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For:	Pickhardt PJ. Screening CT colonography: how I do it. AJR Am J Roentgenol 2007;189:290-8. [PMID: 17646453 DOI: 10.2214/ajr.07.2136] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]

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Cited by Other Article(s)

Kassavin M, Chang KJ. Computed Tomography Colonography: 2025 Update. Radiol Clin North Am 2025;63:405-417. [PMID: 40221183 DOI: 10.1016/j.rcl.2024.09.009] [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: 04/14/2025]

Pooler BD, Kim DH, Matkowskyj KA, Newton MA, Halberg RB, Grady WM, Hassan C, Pickhardt PJ. Natural History of Colorectal Polyps Undergoing Longitudinal in Vivo CT Colonography Surveillance. Radiology 2024;310:e232078. [PMID: 38289210 PMCID: PMC10831482 DOI: 10.1148/radiol.232078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 02/01/2024]

Abstract

Background The natural history of colorectal polyps is not well characterized due to clinical standards of care and other practical constraints limiting in vivo longitudinal surveillance. Established CT colonography (CTC) clinical screening protocols allow surveillance of small (6-9 mm) polyps. Purpose To assess the natural history of colorectal polyps followed with CTC in a clinical screening program, with histopathologic correlation for resected polyps. Materials and Methods In this retrospective study, CTC was used to longitudinally monitor small colorectal polyps in asymptomatic adult patients from April 1, 2004, to August 31, 2020. All patients underwent at least two CTC examinations. Polyp growth patterns across multiple time points were analyzed, with histopathologic context for resected polyps. Regression analysis was performed to evaluate predictors of advanced histopathology. Results In this study of 475 asymptomatic adult patients (mean age, 56.9 years ± 6.7 [SD]; 263 men), 639 unique polyps (mean initial diameter, 6.3 mm; volume, 50.2 mm3) were followed for a mean of 5.1 years ± 2.9. Of these 639 polyps, 398 (62.3%) underwent resection and histopathologic evaluation, and 41 (6.4%) proved to be histopathologically advanced (adenocarcinoma, high-grade dysplasia, or villous content), including two cancers and 38 tubulovillous adenomas. Advanced polyps showed mean volume growth of +178% per year (752% per year for adenocarcinomas) compared with +33% per year for nonadvanced polyps and -3% per year for unresected, unretrieved, or resolved polyps (P < .001). In addition, 90% of histologically advanced polyps achieved a volume of 100 mm3 and/or volume growth rate of 100% per year, compared with 29% of nonadvanced and 16% of unresected or resolved polyps (P < .001). Polyp volume-to-diameter ratio was also significantly greater for advanced polyps. For polyps observed at three or more time points, most advanced polyps demonstrated an initial slower growth interval, followed by a period of more rapid growth. Conclusion Small colorectal polyps ultimately proving to be histopathologically advanced neoplasms demonstrated substantially faster growth and attained greater overall size compared with nonadvanced polyps. Clinical trial registration no. NCT00204867 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Dachman in this issue.

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Affiliation(s)

B. Dustin Pooler From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
David H. Kim From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
Kristina A. Matkowskyj From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
Michael A. Newton From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
Richard B. Halberg From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
William M. Grady From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
Cesare Hassan From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
Perry J. Pickhardt From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)

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Pooler BD, Kim DH, Matkowskyj KA, Newton MA, Halberg RB, Grady WM, Hassan C, Pickhardt PJ. Growth rates and histopathological outcomes of small (6-9 mm) colorectal polyps based on CT colonography surveillance and endoscopic removal. Gut 2023;72:2321-2328. [PMID: 37507217 PMCID: PMC10822024 DOI: 10.1136/gutjnl-2022-326970] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023]

Abstract

BACKGROUND AND AIMS

The natural history of small polyps is not well established and rests on limited evidence from barium enema studies decades ago. Patients with one or two small polyps (6-9 mm) at screening CT colonography (CTC) are offered CTC surveillance at 3 years but may elect immediate colonoscopy. This practice allows direct observation of the growth of subcentimetre polyps, with histopathological correlation in patients undergoing subsequent polypectomy.

DESIGN

Of 11 165 asymptomatic patients screened by CTC over a period of 16.4 years, 1067 had one or two 6-9 mm polyps detected (with no polyps ≥10 mm). Of these, 314 (mean age, 57.4 years; M:F, 141:173; 375 total polyps) elected immediate colonoscopic polypectomy, and 382 (mean age 57.0 years; M:F, 217:165; 481 total polyps) elected CTC surveillance over a mean of 4.7 years. Volumetric polyp growth was analysed, with histopathological correlation for resected polyps. Polyp growth and regression were defined as volume change of ±20% per year, with rapid growth defined as +100% per year (annual volume doubling). Regression analysis was performed to evaluate predictors of advanced histology, defined as the presence of cancer, high-grade dysplasia (HGD) or villous components.

RESULTS

Of the 314 patients who underwent immediate polypectomy, 67.8% (213/314) harboured adenomas, 2.2% (7/314) with advanced histology; no polyps contained cancer or HGD. Of 382 patients who underwent CTC surveillance, 24.9% (95/382) had polyps that grew, while 62.0% (237/382) remained stable and 13.1% (50/382) regressed in size. Of the 58.6% (224/382) CTC surveillance patients who ultimately underwent colonoscopic resection, 87.1% (195/224) harboured adenomas, 12.9% (29/224) with advanced histology. Of CTC surveillance patients with growing polyps who underwent resection, 23.2% (19/82) harboured advanced histology vs 7.0% (10/142) with stable or regressing polyps (OR: 4.0; p<0.001), with even greater risk of advanced histology in those with rapid growth (63.6%, 14/22, OR: 25.4; p<0.001). Polyp growth, but not patient age/sex or polyp morphology/location were significant predictors of advanced histology.

CONCLUSION

Small 6-9 mm polyps present overall low risk to patients, with polyp growth strongly associated with higher risk lesions. Most patients (75%) with small 6-9 mm polyps will see polyp stability or regression, with advanced histology seen in only 7%. The minority of patients (25%) with small polyps that do grow have a 3-fold increased risk of advanced histology.

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Lee MH, Zea R, Garrett JW, Graffy PM, Summers RM, Pickhardt PJ. Abdominal CT Body Composition Thresholds Using Automated AI Tools for Predicting 10-year Adverse Outcomes. Radiology 2023;306:e220574. [PMID: 36165792 PMCID: PMC9885340 DOI: 10.1148/radiol.220574] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 01/26/2023]

Abstract

Background CT-based body composition measures derived from fully automated artificial intelligence tools are promising for opportunistic screening. However, body composition thresholds associated with adverse clinical outcomes are lacking. Purpose To determine population and sex-specific thresholds for muscle, abdominal fat, and abdominal aortic calcium measures at abdominal CT for predicting risk of death, adverse cardiovascular events, and fragility fractures. Materials and Methods In this retrospective single-center study, fully automated algorithms for quantifying skeletal muscle (L3 level), abdominal fat (L3 level), and abdominal aortic calcium were applied to noncontrast abdominal CT scans from asymptomatic adults screened from 2004 to 2016. Longitudinal follow-up documented subsequent death, adverse cardiovascular events (myocardial infarction, cerebrovascular event, and heart failure), and fragility fractures. Receiver operating characteristic (ROC) curve analysis was performed to derive thresholds for body composition measures to achieve optimal ROC curve performance and high specificity (90%) for 10-year risks. Results A total of 9223 asymptomatic adults (mean age, 57 years ± 7 [SD]; 5152 women and 4071 men) were evaluated (median follow-up, 9 years). Muscle attenuation and aortic calcium had the highest diagnostic performance for predicting death, with areas under the ROC curve of 0.76 for men (95% CI: 0.72, 0.79) and 0.72 for women (95% CI: 0.69, 0.76) for muscle attenuation. Sex-specific thresholds were higher in men than women (P < .001 for muscle attenuation for all outcomes). The highest-performing markers for risk of death were muscle attenuation in men (31 HU; 71% sensitivity [164 of 232 patients]; 72% specificity [1114 of 1543 patients]) and aortic calcium in women (Agatston score, 167; 70% sensitivity [152 of 218 patients]; 70% specificity [1427 of 2034 patients]). Ninety-percent specificity thresholds for muscle attenuation for both risk of death and fragility fractures were 23 HU (men) and 13 HU (women). For aortic calcium and risk of death and adverse cardiovascular events, 90% specificity Agatston score thresholds were 1475 (men) and 735 (women). Conclusion Sex-specific thresholds for automated abdominal CT-based body composition measures can be used to predict risk of death, adverse cardiovascular events, and fragility fractures. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Ohliger in this issue.

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Affiliation(s)

Matthew H. Lee From the Departments of Radiology (M.H.L., R.Z., J.W.G., P.M.G., P.J.P.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792; and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.)
Ryan Zea From the Departments of Radiology (M.H.L., R.Z., J.W.G., P.M.G., P.J.P.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792; and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.)
John W. Garrett From the Departments of Radiology (M.H.L., R.Z., J.W.G., P.M.G., P.J.P.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792; and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.)
Peter M. Graffy From the Departments of Radiology (M.H.L., R.Z., J.W.G., P.M.G., P.J.P.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792; and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.)
Ronald M. Summers From the Departments of Radiology (M.H.L., R.Z., J.W.G., P.M.G., P.J.P.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792; and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.)
Perry J. Pickhardt From the Departments of Radiology (M.H.L., R.Z., J.W.G., P.M.G., P.J.P.) and Medical Physics (J.W.G.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792; and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.)

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Chen LS, Chen SJ, Hsu TW, Chang SH, Hou CJ, Lin CW, Chen YR, Hsieh CC, Han SC, Chang KY. Exploring the interior of 3D endoluminal lesions in the air spaces by a novel electronic biopsy technique: A preliminary study of endoluminal colon lesions. PLoS One 2023;18:e0284142. [PMID: 37167339 PMCID: PMC10174533 DOI: 10.1371/journal.pone.0284142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/08/2023] [Indexed: 05/13/2023] Open

Tachibana R, Näppi JJ, Hironaka T, Yoshida H. Self-Supervised Adversarial Learning with a Limited Dataset for Electronic Cleansing in Computed Tomographic Colonography: A Preliminary Feasibility Study. Cancers (Basel) 2022;14:4125. [PMID: 36077662 PMCID: PMC9454562 DOI: 10.3390/cancers14174125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open

Pickhardt PJ. CT Colonography: The Role of Radiologist Training. Radiology 2022;303:371-372. [PMID: 35166590 PMCID: PMC9081517 DOI: 10.1148/radiol.213148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 12/31/2022]

Wentland AL, Nystrom J, Lubner MG, Mao L, Abel EJ, Pickhardt PJ. Natural history of simple renal cysts: longitudinal CT-based evaluation. Abdom Radiol (NY) 2022;47:1124-1132. [PMID: 35080631 DOI: 10.1007/s00261-022-03421-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/29/2022]

Abstract

PURPOSE

Simple renal cysts are common benign lesions that arise from the renal parenchyma. Cyst growth can lead to confusion as well as concern from patients and referring providers about the need for imaging follow-up or additional evaluation. The purpose of this study was to evaluate the natural history of simple renal cysts and determine the best metric to characterize cyst evolution.

METHODS

222 simple renal cysts in 182 adults (age = 58.4 ± 6.0 years) were longitudinally evaluated on non-contrast CT examinations over a mean interval of 7.5 ± 2.8 years. Axial long axis, surface area, and volume were evaluated at baseline and follow-up CT examinations. Absolute and percent annualized growth rates were computed between CT studies for each parameter.

RESULTS

At baseline CT examinations, mean (± SD) axial long axis, surface area, and volume measurements were 2.5 ± 1.7 cm, 2.5 ± 4.5 cm², and 17.6 ± 52.5 ml, respectively. On follow-up examinations, measurements were 3.4 ± 2.0 cm, 4.2 ± 5.9 cm², and 34.4 ± 92.3 ml, respectively. Significant differences (p < 0.01) were found between baseline and follow-up values for each parameter. The absolute growth rate of each parameter was + 0.1 ± 0.1 cm/year, + 2.1 ± 3.4 cm²/year, and + 2.0 ± 5.6 ml/year, respectively. The percent annualized growth rate for each parameter was +6.5 ± 7.3%/year, +18 ± 24%/year, and +46 ± 100%/year, respectively. Overall, 86% (190/222) of cysts increased in size over time; most notably 78% (174/222) increased by ≥ 6% in volume per year. None of the simple cysts developed septations or solid components on follow-up examinations.

CONCLUSION

The majority of simple renal cysts increase in size over time, which was not associated with the development of complex features. Surface area and volume are the parameters most indicative of cyst growth or regression over time. In patients with enlarging asymptomatic simple renal cysts, no follow-up imaging is indicated.

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Cao W, Pomeroy MJ, Zhang S, Tan J, Liang Z, Gao Y, Abbasi AF, Pickhardt PJ. An Adaptive Learning Model for Multiscale Texture Features in Polyp Classification via Computed Tomographic Colonography. SENSORS (BASEL, SWITZERLAND) 2022;22:907. [PMID: 35161653 PMCID: PMC8840570 DOI: 10.3390/s22030907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 12/10/2022]

Abstract

Objective: As an effective lesion heterogeneity depiction, texture information extracted from computed tomography has become increasingly important in polyp classification. However, variation and redundancy among multiple texture descriptors render a challenging task of integrating them into a general characterization. Considering these two problems, this work proposes an adaptive learning model to integrate multi-scale texture features. Methods: To mitigate feature variation, the whole feature set is geometrically split into several independent subsets that are ranked by a learning evaluation measure after preliminary classifications. To reduce feature redundancy, a bottom-up hierarchical learning framework is proposed to ensure monotonic increase of classification performance while integrating these ranked sets selectively. Two types of classifiers, traditional (random forest + support vector machine)- and convolutional neural network (CNN)-based, are employed to perform the polyp classification under the proposed framework with extended Haralick measures and gray-level co-occurrence matrix (GLCM) as inputs, respectively. Experimental results are based on a retrospective dataset of 63 polyp masses (defined as greater than 3 cm in largest diameter), including 32 adenocarcinomas and 31 benign adenomas, from adult patients undergoing first-time computed tomography colonography and who had corresponding histopathology of the detected masses. Results: We evaluate the performance of the proposed models by the area under the curve (AUC) of the receiver operating characteristic curve. The proposed models show encouraging performances of an AUC score of 0.925 with the traditional classification method and an AUC score of 0.902 with CNN. The proposed adaptive learning framework significantly outperforms nine well-established classification methods, including six traditional methods and three deep learning ones with a large margin. Conclusions: The proposed adaptive learning model can combat the challenges of feature variation through a multiscale grouping of feature inputs, and the feature redundancy through a hierarchal sorting of these feature groups. The improved classification performance against comparative models demonstrated the feasibility and utility of this adaptive learning procedure for feature integration.

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Detection of High-Risk Sessile Serrated Lesions: Multi-Target Stool DNA Versus CT Colonography. AJR Am J Roentgenol 2021;218:670-676. [PMID: 34755523 DOI: 10.2214/ajr.21.26719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]

Abstract

Background: The serrated pathway for colorectal cancer (CRC) development is increasingly recognized. Patients with sessile serrated lesions (SSLs) that are large (≥10 mm) and/or have dysplasia (i.e., high-risk SSLs) are at higher risk of progression to CRC. Detection of SSLs is challenging given their predominantly flat and right-sided location. The yield of non-invasive screening tests for detection of high-risk SSLs is unclear. Objective: The aim of this study was to compare non-invasive screen detection of high-risk SSLs between the multi-target stool DNA test (mt-sDNA; Cologuard) and CT colonography (CTC). Methods: This retrospective study included 7974 asymptomatic adults (4705 women, 3269 men; mean age 60.0 years) who underwent CRC screening at a single center by mt-sDNA (Cologuard) from 2014-2019 (n=3987) or by CTC from 2009-2019 (n=3987). Clinical interpretations of CTC examinations were recorded. Subsequent colonoscopy findings and histology of resected polyps were also recorded. Chi-square or two-sample t tests were used to compare results between mt-sDNA and CTC using 6-mm and 10-mm thresholds for test positivity. Results: The overall colonoscopy referral rate for a positive screening test was 13.1% (522/3987) for mt-sDNA versus 12.2% (487/3987; p=.23) and 6.5% (260/3987; p<.001) for CTC at 6-mm and 10-mm thresholds, respectively. The PPV for high-risk SSLs was 5.5% (26/476) for mt-sDNA, versus 14.4% (66/457; p<.001) and 25.9% (63/243; p<.001) for CTC at 6-mm and 10-mm thresholds, respectively. The overall screening yield of high-risk SSLs was 0.7% (26/3987) for mt-sDNA versus 1.7% (66/3987; p<.001) and 1.6% (63/3987; p<.001) for CTC at 6-mm and 10-mm thresholds, respectively. Conclusions: CTC at 6-mm and 10-mm thresholds had significantly higher yield and PPV for high-risk SSLs compared with mt-sDNA. Clinical Impact: The significantly higher detection of high-risk SSLs by CTC than by mt-sDNA should be included in discussions with patients who decline colonoscopy and opt for noninvasive screening.

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Lee MH, Lubner MG, Mellnick VM, Menias CO, Bhalla S, Pickhardt PJ. The CT scout view: complementary value added to abdominal CT interpretation. Abdom Radiol (NY) 2021;46:5021-5036. [PMID: 34075469 DOI: 10.1007/s00261-021-03135-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 12/30/2022]

Perez AA, Pickhardt PJ. Intestinal malrotation in adults: prevalence and findings based on CT colonography. Abdom Radiol (NY) 2021;46:3002-3010. [PMID: 33558953 DOI: 10.1007/s00261-021-02959-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 12/26/2022]

Popic J, Tipuric S, Balen I, Mrzljak A. Computed tomography colonography and radiation risk: How low can we go? World J Gastrointest Endosc 2021;13:72-81. [PMID: 33763187 PMCID: PMC7958467 DOI: 10.4253/wjge.v13.i3.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/23/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open

Chen LS, Hsu TW, Chen SJ, Chang SH, Lin CW, Chen YR, Hsieh CC, Han SC, Chang KY, Hou CJ. Improving Image Correlation and Differentiation of 3D Endoluminal Lesions in the Air Spaces Using a Novel Target Gray Level Mapping Technique: A Preliminary Study of Its Application to Computed Tomographic Colonography and Comparison with Traditional Surface Rendering Method. J Med Biol Eng 2020;40:868-879. [PMID: 33013258 PMCID: PMC7519704 DOI: 10.1007/s40846-020-00565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]

Abstract

Purpose

To improve the three dimensional (3D) and two dimensional (2D) image correlation and differentiation of 3D endoluminal lesions in the traditional surface rendering (SR) computed tomographic endoscopy (CTE), a target gray level mapping (TGM) technique is developed and applied to computed tomographic colonography (CTC) in this study.

Methods

A study of sixty-two various endoluminal lesions from thirty patients (13 males, 17 females; age range 31–90 years) was approved by our institutional review board and evaluated retrospectively. The endoluminal lesions were segmented using gray level threshold. The marching cubes algorithm was used to detect isosurfaces in the segmented volumetric data sets. TGM allows users to interactively apply grey level mapping (GM) to region of interest (ROI) in the 3D CTC. Radiologists conducted the clinical evaluation and the resulting data were analyzed.

Results

TGM and GM are significantly superior to SR in terms of surface texture, 3D shape, the confidence of 3D to 2D, 2D to 3D image correlation, and clinical classification of endoluminal lesions (P < 0.01). The specificity and diagnostic accuracy of GM and TGM methods are significantly better than those of SR (P < 0.01). Moreover, TGM performs better than GM (specificity: 75.0–85.7% vs. 53.6–64.3%; accuracy: 88.7–93.5% vs. 77.4–83.9%). TGM is a preferable display mode for further localization and differentiation of a lesion in CTC navigation.

Conclusions

Compared with only the spatial shape information in traditional SR of CTC images, the 3D shapes and gray level information of endoluminal lesions can be provided by TGM simultaneously. 3D to 2D image correlations are also increased and facilitated at the same time. TGM is less affected by adjacent colon surfaces than GM. TGM serves as a better way to improve the image correlation and differentiation of endoluminal lesions.

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Pickhardt PJ, Graffy PM, Weigman B, Deiss-Yehiely N, Hassan C, Weiss JM. Diagnostic Performance of Multitarget Stool DNA and CT Colonography for Noninvasive Colorectal Cancer Screening. Radiology 2020;297:120-129. [PMID: 32779997 DOI: 10.1148/radiol.2020201018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Abstract

BackgroundMultitarget stool DNA (mt-sDNA) screening has increased rapidly since simultaneous approval by the U.S. Food and Drug Administration and Centers for Medicare and Medicaid Services in 2014, whereas CT colonography screening remains underused and is not covered by Centers for Medicare and Medicaid Services.PurposeTo report postapproval clinical experience with mt-sDNA screening for colorectal cancer (CRC) and compare results with CT colonography screening at the same center.Materials and MethodsIn this retrospective cohort study, asymptomatic adults underwent clinical mt-sDNA screening during a 5-year interval (2014-2019). Electronic medical records were searched to verify test results and document subsequent optical colonoscopy and histopathologic findings. A similar analysis was performed for CT colonography screening during a 15-year interval (2004-2019), with consideration of thresholds for positivity of both 6-mm and 10-mm polyp sizes. χ² or two-sample t tests were used for group comparisons.ResultsA total of 3987 asymptomatic adult patients (mean age, 64 years ± 9 [standard deviation]; 2567 women) underwent mt-sDNA screening and 9656 patients (mean age, 57 years ± 8; 5200 women) underwent CT colonography. Test-positive rates for mt-sDNA and for 6-mm- and 10-mm-threshold CT colonography were 15.2%, 16.4%, and 6.7%, respectively. Optical colonoscopy follow-up rates for positive results of mt-sDNA and 6-mm- and 10-mm-threshold CT colonography were 13.1%, 12.3%, and 5.9%, respectively. Positive predictive values (PPVs) for any neoplasm 6 mm or greater, advanced neoplasia, and CRC for mt-sDNA were 54.2%, 22.7%, and 1.9% respectively; for 6-mm-threshold CT colonography, PPVs were 76.8%, 44.3%, and 2.7%; for 10-mm-threshold CT colonography, PPVs were 84.5%, 75.2%, and 5.2%, respectively (P < .001 for mt-sDNA vs CT colonography for all except 6-mm CRC at CT colonography). For mt-sDNA versus 6-mm-threshold CT colonography, overall detection rates for advanced neoplasia were 2.7% and 5.0%, respectively (P < .001); corresponding detection rates for CRC were 0.23% and 0.31%, respectively (P = .43).ConclusionThe detection rates of advanced neoplasia at CT colonography screening were greater than those of multitarget stool DNA. Detection rates were similar for colorectal cancer.© RSNA, 2020See also the editorial by Yee in this issue.

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Affiliation(s)

Perry J Pickhardt From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
Peter M Graffy From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
Benjamin Weigman From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
Nimrod Deiss-Yehiely From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
Cesare Hassan From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
Jennifer M Weiss From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)

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

Geographic Dispersion and Rural Versus Urban Utilization of CT Colonography in the United States. J Am Coll Radiol 2020;17:475-483. [DOI: 10.1016/j.jacr.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]

Traditional Serrated Adenomas on CT Colonography: International Multicenter Experience With This Rare Colorectal Neoplasm. AJR Am J Roentgenol 2020;214:355-361. [DOI: 10.2214/ajr.19.21882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]

Positive Oral Contrast Material for Abdominal CT: Current Clinical Indications and Areas of Controversy. AJR Am J Roentgenol 2020;215:69-78. [PMID: 31913069 DOI: 10.2214/ajr.19.21989] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]

Positive Oral Contrast Solution at MDCT for Suspected Acute Appendicitis in Adults: Rate of Appendiceal Luminal Filling of Normal and Inflamed Appendixes. AJR Am J Roentgenol 2019;213:W211-W217. [DOI: 10.2214/ajr.18.21019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]

Mankowski Gettle L, Kim DH, Pickhardt PJ. Anorectal pitfalls in computed tomography colonography. Abdom Radiol (NY) 2019;44:3606-3624. [PMID: 31432213 DOI: 10.1007/s00261-019-02186-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Ivancic MM, Anson LW, Pickhardt PJ, Megna B, Pooler BD, Clipson L, Reichelderfer M, Sussman MR, Dove WF. Conserved serum protein biomarkers associated with growing early colorectal adenomas. Proc Natl Acad Sci U S A 2019;116:8471-8480. [PMID: 30971492 PMCID: PMC6486772 DOI: 10.1073/pnas.1813212116] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open

Positive Predictive Value for Colorectal Lesions at CT Colonography: Analysis of Factors Impacting Results in a Large Screening Cohort. AJR Am J Roentgenol 2019;213:W1-W8. [PMID: 30973775 DOI: 10.2214/ajr.18.20686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Abstract

OBJECTIVE. The purpose of this study is to evaluate factors affecting the positive predictive value (PPV) for detecting colorectal lesions at CT colonography (CTC), using optical colonoscopy (OC) as the reference standard for concordance. MATERIALS AND METHODS. Consecutive CTC studies from a single screening program interpreted as positive for at least one detected colorectal lesion 6 mm or larger and sent for subsequent OC were analyzed according to per-polyp and per-patient results. Univariable and multivariable analysis of multiple input factors was performed. RESULTS. Of 1650 studies (median patient age, 59.7 years; 877 men and 773 women) with 2688 total CTC-detected lesions 6 mm or larger, the overall PPVs were 88.8% (2386/2688) by polyp and 90.8% (1499/1650) by patient. The by-polyp PPV was significantly higher for polypoid (91.2%; 1793/1965) versus flat or nonpolypoid (79.4%; 459/578) lesions (p < 0.0001). Overall per-patient PPVs were 72.3% (1193/1650) for any neoplasia 6 mm or larger and 38.8% (641/1650) for advanced neoplasia. PPVs for advanced neoplasia increased by CTC Reporting and Data System category: 5.8% (45/781) for C2, 67.1% (511/762) for C3, and 79.4% (85/107) for C4. PPVs for cancer also increased by CTC Reporting and Data System category: 0% (0/781) for C2, 2.2% (17/762) for C3, and 52.3% (56/107) for C4. On multivariable regression analysis, polyp morphologic type (flat vs polypoid) and diagnostic confidence were the strongest predictors of CTC-OC concordance. CTC PPV results are somewhat underestimated because 28.8% (87/302) of CTC-OC-discordant results were categorized as likely OC false-negatives at consensus review. CONCLUSION. Concordance between CTC and OC is high for relevant colorectal polyps and masses. Unlike stool-based tests that provide only a binary positive or negative result, CTC can specify the nature of the positive findings, resulting in much greater specificity and risk stratification for patient management decisions.

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Narayan AK, Lopez DB, Kambadakone AR, Gervais DA. Nationwide, Longitudinal Trends in CT Colonography Utilization: Cross-Sectional Survey Results From the 2010 and 2015 National Health Interview Survey. J Am Coll Radiol 2019;16:1052-1057. [PMID: 30885451 DOI: 10.1016/j.jacr.2018.12.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/17/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023]

Abstract

PURPOSE

Colon cancer screening reduces deaths from colorectal cancer. Screening rates have plateaued; however, studies have found that giving patients a choice between different screening tests improves adherence. CT colonography is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). With increasing insurance coverage of CT colonography nationwide, there are limited estimates of CT colonography utilization over time. Our purpose was to estimate CT colonography utilization over time using nationally representative cross-sectional survey data.

METHODS

We utilized 2010 and 2015 National Health Interview Survey cross-sectional data. Participants between ages 50 and 75 without colorectal cancer history were included. Accounting for complex survey design elements, logistic regression analyses evaluated changes in CT colonography utilization over time, adjusted for potential confounders, and stratified by insurance and age.

RESULTS

Overall, 21,686 respondents were included (8,965 in 2010, 12,721 in 2015). Reported CT colonography utilization decreased from 1.2% to 0.9% (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.86-0.98). Stratified analyses revealed no changes in utilization in patients with private insurance (P = .35) and in patients younger than 65 (P = .07). Overall awareness of CT colonography decreased from 20.5% to 15.9% (OR 0.93, 95% CI 0.91-0.95). Reported optical colonoscopy utilization increased from 57.9% to 63.6% (OR 1.03, 95% CI 1.02-1.05).

CONCLUSION

Despite increasing self-reported utilization of optical colonoscopy from 2010 to 2015, survey results suggest that CT colonography awareness (∼16%) and utilization (∼1%) remain low. Improved public awareness and coverage expansion to Medicare-aged populations will promote improved CT colonography utilization and overall colorectal cancer screening rates.

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Pickhardt PJ, Pooler BD, Matkowskyj KA, Kim DH, Grady WM, Halberg RB. Volumetric growth rates of sessile serrated adenomas/polyps observed in situ at longitudinal CT colonography. Eur Radiol 2019;29:5093-5100. [PMID: 30741343 DOI: 10.1007/s00330-019-5999-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/21/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022]

Abstract

OBJECTIVE

Sessile serrated adenomas/polyps (SSA/Ps) are now recognized as potential cancer precursors, but little is known about their natural history. We assessed the in vivo growth rates of histologically proven SSA/Ps at longitudinal CT colonography (CTC) and compared results with non-advanced tubular adenomas (TAs).

METHODS

We identified a cohort of 53 patients (mean age, 54.8 ± 5.5 years; M:F, 26:27) from one center with a total of 58 SSA/Ps followed longitudinally at CTC (mean follow-up interval, 5.3 ± 1.9 years). Initial and final size measurements were determined using dedicated CTC software. Findings were compared with 141 non-advanced TAs followed at CTC (mean, 4.1 ± 2.3 years) in 113 patients (mean age, 56.8 ± 6.9 years).

RESULTS

SSA/Ps were more often flat (62% [36/58] vs. 14% [20/141], p < 0.0001) and right-sided (98% [57/58] vs. 46% [65/141], p < 0.0001) compared with TAs. Initial average diameter was greater for SSA/Ps (9.3 mm vs. 6.3 mm; p < 0.0001). Mean annual volumetric growth was + 12.7%/year for SSA/Ps vs. + 36.4%/year for TAs (p = 0.028). Using a previously defined threshold of + 20% increase in volume/year to define progression, 22% (13/58) of SSA/Ps and 41% (58/141) of TAs progressed (p = 0.014). None of the SSA/Ps had dysplasia or invasive cancer at histopathology.

CONCLUSIONS

Sessile serrated adenoma/polyps demonstrate slower growth compared with conventional non-advanced tubular adenomas, despite larger initial linear size. This less aggressive behavior may help explain the more advanced patient age for serrated pathway cancers. Furthermore, these findings could help inform future colonoscopic surveillance strategies, as current guidelines are largely restricted to expert opinion related to the absence of natural history data.

KEY POINTS

• Sessile serrated adenoma/polyps (SSA/Ps) tend to be flat, right-sided, and demonstrate slower growth compared with conventional non-advanced tubular adenomas. • This less aggressive behavior of SSA/Ps may help explain the more advanced patient age for serrated pathway cancers.

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CT colonography screening in extracolonic cancer survivors: impact on rates of colorectal and extracolonic findings by cancer type. Abdom Radiol (NY) 2019;44:31-40. [PMID: 30066170 DOI: 10.1007/s00261-018-1708-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Pooler BD, Lubner MG, Theis JR, Halberg RB, Liang Z, Pickhardt PJ. Volumetric Textural Analysis of Colorectal Masses at CT Colonography: Differentiating Benign versus Malignant Pathology and Comparison with Human Reader Performance. Acad Radiol 2019;26:30-37. [PMID: 29566994 DOI: 10.1016/j.acra.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/23/2018] [Accepted: 03/02/2018] [Indexed: 12/31/2022]

Pickhardt PJ, Lee SJ, Liu J, Yao J, Lay N, Graffy PM, Summers RM. Population-based opportunistic osteoporosis screening: Validation of a fully automated CT tool for assessing longitudinal BMD changes. Br J Radiol 2018;92:20180726. [PMID: 30433815 DOI: 10.1259/bjr.20180726] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open

Abstract

METHODS:

The automated BMD tool was retrospectively applied to non-contrast abdominal CT scans in 1603 consecutive asymptomatic adults (mean age, 55.9 years; 770 M/833 F) undergoing longitudinal screening (mean interval, 5.7 years; range, 1.0-12.3 years). The spinal column was automatically segmented, with standardized L1 and L2 anterior trabecular ROI placement. Automated and manual L1 HU values were compared, as were automated supine-prone measures. L1-L2 CT attenuation values were converted to BMD values through a linear regression model. BMD values and changes were assessed according to age and gender.

RESULTS:

Success rate of the automated BMD tool was 99.8 % (four failed cases). Both automated supine vs prone and manual vs automated L1 attenuation measurements showed good agreement. Overall mean annual rate of bone loss was greater in females than males (-2.0% vs -1.0%), but the age-specific rate declined faster in females from age 50 (-2.1%) to age 65 (-0.3%) compared with males (-0.9% to -0.5%). Mean BMD was higher in females than males at age 50 (143.6 vs 135.1 mg cm^-³), but post-menopausal bone loss in females reversed this relationship beyond age 60. By age 70, mean BMD in females and males was 100.8 and 107.7 mg cm^-³ , respectively.

CONCLUSION:

This robust, fully automated CT BMD tool allows for both individualized and population-based assessment. Mean BMD was lower in men than women aged 50-60, but accelerated post-menopausal bone loss in women resulted in lower values beyond age 60.

ADVANCES IN KNOWLEDGE:

This fully automated tool can be applied to routine abdominal CT scans for prospective or retrospective opportunistic BMD assessment, including change over time. Mean BMD was lower in men compared with women aged 50-60 years, but accelerated bone loss in women during this early post-menopausal period resulted in lower BMD values for women beyond age 60.

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Sangster GP, Ballard DH, Nazar M, Tsai R, Donato M, D'Agostino HB. Multimodality Imaging Review of Anorectal and Perirectal Diseases With Histological, Endoscopic, and Operative Correlation, Part I: Anatomy and Neoplasms. Curr Probl Diagn Radiol 2018;48:494-508. [PMID: 30172447 DOI: 10.1067/j.cpradiol.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/28/2022]

Goh Y, Dan YY, Chua W, Jagmohan P, Lee JKT, Thian YL. Diagnostic utility of whole body CT scanning in patients with unexplained weight loss. PLoS One 2018;13:e0200686. [PMID: 30052642 PMCID: PMC6063413 DOI: 10.1371/journal.pone.0200686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open

Abstract

BACKGROUND

Unexplained weight loss is a non-specific complaint with myriad potential etiologies. Increasingly, whole body CT studies are being performed in patients with unexplained weight loss to exclude organic etiologies such as malignancy. Our study aims to assess the diagnostic accuracy and yield of whole body CT in these patients.

METHODS AND MATERIALS

Patients who had a whole body CT scan for investigation of unexplained weight loss as their primary complaint from 2009-2012 were retrospectively reviewed. CT scans were classified into 4 categories: (1) Definite/highly suspicious for underlying organic cause (2) Indeterminate for underlying organic cause (3) No findings accounting for weight loss and only incidental findings and (4) Normal study. Scan findings were correlated with the final diagnosis after all investigations. Univariate logistic regression was performed to determine associations between patient's baseline variables and positive CT scan findings.

RESULTS

Of 301 eligible patients during the study period, 101 patients were excluded due to known history of malignancy, inadequate follow-up or inadequate scan technique. 200 patients were included in the final analyses. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT for organic pathology were 72.0%, 90.7%, 87.0%, 78.9% and 82.0% respectively. Additional symptoms, abnormal physical examinations, anemia, and raised tumor markers were significantly correlated with positive CT findings. Overall, the diagnostic yield of whole body CT scan for patients with unexplained weight loss was 33.5%.

CONCLUSIONS

Whole body CT imaging may be a useful investigation for the noninvasive workup of patients with unexplained weight loss, with diagnostic yield of 33.5% and good sensitivity, specificity, positive and negative predictive values for organic etiologies.

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Addressing Racial Disparity in Colorectal Cancer Screening With CT Colonography: Experience in an African-American Cohort. Clin Colorectal Cancer 2018;17:e363-e367. [DOI: 10.1016/j.clcc.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 01/09/2023]

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

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

Computer-Aided Detection of Colorectal Polyps at CT Colonography: Prospective Clinical Performance and Third-Party Reimbursement. AJR Am J Roentgenol 2017;208:1244-1248. [DOI: 10.2214/ajr.16.17499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]

Predicting Future Hip Fractures on Routine Abdominal CT Using Opportunistic Osteoporosis Screening Measures: A Matched Case-Control Study. AJR Am J Roentgenol 2017;209:395-402. [PMID: 28570093 DOI: 10.2214/ajr.17.17820] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]

Abstract

OBJECTIVE

Hip fracture is a major consequence of low bone mineral density, which is treatable but underdiagnosed. The purpose of this case-control study is to determine whether lumbar vertebral trabecular attenuation, vertebral compression fractures, and femoral neck T scores readily derived from abdominopelvic CT scans obtained for various indications are associated with future hip fragility fracture.

MATERIALS AND METHODS

A cohort of 204 patients with hip fracture (130 women and 74 men; mean age, 74.3 years) who had undergone abdominopelvic CT before fracture occurred (mean interval, 24.8 months) was compared with an age- and sex-matched control cohort without hip fracture. L1 trabecular attenuation, vertebral compression fractures of grades 2 and 3, and femoral neck T scores derived from asynchronous quantitative CT were recorded. The presence of one or more clinical risk factor for fracture was also recorded. Multivariate logistic regression models were used to determine the association of each measurement with the occurrence of hip fracture.

RESULTS

The mean L1 trabecular attenuation value, the presence of one or more vertebral compression fracture, and CT-derived femoral neck T scores were all significantly different in patients with hip fracture versus control subjects (p < 0.01). Logistic regression models showed a significant association of all measurements with hip fracture outcome after adjustments were made for age, sex, and the presence of one or more clinical risk factor. L1 trabecular attenuation and CT-derived femoral neck T scores showed moderate accuracy in differentiating case and control patients (AUC, 0.70 and 0.78, respectively).

CONCLUSION

L1 trabecular attenuation, CT-derived femoral neck T scores, and the presence of at least one vertebral compression fracture on CT are all associated with future hip fragility fracture in adults undergoing routine abdominopelvic CT for a variety of conditions.

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Muenzel D, Bar-Ness D, Roessl E, Blevis I, Bartels M, Fingerle AA, Ruschke S, Coulon P, Daerr H, Kopp FK, Brendel B, Thran A, Rokni M, Herzen J, Boussel L, Pfeiffer F, Proksa R, Rummeny EJ, Douek P, Noël PB. Spectral Photon-counting CT: Initial Experience with Dual–Contrast Agent K-Edge Colonography. Radiology 2017;283:723-728. [DOI: 10.1148/radiol.2016160890] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Bortz J. Potential pitfalls in the anorectal region during CT colonography: A discussion and pictorial overview of common pitfalls. SA J Radiol 2017. [DOI: 10.4102/sajr.v21i1.1108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open

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

Abstract

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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Pickhardt PJ, Pooler BD, Mbah I, Weiss JM, Kim DH. Colorectal Findings at Repeat CT Colonography Screening after Initial CT Colonography Screening Negative for Polyps Larger than 5 mm. Radiology 2016;282:139-148. [PMID: 27552558 DOI: 10.1148/radiol.2016160582] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

Abstract

Purpose To determine the rate and types of polyps detected at repeat computed tomographic (CT) colonography screening after initial negative findings at CT colonography screening. Materials and Methods Among 5640 negative CT colonography screenings (no polyps ≥ 6 mm) performed before 2010 at one medical center, 1429 (25.3%; mean age, 61.4 years; 736 women, 693 men) patients have returned for repeat CT colonography screening (mean interval, 5.7 years ± 0.9; range, 4.5-10.7 years). Positive rates and histologic findings of initial and repeat screening were compared in this HIPAA-compliant, institutional review board-approved study. For all patients with positive findings at repeat CT colonography, the findings were directly compared against the initial CT colonography findings. Fisher exact, Pearson χ², and Student t tests were applied as indicated. Results Repeat CT colonography screening was positive for lesions 6 mm or larger in 173 (12.1%) adults (compared with 14.3% at initial CT colonography screening, P = .29). In the 173 patients, 29.5% (61 of 207) of nondiminutive polyps could be identified as diminutive at the initial CT colonography and 12.6% (26 of 207) were missed. Large polyps, advanced neoplasia (advanced adenomas and cancer), and invasive cancer were seen in 3.8% (55 of 1429), 2.8% (40 of 1429), and 0.14% (two of 1429), respectively, at follow-up, compared with 5.2% (P = .02), 3.2% (P = .52), and 0.45% (P = .17), respectively, at initial screening. Of 42 advanced lesions in 40 follow-up screenings, 33 (78.6%) were right sided and 22 (52.4%) were flat, compared with 45.4% (P < .001) and 11.3% (P < .001), respectively, at initial screening. Large right-sided serrated lesions were confirmed in 20 individuals (1.4%), compared with 0.5% (P < .001) confirmed at initial screening. Conclusion Positive rates for large polyps at repeat CT colonography screening (3.7%) were lower compared with those at initial screening (5.2%). However, more advanced right-sided lesions were detected at follow-up CT colonography, many of which were flat, serrated lesions. The cumulative findings support both the nonreporting of diminutive lesions and a 5-10-year screening interval. ^© RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on August 30, 2016.

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

Abstract

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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Fuster D, Pagès M, Granados U, Perlaza P, Rubello D, Lomeña F. Update on PET/CT colonography in the diagnosis of colorectal cancer. Rev Esp Med Nucl Imagen Mol 2016;35:246-52. [DOI: 10.1016/j.remn.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/23/2022]

Fuster D, Pagès M, Granados U, Perlaza P, Rubello D, Lomeña F. Update on PET/CT colonography in the diagnosis of colorectal cancer. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]

Lee MH, Hinshaw JL, Kim DH, Pickhardt PJ. Symptomatic Versus Asymptomatic Colorectal Cancer: Predictive Features at CT Colonography. Acad Radiol 2016;23:712-7. [PMID: 26852246 DOI: 10.1016/j.acra.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 01/05/2023]

Abstract

RATIONALE AND OBJECTIVES

Computed tomographic colonography (CTC) is a robust tool for evaluating colorectal lesions in both screening and diagnostic settings. The purpose of this study was to assess the relationship between colorectal cancer (CRC) tumor characteristics and patient symptomatology.

MATERIALS AND METHODS

This is a retrospective analysis of all pathology-confirmed cases of CRC evaluated with CTC at our institution from October 2004 to October 2012. Cases were reviewed to determine tumor size, morphology, and degree of luminal narrowing. An electronic medical record review was performed to delineate specific patient symptomatology and determine depth of invasion.

RESULTS

A total of 55 patients (36 symptomatic and 19 asymptomatic) with a total of 63 CRCs were evaluated by CTC during the study time period. The most common symptoms were gastrointestinal (GI) bleeding/anemia (n = 26), followed by obstructive symptoms (n = 23), and constitutional symptoms (n = 5). Symptomatic cancers were more likely to have annular morphology (n = 30/43, 70% vs. n = 3/20, 15%; odds ratio [OR] = 13.1, P = 0.0003), whereas asymptomatic cancers were more likely to be polypoid (n = 11/20, 55% vs. n = 6/43, 14%, OR = 7.5, P = 0.001). Symptomatic cancers were also larger (46.1 ± 22.4 vs. 38.8 ± 18.4 mm, P = 0.005) and resulted in greater luminal narrowing (8.7 ± 8.5 mm vs. 35.8 ± 18.8 mm, P < 0.0001) with deeper invasion (n = 29/35 [invasion unknown for 8 cases], 83% vs. n = 6/20, 30%, OR = 11.3, P = 0.0003). Invasive cancers were more likely to have annular morphology (66%, 23/25, P = 0.002).

CONCLUSIONS

There is an intuitive and predictable relationship between tumor characteristics on CTC and patient symptoms. Annular morphology, tumor size, degree of luminal narrowing, and invasive disease all correlate with the presence of symptoms.

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Maggialetti N, Capasso R, Pinto D, Carbone M, Laporta A, Schipani S, Piccolo CL, Zappia M, Reginelli A, D'Innocenzo M, Brunese L. Diagnostic value of computed tomography colonography (CTC) after incomplete optical colonoscopy. Int J Surg 2016;33 Suppl 1:S36-44. [PMID: 27255132 DOI: 10.1016/j.ijsu.2016.05.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

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

Objective and Subjective Intrapatient Comparison of Iohexol Versus Diatrizoate for Bowel Preparation Quality at CT Colonography. AJR Am J Roentgenol 2016;206:1202-7. [PMID: 27010251 DOI: 10.2214/ajr.15.15373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]

Abstract

OBJECTIVE

The purpose of this study is to objectively and subjectively compare nonionic iohexol and ionic diatrizoate iodinated oral contrast agents as part of a cathartic bowel regimen within the same CT colonography (CTC) cohort, with otherwise identical preparations.

MATERIALS AND METHODS

In this retrospective study, 46 adults with no symptoms (mean age, 59.4 years; 26 men and 20 women) returning for follow-up CTC over a 9-month interval underwent the same bowel preparation with the exception of 75 mL of iohexol 350 in place of 60 mL of diatrizoate. All other preparation components (bisacodyl, magnesium citrate, and 2% barium) remained constant. Objective volumetric analysis of residual colonic fluid volume and fluid attenuation was performed. Additionally, two radiologists experienced with CTC who were blinded to the specific bowel preparation scored each of six colonic segments for adherent residual solid stool using a previously validated 4-point scale (0 for no stool; 1-3 for increasing residual stool). A paired t test was used for comparison of the cohorts.

RESULTS

No clear clinically meaningful difference was found between the two preparations on overall objective or subjective evaluation. The mean (± SD) residual fluid volume was 173 ± 126 mL with the iohexol preparation and 130 ± 79 mL with the diatrizoate preparation (p = 0.02). The mean total colonic stool score was 2.5 (0.42/segment) with iohexol and 2.3 (0.38/segment) with diatrizoate (p = 0.69). The mean fluid attenuation was higher with iohexol (849 ± 270 HU) compared with diatrizoate (732 ± 168 HU) (p = 0.03).

CONCLUSION

On the basis of this direct intrapatient comparison, we found that oral iohexol is a suitable alternative to diatrizoate for fluid tagging as part of a cathartic bowel preparation at CTC. Because this nonionic tagging agent is more palatable, less expensive, and likely safer than ionic diatrizoate, our CTC program now uses iohexol as the standard recommended regimen.

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Longitudinal Changes in Liver Fat Content in Asymptomatic Adults: Hepatic Attenuation on Unenhanced CT as an Imaging Biomarker for Steatosis. AJR Am J Roentgenol 2016;205:1167-72. [PMID: 26587921 DOI: 10.2214/ajr.15.14724] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]

Abstract

OBJECTIVE

The objective of this study was to evaluate changes in liver fat content over time in asymptomatic adults and to investigate the factors that may influence these changes.

MATERIALS AND METHODS

Liver attenuation on unenhanced CT images of 1022 asymptomatic adults (556 women and 466 men; mean age at the time of the index CT examination, 56.7 years) was retrospectively measured on initial and surveillance CT colonography screening examinations (mean [± SD] interval, 5.5 ± 0.8 years). Changes in liver attenuation (expressed as Hounsfield units) were assessed according to various factors, including body mass index (BMI), age, and sex.

RESULTS

Mean liver attenuation was 60.3 HU on the index CT scan and 58.4 HU on the 5-year follow-up CT scan (p < 0.0001). Changes in liver attenuation greater than 10 HU, 5-10 HU, and less than 5 HU were observed in 187 (18%), 212 (21%), and 623 (61%) individuals, respectively. Changes in attenuation greater than 10 HU were negative (i.e., fattier liver) in 130 of 187 individuals (70%) and were more likely to be associated with an increase in BMI (83 of 130 individuals [64%] vs 19 of 57 individuals [33%]; p < 0.0001). For changes in attenuation of 5 HU or more, negative (steatotic) changes outnumbered positive changes, occurring in 258 of 1022 individuals (25%) versus 141 of 1022 individuals (14%) (p < 0.0001). Changes in BMI were negatively correlated with changes in attenuation (p = 0.015). There was no statistically significant correlation between changes in attenuation and either age or sex. An improved lipid profile and the use of a lipid-lowering medication regimen correlated with an interval decrease in liver attenuation.

CONCLUSION

Changes in liver attenuation over time, reflecting temporal changes in fat content, were quite variable in this asymptomatic adult population and were only partially explained by the factors examined. These observations may provide early insight into the natural history of incidental hepatic steatosis in asymptomatic adults.

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Kim DH, Matkowskyj KA, Lubner MG, Hinshaw JL, Munoz Del Rio A, Pooler BD, Weiss JM, Pickhardt PJ. Serrated Polyps at CT Colonography: Prevalence and Characteristics of the Serrated Polyp Spectrum. Radiology 2016;280:455-63. [PMID: 26878227 DOI: 10.1148/radiol.2016151608] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]

Abstract

Purpose To report the prevalence and characteristics of serrated polyps identified in a large, average-risk population undergoing screening computed tomographic (CT) colonography. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board of the University of Wisconsin School of Medicine and Public Health. The need for informed consent was waived. Nine thousand six hundred examinations from 8289 patients were enrolled in a single-institution CT colonography-based screening program (from 2004 to 2011) and were evaluated for the presence of nondiminutive serrated lesions and advanced adenomas. The prevalence and characteristics of these lesions were tabulated. Generalized estimating equation regressions of polyp characteristics that may contribute to visualization of serrated lesions were investigated, including polyp size, location, and morphologic appearance; histologic findings; and presence or absence of contrast material tagging. Results Nondiminutive serrated lesions (≥6 mm) were seen at CT colonography-based screening with a prevalence of 3.1% (254 of 8289 patients). Sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs) constituted 36.8% (137 of 372) and 4.3% (16 of 372) of serrated lesions, respectively; hyperplastic polyps (HPs) accounted for 58.9% (219 of 372 lesions). SSA and TSA tended to be large (mean size, 10.6 mm and 14.1 mm, respectively), with size categories and polyp subgroups significantly associated (P < .0001). SSA tended to be proximal in location (91.2%, 125 of 137 lesions) and flat in morphologic appearance (39.4%, 54 of 137 lesions) compared with TSA and HP. The presence of high-grade dysplasia in serrated lesions was uncommon when compared with advanced adenomas (one of 372 lesions vs 22 of 395 lesions, respectively; P < .0001). Multivariate analysis showed that contrast material tagging markedly improved serrated polyp detection with an odds ratio of 40.4 (95% confidence interval: 10.1, 161.4). Conclusion Serrated lesions are seen at CT colonography-based screening with a nondiminutive prevalence of 3.1%. These lesions tend to be large, flat, and proximal in location. Adherent contrast material coating on these polyps aids in their detection, despite an often flat morphologic appearance. (©) RSNA, 2016 Online supplemental material is available for this article.

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Affiliation(s)

David H Kim From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
Kristina A Matkowskyj From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
Meghan G Lubner From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
J Louis Hinshaw From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
Alejandro Munoz Del Rio From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
B Dustin Pooler From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
Jennifer M Weiss From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
Perry J Pickhardt From the Department of Radiology (D.H.K., M.G.L., J.L.H., A.M.d.R., B.D.P., P.J.P.), Department of Pathology (K.A.M.), and Section of Gastroenterology and Hepatology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252

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

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

Abstract

OBJECTIVE

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

SUBJECTS AND METHODS

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

RESULTS

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

CONCLUSION

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

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