged, is not desirable.
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Affiliation(s)
- Abraham H Dachman
- Department of Radiology, The University of Chicago, MC 2026, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
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Silva AC, Vens EA, Hara AK, Fletcher JG, Fidler JL, Johnson CD. Evaluation of benign and malignant rectal lesions with CT colonography and endoscopic correlation. Radiographics 2006; 26:1085-99. [PMID: 16844933 DOI: 10.1148/rg.264055166] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Colorectal carcinoma is a significant cause of death from cancer in the United States, and early detection and treatment are critical. Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that is a potential alternative to conventional colonoscopy for colorectal cancer screening. Rectal disease (eg, polyps, cancerous lesions, extramucosal lesions, inflammatory disease) can be especially challenging to diagnose with CT colonography because of several factors that can simulate or obscure the disease (eg, over- or underdistention, rectal tube, stool, artifacts). Familiarity with the spectrum of rectal diseases and with the potential pitfalls and technical limitations of CT colonography will help minimize interpretative and perceptual errors.
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Affiliation(s)
- Alvin C Silva
- Department of Diagnostic Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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Jin KN, Lee JM, Kim SH, Shin KS, Lee JY, Han JK, Choi BI. The diagnostic value of multiplanar reconstruction on MDCT colonography for the preoperative staging of colorectal cancer. Eur Radiol 2006; 16:2284-91. [PMID: 16741717 DOI: 10.1007/s00330-006-0316-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 02/21/2006] [Accepted: 04/18/2006] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to determine whether multiplanar reconstruction (MPR) images can improve the accuracy of MDCT-based colorectal cancer preoperative staging by receiver-operating characteristic (ROC) analysis. Fifty-five patients with colorectal cancer underwent contrast-enhanced CT colonography using an 8- or 16-row scanner. Two separate interval reviews of the axial MDCT datasets with/without MPR images (coronal and sagittal) were performed independently by two radiologists blinded to both the colonoscopic and histopathologic results. At each review session, the radiologists were asked to determine the colorectal cancer TNM stage within the context of differentiating < or =T3 from T4, N0 from > or =N1 and M0 from M1 using a five-point confidence scale. The radiologists' performance for staging the colorectal cancer using axial CT datasets with/without MPR images was evaluated using ROC analysis. Sensitivities, specificities and interobserver agreement were assessed. When MPR images were added, significant improvement was achieved by both radiologists for differentiating N0 from > or =N1 in terms of both A(Z) (0.651 to 0.769; 0.573 to 0.713) and specificity (26.7 to 69.2%; 23.1 to 76.9%) (P<0.05). For T staging, ROC analysis failed to show a significant improvement in terms of differentiating < or =T3 from T4 for either radiologist (P>0.05), but a significant improvement in the specificity (70 to 90%; 80 to 92%) was achieved by one radiologist (P<0.05). In terms of the M staging, a significant improvement in the Az (0.844 to 0.996) was observed for the combined interpretation of the axial and MPR images by one radiologist (P<0.05). Furthermore, substantial or almost perfect interobserver agreement was achieved for all TNM stagings for the combined interpretations (kappa=0.641-0.866), whereas only fair to substantial agreement was achieved for the axial images alone (kappa=0.337-0.707). In conclusion, the combined interpretation of the axial and MPR MDCT images significantly improved the local staging of colorectal cancer compared with assessments based on axial images alone.
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Affiliation(s)
- Kwang Nam Jin
- Department of Radiology, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea
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Abstract
Advances in imaging techniques are changing the way radiologists undertake imaging of the gastrointestinal tract and their ability to answer questions posed by surgeons. In this paper we discuss the technological improvements of imaging studies that have occurred in the last few years and how these help to better diagnosing alimentary tract disease.
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Affiliation(s)
- Dean-Dt Maglinte
- UH 0279, Department of Radiology, 550 N, University Blvd, Indianapolis, IN 46202, USA.
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Lauenstein TC. MR colonography: current status. Eur Radiol 2006; 16:1519-26. [PMID: 16770654 DOI: 10.1007/s00330-006-0260-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 03/14/2006] [Accepted: 03/16/2006] [Indexed: 01/29/2023]
Abstract
Magnetic resonance colonography (MRC) has gained access into clinical routine as a means for the assessment of the large bowel. There are widely accepted indications for MRC, especially in patients with incomplete conventional colonoscopy. Furthermore, virtual MRC is more and more propagated as a screening tool, with advantages especially inherent to the non-invasive character of this procedure and the lack of ionizing radiation exposition. Beyond a sufficiently high diagnostic accuracy, outstanding patient acceptance is a major advantage of MRC as a diagnostic modality. This review article describes indications, techniques and clinical outcome of current MRC approaches. Furthermore, the impact of fecal tagging concepts is discussed.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Radiology, The Emory Clinic, 1365 Clifton Road, Building A, Suite AT-627, Atlanta, GA 30322, USA.
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Jensch S, van Gelder RE, Venema HW, Reitsma JB, Bossuyt PMM, Laméris JS, Stoker J. Effective radiation doses in CT colonography: results of an inventory among research institutions. Eur Radiol 2006; 16:981-7. [PMID: 16418863 DOI: 10.1007/s00330-005-0047-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 08/12/2005] [Accepted: 09/29/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to estimate the effective dose that is currently used in CT colonography using scan parameters that were collected for this purpose, and to investigate trends in time. PubMed was systematically searched from 1996 until January 2004 for studies investigating CT colonography. Research institutions were contacted and asked for their current scan protocol. Thirty-six institutions published 74 studies. Twenty-eight of the 36 institutions provided their current protocol. The median effective dose in 2004 was 5.1 mSv (range 1.2-11.7 mSv) per position. Most institutions (93%) scan in both the supine and prone positions. The median mAs value was 67 mAs (range 20-200), median collimation was 2.5 mm (range 0.75-5). From 1996 until 2004 a significant decrease in mAs and collimation (P=0.006, P<0.0001, respectively) was observed, while institutions that used a multislice scanner increased (P<0.0001). The effective dose remained constant (P=0.76). In 2004 the median effective dose for a complete CT colonography was 10.2 mSv. Despite the increasing use of multislice scanners, which are slightly less dose-efficient, the median effective dose remained approximately constant between 1996 and 2004. This is mainly caused by the use of lower mAs settings.
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Affiliation(s)
- Sebastiaan Jensch
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Lauenstein TC, Ajaj W, Kuehle CA. Virtual colonoscopy by MRI: state-of-the-art and future directions. Gastrointest Endosc Clin N Am 2005; 15:797-811. [PMID: 16278139 DOI: 10.1016/j.giec.2005.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
MR colonography has been shown to be an appropriate diagnostic tool for the detection of colorectal lesions. The technique is based on the acquisition of T1-weighted sequences after the administration of water enema and the intravenous administration of paramagnetic contrast. This article describes the technical requirements for MR colonoscopy and the procedures of data acquisition and image interpretation. The advantages and drawbacks of MR colonoscopy also are outlined.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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