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Cadi M, Dieumegard B, Moussali J, Meskins C, Richa H, Lenczner G, Guigui J, Rotenberg L, Peletier S, Beges C. Optimisation de la coloscopie virtuelle. JOURNAL D'IMAGERIE DIAGNOSTIQUE ET INTERVENTIONNELLE 2021; 4:140-157. [DOI: 10.1016/j.jidi.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Abstract
Significant anxiety has been expressed by some over the radiation risks associated with computed tomography (CT), particularly when it applies to a screening examination such as CT colonography. These theoretic risks are far outweighed by the significant benefits colorectal cancer screening offers. Regardless of how significant the theoretic risk of CT radiation is in the older population, the ALARA principle maintains that radiation dose should be reduced to As Low As Reasonably Achievable. This article will discuss various strategies that may be utilized to reduce radiation dose and mitigate any increase in image noise that may occur.
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Affiliation(s)
- Kevin J Chang
- Department of Radiology, Newton-Wellesley Hospital, Brown University Alpert Medical School, 2014 Washington Street, Newton, MA 02462, USA.
| | - Judy Yee
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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Abstract
CT colonography (CTC) has demonstrated equivalent accuracy to optical colonoscopy in the detection of clinically relevant polyps and tumors but this is only possible when technique is optimized. The two most important features of a high-quality CTC are a well-prepared colon and a distended colon. This article will discuss the dietary, bowel preparation, and fecal/fluid tagging options to best prepare the colon. Strategies to optimally distend the colon will also be discussed. CT scan techniques including patient positioning and radiation dose optimization will be reviewed. With proper technique which includes sufficient bowel preparation, fecal/fluid tagging, bowel distension, and optimized scan technique, high-quality CTC examinations should become more feasible, easier to interpret, and more consistently reproducible leading to increased utilization and increased referrals.
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The effect of without using anisodamine during CT enterography on image quality, diagnostic performance and latent side effects. Clin Imaging 2017; 48:106-112. [PMID: 29059545 DOI: 10.1016/j.clinimag.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/17/2017] [Accepted: 09/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine whether no anisodamine injection before CTE was feasible without impairing image quality and diagnostic performance. MATERIALS The change of mural thickness and luminal diameter were compared between using and no using anisodamine. The diagnostic performance of small-bowel disease was analyzed and compared. RESULTS No motion artifact was detected in two groups. There was no significant difference regarding the change of luminal diameter and mural thickness (all P>0.05). The diagnostic accuracy of small-bowel disease was no significant difference (P=0.63). CONCLUSION Lack of anisodamine injection before CTE did not impair image quality and diagnostic performance compared with CTEs performed with anisodamine injection.
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Woodbridge L, Wylie P. Current Issues in Computed Tomography Colonography. Semin Ultrasound CT MR 2016; 37:331-8. [PMID: 27342897 DOI: 10.1053/j.sult.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Scalise P, Mantarro A, Pancrazi F, Neri E. Computed tomography colonography for the practicing radiologist: A review of current recommendations on methodology and clinical indications. World J Radiol 2016; 8:472-483. [PMID: 27247713 PMCID: PMC4882404 DOI: 10.4329/wjr.v8.i5.472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/23/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most relevant causes of morbidity and mortality in Western societies. CRC screening is actually based on faecal occult blood testing, and optical colonoscopy still remains the gold standard screening test for cancer detection. However, computed tomography colonography (CT colonography) constitutes a reliable, minimally-invasive method to rapidly and effectively evaluate the entire colon for clinically relevant lesions. Furthermore, even if the benefits of its employment in CRC mass screening have not fully established yet, CT colonography may represent a reasonable alternative screening test in patients who cannot undergo or refuse colonoscopy. Therefore, the purpose of our review is to illustrate the most updated recommendations on methodology and the current clinical indications of CT colonography, according to the data of the existing relevant literature.
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Devir C, Kebapci M, Temel T, Ozakyol A. Comparison of 64-Detector CT Colonography and Conventional Colonoscopy in the Detection of Colorectal Lesions. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e19518. [PMID: 27110333 PMCID: PMC4835868 DOI: 10.5812/iranjradiol.19518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/16/2014] [Accepted: 08/29/2014] [Indexed: 01/29/2023]
Abstract
Background: Colon cancer is a leading cause of morbidity and mortality in developed countries. The early detection of colorectal cancer using screening programs is important for managing early-stage colorectal cancers and polyps. Modalities that allow examination of the entire colon are conventional colonoscopy, double contrast barium enema examination and multi-detector computed tomography (MDCT) colonography. Objectives: To compare CT colonography and conventional colonoscopy results and to evaluate the accuracy of CT colonography for detecting colorectal lesions. Patients and Methods: In a prospective study performed at Gastroenterology and Radiology Departments of Medical Faculty of Eskisehir Osmangazi University, CT colonography and colonoscopy results of 31 patients with family history of colorectal carcinoma, personal or family history of colorectal polyps, lower gastrointestinal tract bleeding, change in bowel habits, iron deficiency anemia and abdominal pain were compared. Regardless of the size, CT colonography and conventional colonoscopy findings for all the lesions were cross - tabulated and the sensitivity, specificity, and positive and negative predictive values were calculated. To assess the agreement between CT colonography and conventional colonoscopy examinations, the Kappa coefficient of agreementt was used. Statistical analysis was performed by SPSS ver 15.0. Results: Regardless of the size, MDCT colonography showed 83% sensitivity and 95% specificity, with a positive predictive value of 95% and a negative predictive value of 83% for the detection of colorectal polyps and masses. MDCT colonography displayed 92% sensitivity and 95% specificity, with a positive predictive value of 92% and a negative predictive value of 95% for polyps ≥ 10 mm. For polyps between 6mm and 9 mm, MDCT colonography displayed 75% sensitivity and 100% specificity, with a positive predictive value of 100% and a negative predictive value of 90%. For polyps ≤ 5 mm MDCT colonography displayed 88% sensitivity and 100% specificity with a positive predictive value of 100% and a negative predictive value of 95%. Conclusions: CT colonography is a safe and minimally invasive technique, a valuable diagnostic tool for examining the entire colon and a good alternative compared to other colorectal cancer screening tests because of its high sensitivity values in colorectal lesions over 1 cm.
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Affiliation(s)
- Cigdem Devir
- Department of Radiology, Research and Training Hospital, Kutahya Dumlupinar University, Kutahya, Turkey
| | - Mahmut Kebapci
- Department of Radiology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tuncer Temel
- Department of Gastroenterology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
- Corresponding author: Temel Tuncer, Department of Gastroenterology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey. Tel: +90-5327150330, E-mail:
| | - Aysegul Ozakyol
- Department of Gastroenterology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
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Jang JK, Park SH, Lee JS, Kim HJ, Kim AY, Ha HK. Effect of Reducing Abdominal Compression during Prone CT Colonography on Ascending Colonic Rotation during Supine-to-Prone Positional Change. Korean J Radiol 2016; 17:47-55. [PMID: 26798215 PMCID: PMC4720810 DOI: 10.3348/kjr.2016.17.1.47] [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: 08/06/2015] [Accepted: 11/06/2015] [Indexed: 01/27/2023] Open
Abstract
Objective To determine the effect of reduced abdominal compression in prone position on ascending colonic movement during supine-to-prone positional change during CT colonography (CTC). Materials and Methods Eighteen consecutive patients who had undergone prone CTC scanning with cushion blocks placed under the chest and hip/thigh to reduce abdominal compression and had confirmed sessile polyps ≥ 6 mm in the well-distended, straight, mid-ascending colon, were included. Radial location along the ascending colonic luminal circumference (°) was measured for 24 polyps and 54 colonic teniae on supine and prone CTC images. The supine-to-prone change ranging between -180° and +180° (- and + for internal and external colonic rotations, respectively), was determined. In addition, possible causes of any ascending colonic rotations were explored. Results Abdominal compression during prone CTC scanning completely disappeared with the use of cushion blocks in 17 of 18 patients. However, some degrees of ascending colonic rotation were still observed, with the radial location changes of -22° to 61° (median, 13.9°) for the polyps and similar degrees for teniae. Fifty-four percent and 56% of polyps and teniae, respectively, showed changes > 10°. The radial location change of the polyps was significantly associated with the degree of anterior shift of the small bowel and mesentery (r = 0.722, p < 0.001) and the degree of posterior displacement of the ascending colon (r = 0.566, p = 0.004) during supine-to-prone positional change. Conclusion Ascending colonic rotation upon supine-to-prone positional change during CTC, mostly in the form of external rotation, is not eliminated by removing abdominal compression in prone position.
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Affiliation(s)
- Jong Keon Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Jin Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ah Young Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Kwon Ha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Volumetric analysis of colonic distention according to patient position at CT colonography: diagnostic value of the right lateral decubitus series. AJR Am J Roentgenol 2015; 203:W623-8. [PMID: 25415727 DOI: 10.2214/ajr.13.12369] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to compare total colonic gas volume and segmental luminal distention according to patient position on CT colonography (CTC), as well as to determine which two views should constitute the routine protocol. MATERIALS AND METHODS Volumetric analysis was retrospectively performed on CTC examinations from 146 adults (mean age, 59.2 years; 81 men and 65 women; mean body mass index [BMI], 30.9) for whom supine, prone, and right lateral decubitus series were sequentially obtained using continuous low-pressure CO2 insufflation. Total colonic gas volumes were assessed using a novel automated volumetric tool. In addition, two radiologists scored distention by segment using a 4-point scale (4=optimal; 3=adequate; 2=inadequate; 1=collapsed). RESULTS Mean (±SD) colonic gas volumes for supine, prone, and decubitus positioning were 1617±567, 1441±505, and 1901±627, respectively (p<0.001). Colonic volume was highest on the right lateral decubitus series in 73.3% (107/146) and lowest in 6.2% (9/146) of cases, whereas the prone series was highest in 0.7% (1/146) and lowest in 73.3% (107/146) of cases. Overall mean segmental reader scores and percentages of inadequate or collapsed for supine, prone, and decubitus positions were 3.48, 3.33, and 3.71 and 10.4%, 12.1%, and 4.2%, respectively (p<0.001). The only mean segmental scores below 3.0 were the sigmoid colon on supine (2.68) and prone (2.58) series, compared with 3.23 on decubitus series (p<0.001). Improvement in distention in both decubitus and supine positions over the prone position increased further with increasing BMI (p<0.001). CONCLUSION The right lateral decubitus position consistently yields the best colonic distention at CTC and significantly improves evaluation of the sigmoid colon. Prone distention was the worst, particularly as BMI increased. Routine supine and decubitus positioning should be considered for standard CTC protocols, particularly in obese individuals. Automated volumetric analysis provides for rapid objective assessment of colonic distention.
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Colonic distention at CT colonography: randomized evaluation of both IV hyoscine butylbromide and automated carbon dioxide insufflation. AJR Am J Roentgenol 2015; 204:76-82. [PMID: 25539240 DOI: 10.2214/ajr.14.12772] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the efficacy of IV hyoscine butylbromide as a bowel relaxant and automated carbon dioxide insufflation in CT colonography in terms of colonic distention and perceived burden. SUBJECTS AND METHODS; Two hundred twenty-four participants were randomly allocated to one of four groups: control (no bowel relaxant and IV saline placebo before CT colonography with manual carbon dioxide insufflation), hyoscine butylbromide (IV hyoscine butylbromide before examination with manual carbon dioxide insufflation), automated (no bowel relaxant before examination with automated carbon dioxide insufflation), and combined (hyoscine butylbromide before examination with automated carbon dioxide insufflation). The degree of colonic distention on a 4-point scale, examination time, and participants' satisfaction, as measured by their responses to a questionnaire, were assessed. RESULTS The mean distention grades of all the colonic segments and both positions were 3.22 in the control group, 3.28 in the hyoscine butylbromide group, 3.77 in the automated group, and 3.74 in the combined group. Compared with manual carbon dioxide insufflation, automated carbon dioxide insufflation significantly improved the clinical adequacy of colonic distention and shortened examination time. No statistically significant difference was seen in the clinical adequacy of distention between participants who received hyoscine butylbromide and those who did not, or in examination time. Overall, the participants' experiences were not different. CONCLUSION Colonic distention was statistically significantly improved by automated carbon dioxide insufflation, but not by the administration of hyoscine butylbromide. The participants' tolerance was similar in each group.
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Levine MS, Yee J. History, evolution, and current status of radiologic imaging tests for colorectal cancer screening. Radiology 2015; 273:S160-80. [PMID: 25340435 DOI: 10.1148/radiol.14140531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer screening is thought to be an effective tool with which to reduce the mortality from colorectal cancer through early detection and removal of colonic adenomas and early colon cancers. In this article, we review the history, evolution, and current status of imaging tests of the colon-including single-contrast barium enema, double-contrast barium enema, computed tomographic (CT) colonography, and magnetic resonance (MR) colonography-for colorectal cancer screening. Despite its documented value in the detection of colonic polyps, the double-contrast barium enema has largely disappeared as a screening test because it is widely perceived as a labor-intensive, time-consuming, and technically demanding procedure. In the past decade, the barium enema has been supplanted by CT colonography as the major imaging test in colorectal cancer screening in the United States, with MR colonography emerging as another viable option in Europe. Although MR colonography does not require ionizing radiation, the radiation dose for CT colonography has decreased substantially, and regular screening with this technique has a high benefit-to-risk ratio. In recent years, CT colonography has been validated as an effective tool for use in colorectal cancer screening that is increasingly being disseminated.
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Affiliation(s)
- Marc S Levine
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (M.S.L.); and Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (J.Y.)
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Sakamoto T, Utsunomiya D, Mitsuzaki K, Matsuda K, Kawakami M, Yamamura S, Urata J, Arakawa A, Yamashita Y. Colonic distention at screening CT colonography: role of spasmolytic agents and body habitus. Kurume Med J 2014; 61:9-15. [PMID: 25400236 DOI: 10.2739/kurumemedj.ms64002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sufficient colonic dilation is important when using CT colonography (CTC) for colorectal cancer screening. We investigated the effect of antispasmodic agents and the patient body habitus on the degree of colonic dilation in screening CTC.We assessed the effect of clinical characteristics [age, gender, body mass index (BMI), and the presence of diverticula] and the use of antispasmodics on colonic distention in 140 patients who underwent CTC for colorectal cancer screening. The CTC was performed in both the supine- and prone positions. Seventy patients received antispasmodics prior to CT examination and the other 70 did not. Colonic distention was scored using a 5-point scale: 1=collapsed, 2=poorly visualized, 3=visualized but underdistended, 4=acceptable, and 5=excellent. Images scored as 4 or 5 were considered to be of diagnostic quality. The mean visual evaluation score was significantly higher in the supine- than the prone position (4.2±0.5 vs. 4.0±0.5, p<0.01). For the supine position, only the use of antispasmodic was statistically associated with sufficient colonic dilation by univariate logistic analysis (odds ratio=2.365, p=0.03). For the prone position, age, BMI, and the use of antispasmodic were statistically associated with sufficient colonic dilation by multivariate analysis. The odds ratio of these parameters was 0.955 (p=0.02), 0.874 (p=0.03), and 2.391 (p=0.02), respectively.We obtained sufficient colonic dilation with an antispasmodic for CTC in both positions. Younger age and a lower BMI were also associated with better colonic dilation in the prone position.
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Lung P, Burling D, Kallarackel L, Muckian J, Ilangovan R, Gupta A, Marshall M, Shorvon P, Halligan S, Bhatnagar G, Bassett P, Taylor S. Implementation of a new CT colonography service: 5 Year experience. Clin Radiol 2014; 69:597-605. [DOI: 10.1016/j.crad.2014.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 11/25/2022]
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Tsurumaru D, Kawanami S, Nishimuta Y, Miyasaka M, Asayama Y, Honda H. Contrast-Enhanced CT Colonography Features of Rectal Carcinoid Tumors. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/act.2014.32005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Haan MC, Boellaard TN, Bossuyt PM, Stoker J. Colon distension, perceived burden and side-effects of CT-colonography for screening using hyoscine butylbromide or glucagon hydrochloride as bowel relaxant. Eur J Radiol 2012; 81:e910-6. [PMID: 22683196 DOI: 10.1016/j.ejrad.2012.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Compare colonic distension and perceived burden of CT-colonography between participants receiving hyoscine butylbromide (buscopan) and glucagon hydrochloride as bowel relaxant. MATERIALS AND METHODS Data were collected within a screening trial. Participants received 20mg buscopan intravenously or 1mg of glucagon intravenously (if buscopan contra-indicated). Colon distension per segment was assessed using a 4-point scale (prone and supine). Data on perceived burden of CT-colonography were collected using a questionnaire two weeks after the examination. Outcome measures between groups were compared using propensity score matching. We used a stratified Wilcoxon-Mann-Whitney test statistic for quantitative and Cochran-Mantel-Haenszel statistics for categorical variables. RESULTS 541 participants were included: 336 (62%) received buscopan and 205 received glucagon. All buscopan recipients had an adequately distended colon, compared to 96% in the glucagon group (RR 7.31, 95% CI: 1.61-33.28). More glucagon recipients scored the insufflation as rather or extremely burdensome (25% vs. 16%; overall mean score 2.7 vs. 2.4; p<0.001) and more found the entire CT-colonography rather or extremely burdensome (14% vs. 7%; 2.2 vs. 1.9; p=0.001). Most frequently reported side effects were a dry mouth in the buscopan group (15%) and nausea in the glucagon group (13%). CONCLUSION Compared to glucagon, premedication with buscopan results in significantly more adequately distended colons and a less burdensome procedure. When buscopan can be used, it is the preferred bowel relaxant.
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Affiliation(s)
- Margriet C de Haan
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Zijta F, Nederveen A, Jensch S, Florie J, Bipat S, van der Paardt M, van Swijndregt AM, Stoker J. Feasibility of using automated insufflated carbon dioxide (CO2) for luminal distension in 3.0T MR colonography. Eur J Radiol 2012; 81:1128-33. [DOI: 10.1016/j.ejrad.2011.02.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 02/28/2011] [Indexed: 11/25/2022]
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Boellaard TN, de Haan MC, Venema HW, Stoker J. Colon distension and scan protocol for CT-colonography: an overview. Eur J Radiol 2011; 82:1144-58. [PMID: 22154604 DOI: 10.1016/j.ejrad.2011.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/31/2011] [Indexed: 12/18/2022]
Abstract
This article reviews two important aspects of CT-colonography, namely colonic distension and scan parameters. Adequate distension should be obtained to visualize the complete colonic lumen and optimal scan parameters should be used to prevent unnecessary radiation burden. For optimal distension, automatic carbon dioxide insufflation should be performed, preferably via a thin, flexible catheter. Hyoscine butylbromide is - when available - the preferred spasmolytic agent because of the positive effect on insufflation and pain/burden and its low costs. Scans in two positions are required for adequate distension and high polyp sensitivity and decubitus position may be used as an alternative for patients unable to lie in prone position. The great intrinsic contrast between air or tagging and polyps allows the use of low radiation dose. Low-dose protocol without intravenous contrast should be used when extracolonic findings are deemed unimportant. In patients suspected for colorectal cancer, normal abdominal CT scan protocols and intravenous contrast should be used in supine position for the evaluation of extracolonic findings. Dose reduction can be obtained by lowering the tube current and/or voltage. Tube current modulation reduces the radiation dose (except in obese patients), and should be used when available. Iterative reconstructions is a promising dose reducing tool and dual-energy CT is currently evaluated for its applications in CT-colonography. This review also provides our institution's insufflation procedure and scan parameters.
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Affiliation(s)
- Thierry N Boellaard
- Department of Radiology, Academic Medical Center, University of Amsterdam, PB 22660, 1100 DD Amsterdam, The Netherlands.
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Comparing hyoscine and drotaverine effects on colon in CT colonography. Open Med (Wars) 2011. [DOI: 10.2478/s11536-010-0065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractHyoscine and drotaverine effectiveness was compared for the purposes of achieving optimum distension following insufflation in CT colonography. The in vitro effects of hyoscine and drotaverine on tone and contractility of SM preparations isolated from different areas of human colon were studied by isometric registration of contractile activity. Both medications have a relaxing effect on SM preparations and inhibit their spontaneous contractions. The drotaverine-induced effects were reliably more marked than the hyoscine-induced ones. CT colonography was performed in 70 patients who were injected with equal doses of either hyoscine (n=32) or drotaverine (n=38). The degree of drug-induced distension in both groups was determined by measuring the lumen of the colon on a 2D reconstruction. In most colon areas the width of the distended lumen was greater in the drotaverine-treated patients. We concluded that drotaverine can be used as a means to facilitate colonic distension.
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Current techniques in the performance, interpretation, and reporting of CT colonography. Gastrointest Endosc Clin N Am 2010; 20:169-92. [PMID: 20451809 DOI: 10.1016/j.giec.2010.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The technical objective of computed tomographic colonography (CTC) is to acquire high-quality computed tomography images of the cleansed, well-distended colon for polyp detection. In this article the authors provide an overview of the technical components of CTC, from preparation of the patient to acquisition of the imaging data and basic methods of interpretation. In each section, the best evidence for current practices and recommendations is reviewed. Each of the technical components must be optimized to achieve high sensitivity in polyp detection.
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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.
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Siewert B, Kruskal JB, Eisenberg R, Hall F, Sosna J. Quality initiatives: quality improvement grand rounds at Beth Israel Deaconess Medical Center: CT colonography performance review after an adverse event. Radiographics 2009; 30:23-31. [PMID: 19901086 DOI: 10.1148/rg.301095125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
As computed tomographic (CT) colonography is being used increasingly in clinical practice, an effective quality improvement process must be ensured. The quality improvement process is outlined for the reader by using an adverse event during CT colonography as an example. Components of this process are the approach to a sentinel event, performance of a root cause analysis, and development of strategies for minimizing errors after a serious adverse event. Important factors include indications and contraindications for the examination, proper imaging technique, training of personnel, complications of the procedure, and legal implications. Complications from CT colonography are rare. Attention must be paid to the correct technique for colonic insufflation, particularly in older patients and those who are symptomatic. Root cause analysis provides valuable tools for identification and implementation of improvements designed to avoid similar and other adverse events and to minimize damage.
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Affiliation(s)
- Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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24
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Nagata K, Okawa T, Honma A, Endo S, Kudo SE, Yoshida H. Full-laxative versus minimum-laxative fecal-tagging CT colonography using 64-detector row CT: prospective blinded comparison of diagnostic performance, tagging quality, and patient acceptance. Acad Radiol 2009; 16:780-9. [PMID: 19375954 DOI: 10.1016/j.acra.2008.12.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 12/24/2008] [Accepted: 12/30/2008] [Indexed: 12/18/2022]
Abstract
RATIONALE AND OBJECTIVES To compare prospectively 64-detector-row computed tomographic colonography (CTC) after a full-laxative tagging-based preparation (full preparation) with a minimum-laxative tagging-based preparation (minimum preparation) with respect to diagnostic performance in the detection of polyps, tagging quality, and patient acceptance. MATERIALS AND METHODS Consecutive 101 patients at high risk for developing colorectal cancer were alternately assigned to either a full preparation group (n = 51) or a minimum preparation group (n = 50) for fecal-tagging CTC. The full preparation consisted of administration of 2-L polyethylene glycol solution with 20 mL of sodium diatrizoate for fecal tagging. The minimum preparation consisted of ingestion of a total of 45 mL of sodium diatrizoate during the 3 days before and 10 mL of sodium picosulfate solution the night before CT. Colonoscopy was used as the reference standard. We assessed the accuracy of polyp detection and the tagging quality for each preparation. All patients were given questionnaires related to their acceptance. RESULTS Per-patient sensitivity, specificity, and positive and negative predictive values for polyps > or = 6 mm were as follows: full preparation group, 97%, 92%, 88%, and 98%, respectively; minimum preparation group, 88%, 68%, 56%, and 92%, respectively. Average visual subjective tagging scores for the full and minimum preparation groups were 94.6% and 76.1%, respectively (P < .0001). Minimum preparation was better tolerated than full preparation. CONCLUSION Although full-laxative and minimum-laxative fecal-tagging CTC yielded an equally high sensitivity in the detection of polyps > or = 6 mm, the full-laxative fecal-tagging CTC yielded a better specificity than did the minimum-laxative fecal-tagging CTC. Thus, it is desirable to offer patients an option of either full-laxative fecal-tagging CTC for highest diagnostic accuracy and ability to perform a same-day therapeutic colonoscopy without additional bowel preparation, or minimum-laxative fecal-tagging CTC for those unwilling to undergo full preparation but willing to accept moderate decrease in specificity.
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Affiliation(s)
- Koichi Nagata
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 400C, MA 02114, USA.
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Abstract
CT colonography (CTC), also termed virtual colonoscopy, is increasingly accepted at sites throughout the world as a new effective tool for the diagnosis and screening of colorectal carcinoma. This article presents information of related issues of bowel cleansing, stool and fluid tagging, bowel distention and multidetector CT scanning parameters. The author presents discussion of interpretation of CTC, appropriate applications of CTC and potential complications.
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Affiliation(s)
- Judy Yee
- University of California, San Francisco, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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26
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Farraye FA, Adler DG, Chand B, Conway JD, Diehl DL, Kantsevoy SV, Kwon RS, Mamula P, Rodriguez SA, Shah RJ, Wong Kee Song LM, Tierney WM. Update on CT colonography. Gastrointest Endosc 2009; 69:393-8. [PMID: 19231482 DOI: 10.1016/j.gie.2008.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 10/09/2008] [Indexed: 02/08/2023]
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Regge D, Neri E, Turini F, Chiara G. Role of CT colonography in inflammatory bowel disease. Eur J Radiol 2009; 69:404-8. [PMID: 19167180 DOI: 10.1016/j.ejrad.2008.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 11/14/2008] [Indexed: 02/07/2023]
Abstract
CT colonography (CTC), or virtual colonoscopy, is a non-invasive imaging method that uses CT data sets combined with specialized imaging software to examine the colon. CTC is not used routinely in patients with inflammatory bowel disease (IBD). However, investigating contemporarily the colon, other abdominal organs and the peritoneum with CTC is at times useful in patients with IBD, especially when other diagnostic tools fail. Furthermore, since symptoms of colorectal cancer sometimes superimpose to those of inflammatory disease, it may happen to image patients with IBD incidentally. If clinical signs are suggestive for inflammatory disease, exam technique should be modified accordingly and distinguishing radiological findings searched for.
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Affiliation(s)
- Daniele Regge
- Institute for Cancer Research and Treatment, Candiolo, Turin, Italy.
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28
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Optimizing the degree of distension and reducing discomfort in CT colonography by means of a microprocessor interface system for air insufflation. Open Med (Wars) 2008. [DOI: 10.2478/s11536-008-0065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe patients’ discomfort during CT colonography determines which method is used and its frequency of use. The discomfort is largely associated with the colon’s insufflation with gas. A system for an automatic room-air insufflation has been developed that ensures a continuous and steady air insufflation and an increase in colonic pressure and enables a relatively fast decompression. This system provides constant pressure monitoring and can alert the operator, if necessary. The degree of discomfort was evaluated for 36 patients, who were subjected to manual and automated air insufflation. The degree of the colonic distension achieved by the two methods was compared. The data analysis showed a significantly lower level of discomfort in patients with automated air insufflation. The degree of colonic distension was evaluated by comparing the diameters of similar segments of the colon, as well as by the subjective opinion of the operator. The distension with automated air insufflation was higher than that with manual air insufflation. In some cases there was a significant difference (P<0,05). In conclusion, the results show that the automatic insufflation of air at room temperature can be used to optimize CT colonography.
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29
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Abstract
OBJECTIVE The purpose of this study was to prospectively evaluate the effect of the order of positions on sustained rectal pressure and factors affecting pain perceived by patients during air-insufflated CT colonography. SUBJECTS AND METHODS Rectal pressure was measured in the supine and prone positions for CT colonography of 379 patients in two groups. One hundred seventy-seven patients underwent imaging supine and then prone, and 202 patients were prone and then supine. Insufflation and patient pain parameters were based on patient self-report and investigator visualization of observable indicators. Colonic distention, residual feces or fluid, and diverticulosis were evaluated with a semiquantitative scoring system. Fisher's exact, Student's t, and chi-square tests as well as multivariate logistic regression analysis were performed. RESULTS Pressure was higher in the prone than in the supine position in both groups (p < 0.001). The measured pressure in the initial position did not differ between groups (p = 0.88). Pressure increased from 38.3 to 40.07 mm Hg in the second position in the supine-first group and decreased from 38.3 to 32.25 mm Hg in the second position in the prone-first group (p < 0.001). The percentage of patients with pain in the second position was 40% in the supine-first group compared with 18% in the prone-first group (p < 0.003). Distention did not differ between the groups. Pain was associated with increased pressure and diverticulosis (p < 0.001) but not with retained feces or fluid. CONCLUSION Sustained pressure in the air-insufflated colon was higher in the prone than in the supine position. Imaging in the prone position first results in a significant decrease in pressure in the latter phase and less pain. Pain was associated with pressure and diverticulosis.
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30
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Abstract
Computed tomographic colonography is a modern technique to evaluate the colon, which may be more appealing to patients than invasive methods. The potential of this test, including current and future developments are presented in this review. The essential steps required to perform a diagnostic quality computed tomographic colonography are discussed as well as different methods of study interpretation. The current status and promising areas of future investigation are also discussed.
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Affiliation(s)
- Rizwan Aslam
- University of California San Francisco, CA, USA.
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31
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Juchems MS, Ernst AS, Brambs HJ, Aschoff AJ. Computer-aided detection in computer tomography colonography: a review. ACTA ACUST UNITED AC 2008; 2:487-95. [DOI: 10.1517/17530059.2.5.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kinner S, Antoch G, Bockisch A, Veit-Haibach P. Whole-body PET/CT-colonography: a possible new concept for colorectal cancer staging. ACTA ACUST UNITED AC 2008; 32:606-12. [PMID: 17387540 DOI: 10.1007/s00261-007-9202-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of death, and necessitates a conjointly performed staging. Until now, a multi-step-examination including optical colonoscopy, cross-sectional and functional imaging is recommended. However, a single examination for whole-body staging with a dedicated CRC staging protocol is desirable. Thus, we developed and evaluated a combined whole-body PET/CT-colonography protocol for dedicated CRC staging in routine clinical use. METHODS We integrated CT-colonography into a whole-body PET/CT protocol to achieve a specific "all-in-one" examination for patients suspected of having CRC. After oral and rectal bowel distension, PET/CT-colonography has been performed in 55 patients. All patients had optical colonoscopy one day before PET/CT. PET/CT data sets were evaluated concerning detection and evaluation of colorectal tumour sites, lymph nodes and distant metastases; these results were compared to the results of CT-colonography alone. Surgical resection and/or biopsy served as standards of reference in all patients. RESULTS All examinations were fully diagnostic and well tolerated by the patients. PET/CT-colonography showed highly accurate results for overall TNM-evaluation and was significantly more accurate than CT-colonography alone. CONCLUSIONS Staging patients with whole-body PET/CT-colonography is technically feasible and accurate. Patients with incomplete colonoscopy or potential synchronous bowel lesions might benefit from this approach.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.
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33
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Veit-Haibach P. Potential New Staging Perspectives in Colorectal Cancer. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Park SH, Yee J, Kim SH, Kim YH. Fundamental elements for successful performance of CT colonography (virtual colonoscopy). Korean J Radiol 2007; 8:264-75. [PMID: 17673837 PMCID: PMC2627155 DOI: 10.3348/kjr.2007.8.4.264] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
There are many factors affecting the successful performance of CT colonography (CTC). Adequate colonic cleansing and distention, the optimal CT technique and interpretation with using the newest CTC software by a trained reader will help ensure high accuracy for lesion detection. Fecal and fluid tagging may improve the diagnostic accuracy and allow for reduced bowel preparation. Automated carbon dioxide insufflation is more efficient and may be safer for colonic distention as compared to manual room air insufflation. CT scanning should use thin collimation of < or =3 mm with a reconstruction interval of < or =1.5 mm and a low radiation dose. There is not any one correct method for the interpretation of CTC; therefore, readers should be well-versed with both the primary 3D and 2D reviews. Polyps detected at CTC should be measured accurately and reported following the "polyp size-based" patient management system. The time-intensive nature of CTC and the limited resources for training radiologists appear to be the major barriers for implementing CTC in Korea.
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Affiliation(s)
- Seong Ho Park
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2dong, Songpa-gu, 138-736 Seoul, Korea.
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35
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Aschoff AJ, Ernst AS, Brambs HJ, Juchems MS. CT colonography: an update. Eur Radiol 2007; 18:429-37. [PMID: 17899101 DOI: 10.1007/s00330-007-0764-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 07/25/2007] [Accepted: 08/24/2007] [Indexed: 12/19/2022]
Abstract
Computed tomographic (CT) colonography (CTC)--also known as "virtual colonoscopy"--was first described more than a decade ago. As advancements in scanner technology and three-dimensional (3D) postprocessing helped develop this method to mature into a potential option in screening for colorectal cancer, the fundamentals of the examination remained the same. It is a minimally invasive, CT-based procedure that simulates conventional colonoscopy using 2D and 3D computerized reconstructions. The primary aim of CTC is the detection of colorectal polyps and carcinomas. However, studies reveal a wide performance variety in regard to polyp detection, especially for smaller polyps. This article reviews the available literature, discusses established indications as well as open issues and highlights potential future developments of CTC.
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Affiliation(s)
- Andrik J Aschoff
- Diagnostic and Interventional Radiology, University Hospitals of Ulm, Steinhoevelstr. 9, 89070, Ulm, Germany.
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36
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Vasovagal reactions in CT colonography. ACTA ACUST UNITED AC 2007; 32:552-5. [DOI: 10.1007/s00261-006-9055-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 05/15/2006] [Indexed: 10/23/2022]
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37
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State-of-the-art CT colonography: Update on technique and performance. CURRENT COLORECTAL CANCER REPORTS 2007. [DOI: 10.1007/s11888-007-0016-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Yoshida H, Näppi J. CAD in CT colonography without and with oral contrast agents: progress and challenges. Comput Med Imaging Graph 2007; 31:267-84. [PMID: 17376650 DOI: 10.1016/j.compmedimag.2007.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Computed tomographic colonography (CTC), also known as virtual colonoscopy, is an emerging alternative technique for screening of colon cancers. CTC uses CT to provide a series of cross-sectional images of the colon for detection of polyps and masses. Fecal tagging is a means of labeling of residual feces by an oral contrast agent for improving the accuracy in the detection of polyps. Computer-aided diagnosis (CAD) for CTC automatically determines the locations of suspicious polyps and masses in CTC and presents them to radiologists, typically as a second opinion. Despite its relatively short history, CAD has become one of the mainstream techniques that could make CTC prime time for screening of colorectal cancer. Rapid technical developments have advanced CAD substantially during the last several years, and a fundamental scheme for the detection of polyps has been established, in which sophisticated 3D image processing, analysis, and display techniques play a pivotal role. The latest CAD systems indicate a clinically acceptable high sensitivity and a low false-positive rate, and observer studies have demonstrated the benefits of these systems in improving radiologists' detection performance. Some technical and clinical challenges, however, remain unresolved before CAD can become a truly useful tool for clinical practice. Also, new challenges are facing CAD as the methods for bowel preparation and image acquisition, such as tagging of fecal residue with oral contrast agents, and interpretation of CTC images evolve. This article reviews the current status and future challenges in CAD for CTC without and with fecal tagging.
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Affiliation(s)
- Hiroyuki Yoshida
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Suite 220, Boston, MA 02114, USA.
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39
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Abstract
Virtual colonoscopy (VC) has acquired an important role in evaluation of the colon. In some situations it may be a safer method to visualize the colon effectively, or it may be the only available option when other techniques have failed. This article reviews state-of-the art VC technique and the results of current performance trials. It discusses the rationale for using various colonic cleansing regimens for VC. It also discusses the two distending agents for VC (room air and carbon dioxide) and presents practical tips for administration and the role of antispasmodic drugs.
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Affiliation(s)
- Luis A Landeras
- Department of Radiology, University of California in San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA.
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40
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Nagata K, Endo S, Ichikawa T, Dasai K, Moriya K, Kushihashi T, Kudo SE. Polyethylene glycol solution (PEG) plus contrast medium vs PEG alone preparation for CT colonography and conventional colonoscopy in preoperative colorectal cancer staging. Int J Colorectal Dis 2007; 22:69-76. [PMID: 16583194 DOI: 10.1007/s00384-006-0113-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2006] [Indexed: 02/04/2023]
Abstract
PURPOSE This study evaluated the usefulness of combined polyethylene glycol solution plus contrast medium bowel preparation (PEG-C preparation) followed by dual-contrast computed tomography enema (DCCTE) and conventional colonoscopy. The main purpose of these examinations is the preoperative staging of already known tumors. MATERIALS AND METHODS One hundred patients with colorectal tumors were alternately allocated to either a polyethylene glycol solution preparation (PEG preparation) group (n=50) or a PEG-C preparation group (n=50) before undergoing conventional colonoscopy and computed tomographic (CT) colonography. After conventional colonoscopy, multidetector row CT scans were performed. Air images were reconstructed for both groups; contrast medium images were additionally reconstructed for the PEG-C preparation group. DCCTE images were a composite of air images and contrast medium images without use of dedicated electronic cleansing software. Quality scores (the presence or absence of blind spots of the colon) were compared between the two groups. RESULTS Complete tumor images were obtained by DCCTE for all 50 (100%) lesions in the PEG-C preparation group, as compared with only nine of the 50 lesions (18%) in the PEG preparation group (air-contrast CT enema). The overall quality score in the PEG-C preparation group was significantly better than that in the PEG preparation group (P<0.0001). CONCLUSIONS DCCTE showed the entire colon without blind spots in nearly all patients in the PEG-C preparation group because the areas under residual fluid were reconstructed as contrast medium images. DCCTE and conventional colonoscopy after PEG-C preparation are feasible and safe procedures that can be used for preoperative evaluation in patients with colorectal cancer.
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Affiliation(s)
- Koichi Nagata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan.
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41
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Abstract
Published results to date have indicated a good per patient sensitivity of computed tomographic colonography (CTC) for colorectal cancer and for polyps measuring 10 mm or more together with a very good specificity. Sensitivity and specificity for polyps in the range of 6-10 mm are moderate. These results, however, can be achieved only with meticulous attention to technique including adequate colonic distention, and acquisition of supine and prone thin-section computed tomographic (CT) images. Moreover, there is a significant learning curve involved in the interpretation of CTC studies, with performance statistics improving with operator experience. Radiologists must be comfortable in reporting directly from workstation monitors and have access to and be familiar with software for multiplanar and endoluminal reconstructions. In addition to maximize polyp detection and minimize false positive results, reporting radiologists must have a working knowledge of normal colorectal anatomy and pathology on CTC and be familiar with potential pitfalls in interpretation. Besides the description of several possible causes for perceptive errors, also a literature search of perceptive errors in CTC is included in this paper.
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Affiliation(s)
- C Y Nio
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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42
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SLATER A. Alteration in bowel habit. IMAGING 2006. [DOI: 10.1259/imaging/15701929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Screening of asymptomatic average-risk patients for presence of colon cancer and early detection in precursor stages is of great interest to general population. Comprehensive evaluation of symptomatic or high-risk patients represents another important clinical focus. Available techniques for total colon imaging, rectal cancer staging and the role of positron emission tomography are discussed.
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Affiliation(s)
- Christoph Wald
- Department of Diagnostic Radiology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
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Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH. Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol 2006; 186:1491-6. [PMID: 16714635 DOI: 10.2214/ajr.05.0416] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Our objective was to prospectively compare colonic distention and patient comfort at screening CT colonography (CTC) with patient-controlled room air (RA) insufflation versus automated carbon dioxide (CO2) delivery. SUBJECTS AND METHODS Two hundred eight adults undergoing CTC were randomized to RA or CO2 (104 per method). Colonic distention was prospectively assessed by segment using a 4-point scale (1 = optimal, 2 = adequate, 3 = inadequate, 4 = collapsed). Adequacy of combined supine/prone segmental evaluation was also recorded. Patients provided discomfort ratings on a 0-10 scale (0-1 = none/insignificant, 2-3 = minimal, 4-6 = intermediate, 7-10 = significant) before, during, and after the procedure. RESULTS No significant differences in segmental distention were observed in the prone position between techniques. In the supine position, CO2 resulted in significantly greater distention in the sigmoid, descending, and transverse segments (p < 0.01). After combined supine/prone assessment, two/104 (1.9%) and three/104 (2.9%) patients were judged to have an inadequately evaluated segment on RA and CO2, respectively (four sigmoid, one transverse). Mean discomfort scores for RA and CO2 were 3.97 and 5.08 during the examination (p < 0.01); 0.91 and 0.42 immediately after (p < 0.01); 0.51 and 0.25 15 min later (p < 0.05); and 0.15 and 0.04 2 hours later (p < 0.01), respectively. During active distention, 19 (18.3%) and 33 (31.7%) patients reported significant transient discomfort with RA and CO2, respectively (p < 0.05). Beyond 15 min, only two (1.9%) patients with RA and no patients with CO2 had a discomfort level higher than 3. CONCLUSION Although patient-controlled RA insufflation and automated CO2 delivery each resulted in negligible postprocedure discomfort and reliable colonic distention, CO2 was better for both categories.
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Affiliation(s)
- Theodore J Shinners
- Department of Radiology, University of Wisconsin Medical School, Clinical Science Center, 600 Highland Ave., Madison, WI 53792, USA
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45
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Bielen DJLE, Bosmans HTC, De Wever LLI, Maes F, Tejpar S, Vanbeckevoort D, Marchal GJF. Clinical validation of high-resolution fast spin-echo MR colonography after colon distention with air. J Magn Reson Imaging 2006; 22:400-5. [PMID: 16106357 DOI: 10.1002/jmri.20397] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
To evaluate the feasibility of MR colonography (MRC) with air using two-dimensional (2D) T1-weighted fast spin-echo (T1wFSE) in patients scheduled for conventional colonoscopy (CC) after classic bowel preparation, and assess the ability of the technique to detect colonic lesions. The distention was sufficient for diagnosis, and the technique provided adequate delineation of the wall in the majority of segments. Residual fluid obscured the wall in different segments, especially in the ascending and descending colon (supine position) and in the cecum, transverse, and sigmoid colon (prone position). These findings were consistent with CT colonography. MRC visualized three lesions, missed one lesion >10 mm, visualized none of four lesions <5 mm, and yielded one false-positive lesion (5-10 mm). Missed lesions can be due to inconsistency in the slice positions between consecutive breath-holds, which is inherent to the multishot technique. Residual fluid may have obscured the smaller lesions. The shortcomings of the technique are limited coverage and signal drop-off at the borders of the field of view (FOV). Before multishot 2D T1wFSE colonography can become a valid screening method, improved patient preparation and a more practical technique are needed.
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Affiliation(s)
- Didier J L E Bielen
- Department of Radiology, University Hospital Gasthuisberg K.U. Leuven, Leuven, Belgium.
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Burling D, Taylor SA, Halligan S, Gartner L, Paliwalla M, Peiris C, Singh L, Bassett P, Bartram C. Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation. AJR Am J Roentgenol 2006; 186:96-103. [PMID: 16357385 DOI: 10.2214/ajr.04.1506] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of our study was to compare the effects of automated and manual carbon dioxide insufflation before CT colonography on distention and patient acceptance. SUBJECTS AND METHODS One hundred forty-one symptomatic subjects underwent CT colonography using either an automated device (n = 47) or a manual method (n = 94) for carbon dioxide insufflation. CT data sets were assessed retrospectively in consensus by two blinded observers who graded distention for six colonic segments using a 4-point scale. An additional assessment of the overall clinical adequacy of distention (yes/no) was also made, and any learning curve was sought. Each patient completed a validated 24-point patient questionnaire reflecting patient satisfaction and discomfort. Distention scores, clinical adequacy, and questionnaire responses were analyzed using ordered logistic regression, Fisher's exact test, and the Mann-Whitney test statistic, respectively. RESULTS Automated insufflation significantly improved distention overall (p = 0.001). For individual segments, distention was significantly improved in the sigmoid (p = 0.007) and descending (p < 0.001) colons when the patient was supine; and in the sigmoid (p = 0.02), descending (p = 0.001), and transverse (p = 0.02) colons when supine and prone positions were combined. No significant difference was seen in the clinical adequacy of distention, nor was there evidence of any learning curve for either insufflation method. Subjects were more weary after automated insufflation (p = 0.03), but no significant difference was seen for the remaining 23 questionnaire items or for feelings of bloating or discomfort. CONCLUSION Automated carbon dioxide insufflation significantly improves colonic distention compared with manual insufflation. Benefit is greatest in the left colon, particularly when the patient is supine. Patient acceptance is similar to that for manual insufflation.
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Affiliation(s)
- David Burling
- Department of Intestinal Imaging, St. Mark's and Northwick Park Hospitals, Harrow HA1 3UJ, UJK
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47
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Banerjee S, Van Dam J. CT colonography for colon cancer screening. Gastrointest Endosc 2006; 63:121-33. [PMID: 16377329 DOI: 10.1016/j.gie.2005.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 07/01/2005] [Indexed: 02/08/2023]
Affiliation(s)
- Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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Abstract
CT colonography (CTC) is a promising method for colorectal cancer screening because it provides a full structural evaluation of the entire colon. It has a superior safety profile, a low rate of complications, and high patient acceptance. In addition, CTC offers the real possibility of eliminating the cathartic bowel preparation, one of the biggest obstacles to patient compliance with colorectal cancer screening. Results of CTC studies in recently published literature are extremely encouraging, demonstrating that this method of screening can detect lesions equal to or larger than 8 mm with few false-positive findings.
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Affiliation(s)
- Matthew A Barish
- Department of Radiology, 3D & Image Processing Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Gutman F, Alberini JL, Wartski M, Vilain D, Le Stanc E, Sarandi F, Corone C, Tainturier C, Pecking AP. Incidental colonic focal lesions detected by FDG PET/CT. AJR Am J Roentgenol 2005; 185:495-500. [PMID: 16037527 DOI: 10.2214/ajr.185.2.01850495] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess the performance of FDG PET/CT for the detection of colonic lesions, especially advanced neoplasms (villous or >10-mm adenomas, carcinomas). Because of 18F FDG accumulation in adenomatous polyps, PET using FDG can detect early premalignant colorectal lesions. MATERIALS AND METHODS FDG PET/CT studies performed for a 1-year period in 1,716 consecutive patients with various malignant diseases, except colorectal cancer, were retrospectively reviewed. PET images obtained 1 hr after FDG injection and non-contrast CT images used for attenuation correction were fused for analysis. Of 45 patients showing intense focal colonic FDG uptake, 20 patients (with 21 foci) underwent a colonoscopic investigation, and, when necessary, polyp resection. The intensity of FDG uptake was quantified using the standardized uptake value (SUV(max)). RESULTS The FDG colonic foci were associated with 18 colonoscopic abnormalities in 15 patients, with no colonic abnormality detected in five patients (false-positive [FP] results). Histopathologic findings revealed advanced neoplasms in 13 patients (13 villous adenomas and three carcinomas) and two cases of hyperplastic polyps. A difference in the mean SUV(max) was found between FP and true-positive colonic FDG foci but was not statistically significant (p = 0.14). CONCLUSION Presence of a focal colonic FDG uptake incidental finding on a PET/CT scan justifies a colonoscopy to detect (pre-)malignant lesions. The fusion of PET and CT images allows an accurate localization of the lesions. PET/CT is a useful tool to differentiate pathologic from physiologic FDG uptake.
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Affiliation(s)
- Fabrice Gutman
- Department of Nuclear Medicine, Rene Huguenin Cancer Research Center, 35 Rue Dailly, Saint-Cloud, France 92210
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Nicholson FB, Barro JL, Bartram CI, Dehmeshki J, Halligan S, Taylor S, Kamm MA. The role of CT colonography in colorectal cancer screening. Am J Gastroenterol 2005; 100:2315-23. [PMID: 16181386 DOI: 10.1111/j.1572-0241.2005.50391.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Computed tomographic colonography (CTC) is a relatively noninvasive technique for large bowel imaging that has the ability to detect colorectal neoplasia. Already well established as a reliable diagnostic tool in symptomatic patients who are unable to undergo complete colonoscopy, it is now being considered as a viable method for population screening. Advances in technique over the past 10 yr make this an attractive alternative, including reduced bowel preparation and stool tagging, three-dimensional (3D) image reconstruction, computer-aided detection software, and low-radiation dose protocols. CTC may be favored by patients compared to other available screening tests due to the ease of performance and comfort. Although published studies vary in relation to the sensitivity of this test for the detection of polyps, in the best hands a sensitivity of greater than 90% for detection of polyps at least 10 mm in diameter may be obtained. Although not yet endorsed for widespread use by major gastroenterological societies, CTC shows promise as a screening tool.
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