Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Hassan C, Pickhardt PJ, Pickhardt P, Laghi A, Kim DH, Kim D, Zullo A, Iafrate F, Di Giulio L, Morini S. Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm: model simulation with cost-effectiveness analysis. ACTA ACUST UNITED AC 2008;168:696-705. [PMID: 18413551 DOI: 10.1001/archinte.168.7.696] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

For:	Hassan C, Pickhardt PJ, Pickhardt P, Laghi A, Kim DH, Kim D, Zullo A, Iafrate F, Di Giulio L, Morini S. Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm: model simulation with cost-effectiveness analysis. ACTA ACUST UNITED AC 2008;168:696-705. [PMID: 18413551 DOI: 10.1001/archinte.168.7.696] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Number

Cited by Other Article(s)

Patil NS, Kielar AZ. Use of Opportunistic CT Biomarkers: Population Health Opportunities in Radiology. Can Assoc Radiol J 2024;75:22-23. [PMID: 37535874 DOI: 10.1177/08465371231186356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open

Pickhardt PJ, Summers RM, Garrett JW, Krishnaraj A, Agarwal S, Dreyer KJ, Nicola GN. Opportunistic Screening: Radiology Scientific Expert Panel. Radiology 2023;307:e222044. [PMID: 37219444 PMCID: PMC10315516 DOI: 10.1148/radiol.222044] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/03/2022] [Accepted: 12/01/2022] [Indexed: 05/24/2023]

Affiliation(s)

Perry J. Pickhardt From the Departments of Radiology (P.J.P., J.W.G.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Va (A.K.); Lenox Hill Radiology, New York, NY (S.A.); Harvard Medical School and Mass General Brigham, Boston, Mass (K.J.D.); and Hackensack Radiology Group, Hackensack, NJ (G.N.N.)
Ronald M. Summers From the Departments of Radiology (P.J.P., J.W.G.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Va (A.K.); Lenox Hill Radiology, New York, NY (S.A.); Harvard Medical School and Mass General Brigham, Boston, Mass (K.J.D.); and Hackensack Radiology Group, Hackensack, NJ (G.N.N.)
John W. Garrett From the Departments of Radiology (P.J.P., J.W.G.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Va (A.K.); Lenox Hill Radiology, New York, NY (S.A.); Harvard Medical School and Mass General Brigham, Boston, Mass (K.J.D.); and Hackensack Radiology Group, Hackensack, NJ (G.N.N.)
Arun Krishnaraj From the Departments of Radiology (P.J.P., J.W.G.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Va (A.K.); Lenox Hill Radiology, New York, NY (S.A.); Harvard Medical School and Mass General Brigham, Boston, Mass (K.J.D.); and Hackensack Radiology Group, Hackensack, NJ (G.N.N.)
Sheela Agarwal From the Departments of Radiology (P.J.P., J.W.G.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Va (A.K.); Lenox Hill Radiology, New York, NY (S.A.); Harvard Medical School and Mass General Brigham, Boston, Mass (K.J.D.); and Hackensack Radiology Group, Hackensack, NJ (G.N.N.)
Keith J. Dreyer From the Departments of Radiology (P.J.P., J.W.G.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Va (A.K.); Lenox Hill Radiology, New York, NY (S.A.); Harvard Medical School and Mass General Brigham, Boston, Mass (K.J.D.); and Hackensack Radiology Group, Hackensack, NJ (G.N.N.)
Gregory N. Nicola From the Departments of Radiology (P.J.P., J.W.G.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Va (A.K.); Lenox Hill Radiology, New York, NY (S.A.); Harvard Medical School and Mass General Brigham, Boston, Mass (K.J.D.); and Hackensack Radiology Group, Hackensack, NJ (G.N.N.)

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Zhu J, Luo J, Ma Y. Screening of serum exosome markers for colorectal cancer based on Boruta and multi-cluster feature selection algorithms. Mol Cell Toxicol 2023. [DOI: 10.1007/s13273-023-00348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]

Vivas-Valencia C, Zhou Y, Sai A, Imperiale TF, Kong N. A two-phase approach to re-calibrating expensive computer simulation for sex-specific colorectal neoplasia development modeling. BMC Med Inform Decis Mak 2022;22:244. [PMID: 36117168 PMCID: PMC9482725 DOI: 10.1186/s12911-022-01991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

Medical evidence from more recent observational studies may significantly alter our understanding of disease incidence and progression, and would require recalibration of existing computational and predictive disease models. However, it is often challenging to perform recalibration when there are a large number of model parameters to be estimated. Moreover, comparing the fitting performances of candidate parameter designs can be difficult due to significant variation in simulated outcomes under limited computational budget and long runtime, even for one simulation replication.

METHODS

We developed a two-phase recalibration procedure. As a proof-of-the-concept study, we verified the procedure in the context of sex-specific colorectal neoplasia development. We considered two individual-based state-transition stochastic simulation models, estimating model parameters that govern colorectal adenoma occurrence and its growth through three preclinical states: non-advanced precancerous polyp, advanced precancerous polyp, and cancerous polyp. For the calibration, we used a weighted-sum-squared error between three prevalence values reported in the literature and the corresponding simulation outcomes. In phase 1 of the calibration procedure, we first extracted the baseline parameter design from relevant studies on the same model. We then performed sampling-based searches within a proper range around the baseline design to identify the initial set of good candidate designs. In phase 2, we performed local search (e.g., the Nelder-Mead algorithm), starting from the candidate designs identified at the end of phase 1. Further, we investigated the efficiency of exploring dimensions of the parameter space sequentially based on our prior knowledge of the system dynamics.

RESULTS

The efficiency of our two-phase re-calibration procedure was first investigated with CMOST, a relatively inexpensive computational model. It was then further verified with the V/NCS model, which is much more expensive. Overall, our two-phase procedure showed a better goodness-of-fit than the straightforward employment of the Nelder-Mead algorithm, when only a limited number of simulation replications were allowed. In addition, in phase 2, performing local search along parameter space dimensions sequentially was more efficient than performing the search over all dimensions concurrently.

CONCLUSION

The proposed two-phase re-calibration procedure is efficient at estimating parameters of computationally expensive stochastic dynamic disease models.

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Pickhardt PJ. Value-added Opportunistic CT Screening: State of the Art. Radiology 2022;303:241-254. [PMID: 35289661 PMCID: PMC9083232 DOI: 10.1148/radiol.211561] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022]

Ohtsuka M, Iwamoto K, Naito A, Imasato M, Hyuga S, Nakahara Y, Mikamori M, Furukawa K, Moon J, Asaoka T, Kishi K, Shamma A, Akamatsu H, Mizushima T, Yamamoto H. Circulating MicroRNAs in Gastrointestinal Cancer. Cancers (Basel) 2021;13:cancers13133348. [PMID: 34283058 PMCID: PMC8267753 DOI: 10.3390/cancers13133348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open

Affiliation(s)

Masahisa Ohtsuka Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.) Department of Molecular Pathology, Division of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita, Osaka 565-0871, Japan; (A.S.); (H.Y.) Correspondence: ; Tel.: +81-6-6771-6051; Fax: +81-6-6771-2838
Kazuya Iwamoto Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Atsushi Naito Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Mitsunobu Imasato Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Satoshi Hyuga Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Yujiro Nakahara Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Manabu Mikamori Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Kenta Furukawa Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Jeongho Moon Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Tadafumi Asaoka Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Kentaro Kishi Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Awad Shamma Department of Molecular Pathology, Division of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita, Osaka 565-0871, Japan; (A.S.); (H.Y.)
Hiroki Akamatsu Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Tsunekazu Mizushima Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan; (K.I.); (A.N.); (M.I.); (S.H.); (Y.N.); (M.M.); (K.F.); (J.M.); (T.A.); (K.K.); (H.A.); (T.M.)
Hirofumi Yamamoto Department of Molecular Pathology, Division of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita, Osaka 565-0871, Japan; (A.S.); (H.Y.)

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Hong YR, Xie Z, Turner K, Datta S, Bishnoi R, Shah C. Utilization Pattern of Computed Tomographic Colonography in the United States: Analysis of the U.S. National Health Interview Survey. Cancer Prev Res (Phila) 2020;14:113-122. [DOI: 10.1158/1940-6207.capr-20-0175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/02/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]

Ricci ZJ, Kobi M, Flusberg M, Yee J. CT Colonography in Review With Tips and Tricks to Improve Performance. Semin Roentgenol 2020;56:140-151. [PMID: 33858640 DOI: 10.1053/j.ro.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]

Prevalence and clinical significance of incidental extra-intestinal findings in MR enterography: experience of a single University Centre. Radiol Med 2020;126:181-188. [PMID: 32495273 DOI: 10.1007/s11547-020-01235-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]

Pan Z, Miao L. Serum microRNA-592 serves as a novel potential biomarker for early diagnosis of colorectal cancer. Oncol Lett 2020;20:1119-1126. [PMID: 32724351 PMCID: PMC7377022 DOI: 10.3892/ol.2020.11682] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 04/01/2020] [Indexed: 12/24/2022] Open

Al-Sheikh YA, Ghneim HK, Alharbi KK, Aboul-Soud MAM. Screening for differentially‑expressed microRNA biomarkers in Saudi colorectal cancer patients by small RNA deep sequencing. Int J Mol Med 2019;44:2027-2036. [PMID: 31638163 PMCID: PMC6844639 DOI: 10.3892/ijmm.2019.4362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/05/2019] [Indexed: 01/01/2023] Open

Abstract

Colorectal cancer (CRC) is mostly diagnosed at late stages leading to high mortality rates due to the scarcity of efficient screening approaches exhibiting high diagnostic utility. The current study employed a small-RNA deep-sequencing approach for screening microRNA (miRNA) differentially expressed genes (DEGs), and evaluating their potential as early diagnostic circulating biomarkers for CRC in clinical plasma and tissue samples from a Saudi patient population. The cohort followed a paired-study design composed of 20 CRC patients, providing plasma (P) and tissue (T) samples of CRC, and adjacent normal mucosa (CT). Also, control plasma (CP) samples were obtained from neoplasm-free healthy individuals to compare its miRNA levels with those in P samples. Illumina high-throughput (HiSeq 2000) sequencing was performed for the identification of known and novel miRNA genes that were differentially expressed in the plasma and tissues of CRC patients compared with CT and CP controls. While we identified only one known (hsa-miR-182-5p, significantly upregulated) and no novel DEGs at the most stringent significance level (P<0.001) in the P-CP comparison, we found 3 and none at P<0.01, 7 and 9 at P<0.05 level, respectively. In the T-CT comparison, the results revealed 24 known and 196 novel miRNA DEGs (P<0.001), 31 and 204 (P<0.01), 41 and 213 (P<0.05), respectively. Sequencing data were then analyzed by bioinformatics for potential diagnostic miRNAs. Network functional analysis for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway implicated two pathways rooted to signal transduction [Wnt and mitogen-activated protein kinase (MAPK)] that were enriched in CRC patients. Our results suggest that characterizing plasma and tissue profiles of CRC by deep sequencing may be a good strategy for identifying known and novel miRNAs and that the validated miRNAs described here may serve as potential CRC-associated biomarkers. Further research is necessary for determining their screen index values and diagnostic utility for the diagnosis of CRC.

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Graffy PM, Sandfort V, Summers RM, Pickhardt PJ. Automated Liver Fat Quantification at Nonenhanced Abdominal CT for Population-based Steatosis Assessment. Radiology 2019;293:334-342. [PMID: 31526254 DOI: 10.1148/radiol.2019190512] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Abstract

Background Nonalcoholic fatty liver disease and its consequences are a growing public health concern requiring cross-sectional imaging for noninvasive diagnosis and quantification of liver fat. Purpose To investigate a deep learning-based automated liver fat quantification tool at nonenhanced CT for establishing the prevalence of steatosis in a large screening cohort. Materials and Methods In this retrospective study, a fully automated liver segmentation algorithm was applied to noncontrast abdominal CT examinations from consecutive asymptomatic adults by using three-dimensional convolutional neural networks, including a subcohort with follow-up scans. Automated volume-based liver attenuation was analyzed, including conversion to CT fat fraction, and compared with manual measurement in a large subset of scans. Results A total of 11 669 CT scans in 9552 adults (mean age ± standard deviation, 57.2 years ± 7.9; 5314 women and 4238 men; median body mass index [BMI], 27.8 kg/m²) were evaluated, including 2117 follow-up scans in 1862 adults (mean age, 59.2 years; 971 women and 891 men; mean interval, 5.5 years). Algorithm failure occurred in seven scans. Mean CT liver attenuation was 55 HU ± 10, corresponding to CT fat fraction of 6.4% (slightly fattier in men than in women [7.4% ± 6.0 vs 5.8% ± 5.7%; P < .001]). Mean liver Hounsfield unit varied little by age (<4 HU difference among all age groups) and only weak correlation was seen with BMI (r² = 0.14). By category, 47.9% (5584 of 11 669) had negligible or no liver fat (CT fat fraction <5%), 42.4% (4948 of 11 669) had mild steatosis (CT fat fraction of 5%-14%), 8.8% (1025 of 11 669) had moderate steatosis (CT fat fraction of 14%-28%), and 1% (112 of 11 669) had severe steatosis (CT fat fraction >28%). Excellent agreement was seen between automated and manual measurements, with a mean difference of 2.7 HU (median, 3 HU) and r² of 0.92. Among the subcohort with longitudinal follow-up, mean change was only -3 HU ± 9, but 43.3% (806 of 1861) of patients changed steatosis category between first and last scans. Conclusion This fully automated CT-based liver fat quantification tool allows for population-based assessment of hepatic steatosis and nonalcoholic fatty liver disease, with objective data that match well with manual measurement. The prevalence of at least mild steatosis was greater than 50% in this asymptomatic screening cohort. © RSNA, 2019.

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[Colorectal cancer: role of imaging in screening]. Radiologe 2019;59:23-34. [PMID: 30564957 DOI: 10.1007/s00117-018-0479-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]

Liu X, Xu X, Pan B, He B, Chen X, Zeng K, Xu M, Pan Y, Sun H, Xu T, Hu X, Wang S. Circulating miR-1290 and miR-320d as Novel Diagnostic Biomarkers of Human Colorectal Cancer. J Cancer 2019;10:43-50. [PMID: 30662524 PMCID: PMC6329864 DOI: 10.7150/jca.26723] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022] Open

O'Connor SD, Graffy PM, Zea R, Pickhardt PJ. Does Nonenhanced CT-based Quantification of Abdominal Aortic Calcification Outperform the Framingham Risk Score in Predicting Cardiovascular Events in Asymptomatic Adults? Radiology 2018;290:108-115. [PMID: 30277443 DOI: 10.1148/radiol.2018180562] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]

Abstract

Purpose To determine if abdominal aortic calcification (AAC) at CT predicts cardiovascular events independent of Framingham risk score (FRS). Materials and Methods For this retrospective study, electronic health records for 829 asymptomatic patients (mean age, 57.9 years; 451 women, 378 men) who underwent nonenhanced CT colonography screening between April 2004 and March 2005 were reviewed for subsequent cardiovascular events; mean follow-up interval was 11.2 years ± 2.8 (standard deviation). Institutional review board approval was obtained. CT-based AAC was retrospectively quantified as a modified Agatston score by using a semiautomated tool. Kaplan-Meier curves and Cox proportional hazards models were used for time-to-event analysis; receiver operating characteristic curves and net reclassification improvement compared predictive abilities of AAC and FRS. Results An index cardiovascular event occurred after CT in 156 (19%) of 829 patients (6.7 years ± 3.5, including heart attack in 39 [5%] and death in 79 [10%]). AAC was higher in the cardiovascular event cohort (mean AAC, 3478 vs 664; P < .001). AAC was a strong predictor of cardiovascular events at both univariable and multivariable Cox modeling, independent of FRS (P < .001). Kaplan-Meier plots showed better separation with AAC over FRS. The area under the receiver operating characteristic curve (AUC) was higher for AAC than FRS at all evaluated time points (eg, AUC of 0.82 vs 0.64 at 2 years; P = .014). By using a cutoff point of 200, AAC improved FRS risk categorization with net reclassification improvement of 35.4%. Conclusion CT-based abdominal aortic calcification was a strong predictor of future cardiovascular events, outperforming the Framingham risk score. This finding suggests a potential opportunistic role in abdominal nonenhanced CT scans performed for other clinical indications. © RSNA, 2018.

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CT Colonography Performance for the Detection of Polyps and Cancer in Adults ≥ 65 Years Old: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018;211:40-51. [DOI: 10.2214/ajr.18.19515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Pickhardt PJ, Yee J, Johnson CD. CT colonography: over two decades from discovery to practice. Abdom Radiol (NY) 2018. [PMID: 29516105 DOI: 10.1007/s00261-018-1501-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Yee J, McFarland E. Extracolonic findings and radiation at CT colonography: what the referring provider needs to know. Abdom Radiol (NY) 2018;43:554-565. [PMID: 29450613 DOI: 10.1007/s00261-018-1461-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Imaging and Screening for Colorectal Cancer with CT Colonography. Radiol Clin North Am 2017;55:1183-1196. [DOI: 10.1016/j.rcl.2017.06.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]

Issa IA, Noureddine M. Colorectal cancer screening: An updated review of the available options. World J Gastroenterol 2017;23:5086-5096. [PMID: 28811705 PMCID: PMC5537177 DOI: 10.3748/wjg.v23.i28.5086] [Citation(s) in RCA: 384] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/02/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open

Extracolonic Findings at Screening CT Colonography: Prevalence, Benefits, Challenges, and Opportunities. AJR Am J Roentgenol 2017;209:94-102. [DOI: 10.2214/ajr.17.17864] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Behbahani S, Mittal S, Patlas MN, Moshiri M, Menias CO, Katz DS. "Incidentalomas" on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations. Abdom Radiol (NY) 2017;42:1046-1061. [PMID: 27695953 DOI: 10.1007/s00261-016-0914-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Scharitzer M, Tamandl D, Ba-Ssalamah A. Zufallsbefunde von Leber, Gallensystem, Pankreas und Milz bei asymptomatischen Patienten. Radiologe 2017;57:270-278. [DOI: 10.1007/s00117-017-0235-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

CT Colonographic Screening of Patients With a Family History of Colorectal Cancer: Comparison With Adults at Average Risk and Implications for Guidelines. AJR Am J Roentgenol 2017;208:794-800. [PMID: 28125785 DOI: 10.2214/ajr.16.16724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Abstract

OBJECTIVE

The purposes of this study were to compare rates of lesion detection at CT colonographic (CTC) screening of adults without symptoms who had and who did not have a family history of colorectal cancer according to American Cancer Society guidelines and to consider the clinical implications.

MATERIALS AND METHODS

Over 134 months, consecutively registered CTC cohorts of adults without symptoms who had (n = 156; 88 [56.4%] women; 68 [43.6%] men; mean age, 56.3 years) and who did not have (n = 8857; 4757 [53.7%] women; 4100 [46.3%] men; mean age, 56.6 years) an American Cancer Society-defined family history of colorectal cancer (first-degree relative with diagnosis before age 60 years or two first-degree relatives with diagnosis at any age) were compared for relevant colorectal findings.

RESULTS

For the family history versus no family history cohorts, the frequency of all nondiminutive polyps (≥ 6 mm) reported at CTC was 23.7% versus 15.5% (p = 0.007); small polyps (6-9 mm), 13.5% versus 9.1% (p = 0.068); and large polyps (≥ 10 mm), 10.2% versus 6.5% (p = 0.068). The rate of referral for colonoscopy was greater for the family history cohort (16.0% vs 10.5%; p = 0.035). However, the frequencies of proven advanced adenoma (4.5% vs 3.2%; p = 0.357), nonadvanced adenoma (5.1% vs 2.6%; p = 0.070), and cancer (0.0% vs 0.4%; p = 0.999) were not significantly increased. The difference in positive rates between the two cohorts (11.5% vs 4.3%; p < 0.001) was primarily due to nonneoplastic findings of no colorectal cancer relevance, such as small hyperplastic polyps, diverticular disease, and false-positive CTC findings.

CONCLUSION

Although the overall CTC-positive and colonoscopy referral rates were higher in the family history cohort, the clinically relevant frequencies of advanced neoplasia and cancer were not sufficiently increased to preclude CTC screening. These findings support the use of CTC as a front-line screening option in adults with a family history of colorectal cancer.

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Medicare cost of colorectal cancer screening: CT colonography vs. optical colonoscopy. ACTA ACUST UNITED AC 2016;40:2966-76. [PMID: 26350285 PMCID: PMC4628615 DOI: 10.1007/s00261-015-0538-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Indeterminate but Likely Unimportant Extracolonic Findings at Screening CT Colonography (C-RADS Category E3): Incidence and Outcomes Data From a Clinical Screening Program. AJR Am J Roentgenol 2016;207:996-1001. [PMID: 27505184 DOI: 10.2214/ajr.16.16275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Abstract

OBJECTIVE

The purpose of this study was to analyze the incidence and outcomes of unsuspected indeterminate but likely unimportant extracolonic findings (CT Colonography Reporting and Data System [C-RADS] category E3) at screening CT colonography (CTC).

MATERIALS AND METHODS

Over 99 months (April 2004 through June 2012), 7952 consecutive adults without symptoms of colorectal cancer (4277 women, 3675 men; mean age ± SD, 56.7 ± 7.3 years) underwent first-time screening CTC. Findings prospectively placed into C-RADS category E3 were retrospectively reviewed, including follow-up (range, 2-10 years) and ultimate clinical outcome.

RESULTS

Unsuspected C-RADS category E3 extracolonic findings were detected in 9.1% (725/7952) of our patient population. A total of 751 category E3 findings were detected among these 725 patients; 25 patients had multiple findings. Commonly involved organ systems included gynecologic (24.4%, 183/751), genitourinary (20.9%, 157/751), lung (20.6%, 155/751), and gastrointestinal (16.1%, 121/751). Consideration for further imaging, if clinically warranted, was suggested in 83.8% (608/725). Sixty-five patients were lost to follow-up. Conditions requiring treatment or surveillance were ultimately diagnosed in 8.3% (55/660), including eight malignant neoplasms. In the remaining 605 patients, 25 (4.1%) underwent invasive biopsy or surgery to prove benignity (including 18 complex adnexal masses), and 278 (46.0%) received additional imaging follow-up.

CONCLUSION

Indeterminate but likely unimportant extracolonic findings (C-RADS category E3) occurred in less than 10% of adults without symptoms of colorectal cancer who underwent screening CTC. Over 90% of these findings ultimately proved to be clinically insignificant, with fewer than 5% requiring an invasive procedure to prove benign disease, the majority of which (> 70%) were complex adnexal lesions in women.

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Yee J, Chang KJ, Dachman AH, Kim DH, McFarland EG, Pickhardt PJ, Cash BD, Bruining DH, Zalis ME. The Added Value of the CT Colonography Reporting and Data System. J Am Coll Radiol 2016;13:931-5. [DOI: 10.1016/j.jacr.2016.04.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 12/20/2022]

Emerging stool-based and blood-based non-invasive DNA tests for colorectal cancer screening: the importance of cancer prevention in addition to cancer detection. Abdom Radiol (NY) 2016;41:1441-4. [PMID: 27259335 DOI: 10.1007/s00261-016-0798-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Ziemlewicz TJ, Binkley N, Pickhardt PJ. Opportunistic Osteoporosis Screening: Addition of Quantitative CT Bone Mineral Density Evaluation to CT Colonography. J Am Coll Radiol 2016;12:1036-41. [PMID: 26435117 DOI: 10.1016/j.jacr.2015.04.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/20/2015] [Indexed: 12/12/2022]

Patel SS, Kilgore ML. Cost Effectiveness of Colorectal Cancer Screening Strategies. Cancer Control 2016;22:248-58. [PMID: 26068773 DOI: 10.1177/107327481502200219] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open

Theis J, Kim DH, Lubner MG, Muñoz del Rio A, Pickhardt PJ. CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination. Abdom Radiol (NY) 2016;41:10-8. [PMID: 26830606 DOI: 10.1007/s00261-015-0595-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Potentially Important Extracolonic Findings at Screening CT Colonography: Incidence and Outcomes Data From a Clinical Screening Program. AJR Am J Roentgenol 2015;206:313-8. [PMID: 26491809 DOI: 10.2214/ajr.15.15193] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

Abstract

OBJECTIVE

The effect of detection of extracolonic findings at screening CT colonography (CTC) remains controversial. Our objective is to analyze the incidence and outcomes of unsuspected potentially significant (CT Colonography Reporting and Data System [C-RADS] extracolonic category E4) findings in a population undergoing clinical CTC screening.

SUBJECTS AND METHODS

Over the course of 99 months (April 1, 2004, through June 30, 2012), 7952 consecutive asymptomatic adults (3675 men and 4277 women; mean [± SD] age, 56.7 ± 7.3 years) underwent first-time screening CTC. Examinations were prospectively interpreted by radiologists within our abdominal imaging section, and extracolonic findings were recorded and categorized. Potentially significant (i.e., C-RADS extracolonic category E4) findings were retrospectively reviewed with additional analysis of follow-up (range, 2-10 years) and ultimate clinical outcome.

RESULTS

Overall, 2.5% (202/7952) of patients had a potentially significant (C-RADS category E4) extracolonic finding for which further imaging (56%; 113/202) or clinical follow-up (44%; 89/202) was recommended. No patients had multiple category E4 findings. Twenty-two patients were lost to follow-up. Of the remaining 180 patients, 68% (123/180) proved to have clinically significant disease, including 23% (42/180) with malignant or potentially malignant neoplasms and 32% (57/180) with abdominal aortic or other visceral artery aneurysms requiring treatment or surveillance. The most commonly involved organs and systems included the vascular system (26%; 53/202), the genitourinary system (18%; 36/202), the liver (15%; 30/202), the gastrointestinal system (9.9%; 20/202), the lungs (9.4%; 19/202), and the gynecologic system (6.9%; 14/202).

CONCLUSION

Potentially significant extracolonic findings in asymptomatic adults at screening CTC are uncommon (2-3% of cases). However, most of these findings (68%) will prove to be clinically significant, including a number of malignancies and aneurysms requiring treatment or surveillance.

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Bannas P, Bakke J, Patrick JL, Pickhardt PJ. Automated volumetric analysis for comparison of oral sulfate solution (SUPREP) with established cathartic agents at CT colonography. ACTA ACUST UNITED AC 2015;40:11-8. [PMID: 24965898 DOI: 10.1007/s00261-014-0186-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

Patel JD, Chang KJ. The role of virtual colonoscopy in colorectal screening. Clin Imaging 2015;40:315-20. [PMID: 26298421 DOI: 10.1016/j.clinimag.2015.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]

Cost Differences After Initial CT Colonography Versus Optical Colonoscopy in the Elderly. Acad Radiol 2015;22:807-13. [PMID: 25890873 DOI: 10.1016/j.acra.2015.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/20/2015] [Accepted: 03/08/2015] [Indexed: 12/15/2022]

Halligan S, Dadswell E, Wooldrage K, Wardle J, von Wagner C, Lilford R, Yao GL, Zhu S, Atkin W. Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials). Health Technol Assess 2015;19:1-134. [PMID: 26198205 PMCID: PMC4781284 DOI: 10.3310/hta19540] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open

Abstract

BACKGROUND

Computed tomographic colonography (CTC) is a relatively new diagnostic test that may be superior to existing alternatives to investigate the large bowel.

OBJECTIVES

To compare the diagnostic efficacy, acceptability, safety and cost-effectiveness of CTC with barium enema (BE) or colonoscopy.

DESIGN

Parallel randomised trials: BE compared with CTC and colonoscopy compared with CTC (randomisation 2 : 1, respectively).

SETTING

A total of 21 NHS hospitals.

PARTICIPANTS

Patients aged ≥ 55 years with symptoms suggestive of colorectal cancer (CRC).

INTERVENTIONS

CTC, BE and colonoscopy.

MAIN OUTCOME MEASURES

For the trial of CTC compared with BE, the primary outcome was the detection rate of CRC and large polyps (≥ 10 mm), with the proportion of patients referred for additional colonic investigation as a secondary outcome. For the trial of CTC compared with colonoscopy, the primary outcome was the proportion of patients referred for additional colonic investigation, with the detection rate of CRC and large polyps as a secondary outcome. Secondary outcomes for both trials were miss rates for cancer (via registry data), all-cause mortality, serious adverse events, patient acceptability, extracolonic pathology and cost-effectiveness.

RESULTS

A total of 8484 patients were registered and 5384 were randomised and analysed (BE trial: 2527 BE, 1277 CTC; colonoscopy trial: 1047 colonoscopy, 533 CTC). Detection rates in the BE trial were 7.3% (93/1277) for CTC, compared with 5.6% (141/2527) for BE (p = 0.0390). The difference was due to better detection of large polyps by CTC (3.6% vs. 2.2%; p = 0.0098), with no significant difference for cancer (3.7% vs. 3.4%; p = 0.66). Significantly more patients having CTC underwent additional investigation (23.5% vs. 18.3%; p = 0.0003). At the 3-year follow-up, the miss rate for CRC was 6.7% for CTC (three missed cancers) and 14.1% for BE (12 missed cancers). Significantly more patients randomised to CTC than to colonoscopy underwent additional investigation (30% vs. 8.2%; p < 0.0001). There was no significant difference in detection rates for cancer or large polyps (10.7% for CTC vs. 11.4% for colonoscopy; p = 0.69), with no difference when cancers (p = 0.94) and large polyps (p = 0.53) were analysed separately. At the 3-year follow-up, the miss rate for cancer was nil for colonoscopy and 3.4% for CTC (one missed cancer). Adverse events were uncommon for all procedures. In 1042 of 1748 (59.6%) CTC examinations, at least one extracolonic finding was reported, and this proportion increased with age (p < 0.0001). A total of 149 patients (8.5%) were subsequently investigated, and extracolonic neoplasia was diagnosed in 79 patients (4.5%) and malignancy in 29 (1.7%). In the short term, CTC was significantly more acceptable to patients than BE or colonoscopy. Total costs for CTC and colonoscopy were finely balanced, but CTC was associated with higher health-care costs than BE. The cost per large polyp or cancer detected was £4235 (95% confidence interval £395 to £9656).

CONCLUSIONS

CTC is superior to BE for detection of cancers and large polyps in symptomatic patients. CTC and colonoscopy detect a similar proportion of large polyps and cancers and their costs are also similar. CTC precipitates significantly more additional investigations than either BE or colonoscopy, and evidence-based referral criteria are needed. Further work is recommended to clarify the extent to which patients initially referred for colonoscopy or BE undergo subsequent abdominopelvic imaging, for example by computed tomography, which will have a significant impact on health economic estimates.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN95152621.

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Han KT, Kim SJ, Lee SY, Park EC. Cost-effectiveness analysis of HPV vaccination: comparing the general population with socially vulnerable individuals. Asian Pac J Cancer Prev 2015;15:8503-8. [PMID: 25339055 DOI: 10.7314/apjcp.2014.15.19.8503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open

Khashram M, Jones GT, Roake JA. Prevalence of abdominal aortic aneurysm (AAA) in a population undergoing computed tomography colonography in Canterbury, New Zealand. Eur J Vasc Endovasc Surg 2015;50:199-205. [PMID: 26072194 DOI: 10.1016/j.ejvs.2015.04.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/20/2015] [Indexed: 01/22/2023]

Extraurinary Incidental Findings on CT for Hematuria: The Radiologist's Role and Downstream Cost Analysis. AJR Am J Roentgenol 2015;204:1160-7. [DOI: 10.2214/ajr.14.12483] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Pickhardt PJ. CT colonography for population screening: ready for prime time? Dig Dis Sci 2015;60:647-59. [PMID: 25492504 PMCID: PMC4629223 DOI: 10.1007/s10620-014-3454-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]

de Haan MC, Pickhardt PJ, Stoker J. CT colonography: accuracy, acceptance, safety and position in organised population screening. Gut 2015;64:342-50. [PMID: 25468258 DOI: 10.1136/gutjnl-2014-308696] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

Ryckman EM, Summers RM, Liu J, del Rio AM, Pickhardt PJ. Visceral fat quantification in asymptomatic adults using abdominal CT: is it predictive of future cardiac events? ABDOMINAL IMAGING 2015;40:222-6. [PMID: 25015400 PMCID: PMC4293368 DOI: 10.1007/s00261-014-0192-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]

Laghi A. Computed tomography colonography in 2014: an update on technique and indications. World J Gastroenterol 2014;20:16858-67. [PMID: 25492999 PMCID: PMC4258555 DOI: 10.3748/wjg.v20.i45.16858] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/27/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open

Abstract

Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and polyps. This examination technique is less invasive than colonoscopy (CS), easy to perform, and standardized. Reduced bowel preparation and colonic distention using carbon dioxide favor patient compliance. Widespread implementation of a new image reconstruction algorithm has minimized radiation exposure, and the use of dedicated software with enhanced views has enabled easier image interpretation. Integration in the routine workflow of a computer-aided detection algorithm reduces perceptual errors, particularly for small polyps. Consolidated evidence from the literature shows that the diagnostic performances for the detection of CRC and large polyps in symptomatic and asymptomatic individuals are similar to CS and are largely superior to barium enema, the latter of which should be strongly discouraged. Favorable data regarding CTC performance open the possibility for many different indications, some of which are already supported by evidence-based data: incomplete, failed, or unfeasible CS; symptomatic, elderly, and frail patients; and investigation of diverticular disease. Other indications are still being debated and, thus, are recommended only if CS is unfeasible: the use of CTC in CRC screening and in surveillance after surgery for CRC or polypectomy. In order for CTC to be used appropriately, contraindications such as acute abdominal conditions (diverticulitis or the acute phase of inflammatory bowel diseases) and surveillance in patients with a long-standing history of ulcerative colitis or Crohn's disease and in those with hereditary colonic syndromes should not be overlooked. This will maximize the benefits of the technique and minimize potential sources of frustration or disappointment for both referring clinicians and patients.

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Bannas P, Bakke J, Munoz del Rio A, Pickhardt PJ. Intra-individual comparison of magnesium citrate and sodium phosphate for bowel preparation at CT colonography: automated volumetric analysis of residual fluid for quality assessment. Clin Radiol 2014;69:1171-7. [PMID: 25239789 PMCID: PMC4201391 DOI: 10.1016/j.crad.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/30/2014] [Accepted: 08/04/2014] [Indexed: 01/16/2023]

Abstract

AIM

To perform an objective, intra-individual comparison of residual colonic fluid volume and attenuation associated with the current front-line laxative magnesium citrate (MgC) versus the former front-line laxative sodium phosphate (NaP) at CT colonography (CTC).

MATERIALS AND METHODS

This retrospective Health Insurance and Portability and Accountability Act-compliant study had institutional review board approval; informed consent was waived. The study cohort included 250 asymptomatic adults (mean age at index 56.1 years; 124 male/126 female) who underwent CTC screening twice over a 5 year interval. Colon catharsis at initial and follow-up screening employed single-dose NaP and double-dose MgC, respectively, allowing for intra-patient comparison. Automated volumetric analysis of residual colonic fluid volume and attenuation was performed on all 500 CTC studies. Colonic fluid volume <200 ml and mean attenuation between 300-900 HU were considered optimal. Paired t-test and McNemar's test were used to compare differences.

RESULTS

Residual fluid volumes <200 ml were recorded in 192 examinations (76.8%) following MgC and in 204 examinations (81.6%) following NaP (p = 0.23). The mean total residual fluid volume was 155 ± 114 ml for MgC and 143 ± 100 ml for NaP (p = 0.01). The attenuation range of 300-900 HU was significantly more frequent for MgC (n = 220, 88%) than for NaP (n = 127, 50.8%; p < 0.001). Mean fluid attenuation was significantly lower for MgC (700 ± 165 HU) than for NaP (878 ± 155 HU; p < 0.001). Concomitant presence of both optimal fluid volume and attenuation was significantly more frequent for MgC 65.2% than for NaP (38%; p < 0.001).

CONCLUSIONS

Objective intra-individual comparison using automated volumetric analysis suggests that the replacement of NaP by MgC as the front-line laxative for CTC has not compromised overall examination quality.

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Plumb AA, Halligan S. Colorectal cancer screening. Semin Roentgenol 2014;50:101-10. [PMID: 25770340 DOI: 10.1053/j.ro.2014.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]

Regge D, Iussich G, Senore C, Correale L, Hassan C, Bert A, Montemezzi S, Segnan N. Population screening for colorectal cancer by flexible sigmoidoscopy or CT colonography: study protocol for a multicenter randomized trial. Trials 2014;15:97. [PMID: 24678896 PMCID: PMC3977672 DOI: 10.1186/1745-6215-15-97] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/31/2013] [Indexed: 12/15/2022] Open

Abstract

BACKGROUND

Colorectal cancer (CRC) is the second most prevalent type of cancer in Europe. A single flexible sigmoidoscopy (FS) screening at around the age of 60 years prevents about one-third of CRC cases. However, FS screens only the distal colon, and thus mortality from proximal CRC is unaffected. Computed tomography colonography (CTC) is a highly accurate examination that allows assessment of the entire colon. However, the benefit of CTC testing as a CRC screening test is uncertain. We designed a randomized trial to compare participation rate, detection rates, and costs between CTC (with computer-aided detection) and FS as primary tests for population-based screening.

METHODS/DESIGN

An invitation letter to participate in a randomized screening trial comparing CTC versus FS will be mailed to a sample of 20,000 people aged 58 or 60 years, living in the Piedmont region and the Verona district of Italy. Individuals with a history of CRC, adenomas, inflammatory bowel disease, or recent colonoscopy, or with two first-degree relatives with CRC will be excluded from the study by their general practitioners. Individuals responding positively to the invitation letter will be then randomized to the intervention group (CTC) or control group (FS), and scheduled for the screening procedure. The primary outcome parameter of this part of the trial is the difference in advanced neoplasia detection between the two screening tests. Secondary outcomes are cost-effectiveness analysis, referral rates for colonoscopy induced by CTC versus FS, and the expected and perceived burden of the procedures. To compare participation rates for CTC versus FS, 2,000 additional eligible subjects will be randomly assigned to receive an invitation for screening with CTC or FS. In the CTC arm, non-responders will be offered fecal occult blood test (FOBT) as alternative screening test, while in the FS arm, non-responders will receive an invitation letter to undergo screening with either FOBT or CTC. Data on reasons for participation and non-participation will also be collected.

DISCUSSION

This study will provide reliable information concerning benefits and risks of the adoption of CTC as a mass screening intervention in comparison with FS. The trial will also evaluate the role of computer-aided detection in a screening setting.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01739608.

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Pickhardt PJ. CT colonography: does it satisfy the necessary criteria for a colorectal screening test? Expert Rev Gastroenterol Hepatol 2014;8:211-3. [PMID: 24490683 DOI: 10.1586/17474124.2014.887436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]

The Challenges of CT Colonography Reimbursement. J Am Coll Radiol 2013;10:937-42. [DOI: 10.1016/j.jacr.2013.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/13/2013] [Indexed: 12/21/2022]

Fini L, Laghi L, Hassan C, Pestalozza A, Pagano N, Balzarini L, Repici A, Pickhardt PJ, Malesci A. Noncathartic CT colonography to screen for colorectal neoplasia in subjects with a family history of colorectal cancer. Radiology 2013;270:784-90. [PMID: 24475809 DOI: 10.1148/radiol.13130373] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Abstract

PURPOSE

To prospectively assess the diagnostic performance of noncathartic computed tomographic (CT) colonography in the detection of clinically relevant colorectal lesions (≥6 mm polyps or masses) in a well-defined cohort of first-degree relatives of patients with colorectal cancer (CRC), using colonoscopy and histologic review as the standard of reference.

MATERIALS AND METHODS

Institutional review board approval was obtained, and all subjects provided written informed consent. Consecutive patients admitted with CRC (index cases) were prospectively evaluated, and those who agreed to contact their first-degree relatives who were at least 40 years old were included. Available first-degree relatives were invited to undergo noncathartic CT colonography (200 mL of diatrizoate meglumine and diatrizoate sodium). Colonoscopy was performed the following day, and findings from CT colonography were disclosed for each segment. Sensitivity, specificity, and positive and negative predictive values of CT colonography were assessed for detecting subjects with any lesion at least 6 mm, any lesion at least 10 mm, and advanced neoplasia at least 6 mm. Colonoscopy with segmental unblinding and histologic diagnosis were used as the standard of reference. Matching between findings from CT colonography and colonoscopy was allowed when lesions were located in the same or adjacent colon segments and when the size difference was 50% or less.

RESULTS

Three hundred four first-degree relatives (median age, 47 years; age range, 40-79 years; 46.7% women) identified from 221 index cases were included. Overall, CT colonography helped identify 17 of 22 subjects with polyps measuring at least 6 mm (sensitivity, 0.77; 95% confidence interval [CI]: 0.59, 0.95) and helped correctly classify as negative 278 of 282 subjects without lesions measuring at least 6 mm (specificity, 0.99; 95% CI: 0.97, 1.00). CT colonography helped detect eight of nine subjects with polyps measuring at least 10 mm as well as eight of nine subjects with advanced neoplasia measuring at least 6 mm (sensitivity, 0.89 for both). Per-subject positive and negative predictive values for lesions measuring at least 6 mm were 0.81 (17 of 21 subjects; 95% CI: 0.65, 0.97) and 0.98 (282 of 287 subjects; 95% CI: 0.96, 0.99), respectively.

CONCLUSION

Noncathartic CT colonography is an effective screening method in first-degree relatives of patients with CRC.

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Badiani S, Tomas-Hernandez S, Karandikar S, Roy-Choudhury S. Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms. Acta Radiol 2013;54:851-62. [PMID: 23761550 DOI: 10.1177/0284185113486371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]