|
1
|
Futamata Y, Nishiyama S. [Effect of Matrix Size on Lesion Detectability in CT Colonography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:135-144. [PMID: 33612691 DOI: 10.6009/jjrt.2021_jsrt_77.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES While computed tomography colonography (CTC) has become a non-invasive alternative to traditional colonoscopy, superficial lesions tend to be harder to detect, with reports of lesions <2 mm in height being missed. Therefore, for the evaluation of lesion detectability using CTC, optimizing scan parameters becomes important. In this study, we investigate the effect of the reconstructed matrix size from CTC on the lesion conspicuity. METHODS A CTC phantom was scanned, and images were reconstructed with 512, 768 and 1024 matrix sizes with the same raw data. The image data in each matrix size were compared in terms of physical assessment of the task-transfer function (TTF) and the noise power spectrum (NPS), and of visual assessment using Scheffé's paired comparison. RESULTS Comparing 768 and 1024 matrix sizes with that of 512, NPS was higher in high-frequency components. On the other hand, TTF was improved using these larger matrix sizes along with significant statistical differences in the visual assessment. CONCLUSION Larger matrix sizes (768 and 1024) improve the lesion conspicuity, thereby helping to detect superficial and small lesions (size<2 mm) in CTC.
Collapse
Affiliation(s)
- Yoshihiro Futamata
- Division of Radiologic Technology, Department of Medical Technology, Abashiri-Kosei General Hospital (Current address: Division of Radiologic Technology, Department of Medical Technology, Asahikawa-Kosei General Hospital)
| | - Satoshi Nishiyama
- Division of Radiologic Technology, Department of Medical Technology, Abashiri-Kosei General Hospital
| |
Collapse
|
|
2
|
Filograna L, Filograna E, D'Onofrio A, Flor N, Haddad Y, Floris R. Colonic angiodysplasia on CT colonography: case report and characteristic imaging findings. Radiol Case Rep 2018; 12:693-696. [PMID: 29484051 PMCID: PMC5823384 DOI: 10.1016/j.radcr.2017.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 06/26/2017] [Accepted: 07/17/2017] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal angiodysplasia represents the cause of 6% of lower gastrointestinal tract bleeding, particularly in the elderly. Because of the common presentation and age range of affected patients, often patients with occult or massive gastrointestinal bleedings are investigated with colonoscopy, in the suspect of colonic cancer. Other methods are capsule enteroscopy, angiography, double-contrast barium enema, computed tomography angiography, and radionuclide scanning. In this contribution, we describe a case of colonic angiodysplasia first suspected during computed tomography colonography performed after an incomplete colonoscopy in a patient with recent anemization. The purpose is to highlight the computed tomography colonography imaging characteristics of this rare finding during such examination performed due to suspected colon carcinoma as a complementary or substitutive method of colonoscopy.
Collapse
Affiliation(s)
- Laura Filograna
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Enrica Filograna
- Centro di Diagnostica per Immagini, Via dell'Incoronata 5, Nardò, Lecce 73100, Italy
| | - Adolfo D'Onofrio
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Nicola Flor
- Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Servizi Socio Territoriali Santi Paolo e Carlo, Via di Rudinì 8, 20142 Milan, Italy
| | - Yusef Haddad
- Unità Operativa di Medicina Interna, Azienda Ospedaliera Cardinale G.Panico, Via San Pio X, 4, Tricase, Lecce 73039, Italy
| | - Roberto Floris
- Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Viale Oxford 81, 00133 Rome, Italy
| |
Collapse
|
|
3
|
East JE, Atkin WS, Bateman AC, Clark SK, Dolwani S, Ket SN, Leedham SJ, Phull PS, Rutter MD, Shepherd NA, Tomlinson I, Rees CJ. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut 2017; 66:1181-1196. [PMID: 28450390 PMCID: PMC5530473 DOI: 10.1136/gutjnl-2017-314005] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 02/07/2023]
Abstract
Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations-serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation: we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years (weak recommendation, low quality evidence, 90% agreement).
Collapse
Affiliation(s)
- James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adrian C Bateman
- Department of Cellular Pathology, Southampton General Hospital, Southampton, UK
| | - Susan K Clark
- The Polyposis Registry, St. Mark's Hospital, London, UK
| | - Sunil Dolwani
- Cancer Screening, Prevention and Early Diagnosis Group, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Shara N Ket
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon J Leedham
- Gastrointestinal Stem-cell Biology Laboratory, Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Matt D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
- School of Medicine, Durham University, Durham, UK
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, UK
| | - Ian Tomlinson
- Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Colin J Rees
- School of Medicine, Durham University, Durham, UK
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| |
Collapse
|
|
4
|
Nagata K, Endo S, Honda T, Yasuda T, Hirayama M, Takahashi S, Kato T, Horita S, Furuya K, Kasai K, Matsumoto H, Kimura Y, Utano K, Sugimoto H, Kato H, Yamada R, Yamamichi J, Shimamoto T, Ryu Y, Matsui O, Kondo H, Doi A, Abe T, Yamano HO, Takeuchi K, Hanai H, Saida Y, Fukuda K, Näppi J, Yoshida H. Accuracy of CT Colonography for Detection of Polypoid and Nonpolypoid Neoplasia by Gastroenterologists and Radiologists: A Nationwide Multicenter Study in Japan. Am J Gastroenterol 2017; 112:163-171. [PMID: 27779195 PMCID: PMC5223061 DOI: 10.1038/ajg.2016.478] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 07/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to assess prospectively the diagnostic accuracy of computer-assisted computed tomographic colonography (CTC) in the detection of polypoid (pedunculated or sessile) and nonpolypoid neoplasms and compare the accuracy between gastroenterologists and radiologists. METHODS This nationwide multicenter prospective controlled trial recruited 1,257 participants with average or high risk of colorectal cancer at 14 Japanese institutions. Participants had CTC and colonoscopy on the same day. CTC images were interpreted independently by trained gastroenterologists and radiologists. The main outcome was the accuracy of CTC in the detection of neoplasms ≥6 mm in diameter, with colonoscopy results as the reference standard. Detection sensitivities of polypoid vs. nonpolypoid lesions were also evaluated. RESULTS Of the 1,257 participants, 1,177 were included in the final analysis: 42 (3.6%) were at average risk of colorectal cancer, 456 (38.7%) were at elevated risk, and 679 (57.7%) had recent positive immunochemical fecal occult blood tests. The overall per-participant sensitivity, specificity, and positive and negative predictive values for neoplasms ≥6 mm in diameter were 0.90, 0.93, 0.83, and 0.96, respectively, among gastroenterologists and 0.86, 0.90, 0.76, and 0.95 among radiologists (P<0.05 for gastroenterologists vs. radiologists). The sensitivity and specificity for neoplasms ≥10 mm in diameter were 0.93 and 0.99 among gastroenterologists and 0.91 and 0.98 among radiologists (not significant for gastroenterologists vs. radiologists). The CTC interpretation time by radiologists was shorter than that by gastroenterologists (9.97 vs. 15.8 min, P<0.05). Sensitivities for pedunculated and sessile lesions exceeded those for flat elevated lesions ≥10 mm in diameter in both groups (gastroenterologists 0.95, 0.92, and 0.68; radiologists: 0.94, 0.87, and 0.61; P<0.05 for polypoid vs. nonpolypoid), although not significant (P>0.05) for gastroenterologists vs. radiologists. CONCLUSIONS CTC interpretation by gastroenterologists and radiologists was accurate for detection of polypoid neoplasms, but less so for nonpolypoid neoplasms. Gastroenterologists had a higher accuracy in the detection of neoplasms ≥6 mm than did radiologists, although their interpretation time was longer than that of radiologists.
Collapse
Affiliation(s)
- Koichi Nagata
- Japanese CTC Society, Boston, Massachusetts, USA,3D Imaging Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shungo Endo
- Japanese CTC Society, Boston, Massachusetts, USA,Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Tetsuro Honda
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan
| | - Takaaki Yasuda
- Japanese CTC Society, Boston, Massachusetts, USA,Radiology Section, Nagasaki Kamigoto Hospital, Shinkamigoto, Minamimatsuura, Nagasaki, Japan
| | - Michiaki Hirayama
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology, Otaru Kyokai Hospital, Otaru, Hokkaido, Japan
| | - Sho Takahashi
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology, Otaru Kyokai Hospital, Otaru, Hokkaido, Japan
| | - Takashi Kato
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology, Hokkaido Gastroenterology Hospital, Sapporo, Hokkaido, Japan
| | - Shoichi Horita
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Internal Medicine, Hokkaido Gastroenteology Hospital, Sapporo, Hokkaido, Japan
| | - Ken Furuya
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology and Hepatology, Japan Community Health Care Organization (JCHO) Hokkaido Hospital (formerly known as Hokkaido Social Insurance Hospital), Sapporo, Hokkaido, Japan
| | - Kenji Kasai
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Radiology, Japan Community Health Care Organization (JCHO) Hokkaido Hospital (formerly known as Hokkaido Social Insurance Hospital), Sapporo, Hokkaido, Japan
| | - Hiroshi Matsumoto
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology, Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan
| | - Yoshiki Kimura
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology, Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan
| | - Kenichi Utano
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Hideharu Sugimoto
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Hiroyuki Kato
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Rieko Yamada
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Junta Yamamichi
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Takeshi Shimamoto
- Department of Medical Statistics and Information, Kameda Medical Center Makuhari, Chiba-city, Chiba, Japan
| | - Yasuji Ryu
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Osamu Matsui
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hitoshi Kondo
- Japanese CTC Society, Boston, Massachusetts, USA,Center for Digestive Diseases, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Ayako Doi
- Japanese CTC Society, Boston, Massachusetts, USA,Center for Digestive Diseases, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Taro Abe
- Japanese CTC Society, Boston, Massachusetts, USA,Digestive Disease Center, Akita Red Cross Hospital, Akita City, Akita, Japan
| | - Hiro-o Yamano
- Japanese CTC Society, Boston, Massachusetts, USA,Digestive Disease Center, Akita Red Cross Hospital, Akita City, Akita, Japan
| | - Ken Takeuchi
- Japanese CTC Society, Boston, Massachusetts, USA,Center for Gastroenterology and IBD Research, Hamamatsu South Hospital, Hamamatsu, Shizuoka, Japan
| | - Hiroyuki Hanai
- Japanese CTC Society, Boston, Massachusetts, USA,Center for Gastroenterology and IBD Research, Hamamatsu South Hospital, Hamamatsu, Shizuoka, Japan
| | - Yukihisa Saida
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Katsuyuki Fukuda
- Japanese CTC Society, Boston, Massachusetts, USA,Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
| | - Janne Näppi
- 3D Imaging Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hiroyuki Yoshida
- Japanese CTC Society, Boston, Massachusetts, USA,3D Imaging Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,3D Imaging Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 25 New Chardon Street, Suite 400C, Boston, Massachusetts 02114, USA. E-mail:
| |
Collapse
|
|
5
|
Abstract
Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.
Collapse
Affiliation(s)
- Andrea Laghi
- a Department of Radiological Sciences, Oncology and Pathology , Sapienza - University of Rome, ICOT Hospital , Latina , Italy
| |
Collapse
|
|
6
|
CT-Colonography vs. Colonoscopy for Detection of High-Risk Sessile Serrated Polyps. Am J Gastroenterol 2016; 111:516-22. [PMID: 27021193 DOI: 10.1038/ajg.2016.58] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Sessile serrated polyps (SSPs) are suggested to be the precursors of 15-30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should also be designed to detect high-risk SSPs. We compared computed tomography colonography (CTC) with colonoscopy-based screening for the detection of high-risk SSPs in average-risk individuals. METHODS Data from a randomized controlled trial that compared CTC with colonoscopy for population screening were used for the analysis. Individuals diagnosed at CTC with a lesion ≥10 mm in size were referred for colonoscopy. Individuals with only 6-9 mm lesions were offered surveillance CTC. This surveillance CTC was followed by a colonoscopy when a lesion ≥6 mm was detected. Yield of both was accumulated to mimic current American College of Radiology CTC referral strategy (referral of individuals with any lesion ≥6 mm). Per participant detection of ≥1 high-risk (dysplastic and/or ≥10 mm) SSP was compared with colonoscopy using multiple logistic regression analysis. RESULTS In total, 8,844 individuals were invited to participate (in 2:1 allocation), of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSP, compared with 0.8% in the CTC arm (odds ratio (OR) 5.5; 95% confidence interval (CI) 2.6-11.6; P<0.001). In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm (OR 7.7; 95% CI 2.7-21.6; P<0.001). The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1). CONCLUSIONS In a randomized controlled setting, the detection rate of high-risk SSPs was significantly higher with colonoscopy than CTC. These results might have implications for CTC as a CRC modality for opportunistic screening in average-risk adults.
Collapse
|
|
7
|
Kahi CJ, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Lieberman D, Levin TR, Robertson DJ, Rex DK. Colonoscopy surveillance after colorectal cancer resection: recommendations of the US multi-society task force on colorectal cancer. Gastrointest Endosc 2016; 83:489-98.e10. [PMID: 26802191 DOI: 10.1016/j.gie.2016.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Charles J Kahi
- Richard L. Roudebush VA Medical Center, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | | | | | - Tonya Kaltenbach
- Veterans Affairs Palo Alto, Palo Alto, California; Stanford University School of Medicine, Palo Alto, California
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
|
8
|
Kahi CJ, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Lieberman D, Levin TR, Robertson DJ, Rex DK. Colonoscopy Surveillance After Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2016; 150:758-768.e11. [PMID: 26892199 DOI: 10.1053/j.gastro.2016.01.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The US Multi-Society Task Force has developed updated recommendations to guide health care providers with the surveillance of patients after colorectal cancer (CRC) resection with curative intent. This document is based on a critical review of the literature regarding the role of colonoscopy, flexible sigmoidoscopy, endoscopic ultrasound, fecal testing and CT colonography in this setting. The document addresses the effect of surveillance, with focus on colonoscopy, on patient survival after CRC resection, the appropriate use and timing of colonoscopy for perioperative clearing and for postoperative prevention of metachronous CRC, specific considerations for the detection of local recurrence in the case of rectal cancer, as well as the place of CT colonography and fecal tests in post-CRC surveillance.
Collapse
Affiliation(s)
- Charles J Kahi
- Richard L. Roudebush VA Medical Center, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, Indiana.
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | | | | | - Tonya Kaltenbach
- Veterans Affairs Palo Alto, Palo Alto, California; Stanford University School of Medicine, Palo Alto, California
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana
| | | |
Collapse
|
|
9
|
Kahi CJ, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Lieberman D, Levin TR, Robertson DJ, Rex DK. Colonoscopy Surveillance after Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2016; 111:337-46; quiz 347. [PMID: 26871541 DOI: 10.1038/ajg.2016.22] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/07/2015] [Indexed: 12/11/2022]
Abstract
The US Multi-Society Task Force has developed updated recommendations to guide health care providers with the surveillance of patients after colorectal cancer (CRC) resection with curative intent. This document is based on a critical review of the literature regarding the role of colonoscopy, flexible sigmoidoscopy, endoscopic ultrasound, fecal testing and CT colonography in this setting. The document addresses the effect of surveillance, with focus on colonoscopy, on patient survival after CRC resection, the appropriate use and timing of colonoscopy for perioperative clearing and for postoperative prevention of metachronous CRC, specific considerations for the detection of local recurrence in the case of rectal cancer, as well as the place of CT colonography and fecal tests in post-CRC surveillance.
Collapse
Affiliation(s)
- Charles J Kahi
- Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington.,University of Washington School of Medicine, Seattle, Washington
| | | | | | - Tonya Kaltenbach
- Veterans Affairs Palo Alto, Palo Alto, California.,Stanford University School of Medicine, Palo Alto, California
| | | | | | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont.,Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
|
10
|
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]
Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA,
| |
Collapse
|
|
11
|
CT colonography for the detection of nonpolypoid adenomas: sensitivity assessed with restricted national CT colonography trial criteria. AJR Am J Roentgenol 2015; 203:W614-22. [PMID: 25415726 DOI: 10.2214/ajr.13.12356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio<50% and height elevation≤3 mm. MATERIALS AND METHODS In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95% CIs) for nonpolypoid and polypoid lesions were compared by two-sided Z test for independent binomial proportions. RESULTS The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83% (21 of 2531 participants). Eight (38.1%) were advanced adenomas, many (50% [4/8]) only because of large size (≥10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas≥5 mm (n=21) was 0.76; ≥6 mm (n=16), 0.75; and ≥10 mm (n=5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p>0.37). CONCLUSION In this large screening population, nonpolypoid adenomas had a very low prevalence (<1%), and advanced pathologic features were uncommon in polyps<10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.
Collapse
|
|
12
|
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: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of radiation exposure is probably overemphasised, especially with newer technology. At this time-point, it is not entirely clear whether the detection of extracolonic findings at CTC is of net benefit and is cost effective, but with responsible handling, this may be the case. Future efforts will seek to further improve the technique, refine appropriate diagnostic algorithms and study cost-effectiveness.
Collapse
Affiliation(s)
- Margriet C de Haan
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Jaap Stoker
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
|
13
|
Crockett SD, Snover DC, Ahnen DJ, Baron JA. Sessile serrated adenomas: an evidence-based guide to management. Clin Gastroenterol Hepatol 2015; 13:11-26.e1. [PMID: 24216467 DOI: 10.1016/j.cgh.2013.10.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 02/07/2023]
Abstract
The concept of serrated colorectal neoplasia and a serrated pathway to colorectal cancer (CRC) is relatively new and continuing to evolve, but it has become highly relevant to gastroenterologists, pathologist, and oncologists alike. Sessile serrated adenomas (SSA) are now thought to be the major precursor lesion of serrated pathway cancers, which represent up to one-third of all sporadic CRC cases. However, despite their increasingly recognized importance, relatively little is known about the epidemiology and natural history of SSAs, and the molecular and epigenetic aspects are incompletely understood. Endoscopists must be aware of the unique features of SSAs so that the practice of colonoscopic screening for CRC can include optimized detection, removal, and appropriate surveillance of SSAs and other serrated precursor lesions. In this review, we discuss the history, epidemiology, and pathologic aspects of SSAs, as well as a recommended management approach and a discussion of uncertainties and opportunities for future research.
Collapse
Affiliation(s)
- Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Dale C Snover
- Department of Pathology, Fairview Southdale Hospital, Edina, Minnesota
| | - Dennis J Ahnen
- Division of Gastroenterology, Department of Veterans Affairs Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, Colorado
| | - John A Baron
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
|
14
|
Togashi K, Utano K, Kijima S, Sato Y, Horie H, Sunada K, Lefor AT, Sugimoto H, Yasuda Y. Laterally spreading tumors: Limitations of computed tomography colonography. World J Gastroenterol 2014; 20:17552-17557. [PMID: 25516670 PMCID: PMC4265617 DOI: 10.3748/wjg.v20.i46.17552] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/10/2014] [Accepted: 06/05/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To prospectively investigate the detection rate of laterally spreading tumors (LSTs) of the colorectum by computed tomography (CT) colonography (CTC).
METHODS: Patients with LSTs measuring ≥ 20 mm detected during colonoscopy were prospectively enrolled in the study. All patients underwent colonoscopy and subsequent CTC on the same day. CTC was performed using multi-detector CT without contrast in the prone and supine positions. Two radiologists blinded to the existence of LSTs read the virtual endoscopic images as well as 2-D images. LSTs were classified into granular and non-granular types based on colonoscopic appearance.
RESULTS: Forty-seven pathologically proven LSTs were evaluated prospectively. Histology included adenomas in 19, mucosal cancers in 19 and T1 cancers in 9. The mean diameter of the LSTs was 35.1 mm. Twenty-eight (60%) LSTs were correctly identified by CTC, and the configuration was similar to the colonoscopic appearance in most cases. Detection rate for the granular type was significantly higher than that for the non-granular type (71% vs 31%, P = 0.013). Detection rate of adenomas was significantly lower than mucosal cancers (32% vs 79%, P = 0.008) and T1 cancers (32% vs 78%, P = 0.042).
CONCLUSION: The detection rate of LSTs by CTC, particularly the non-granular type was not acceptable. Practitioners should be aware of the relatively low detection rate when using CTC.
Collapse
|
|
15
|
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.
Collapse
|
|
16
|
Kim B, Park SH, Pickhardt PJ, Lee SS, Ahn S, Kim J, Kim JC, Yu CS, Yang SK, Kim AY, Ha HK. Adenomatous neoplasia: postsurgical incidence after normal preoperative CT colonography findings in the colon proximal to an occlusive cancer. Radiology 2014; 273:99-107. [PMID: 24918959 DOI: 10.1148/radiol.14132844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the postoperative incidence of adenomatous neoplasia in the colon proximal to an occlusive colorectal cancer where preoperative computed tomographic (CT) colonography findings were normal. MATERIALS AND METHODS Institutional review board approval, with a waiver of informed consent, was obtained. This observational study included patients with occlusive colorectal cancer who underwent preoperative CT colonography between April 2007 and March 2010 that revealed normal findings (ie, no lesions ≥ 6 mm) in the proximal colon and who underwent postoperative colonoscopy. The primary outcome was postoperative colonoscopic discovery of clinically relevant lesions (ie, nondiminutive [≥ 6 mm] adenomas, advanced adenomas, or cancers) in the proximal colon. The cumulative incidence of clinically relevant lesions in preoperatively normal proximal colon over the postsurgical follow-up time was analyzed by using the Kaplan-Meier method. RESULTS The final cohort included 204 patients (102 men and 102 women; mean age, 57.3 years ± 11.3 [standard deviation]). At a total of 435 postoperative colonoscopies performed over a median follow-up of 29 months (range, 1-74 months), clinically relevant lesions were detected in the proximal colon in 30 patients: Nonadvanced adenomas were detected in 23 patients, and advanced adenomas were detected in seven patients. The cumulative incidence of clinically relevant adenomatous lesions in the preoperatively normal proximal colon 12 and 18 months after preoperative CT colonography was 8.1% (95% confidence interval [CI]: 3.9%, 12.2%) and 9.6% (95% CI: 5%, 14%), respectively. Clinically relevant adenomatous lesions found in the proximal colon within 18 months of preoperative CT colonography were nonadvanced adenomas in 10 of 15 patients. CONCLUSION When the portion of the colon proximal to an occlusive cancer is devoid of nondiminutive lesions at preoperative CT colonography, colonoscopy of the proximal colon following cancer resection rarely finds clinically relevant lesions and is unlikely to reveal any lesions requiring immediate removal until routine 1-year postsurgical follow-up. Online supplemental material is available for this article .
Collapse
Affiliation(s)
- Bohyun Kim
- From the Department of Radiology and Research Institute of Radiology (B.K., S.H.P., S.S.L., A.Y.K., H.K.H.), Department of Pathology (J.K.), Department of Colorectal Surgery (J.C.K., C.S.Y.), and Department of Gastroenterology (S.K.Y.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, University of Wisconsin Medical School, Madison, Wis (P.J.P.); and Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea (S.A.)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Mitsuzaki K. [For practice a high quality screening CT colonography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:375-381. [PMID: 24759218 DOI: 10.6009/jjrt.2014_jsrt_70.4.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
|
18
|
Iussich G, Correale L, Senore C, Hassan C, Segnan N, Campanella D, Bert A, Galatola G, Laudi C, Regge D. Computer-Aided Detection for Computed Tomographic Colonography Screening. Invest Radiol 2014; 49:173-82. [DOI: 10.1097/rli.0000000000000009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
|
19
|
Pickhardt PJ, Lam VP, Weiss JM, Kennedy GD, Kim DH. Carpet lesions detected at CT colonography: clinical, imaging, and pathologic features. Radiology 2013; 270:435-43. [PMID: 24029647 DOI: 10.1148/radiol.13130812] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe carpet lesions (laterally spreading tumors ≥ 3 cm) detected at computed tomographic (CT) colonography, including their clinical, imaging, and pathologic features. MATERIALS AND METHODS The imaging reports for 9152 consecutive adults undergoing initial CT colonography at a tertiary center were reviewed in this HIPAA-compliant, institutional review board-approved retrospective study to identify all potential carpet lesions detected at CT colonography. Carpet lesions were defined as morphologically flat, laterally spreading tumors 3 cm or larger. For those patients with neoplastic carpet lesions, CT colonography studies were analyzed to determine maximal lesion width and height, oral contrast material coating, segmental location, and computer-aided detection (CAD) findings. Demographic data and details of clinical treatment in these patients were reviewed. RESULTS Eighteen carpet lesions in 18 patients (0.2%; mean age, 67.1 years; eight men, 10 women) were identified and were subsequently confirmed at colonoscopy and pathologic examination among 20 potential flat masses (≥3 cm) prospectively identified at CT colonography (there were two nonneoplastic rectal false-positive findings). No additional neoplastic carpet lesions were found in the cohort undergoing colonoscopy after CT colonography and/or surgery (there were no false-negatives). Mean lesion width was 46.5 mm (range, 30-80 mm); mean lesion height was 7.9 mm (range, 4-14 mm). Surface retention of oral contrast material was noted in all 18 cases. All but two lesions were located in the distal rectosigmoid or proximal right colon. At CAD, 17 (94.4%) lesions were detected (mean, 6.2 CAD marks per lesion). Sixteen lesions (88.9%) demonstrated advanced histologic features, including a villous component (n = 11), high-grade dysplasia (n = 4), and invasive cancer (n = 5). Sixteen patients (88.9%) required surgical treatment for complete excision. CONCLUSION CT colonography can effectively depict carpet lesions. Common features in this series included older patient age, rectal or cecal location, surface coating with oral contrast material, multiple CAD hits, advanced yet typically benign histologic features, and surgical treatment.
Collapse
Affiliation(s)
- Perry J Pickhardt
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | | | | | | | | |
Collapse
|
|
20
|
Näppi JJ, Do S, Yoshida H. Computer-Aided Detection of Colorectal Lesions with Super-Resolution CT Colonography: Pilot Evaluation. ABDOMINAL IMAGING : COMPUTATION AND CLINICAL APPLICATIONS : 5TH INTERNATIONAL WORKSHOP, HELD IN CONJUNCTION WITH MICCAI 2013, NAGOYA, JAPAN, SEPTEMBER 22, 2013 : PROCEEDINGS. ABDOMINAL IMAGING (WORKSHOP) (5TH : 2013 : NAGOYA-SHI, JAPAN) 2013; 8198:73-80. [PMID: 25580475 PMCID: PMC4287197 DOI: 10.1007/978-3-642-41083-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Reliable computer-aided detection (CADe) of small polyps and flat lesions is limited by the relatively low image resolution of computed tomographic colonography (CTC). We developed a sinogram-based super-resolution (SR) method to enhance the images of lesion candidates detected by CADe. First, CADe is used to detect lesion candidates at high sensitivity from conventional CTC images. Next, the signal patterns of the lesion candidates are enhanced in sinogram domain by use of non-uniform compressive sampling and iterative reconstruction to produce SR images of the lesion candidates. For pilot evaluation, an anthropomorphic phantom including simulated lesions was filled partially with fecal tagging and scanned by use of a CT scanner. A fully automated CADe scheme was used to detect lesion candidates in the images reconstructed at conventional 0.61-mm and at 0.10-mm SR image resolution. The proof-of-concept results indicate that the SR method has potential to reduce the number of FP CADe detections below that obtainable with the conventional CTC imaging technology.
Collapse
|
|
21
|
Koshkin VS, Hinshaw JL, Wroblewski K, Dachman AH. CAD-associated reader error in CT colonography. Acad Radiol 2012; 19:801-10. [PMID: 22537502 DOI: 10.1016/j.acra.2012.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/08/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES Computed tomographic colonographic interpretation with computer-aided detection (CAD) may be superior to unaided viewing, although polyp characteristics may influence accuracy. Reader error due to polyp characteristics was evaluated in a multiple-case, multiple-reader trial of computed tomographic colonography with CAD. MATERIALS AND METHODS Two experts retrospectively reviewed 52 positive cases (74 polyps) and categorized them as hard, moderate, or easy to detect. Each case was evaluated without and with CAD. Features that may influence a reader's ability to detect a polyp or to accept or reject a CAD mark were tabulated. The association between polyp characteristics and detection rates in the trial was assessed. The difference in detection rates (CAD vs unassisted) was calculated, and regression analysis was performed. RESULTS Of 64 polyps found by CAD, experts categorized 20 as hard, 28 as moderate, and 16 as easy to detect. Reader characterization errors predominated (47.3%) over other errors. Factors associated with lower detection rates included small size, flat morphology, and resemblance to a thickened fold. CAD was superior for polyps resembling lipomas compared to those that did not resemble lipomas (average increase in detection rate with CAD, 12.8% vs 5.5%; P < .05). CONCLUSIONS Polyp characteristic may impair computed tomographic colonographic interpretation augmented by CAD. Readers can avoid errors of measurement by evaluating diminutive polyp candidates with sample measurements. Caution should be taken when evaluating focally thick folds and when using visual impression to dismiss a polyp candidate as a lipoma when it is submerged in densely tagged fluid.
Collapse
|
|
22
|
Laghi A, Rengo M, Graser A, Iafrate F. Current status on performance of CT colonography and clinical indications. Eur J Radiol 2012; 82:1192-200. [PMID: 22749108 DOI: 10.1016/j.ejrad.2012.05.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 05/23/2012] [Indexed: 02/07/2023]
Abstract
CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10mm) accurately detected and small lesions (6-9mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for colonic diseases, leaving to CC only a therapeutic role.
Collapse
Affiliation(s)
- Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology Sapienza - Università di Roma, Polo Pontino, I.C.O.T. Hospital, Via Franco Faggiana 43, 04100 Latina, Italy.
| | | | | | | |
Collapse
|
|
23
|
Cash BD, Rockey DC, Brill JV. AGA standards for gastroenterologists for performing and interpreting diagnostic computed tomography colonography: 2011 update. Gastroenterology 2011; 141:2240-66. [PMID: 22098711 DOI: 10.1053/j.gastro.2011.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Brooks D Cash
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | | |
Collapse
|
|
24
|
Taimouri V, Liu X, Lai Z, Liu C, Pai D, Hua J. Colon segmentation for prepless virtual colonoscopy. ACTA ACUST UNITED AC 2011; 15:709-15. [PMID: 21606039 DOI: 10.1109/titb.2011.2155664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A novel segmentation framework for a prepless virtual colonoscopy (VC) is presented, which reduces the necessity for colon cleansing before the CT scan. The patient is injected rectally with a water-soluble iodinated contrast medium using manual insufflators and a small rectal catheter. Compared to the air-based contrast medium, this technique can better preserve the color lumen and reduce the partial volume effect. However, the contrast medium, together with the fecal materials and air, makes colon wall segmentation challenging. Our solution makes no assumptions about the shape, size, and location of the fecal material in the colon. This generality allows us to label the fecal material accurately and extract the colon wall reliably. The accuracy of our technique has been verified on 60 human subjects. Compared with current VC technologies, our method is shown to be better in terms of both sensitivity and specificity. Further, in our experiments, the accuracy of the technique was comparable to that of optical colonoscopy results.
Collapse
Affiliation(s)
- Vahid Taimouri
- Department of Computer Science, Wayne State University, Detroit, MI 48202, USA.
| | | | | | | | | | | |
Collapse
|
|
25
|
Wylie PN, Burling D. CT colonography: what the gastroenterologist needs to know. Frontline Gastroenterol 2011; 2:96-104. [PMID: 28839590 PMCID: PMC5517201 DOI: 10.1136/fg.2009.000380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2010] [Indexed: 02/04/2023] Open
Affiliation(s)
- Peter N Wylie
- Radiology Department, Royal Free Hospital, London, UK
| | - David Burling
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
| |
Collapse
|
|
26
|
Kim HJ, Park SH, Pickhardt PJ, Yoon SN, Lee SS, Yee J, Kim DH, Kim AY, Kim JC, Yu CS, Ha HK. CT colonography for combined colonic and extracolonic surveillance after curative resection of colorectal cancer. Radiology 2010; 257:697-704. [PMID: 20876390 DOI: 10.1148/radiol.10100385] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the accuracy of contrast material-enhanced computed tomographic (CT) colonography for postoperative surveillance in colorectal cancer patients without clinical or laboratory evidence of disease recurrence. MATERIALS AND METHODS The Institutional Review Board approved this HIPAA-compliant study and waived informed consent. Between January 2006 and December 2007, 742 consecutive patients without clinical or laboratory evidence of recurrence following curative-intent colorectal cancer surgery underwent contrast-enhanced CT colonography. Of these, 548 patients who had subsequent colonoscopy and pathologic confirmation of colonic lesions (reference standard) were included in the colonic analysis. All 742 patients were included in the extracolonic analysis. Sensitivity and specificity of CT colonography for nonanastomotic colonic lesions at least 6 mm in size and anastomotic lesions of any size, including performance according to lesion histologic type, were determined. Diagnostic yields of contrast-enhanced CT colonography for colonic cancers and for extracolonic recurrences were obtained. RESULTS CT colonography depicted all six metachronous cancers and one anastomotic recurrence within the colon in six patients (0.8%; 95% confidence interval [CI]: 0.3%, 1.8%]), for per-patient and per-lesion sensitivities of 100% (95% CIs: 64.3%, 100% and 67.8%, 100%, respectively). All cancer lesions within the colon were amenable to additional curative treatment. CT colonography per-patient and per-lesion sensitivity was 81.8% (95% CI: 60.9%, 93.3%) and 80.8% (95% CI: 64.3%, 97.2%), respectively, for advanced neoplasia and 80.0% (95% CI: 68.6%, 88.1%) and 78.5% (95% CI: 68.3%, 88.7%), respectively, for all adenomatous lesions. Negative predictive values for adenocarcinoma, advanced neoplasia, and all adenomatous lesions were 100%, 99.1%, and 97.0%, respectively. CT colonography specificity was 93.1% (95% CI: 90.4%, 95.2%). Contrast-enhanced CT colonography enabled detection of extracolonic recurrences in an additional 11 patients (1.5%; 95% CI: 0.8%, 2.7%). CONCLUSION Contrast-enhanced CT colonography is an accurate and practical surveillance tool following colorectal cancer surgery in patients without clinical or laboratory evidence of recurrence, allowing for simultaneous less-invasive evaluation of both colon and extracolonic organs. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100385/-/DC1.
Collapse
Affiliation(s)
- Hye Jin Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-Gu, Seoul 138-736, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
27
|
Ignjatovic A, Burling D, Ilangovan R, Clark SK, Taylor SA, East JE, Saunders BP. Flat colon polyps: what should radiologists know? Clin Radiol 2010; 65:958-66. [PMID: 21070898 DOI: 10.1016/j.crad.2010.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/11/2010] [Accepted: 05/28/2010] [Indexed: 02/06/2023]
Abstract
With the recent publication of international computed tomography (CT) colonography standards, which aim to improve quality of examinations, this review informs radiologists about the significance of flat polyps (adenomas and hyperplastic polyps) in colorectal cancer pathways. We describe flat polyp classification systems and propose how flat polyps should be reported to ensure patient management strategies are based on polyp morphology as well as size. Indeed, consistency when describing flat polyps is of increasing importance given the strengthening links between CT colonography and endoscopy.
Collapse
Affiliation(s)
- A Ignjatovic
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, Middlesex, UK
| | | | | | | | | | | | | |
Collapse
|
|
28
|
Abstract
Computed tomography colonography (CTC) in colorectal cancer (CRC) screening has two roles: one present and the other potential. The present role is, without any further discussion, the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy. The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test, sigmoidoscopy and colonoscopy. However, despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientific societies including the American Cancer Society, the American College of Radiology, and the US Multisociety Task Force on Colorectal Cancer, other entities, such as the US Preventive Services Task Force, have considered the evidence insufficient to justify its use as a mass screening method. Medicare has also recently denied reimbursement for CTC as a screening test. Nevertheless, multiple advantages exist for using CTC as a CRC screening test: high accuracy, full evaluation of the colon in virtually all patients, non-invasiveness, safety, patient comfort, detection of extracolonic findings and cost-effectiveness. The main potential drawback of a CTC screening is the exposure to ionizing radiation. However, this is not a major issue, since low-dose protocols are now routinely implemented, delivering a dose comparable or slightly superior to the annual radiation exposure of any individual. Indirect evidence exists that such a radiation exposure does not induce additional cancers.
Collapse
|
|
29
|
Näppi JJ. CADe prompts and observer performance a game of confidence. Acad Radiol 2010; 17:945-7. [PMID: 20599154 DOI: 10.1016/j.acra.2010.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 05/21/2010] [Accepted: 05/23/2010] [Indexed: 11/26/2022]
|
|
30
|
Dachman AH, Obuchowski NA, Hoffmeister JW, Hinshaw JL, Frew MI, Winter TC, Van Uitert RL, Periaswamy S, Summers RM, Hillman BJ. Effect of computer-aided detection for CT colonography in a multireader, multicase trial. Radiology 2010; 256:827-35. [PMID: 20663975 DOI: 10.1148/radiol.10091890] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess the effect of using computer-aided detection (CAD) in second-read mode on readers' accuracy in interpreting computed tomographic (CT) colonographic images. MATERIALS AND METHODS The contributing institutions performed the examinations under approval of their local institutional review board, with waiver of informed consent, for this HIPAA-compliant study. A cohort of 100 colonoscopy-proved cases was used: In 52 patients with findings positive for polyps, 74 polyps of 6 mm or larger were observed in 65 colonic segments; in 48 patients with findings negative for polyps, no polyps were found. Nineteen blinded readers interpreted each case at two different times, with and without the assistance of a commercial CAD system. The effect of CAD was assessed in segment-level and patient-level receiver operating characteristic (ROC) curve analyses. RESULTS Thirteen (68%) of 19 readers demonstrated higher accuracy with CAD, as measured with the segment-level area under the ROC curve (AUC). The readers' average segment-level AUC with CAD (0.758) was significantly greater (P = .015) than the average AUC in the unassisted read (0.737). Readers' per-segment, per-patient, and per-polyp sensitivity for all polyps of 6 mm or larger was higher (P < .011, .007, .005, respectively) for readings with CAD compared with unassisted readings (0.517 versus 0.465, 0.521 versus 0.466, and 0.477 versus 0.422, respectively). Sensitivity for patients with at least one large polyp of 10 mm or larger was also higher (P < .047) with CAD than without (0.777 versus 0.743). Average reader sensitivity also improved with CAD by more than 0.08 for small adenomas. Use of CAD reduced specificity of readers by 0.025 (P = .05). CONCLUSION Use of CAD resulted in a significant improvement in overall reader performance. CAD improves reader sensitivity when measured per segment, per patient, and per polyp for small polyps and adenomas and also reduces specificity by a small amount.
Collapse
Affiliation(s)
- Abraham H Dachman
- Department of Radiology, MC2026, the University of Chicago, Chicago, IL 60637, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
31
|
Suzuki N, Ignjatovic A, Burling D, Taylor SA. CT colonography and non-polypoid colorectal neoplasms. Gastrointest Endosc Clin N Am 2010; 20:565-72. [PMID: 20656252 DOI: 10.1016/j.giec.2010.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Computed tomographic colonography (CTC) has been reported to be as effective as optical colonoscopy in the detection of significant adenomas. However, there are widely conflicting performance data in relation to detection of flat neoplasia. This article describes the potential and limitations of CTC and computer-aided diagnosis in the detection of flat neoplasms.
Collapse
Affiliation(s)
- Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
| | | | | | | |
Collapse
|
|
32
|
Pickhardt PJ, Kim DH, Robbins JB. Flat (nonpolypoid) colorectal lesions identified at CT colonography in a U.S. screening population. Acad Radiol 2010; 17:784-90. [PMID: 20227304 DOI: 10.1016/j.acra.2010.01.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 01/05/2010] [Accepted: 01/07/2010] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to investigate the clinical importance and height definition of flat (nonpolypoid) colorectal lesions detected on screening computed tomographic colonography (CTC). MATERIALS AND METHODS Results from prospective screening CTC in 5107 consecutive asymptomatic adults (mean age, 56.9 years) at a single center were analyzed. All detected colorectal lesions > or = 6 mm were prospectively categorized as polypoid or flat (nonpolypoid). The maximal height of all flat lesions was measured to assess the suggested 3-mm threshold definition. RESULTS Of 954 polyps measuring > or = 6 mm identified on screening CTC, 125 lesions (13.1%) in 106 adults were prospectively categorized as flat, with a mean size of 12.7 mm (range, 6-80 mm), including 73 lesions 6 to 9 mm, 42 lesions 10 to 29 mm, and 10 lesions > or = 3 cm (carpet lesions). For polyps between 6 and 30 mm in size, flat lesions were less likely than polypoid lesions to be neoplastic (25.0% vs 60.3%, P < .001), histologically advanced (5.4% vs 12.1%, P = .07) or malignant (0% vs 0.5%, P = NS). Two of 10 carpet lesions (20%) were malignant, compared to 50% of polypoid masses > or = 3 cm. Of nine flat lesions seen only on colonoscopy (false-negatives on CTC), two were neoplastic (tubular adenomas), and none was histologically advanced. For all flat lesions between 6 and 30 mm, the maximal height averaged 2.2 mm and was < or =3 mm in 86.1%, including 93.2% of small 6-mm to 9-mm flat lesions. CONCLUSION In a US screening population, flat colorectal lesions detected on CTC demonstrated less aggressive histologic features compared to polypoid lesions. Excluding carpet lesions, a maximal height of 3 mm appears to be a reasonable definition.
Collapse
Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252, USA.
| | | | | |
Collapse
|
|
33
|
Cha EY, Park SH, Lee SS, Kim JC, Yu CS, Lim SB, Yoon SN, Shin YM, Kim AY, Ha HK. CT colonography after metallic stent placement for acute malignant colonic obstruction. Radiology 2010; 254:774-82. [PMID: 20177092 DOI: 10.1148/radiol.09090842] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the feasibility of using computed tomographic (CT) colonography for preoperative examination of the proximal colon after metallic stent placement in patients with acute colon obstruction caused by colorectal cancer. MATERIALS AND METHODS Institutional review board approval was obtained, and patient informed consent was waived. Fifty patients (mean age +/- standard deviation, 58.5 years +/- 11.7), who demonstrated no postprocedural complication after successful placement of self-expandable metallic stents to treat acute colon obstruction caused by cancer, underwent CT colonography 1-43 days (median, 5 days) after stent placement. CT colonography was performed after cathartic preparation by using magnesium citrate (n = 20) or sodium phosphate (n = 3), combined with oral bisacodyl, or by using polyethylene glycol (n = 27). Fecal/fluid tagging was achieved by using 100 mL of meglumine diatrizoate. The colon was distended by means of pressure-monitored CO(2) insufflation. The sensitivity and specificity of CT colonography in evaluating the colon proximal to the stent and CT colonography-related complications were assessed. The 95% confidence intervals (CIs) were calculated for proportional data. RESULTS Per-lesion and per-patient sensitivities of CT colonography for lesions 6 mm or larger in diameter in the colon proximal to the stent were 85.7% (12 of 14 lesions; 95% CI: 58.8%, 97.2%) and 90% (nine of 10 patients; 95% CI: 57.4%, 99.9%), respectively. CT colonography depicted all synchronous cancers (two lesions) and advanced adenomas (five lesions). Per-patient specificity for lesions 6 mm and larger in the proximal colon was 85.7% (18 of 21 patients; 95% CI: 64.5%, 95.9%). CT colonography did not generate any false diagnosis of synchronous cancer. False-positive findings at CT colonography did not result in a change in surgical plan for any patients. No CT colonography-associated stent dislodgment/migration or colonic perforation occurred in any patient (95% CI: 0%, 6.2%). CONCLUSION CT colonography is a safe and useful method for preoperative examination of the proximal colon after metallic stent placement in patients with acute colon obstruction caused by cancer. (c) RSNA, 2010.
Collapse
Affiliation(s)
- Eun-Young Cha
- Department of Radiology and Research Institute of Radiology and Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Gu, Seoul 138-040, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
34
|
Pickhardt PJ, Kim DH. Performance of CT colonography for detecting small, diminutive, and flat polyps. Gastrointest Endosc Clin N Am 2010; 20:209-26. [PMID: 20451811 DOI: 10.1016/j.giec.2010.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The primary goal of colorectal cancer screening and prevention is the detection and removal of advanced neoplasia. Computerized tomography (CT) colonography is now well established as an effective screening test. Areas of greater uncertainty include the performance characteristics of CT colonography for detecting small (6-9 mm), diminutive (< or =5 mm), and flat (nonpolypoid) lesions. However, the actual clinical relevance of small, diminutive, and flat polyps has also been the source of debate. This article addresses these controversial and often misunderstood issues.
Collapse
Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252, USA.
| | | |
Collapse
|
|
35
|
McFarland EG, Fletcher JG, Pickhardt P, Dachman A, Yee J, McCollough CH, Macari M, Knechtges P, Zalis M, Barish M, Kim DH, Keysor KJ, Johnson CD. ACR Colon Cancer Committee white paper: status of CT colonography 2009. J Am Coll Radiol 2010; 6:756-772.e4. [PMID: 19878883 DOI: 10.1016/j.jacr.2009.09.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 09/02/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE To review the current status and rationale of the updated ACR practice guidelines for CT colonography (CTC). METHODS Clinical validation trials in both the United States and Europe are reviewed. Key technical aspects of the CTC examination are emphasized, including low-dose protocols, proper insufflation, and bowel preparation. Important issues of implementation are discussed, including training and certification, definition of the target lesion, reporting of colonic and extracolonic findings, quality metrics, reimbursement, and cost-effectiveness. RESULTS Successful validation trials in screening cohorts both in the United States with ACRIN and in Germany demonstrated sensitivity > or = 90% for patients with polyps >10 mm. Proper technique is critical, including low-dose techniques in screening cohorts, with an upper limit of the CT dose index by volume of 12.5 mGy per examination. Training new readers includes the requirement of interactive workstation training with 2-D and 3-D image display techniques. The target lesion is defined as a polyp > or = 6 mm, consistent with the American Cancer Society joint guidelines. Five quality metrics have been defined for CTC, with pilot data entered. Although the CMS national noncoverage decision in May 2009 was a disappointment, multiple third-party payers are reimbursing for screening CTC. Cost-effective modeling has shown CTC to be a dominant strategy, including in a Medicare cohort. CONCLUSION Supported by third-party payer reimbursement for screening, CTC will continue to further transition into community practice and can provide an important adjunctive examination for colorectal screening.
Collapse
|