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Caiado AHM, Nahas SC, Oliveira IRS, Ueda SKN, Nahas CSR, Rocha MS, Torres US, Buchpiguel CA. Accuracy of CT colonography with mannitol preparation for detecting synchronous lesions in obstructive colorectal cancer. Eur J Radiol 2025; 188:112151. [PMID: 40344713 DOI: 10.1016/j.ejrad.2025.112151] [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] [Received: 01/12/2025] [Revised: 03/20/2025] [Accepted: 04/30/2025] [Indexed: 05/11/2025]
Abstract
OBJECTIVE Preoperative detection of advanced neoplasms is essential for surgical planning in colorectal cancer (CRC). CT colonography (CTC) has emerged as a reliable alternative when obstructive CRC prevents complete optical colonoscopy (OC). Mannitol, commonly used for OC preparation in some countries, offers potential advantages over polyethylene glycol (PEG), including low cost, reduced ingestion volume, fast action, and a more palatable sweet taste. We evaluated the diagnostic accuracy of mannitol-based CTC for detecting synchronous lesions in CRC, hypothesizing that this low-volume preparation could maintain high accuracy while improving patient tolerability. METHODS Of 150 CRC patients with incomplete OC who underwent preoperative CTC following cathartic preparation with mannitol, 62 were retrospectively analyzed. Their CTC findings were compared with postoperative surgical and pathological results and follow-up OC. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for lesions ≥6 mm. In addition, the quality of bowel preparation with mannitol (amount of liquid and solid residue) was compared with historical data from published studies. RESULTS In 62 patients (372 segments), 26 synchronous lesions were identified (9 ≥ 10 mm, 17 sized 6-9 mm). For lesions ≥6 mm, CTC achieved a sensitivity of 92.3 % (95 % CI: 74.9-99.1 %), specificity of 99.1 % (95 % CI: 97.5-99.8 %), PPV of 88.9 % (95 % CI: 70.8-97.6 %), and NPV of 99.4 % (95 % CI: 97.9-99.9 %). Bowel cleansing was adequate, with 82.8 % of segments showing no or minimal residual fluid and 96.3 % with no or minimal solid residue. CONCLUSION CTC with a mannitol-based preparation demonstrated high accuracy in detecting synchronous neoplasms among patients with obstructive CRC and incomplete OC. These findings suggest that mannitol is a feasible alternative to PEG, maintaining excellent diagnostic performance while possibly improving tolerability. Additionally, it could streamline surgical planning and improve overall outcomes in modern CRC management.
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Affiliation(s)
- Angela H M Caiado
- Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 75, Sao Paulo, SP 05403-010, Brazil; Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo, SP 04580-060, Brazil.
| | - Sergio C Nahas
- Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 75, Sao Paulo, SP 05403-010, Brazil
| | - Ilka R S Oliveira
- Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 75, Sao Paulo, SP 05403-010, Brazil; Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo, SP 04580-060, Brazil
| | - Serli K N Ueda
- Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 75, Sao Paulo, SP 05403-010, Brazil; Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo, SP 04580-060, Brazil
| | - Caio S R Nahas
- Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 75, Sao Paulo, SP 05403-010, Brazil
| | - Manoel S Rocha
- Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 75, Sao Paulo, SP 05403-010, Brazil
| | - Ulysses S Torres
- Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo, SP 04580-060, Brazil
| | - Carlos A Buchpiguel
- Faculdade de Medicina, Universidade de Sao Paulo, Rua Doutor Ovidio Pires de Campos, 75, Sao Paulo, SP 05403-010, Brazil
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Chawla T, Hurrell C, Keough V, Lindquist CM, Mohammed MF, Samson C, Sugrue G, Walsh C. Canadian Association of Radiologists Practice Guidelines for Computed Tomography Colonography. Can Assoc Radiol J 2024; 75:54-68. [PMID: 37411043 DOI: 10.1177/08465371231182975] [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: 07/08/2023] Open
Abstract
Colon cancer is the third most common malignancy in Canada. Computed tomography colonography (CTC) provides a creditable and validated option for colon screening and assessment of known pathology in patients for whom conventional colonoscopy is contraindicated or where patients self-select to use imaging as their primary modality for initial colonic assessment. This updated guideline aims to provide a toolkit for both experienced imagers (and technologists) and for those considering launching this examination in their practice. There is guidance for reporting, optimal exam preparation, tips for problem solving to attain high quality examinations in challenging scenarios as well as suggestions for ongoing maintenance of competence. We also provide insight into the role of artificial intelligence and the utility of CTC in tumour staging of colorectal cancer. The appendices provide more detailed guidance into bowel preparation and reporting templates as well as useful information on polyp stratification and management strategies. Reading this guideline should equip the reader with the knowledge base to perform colonography but also provide an unbiased overview of its role in colon screening compared with other screening options.
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Affiliation(s)
- Tanya Chawla
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Valerie Keough
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris M Lindquist
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohammed F Mohammed
- Abdominal Radiology Section, Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Caroline Samson
- Département de Radiologie, Radio-oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Quebec, Canada
| | - Gavin Sugrue
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia Walsh
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
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Rengo M, Tiberia F, Vicini S, Bellini D, Celestre M, Trionfera G, Laghi A, Carbone I. CT colonography: can we achieve an adequate bowel preparation without diet restriction? Eur Radiol 2023; 33:5184-5192. [PMID: 36806568 PMCID: PMC10289920 DOI: 10.1007/s00330-023-09471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To evaluate if an adequate bowel preparation for CT colonography, can be achieved without diet restriction, using a reduced amount of cathartic agent and fecal tagging. To investigate the influence of patients' characteristics on bowel preparation and the impact on patients' compliance. METHODS In total, 1446 outpatients scheduled for elective CT colonography were prospectively enrolled. All patients had the same bowel preparation based on a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) the day before the exam and a fecal tagging agent (60 ml of hyperosmolar oral iodinated agent) the day of the exam. No dietary restrictions were imposed before the exam. The bowel preparation was evaluated using a qualitative and quantitative score. Patients were grouped by age, gender, and presence of diverticula in both scores. Patients' compliance has been evaluated with a questionnaire after the end of the exam and with a phone-calling interview the day after the exam. RESULTS According to the qualitative score, adequate bowel preparation was achieved in 1349 patients (93.29%) and no statistical differences were observed among the subgroups of patients. Quantitative scores demonstrated that colon distension was significantly better in younger patients and without diverticula. A good patients' compliance was observed and most patients (96.5%) were willing to repeat it. CONCLUSIONS The lack of diet restriction does not affect the quality of CTC preparation and good patient's compliance could potentially increase the participation rate in CRC screening programs. KEY POINTS • An adequate quality bowel preparation for CT colonography can be achieved without diet restriction, using a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) and fecal tagging (60 ml of hyperosmolar oral iodinated agent). • A bowel preparation based on the combination of a reduced amount of cathartic agent and fecal tagging, without diet restriction, allows obtaining good quality in more than 90% of patients. • The bowel preparation scheme proposed reduces the distress and discomfort experienced by the patients improving adherence to CTC.
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Affiliation(s)
- Marco Rengo
- Department of Medico-Surgical Sciences and Biotechnologies, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy.
| | - Filippo Tiberia
- Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Simone Vicini
- Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Davide Bellini
- Department of Medico-Surgical Sciences and Biotechnologies, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Michela Celestre
- Diagnostic Imaging Unit, Valmontone Hospital, Via Dei Lecci, Valmontone, RM, Italy
| | - Gianfranco Trionfera
- Diagnostic Imaging Unit, Valmontone Hospital, Via Dei Lecci, Valmontone, RM, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Via Di Grottarossa 1035, 00189, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
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Bai W, Yu D, Zhu B, Yu X, Duan R, Li Y, Yu W, Hua W, Kou C. Diagnostic accuracy of computed tomography colonography in patients at high risk for colorectal cancer: a meta-analysis. Colorectal Dis 2020; 22:1528-1537. [PMID: 32277562 DOI: 10.1111/codi.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/15/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to explore the diagnostic value of computed tomographic colonography (CTC) compared with conventional colonoscopy in individuals at high risk for colorectal cancer. METHOD PubMed, Embase, the Cochrane Library and the Web of Science were searched by two independent reviewers for potentially eligible studies published up to 31 October 2018 that were based on a per-patient analysis. stata, meta-disc and revman were used to perform this meta-analysis. A random-effect model was used, and a subgroup analysis was conducted to explore the sources of heterogeneity. RESULTS A total of 14 full-text articles, involving 3578 patients, were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the area under the summary receiver operating characteristic curve of CTC for detecting polyps ≥ 6 mm were 0.87 (95% CI 0.83-0.90), 0.90 (95% CI 0.86-0.93), 9.08 (95% CI 6.28-13.13), 0.14 (95% CI 0.11-0.18) and 0.94 (95% CI 0.92-0.96), respectively. For polyps ≥ 10 mm, the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of CTC were 0.91 (95% CI 0.86-0.94), 0.98 (95% CI 0.95-0.99), 40.36 (95% CI 19.16-85.03), 0.90 (95% CI 0.06-0.14) and 0.98 (95% CI 0.96-0.99), respectively. CONCLUSION In this meta-analysis, CTC had high diagnostic accuracy for detecting polyps ≥ 6 mm and ≥ 10 mm in patients at high risk of developing colorectal cancer and it had a higher sensitivity and specificity for detecting polyps ≥ 10 mm than polyps ≥ 6 mm. However, the results should be used cautiously due to the significant heterogeneity.
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Affiliation(s)
- W Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - D Yu
- Department of Surgical Oncology, Fifth People's Hospital of Shenyang, Shenyang, China
| | - B Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - X Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - R Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Y Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - W Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - W Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - C Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
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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]
Affiliation(s)
- Zina J Ricci
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
| | - Mariya Kobi
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Milana Flusberg
- Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Judy Yee
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Perry E, Moore H, Reeve J. Computed tomography colonography: Retrospective comparison of laxative plus barium tagging versus iodinated contrast only for bowel preparation and faecal tagging. J Med Imaging Radiat Oncol 2019; 63:203-211. [DOI: 10.1111/1754-9485.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Elisa Perry
- Department of Radiology Middlemore Hospital Auckland New Zealand
| | - Helen Moore
- Department of Radiology Auckland City Hospital Auckland New Zealand
| | - Jane Reeve
- Department of Radiology Auckland City Hospital Auckland New Zealand
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Utano K, Takayanagi D, Nagata K, Aizawa M, Endo S, Nemoto T, Nemoto D, Isohata N, Lefor AK, Togashi K. A novel volume-reduced CT colonography regimen using hypertonic laxative (polyethylene glycol with ascorbic acid): randomized controlled trial. Eur Radiol 2019; 29:5236-5246. [PMID: 30903329 DOI: 10.1007/s00330-019-06127-6] [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] [Received: 10/29/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study is to investigate the feasibility of bowel preparation using a hypertonic laxative (polyethylene glycol with ascorbic acid, PEG + Asc) for CT colonography (CTC) and to examine the volume limit of laxative. METHODS In one institution, patients who met the indications for CTC were enrolled and randomly assigned to CTC with regimen A (800 ml PEG + Asc), B (600 ml PEG + Asc), or C (400 ml PEG + Asc). Sodium diatrizoate was given orally for fecal tagging. On the previous day, patients ate low-residue meals and took the assigned lavage solution after dinner. A reader blinded to the preparation graded residual stool/fluid and fecal tagging quality in six segments of the colorectum. The primary outcome was a proportion of colon segments without stool. One hundred twenty segments in 20 patients with each regimen were needed to show a non-inferiority margin of 15%, assuming 85% of no stool. RESULTS A total of 360 segments in 60 patients were analyzed. There were 83% of segments with no stool in regimen A, 89% in regimen B, and 88% in regimen C. Using the delta method, the 95% confidence interval of the risk difference (6.7%) between regimens A and B was - 2.2% to 15.6%, and the risk difference (5.0%) between regimens A and C was - 4.1% to 14%, both within the non-inferiority margin. Residual fluid and fecal tagging quality were also within the non-inferiority margin. No adverse events occurred. CONCLUSIONS A novel CTC regimen using hypertonic laxative demonstrated optimal colon cleansing effectiveness even with the lowest volume of laxative (UMIN000022851). KEY POINTS • A novel CTC regimen using a hypertonic laxative is feasible. • The lowest volume of laxative provides excellent colon imaging. • However, the lowest volume of laxative did not improve patient acceptance.
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Affiliation(s)
- Kenichi Utano
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Daisuke Takayanagi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Koichi Nagata
- Division of Screening Technology, National Cancer Center, Tokyo, Japan
| | - Masato Aizawa
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Tetsutaro Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Noriyuki Isohata
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan.
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Mitsuzaki K, Iinuma G, Morimoto T, Miyake M, Tomimatsu H. Computed tomographic colonography with a reduced dose of laxative using a novel barium sulfate contrast agent in Japan. Jpn J Radiol 2018; 37:245-254. [PMID: 30554302 DOI: 10.1007/s11604-018-0800-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/09/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To test the tagging efficacy, patient acceptability, and accuracy of computed tomographic colonography (CTC) with a reduced dose of laxative using a novel barium sulfate (BaSO4) contrast agent. MATERIALS AND METHODS CTC followed by optical colonoscopy (OC) was performed on 73 patients with positive results in fecal occult blood tests. They were administrated a BaSO4 suspension and a magnesium citrate solution for bowel preparation. Patients completed a questionnaire about the acceptability of bowel preparation. Tagging efficacy was estimated using a novel categorization system, which classified all segments into 8 categories. The accuracy of detecting protruded lesions ≥ 6 mm was calculated from the comparison of CTC and OC results, using the latter as a reference standard. RESULTS Tagging efficacy was good in 77.3% of colonic segments where residue was observed. The acceptability of bowel preparation for CTC was significantly higher than that for OC. The sensitivity, specificity, and positive and negative predictive values were 0.778, 0.945, 0.824, and 0.929, respectively. All lesions ≥ 7 mm were successfully detected by CTC. CONCLUSION CTC with a reduced dose of laxative using a novel BaSO4 contrast agent has a favorable tagging efficacy, patient acceptability, and accuracy.
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Affiliation(s)
- Katsuhiko Mitsuzaki
- Center for Preventive Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, Japan.
| | - Gen Iinuma
- Department of Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Tsuyoshi Morimoto
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Mototaka Miyake
- Department of Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Hideto Tomimatsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagito, Gifu, Gifu, Japan
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Patient tolerance and acceptance of different colonic imaging modalities: an observational cohort study. Eur J Gastroenterol Hepatol 2018; 30:520-525. [PMID: 29462029 DOI: 10.1097/meg.0000000000001090] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Less invasive alternatives to optical colonoscopy (OC) may improve patient compliance with investigation, but study of patient preference is limited. OBJECTIVES The aims of this study were to determine patient tolerance and acceptability of OC, computed tomography colonography (CTC) and colon capsule endoscopy (CCE) and also to determine the choice of investigation made by fully informed members of the lay public. PATIENTS AND METHODS Patients assigned a Gloucester Comfort Score (GCS, 1-5; as did endoscopists), an overall test experience score (visual analogue scale, 0-10) and completed a 'Friends and Family Test' following OC, CTC or CCE. In the second part of the study, members of the public were given information detailing the nature, tolerance, acceptability, risks and outcomes and invited to choose which test they would prefer in the event that one was needed. RESULTS Assessed by endoscopist and patient, respectively, 24.2 and 49.3% (P<0.005) of symptomatic and 27.3 and 22.1% (P=0.4) of Bowel Cancer Screening Programme patients suffered moderate to severe discomfort (GCS: 4-5) [GCS (mean±SEM): 3.32±0.085, 1.96±0.083 and 1.30±0.088 (P<0.001); overall experience: 5.43, 2.35 and 3.80 (P<0.001)]. In all, 93.6, 96.1 and 85.7% of OC, CTC and CCE patients, respectively, were willing to undergo the same test under the same circumstances. The lay public (n=100) chose a noninvasive test (CTC or CCE) in 55% of the cases to investigate symptoms and chose a Bowel Cancer Screening Programme test in 29% of the cases (P<0.001). CONCLUSION Patient tolerance and experience favours CTC and CCE over OC and informed about all aspects of each procedure; a noninvasive option is commonly chosen by the lay public.
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Steffey MA, Zwingenberger AL, Daniel L, Taylor SL. Assessment of 3 Bowel Preparation Protocols for Computed Tomography Pneumocolonography in Normal Dogs. Vet Surg 2016; 45:929-935. [PMID: 27489142 DOI: 10.1111/vsu.12524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of 3 different bowel preparation protocols on interpretation of computed tomography (CT) pneumocolonography images. STUDY DESIGN Experimental crossover design. ANIMALS Intact male, hound-cross, research colony dogs (n=4). METHODS All dogs received the 3 different bowel preparation protocols for CT pneumocolonography in the same order, with a minimum of 2 weeks between protocols. For each segment of large bowel, the subjective adequacy of bowel cleansing was assessed, residual fecal and bowel volumes were calculated, and the density of fecal material in the bowel lumen was measured. Linear mixed effect models that included a random dog effect were used to evaluate mean differences in outcome measures across protocols. RESULTS No dogs experienced any clinical problems associated with the protocols or CT pneumocolonography. Bowel cleansing was considered adequate for CT pneumocolonography interpretation for all 3 protocols. There was a significant effect of protocol on residual fecal volumes and the fecal:bowel volume ratio, with the 2 protocols that included an extended fast producing the lowest total residual fecal volumes. There was a significant effect of protocol on maximum measured density of residual fecal material with the 2 protocols including iodinated contrast having the highest density. CONCLUSIONS All protocols were sufficient for CT pneumocolonography interpretation and contrast-tagging of residual fecal material was successful with oral iopamidol administration. An at-home bowel cleansing protocol may provide adequate bowel cleansing for CT pneumocolonography image interpretation.
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Affiliation(s)
- Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California.
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Leticia Daniel
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Sandra L Taylor
- Department of Public Health Sciences, Division of Biostatistics, School of Medicine, University of California-Davis, Davis, California
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Moreno CC, Weiss PS, Jarrett TL, Roberts DL, Mittal PK, Votaw JR. Patient Preferences Regarding Colorectal Cancer Screening: Test Features and Cost Willing to Pay Out of Pocket. Curr Probl Diagn Radiol 2015; 45:189-92. [PMID: 26774952 DOI: 10.1067/j.cpradiol.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/12/2015] [Indexed: 12/26/2022]
Abstract
The purpose of this investigation was to evaluate whether test features would make an individual more or less likely to undergo colorectal cancer screening and how much an individual would be willing to pay out of pocket for a screening test. The methods include an administration of a survey to consecutive adult patients of a general medicine clinic. The survey consisted of Likert-scale questions assessing the patients' likelihood of choosing a screening test based on various test characteristics. Additional questions measured the patients' age, race, gender, and maximum out-of-pocket cost they would be willing to pay. Chi-square tests were used to assess the associations between the likelihood questions and the various demographic characteristics. In results, survey response rate was 88.8% (213 of 240). Respondents were 48.4% female (103 of 213), 51.6% male (110 of 213), 82.6% White (176 of 213), 11.3% African-American (24 of 213), and 6.1% other (13 of 213). Risk of internal injury and light exposure to radiation were the least desirable test features. Light sedation was the only test feature that most respondents (54.8%) indicated would make them likely or very likely to undergo a colorectal cancer screening test. The vast majority of respondents (86.8%) were willing to pay less than $200 out of pocket for a colorectal cancer screening test. There was no statistically significant difference in the responses of males and females, or in the responses of individuals of different races or different ages regarding test features, or the amount individuals were willing to pay for a screening test. To conclude, survey results suggest that patient education emphasizing the low complication rate of computed tomographic colonography (CTC), the minimal risks associated with the low-level radiation exposure resulting from CTC, and the benefits of a sedation-free test (eg, no risk of sedation-related complication and no need for a driver) may increase patient acceptance of CTC. Additionally, an out-of-pocket cost of <$200 would be preferable from the patient perspective.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA.
| | - Paul S Weiss
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Thomas L Jarrett
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - David L Roberts
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Pardeep K Mittal
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA
| | - John R Votaw
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA
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12
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Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol 2015; 25:331-45. [PMID: 25278245 PMCID: PMC4291518 DOI: 10.1007/s00330-014-3435-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Meric K, Bakal N, Aydin S, Yesil A, Tekesin K, Simsek M. Fecal tag CT colonography with a limited 2-day bowel preparation following incomplete colonoscopy. Jpn J Radiol 2015; 33:329-35. [PMID: 25895857 DOI: 10.1007/s11604-015-0421-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/08/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to assess the feasibility and patient tolerance of a 2-day limited fecal tag bowel preparation in computed tomographic colonography (CTC) performed for incomplete conventional colonoscopy (CC) patients. MATERIALS AND METHODS Seventy-five patients who underwent a CTC examination fbecause of incomplete CC were included. A low-residue diet was given for 2 days before CTC. Fecal tagging (FT) was done using a barium sulfate suspension. The quality of the preparation, success of tagging and patient experience with the bowel preparation were investigated. RESULTS Four hundred fifty bowel segments were evaluated. The number of solid stool balls of 6-9 mm size was 284; the corresponding figure was 93 for solid stool balls ≥ 10 mm. Residual fluid was present in about one-third of the segments. The fecal tagging efficacy for ≥ 6 mm residual stool balls was 92 %. Overall, 16 (21.3 %) patients presented with colonic lesions at CTC. Three out of four colonic mass lesions had not been diagnosed with CC. Most patients reported mild discomfort. CONCLUSION FT-CTC performed after a limited 2-day bowel preparation seems to be a technically feasible, safe and acceptable procedure that allows a complete a colonic study in incomplete CC patients.
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Affiliation(s)
- Kaan Meric
- Department of Radiology, Haydarpaşa Numune Training and Research Hospital, Tibbiye Caddesi No: 40, 34668, Uskudar, Istanbul, Turkey,
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Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients. Gastroenterol Res Pract 2015; 2015:609150. [PMID: 25873945 PMCID: PMC4385636 DOI: 10.1155/2015/609150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/04/2015] [Indexed: 11/18/2022] Open
Abstract
Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n = 56) and 4-day diet group (n = 45). Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring <6 mm and ≥6 mm. We graded the residual fluid, tagging quality for solid stool, and fluid per bowel segment. We performed a questionnaire to assess patient compliance. Results. 604 bowel segments were evaluated. There was no significant difference between 2-day and 4-day diet groups with respect to residual solid stool, residual fluid, tagging quality for stool, and fluid observed in fecal tag CT colonography (P > 0.05). The prevalence of moderate discomfort was significantly higher in 4-day group (P < 0.001). Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients.
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15
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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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Kim B, Park SH, Hong GS, Lee JH, Lee JS, Kim HJ, Kim AY, Ha HK. Iohexol versus diatrizoate for fecal/fluid tagging during CT colonography performed with cathartic preparation: comparison of examination quality. Eur Radiol 2015; 25:1561-9. [PMID: 25576229 DOI: 10.1007/s00330-014-3568-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/05/2014] [Accepted: 12/12/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aimed to compare iohexol vs. diatrizoate as fecal/fluid tagging agents for computed tomography colonography (CTC) regarding examination quality. METHODS Forty prospective patients (M:F = 23:17; 63 ± 11.6 years) received CTC using 50 mL (350 mgI/mL) oral iohexol for tagging. Forty other indication-matched, age-matched, and sex-matched patients who underwent CTC using 100 mL diatrizoate for tagging and otherwise the same technique, were retrospectively identified. Two groups were compared regarding overall examination quality, per-patient and per-segment scores of colonic bubbles (0 [no bubbles] to 5 [the largest amount]), and the volume, attenuation, and homogeneity (untagged, layered, and homogeneous) of the residual colonic fluid. RESULTS The iohexol group demonstrated a greater amount of colonic bubbles than the diatrizoate group: mean per-patient scores ± SD of 1.2 ± 0.8 vs. 0.7 ± 0.6, respectively (p = 0.003); and rates of segments showing ≥ grade 3 bubbles of 12.9 % (85/659) vs. 1.6 % (11/695), respectively (p = 0.001). Residual colonic fluid amount standardized to the colonic volume did not significantly differ: 7.2 % ± 4.2 vs. 7.8 % ± 3.7, respectively (p = 0.544). Tagged fluid attenuation was mostly comparable between groups and the fluid was homogeneously tagged in 98.7 % (224/227) vs. 99.5 % (218/219) segments, respectively (p = 0.344). Iohexol caused more colonic bubbles when used during cathartic CTC. Otherwise, examination quality was similarly adequate with both iohexol and diatrizoate. KEY POINTS • When used for tagging, iohexol caused significantly more colonic bubbles than diatrizoate. • The residual colonic fluid amount did not significantly differ between iohexol and diatrizoate. • The quality of fluid tagging was similarly adequate in both iohexol and diatrizoate.
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Affiliation(s)
- Bohyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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Ghanouni A, Halligan S, Taylor SA, Boone D, Plumb A, Stoffel S, Morris S, Yao GL, Zhu S, Lilford R, Wardle J, von Wagner C. Quantifying public preferences for different bowel preparation options prior to screening CT colonography: a discrete choice experiment. BMJ Open 2014; 4:e004327. [PMID: 24699460 PMCID: PMC3987721 DOI: 10.1136/bmjopen-2013-004327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES CT colonography (CTC) may be an acceptable test for colorectal cancer screening but bowel preparation can be a barrier to uptake. This study tested the hypothesis that prospective screening invitees would prefer full-laxative preparation with higher sensitivity and specificity for polyps, despite greater burden, over less burdensome reduced-laxative or non-laxative alternatives with lower sensitivity and specificity. DESIGN Discrete choice experiment. SETTING Online, web-based survey. PARTICIPANTS 2819 adults (45-54 years) from the UK responded to an online invitation to take part in a cancer screening study. Quota sampling ensured that the sample reflected key demographics of the target population and had no relevant bowel disease or medical qualifications. The analysis comprised 607 participants. INTERVENTIONS After receiving information about screening and CTC, participants completed 3-4 choice scenarios. Scenarios showed two hypothetical forms of CTC with different permutations of three attributes: preparation, sensitivity and specificity for polyps. PRIMARY OUTCOME MEASURES Participants considered the trade-offs in each scenario and stated their preferred test (or chose neither). RESULTS Preparation and sensitivity for polyps were both significant predictors of preferences (coefficients: -3.834 to -6.346 for preparation, 0.207-0.257 for sensitivity; p<0.0005). These attributes predicted preferences to a similar extent. Realistic specificity values were non-significant (-0.002 to 0.025; p=0.953). Contrary to our hypothesis, probabilities of selecting tests were similar for realistic forms of full-laxative, reduced-laxative and non-laxative preparations (0.362-0.421). However, they were substantially higher for hypothetical improved forms of reduced-laxative or non-laxative preparations with better sensitivity for polyps (0.584-0.837). CONCLUSIONS Uptake of CTC following non-laxative or reduced-laxative preparations is unlikely to be greater than following full-laxative preparation as perceived gains from reduced burden may be diminished by reduced sensitivity. However, both attributes are important so a more sensitive form of reduced-laxative or non-laxative preparation might improve uptake substantially.
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Affiliation(s)
- Alex Ghanouni
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Darren Boone
- Centre for Medical Imaging, University College London, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Sandro Stoffel
- Institute for Health and Consumer Protection, European Commission, Joint Research Centre, Ispra, Italy
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Guiqing Lily Yao
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Shihua Zhu
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Richard Lilford
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
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Evaluating patients' preferences for type of bowel preparation prior to screening CT colonography: convenience and comfort versus sensitivity and specificity. Clin Radiol 2013; 68:1140-5. [PMID: 23948662 DOI: 10.1016/j.crad.2013.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 01/01/2023]
Abstract
AIMS To explore the relative value patients place on comfort and convenience versus test sensitivity and specificity in the context of computed tomographic colonography (CTC) screening. MATERIALS AND METHODS Twenty semi-structured interviews were carried out with patients attending hospital for radiological tests unrelated to CTC. Preferences for CTC with different types of bowel preparation for CTC screening were examined and interviews were analysed thematically. The discussion guide included separate sections on CTC, bowel preparation methods (non-, reduced- and full-laxative), and sensitivity and specificity. Patients were given information on each topic in turn and asked about their views and preferences during each section. RESULTS Following information about the test, patients' attitudes towards CTC were positive. Following information on bowel preparation, full-laxative purgation was anticipated to cause more adverse physical and lifestyle effects than using reduced- or non-laxative preparation. However, stated preferences were approximately equally divided, largely due to patients anticipating that non-laxative preparations would reduce test accuracy (because the bowel was not thoroughly cleansed). Following information on sensitivity and specificity (which supported patients' expectations), the predominant stated preference was for full-laxative preparation. CONCLUSIONS Patients are likely to value test sensitivity and specificity over a more comfortable and convenient preparation. Future research should test this hypothesis on a larger sample.
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Boone DJ, Halligan S, Roth HR, Hampshire TE, Helbren E, Slabaugh GG, McQuillan J, McClelland JR, Hu M, Punwani S, Taylor SA, Hawkes DJ. CT colonography: external clinical validation of an algorithm for computer-assisted prone and supine registration. Radiology 2013; 268:752-60. [PMID: 23687175 DOI: 10.1148/radiol.13122083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To perform external validation of a computer-assisted registration algorithm for prone and supine computed tomographic (CT) colonography and to compare the results with those of an existing centerline method. MATERIALS AND METHODS All contributing centers had institutional review board approval; participants provided informed consent. A validation sample of CT colonographic examinations of 51 patients with 68 polyps (6-55 mm) was selected from a publicly available, HIPAA compliant, anonymized archive. No patients were excluded because of poor preparation or inadequate distension. Corresponding prone and supine polyp coordinates were recorded, and endoluminal surfaces were registered automatically by using a computer algorithm. Two observers independently scored three-dimensional endoluminal polyp registration success. Results were compared with those obtained by using the normalized distance along the colonic centerline (NDACC) method. Pairwise Wilcoxon signed rank tests were used to compare gross registration error and McNemar tests were used to compare polyp conspicuity. RESULTS Registration was possible in all 51 patients, and 136 paired polyp coordinates were generated (68 polyps) to test the algorithm. Overall mean three-dimensional polyp registration error (mean ± standard deviation, 19.9 mm ± 20.4) was significantly less than that for the NDACC method (mean, 27.4 mm ± 15.1; P = .001). Accuracy was unaffected by colonic segment (P = .76) or luminal collapse (P = .066). During endoluminal review by two observers (272 matching tasks, 68 polyps, prone to supine and supine to prone coordinates), 223 (82%) polyp matches were visible (120° field of view) compared with just 129 (47%) when the NDACC method was used (P < .001). By using multiplanar visualization, 48 (70%) polyps were visible after scrolling ± 15 mm in any multiplanar axis compared with 16 (24%) for NDACC (P < .001). CONCLUSION Computer-assisted registration is more accurate than the NDACC method for mapping the endoluminal surface and matching the location of polyps in corresponding prone and supine CT colonographic acquisitions.
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Affiliation(s)
- Darren J Boone
- Centre for Medical Imaging and Centre for Medical Image Computing, University College London, Podium Level 2, University College Hospital, 235 Euston Rd, London NW1 2BU, England
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Sali L, Grazzini G, Ventura L, Falchini M, Borgheresi A, Castiglione G, Grimaldi M, Ianniciello N, Mallardi B, Zappa M, Mascalchi M. Computed tomographic colonography in subjects with positive faecal occult blood test refusing optical colonoscopy. Dig Liver Dis 2013; 45:285-9. [PMID: 23266193 DOI: 10.1016/j.dld.2012.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/29/2012] [Accepted: 11/12/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Refusal of colonoscopy is a drawback of colorectal cancer screening programmes based on faecal occult blood test. Computed-tomographic-colonography is generally more accepted than colonoscopy. AIM To compare adherence to computed-tomographic-colonography and second-invitation colonoscopy in subjects with positive faecal test refusing colonoscopy. METHODS We performed a prospective study in 198 subjects with positive faecal test who refused first referral to colonoscopy in one endoscopy service of the Florence screening programme. Subjects were randomly invited to computed-tomographic-colonography (n = 100) or re-invited to colonoscopy (n = 98). Mail invitation was followed by a questionnaire administered by phone. Computed-tomographic-colonography findings were verified with colonoscopy. RESULTS 32 subjects could not be reached, 71 (35.9%) had undergone colonoscopy on their own; 4 were excluded for contraindications; 30/48 (62.5%) in the computed-tomographic-colonography arm and 11/43 (25.6%) in the colonoscopy arm accepted the proposed examinations (p < 0.001). Four advanced adenomas and 1 cancer were found in the 28 subjects who ultimately underwent computed-tomographic-colonography and 2 advanced adenomas and 2 cancers in the 9 subjects who ultimately underwent second-invitation colonoscopy. CONCLUSION Subjects with positive faecal occult blood test refusing colonoscopy show a higher adherence to computed-tomographic-colonography than to second invitation colonoscopy.
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Affiliation(s)
- Lapo Sali
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale G. Pieraccini 6, 50139 Florence, Italy.
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21
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Sali L, Grazzini G, Carozzi F, Castiglione G, Falchini M, Mallardi B, Mantellini P, Ventura L, Regge D, Zappa M, Mascalchi M, Milani S. Screening for colorectal cancer with FOBT, virtual colonoscopy and optical colonoscopy: study protocol for a randomized controlled trial in the Florence district (SAVE study). Trials 2013; 14:74. [PMID: 23497601 PMCID: PMC3618219 DOI: 10.1186/1745-6215-14-74] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/08/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the most frequent cancer in Europe. Randomized clinical trials demonstrated that screening with fecal occult blood test (FOBT) reduces mortality from CRC. Accordingly, the European Community currently recommends population-based screening with FOBT. Other screening tests, such as computed tomography colonography (CTC) and optical colonoscopy (OC), are highly accurate for examining the entire colon for adenomas and CRC. Acceptability represents a critical determinant of the impact of a screening program. We designed a randomized controlled trial to compare participation rate and diagnostic yield of FOBT, CTC with computer-aided diagnosis, and OC as primary tests for population-based screening. METHODS/DESIGN A total of 14,000 subjects aged 55 to 64 years, living in the Florence district and never screened for CRC, will be randomized in three arms: group 1 (5,000 persons) invited to undergo CTC (divided into: subgroup 1A with reduced cathartic preparation and subgroup 1B with standard bowel preparation); group 2 (8,000 persons) invited to undergo a biannual FOBT for three rounds; and group 3 (1,000 persons) invited to undergo OC. Subjects of each group will be invited by mail to undergo the selected test. All subjects with a positive FOBT or CTC test (that is, mass or at least one polyp ≥ 6 mm) will be invited to undergo a second-level OC. Primary objectives of the study are to compare the participation rate to FOBT, CTC and OC; to compare the detection rate for cancer or advanced adenomas of CTC versus three rounds of biannual FOBT; to evaluate referral rate for OC induced by primary CTC versus three rounds of FOBT; and to estimate costs of the three screening strategies. A secondary objective of the study is to create a biological bank of blood and stool specimens from subjects undergoing CTC and OC. DISCUSSION This study will provide information about participation/acceptability, diagnostic yield and costs of screening with CTC in comparison with the recommended test (FOBT) and OC. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01651624.
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Affiliation(s)
- Lapo Sali
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale G, Pieraccini 6, 50139 Florence, Italy
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Chen ZY, Shen HS, Luo MY, Duan CJ, Cai WL, Lu HB, Zhang GP, Liu Y, Liang JZ. Pilot study on efficacy of reduced cathartic bowel preparation with polyethylene glycol and bisacodyl. World J Gastroenterol 2013; 19:561-568. [PMID: 23382637 PMCID: PMC3558582 DOI: 10.3748/wjg.v19.i4.561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/16/2012] [Accepted: 01/07/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of reduced cathartic bowel preparation with 2 L polyethylene glycol (PEG)-4000 electrolyte solution and 10 mg bisacodyl enteric-coated tablets for computed tomographic colonography (CTC).
METHODS: Sixty subjects who gave informed consent were randomly assigned to study group A, study group B or the control group. On the day prior to CTC, subjects in study group A were given 20 mL 40% wt/vol barium sulfate suspension before 3 mealtimes, 60 mL 60% diatrizoate meglumine diluted in 250 mL water after supper, and 10 mg bisacodyl enteric-coated tablets 1 h before oral administration of 2 L PEG-4000 electrolyte solution. Subjects in study group B were treated identically to those in study group A, with the exception of bisacodyl which was given 1 h after oral PEG-4000. Subjects in the control group were managed using the same strategy as the subjects in study group A, but without administration of bisacodyl. Residual stool and fluid scores, the attenuation value of residual fluid, and discomfort during bowel preparation in the three groups were analyzed statistically.
RESULTS: The mean scores for residual stool and fluid in study group A were lower than those in study group B, but the differences were not statistically significant. Subjects in study group A showed greater stool and fluid cleansing ability than the subjects in study group B. The mean scores for residual stool and fluid in study groups A and B were lower than those in the control group, and were significantly different. There was no significant difference in the mean attenuation value of residual fluid between study group A, study group B and the control group. The total discomfort index during bowel preparation was 46, 45 and 45 in the three groups, respectively, with no significant difference.
CONCLUSION: Administration of 10 mg bisacodyl enteric-coated tablets prior to or after oral administration of 2 L PEG-4000 electrolyte solution enhances stool and fluid cleansing ability, and has no impact on the attenuation value of residual fluid or the discomfort index. The former is an excellent alternative for CTC colorectum cleansing
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Ghanouni A, Smith SG, Halligan S, Taylor SA, Plumb A, Boone D, von Wagner C. An interview study analysing patients' experiences and perceptions of non-laxative or full-laxative preparation with faecal tagging prior to CT colonography. Clin Radiol 2012; 68:472-8. [PMID: 23265916 DOI: 10.1016/j.crad.2012.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/11/2012] [Accepted: 10/22/2012] [Indexed: 12/18/2022]
Abstract
AIM To compare patients' experiences of either non- or full-laxative bowel preparation with additional faecal tagging and subsequent computed tomographic (CT) colonography using in-depth interviews to elicit detailed responses. MATERIALS AND METHODS Patients who received CT colonography after non- (n = 9) or full-laxative (n = 9) preparation participated in a semi-structured telephone interview at least 2 days after the investigation. Full-laxative preparation consisted of magnesium citrate and sodium picosulphate administered at home (or polyethylene glycol, if contraindicated), followed by hospital-based faecal tagging with iohexol. Non-laxative preparation was home-based barium sulphate for faecal tagging. Interviews were transcribed and thematically analysed to identify recurrent themes on patients' perceptions and experiences. RESULTS Experiences of full-laxative preparation were usually negative and characterized by pre-test diarrhoea that caused significant interference with daily routine. Post-test flatus was common. Non-laxative preparation was well-tolerated; patients reported no or minimal changes to bowel habit and rapid return to daily routine. Patients reported worry and uncertainty about the purpose of faecal tagging. For iohexol, this also added burden from waiting before testing. CONCLUSION Patients' responses supported previous findings that non-laxative preparation is more acceptable than full-laxative preparation but both can be improved. Faecal tagging used in combination with laxative preparation is poorly understood, adding burden and worry. Home-based non-laxative preparation is also poorly understood and patients require better information on the purpose and mechanism in order to give fully informed consent. This may also optimize adherence to instructions. Allowing home-based self-administration of all types of preparation would prevent waiting before testing.
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Affiliation(s)
- A Ghanouni
- Department of Epidemiology and Public Health, University College London, London, UK
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Evolving role of computed tomographic colonography in colon cancer screening and diagnosis. South Med J 2012; 105:551-7. [PMID: 23038488 DOI: 10.1097/smj.0b013e318268c602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Computed tomographic colonography (CTC) is a relatively new imaging modality for the examination of patients for colorectal polyps and cancer. It has been validated in its accuracy for the detection of colon cancer and larger polyps (more than likely premalignant). CTC, however, is not widely accepted as a primary screening modality in the United States at present by many third-party payers, including Medicare, and its exact role in screening is evolving. Moreover, there has been opposition to incorporating CTC as an accepted screening instrument, especially by gastroenterologists. Heretofore, optical colonoscopy has been the mainstay in this screening. We discuss these issues and the continuing controversies concerning CTC.
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Lin OS, Kozarek RA, Gluck M, Jiranek GC, Koch J, Kowdley KV, Irani S, Nguyen M, Dominitz JA. Preference for colonoscopy versus computerized tomographic colonography: a systematic review and meta-analysis of observational studies. J Gen Intern Med 2012; 27:1349-1360. [PMID: 22700393 PMCID: PMC3445696 DOI: 10.1007/s11606-012-2115-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 04/03/2012] [Accepted: 04/13/2012] [Indexed: 12/13/2022]
Abstract
In recent years, colorectal cancer (CRC) screening using computerized tomographic colonography (CTC) has attracted considerable attention. In order to better understand patient preferences for CTC versus colonoscopy, we performed a systematic review and meta-analysis of the available literature. Data sources included published studies, abstracts and book chapters, in any language, with publication dates from 1995 through February 2012, and with prospective or retrospective enrollment of diagnostic or screening patients who had undergone both procedures and explicit assessment of their preference for colonoscopy versus CTC. A predefined algorithm identified eligible studies using computer and hand searches performed by two independent investigators. We used a mixed effects model to pool preference differences (defined as the proportion of subjects who preferred CTC minus the proportion who preferred colonoscopy for each study). Twenty-three studies met inclusion criteria, totaling 5616 subjects. In 16 of these studies, patients preferred CTC over colonoscopy, while colonoscopy was preferred in three studies. Due to the high degree of heterogeneity, an overall pooled preference difference was not calculated. Stratified analysis revealed that studies published in radiology journals (preference difference 0.590 [95 % CI 0.485, 0.694]) seemed more likely than studies in gastroenterology (0.218 [-0.015-0.451]) or general medicine journals (-0.158 [-0.389-0.072]) to report preference for CTC (p<0.001). Studies by radiology authors showed a trend towards stronger preference for CTC compared with studies by gastroenterology authors. Symptomatic patients expressed no preference, but screening patients preferred CTC. There was no difference in preferences between studies using "masked" and "unmasked" preference ascertainment methods. Three studies featuring limited bowel preparations for CTC reported marked preference for CTC. There was no evidence of publication bias, while cumulative and exclusion analysis did not show any temporal trend or dominant study. Limitations included data heterogeneity and preference ascertainment limitations. In conclusion, most included studies reported preference for CTC. On stratified analysis, screening patients preferred CTC while diagnostic patients showed no preference. Studies published in radiology journals showed significantly stronger preference for CTC compared with studies in gastroenterology or general medicine journals.
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Affiliation(s)
- Otto S Lin
- C3-Gas, Gastroenterology Section, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA.
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The second ESGAR consensus statement on CT colonography. Eur Radiol 2012; 23:720-9. [PMID: 22983280 PMCID: PMC3563960 DOI: 10.1007/s00330-012-2632-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 03/18/2012] [Accepted: 04/01/2012] [Indexed: 12/14/2022]
Abstract
Objective To update quality standards for CT colonography based on consensus among opinion leaders within the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Material and methods A multinational European panel of nine members of the ESGAR CT colonography Working Group (representing six EU countries) used a modified Delphi process to rate their level of agreement on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval. Results The panel elaborated 86 statements. In the final round the panelists achieved complete consensus in 71 of 86 statements (82 %). Categories including the highest proportion of statements with excellent Cronbach's internal reliability were colon distension, scan parameters, use of intravenous contrast agents, general guidelines on patient preparation, role of CAD and lesion measurement. Lower internal reliability was achieved for the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading, and reporting. Conclusion The recommendations of the consensus should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating. Key Points • Computed tomographic colonography is the optimal radiological method of assessing the colon • This article reviews ESGAR quality standards for CT colonography • This article is aimed to provide CT-colonography guidelines for practising radiologists • The recommendations should help radiologists who are starting/updating their CTC services
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Ulbricht C, Conquer J, Costa D, Hamilton W, Higdon ERB, Isaac R, Rusie E, Rychlik I, Serrano JMG, Tanguay-Colucci S, Theeman M, Varghese M. An evidence-based systematic review of senna (Cassia senna) by the Natural Standard Research Collaboration. J Diet Suppl 2012; 8:189-238. [PMID: 22432689 DOI: 10.3109/19390211.2011.573186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
An evidence-based systematic review, including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
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Pollentine A, Mortimer A, McCoubrie P, Archer L. Evaluation of two minimal-preparation regimes for CT colonography: optimising image quality and patient acceptability. Br J Radiol 2012; 85:1085-92. [PMID: 22422379 DOI: 10.1259/bjr/22421731] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare a 2 day bowel preparation regime of barium, iodine and a mild stimulant laxative with a 1 day iodine-only regime for CT colonography (CTC). METHODS 100 consecutive patients underwent CTC. The first 50 patients (Regime 1) ingested 1 bisacodyl tablet twice a day 3 days before CTC and 1 dose each of 50 ml of barium and 20 ml of iodinated contrast per day starting 2 days before CTC. The second 50 patients (Regime 2) ingested 3 doses of iodinated contrast over 24 h prior to CTC. Volumes of residual stool and fluid, and the effectiveness of stool and fluid tagging, were graded according to methods established by Taylor et al (Taylor S, Slaker A, Burling D, Tam E, Greenhalgh R, Gartner L, et al. CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging. Eur Radiol 2008; 18: 32-42). A 3 day low-residue diet was taken by both cohorts. Questionnaires rating the side-effects and burden of the bowel preparation were compared to a control cohort of patients undergoing barium enema. RESULTS The proportion of colons producing none/scattered stool (score 1) was 90.3% with Regime 1 and 65.0% with Regime 2 (p<0.005). Any residual stool was significantly better tagged with Regime 1 (score 5), with 91.7% of Regime 1 exhibiting optimum tagging vs 71.3% of Regime 2 (p<0.05). No significant differences in side-effects between the bowel preparation regimes for CTC were elicited. Bowel preparation for barium enema was tolerated significantly worse than both of the CTC bowel preparation regimes. CONCLUSION Regime 1, containing a 3 day preparation of a mild laxative, barium and iodine, produced a significantly better prepared colon, with no difference in patient acceptability.
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Affiliation(s)
- A Pollentine
- Department of Radiology, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
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Linguraru MG, Panjwani N, Fletcher JG, Summers RM. Automated image-based colon cleansing for laxative-free CT colonography computer-aided polyp detection. Med Phys 2012; 38:6633-42. [PMID: 22149845 DOI: 10.1118/1.3662918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the performance of a computer-aided detection (CAD) system for detecting colonic polyps at noncathartic computed tomography colonography (CTC) in conjunction with an automated image-based colon cleansing algorithm. METHODS An automated colon cleansing algorithm was designed to detect and subtract tagged-stool, accounting for heterogeneity and poor tagging, to be used in conjunction with a colon CAD system. The method is locally adaptive and combines intensity, shape, and texture analysis with probabilistic optimization. CTC data from cathartic-free bowel preparation were acquired for testing and training the parameters. Patients underwent various colonic preparations with barium or Gastroview in divided doses over 48 h before scanning. No laxatives were administered and no dietary modifications were required. Cases were selected from a polyp-enriched cohort and included scans in which at least 90% of the solid stool was visually estimated to be tagged and each colonic segment was distended in either the prone or supine view. The CAD system was run comparatively with and without the stool subtraction algorithm. RESULTS The dataset comprised 38 CTC scans from prone and/or supine scans of 19 patients containing 44 polyps larger than 10 mm (22 unique polyps, if matched between prone and supine scans). The results are robust on fine details around folds, thin-stool linings on the colonic wall, near polyps and in large fluid/stool pools. The sensitivity of the CAD system is 70.5% per polyp at a rate of 5.75 false positives/scan without using the stool subtraction module. This detection improved significantly (p = 0.009) after automated colon cleansing on cathartic-free data to 86.4% true positive rate at 5.75 false positives/scan. CONCLUSIONS An automated image-based colon cleansing algorithm designed to overcome the challenges of the noncathartic colon significantly improves the sensitivity of colon CAD by approximately 15%.
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Affiliation(s)
- Marius George Linguraru
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20892, USA.
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da Fonte AC, Chojniak R, Ferreira FDO, Pinto PNV, Neto PJDS, Bitencourt AGV. Inclusion of computed tomographic colonography on pre-operative CT for patients with colorectal cancer. Eur J Radiol 2012; 81:e298-303. [DOI: 10.1016/j.ejrad.2011.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 12/20/2022]
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Abstract
OBJECTIVES The aim of this study was to determine if the introduction of faecal tagging to CT colonography (CTC) made the examination easier to tolerate or reduced the number of false-positives. METHODS Our department changed bowel preparation for CT colonography from Picolax (Ferring Pharmaceuticals Ltd, London, UK) to Gastrografin (Bracco Diagnostics Inc, Princeton, NJ) only with a modified diet. Questionnaires were given to a subgroup of patients within these cohorts. The numbers of false-positives were compared between two cohorts before and after this change. false-positives were defined as lesions reported on CT that were not confirmed by subsequent endoscopic examination. Polyps were matched if they were in the same or adjacent segments, and were within 5 mm of the reported size. RESULTS 412 patients were identified from the Picolax cohort, and 116 from the Gastrografin cohort. 62 patients in each group completed questionnaires. Gastrografin produced less diarrhoea; 34% had five or more bowel motions in the previous day and night, compared with 77% for Picolax (p<0.001), although more patients found drinking it unpleasant compared with Picolax (85% reported drinking Picolax as "easy" vs 61% for Gastrografin; p=0.002). Picolax produced more non-diagnostic examinations, although this difference was not statistically significant. There was not a significant reduction in the numbers of false-positives (2 out of 112 for Gastrografin group, 14 out of 389 for the Picolax group; p=0.54). CONCLUSION Switching from Picolax to Gastrografin as a CTC preparation technique produced less diarrhoea, but did not reduce the number of false-positives.
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Affiliation(s)
- A Slater
- Department of Radiology, John Radcliffe Hospital, Oxford, UK.
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Keedy AW, Yee J, Aslam R, Weinstein S, Landeras LA, Shah JN, McQuaid KR, Yeh BM. Reduced cathartic bowel preparation for CT colonography: prospective comparison of 2-L polyethylene glycol and magnesium citrate. Radiology 2011; 261:156-64. [PMID: 21873253 DOI: 10.1148/radiol.11110217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To prospectively compare adequacy of colonic cleansing, adequacy of solid stool and fluid tagging, and patient acceptance by using reduced-volume, 2-L polyethylene glycol (PEG) versus magnesium citrate bowel preparations for CT colonography. MATERIALS AND METHODS This study was approved by the institutional Committee on Human Research and was compliant with HIPAA; all patients provided written consent. In this randomized, investigator-blinded study, 50 patients underwent oral preparation with either a 2-L PEG or a magnesium citrate solution, tagging with oral contrast agents, and subsequent CT colonography and segmentally unblinded colonoscopy. The residual stool (score 0 [best] to 3 [worst]) and fluid (score 0 [best] to 4 [worst]) burden and tagging adequacy were qualitatively assessed. Residual fluid attenuation was recorded as a quantitative measure of tagging adequacy. Patients completed a tolerance questionnaire within 2 weeks of scanning. Preparations were compared for residual stool and fluid by using generalized estimating equations; the Mann-Whitney test was used to compare the qualitative tagging score, mean residual fluid attenuation, and adverse effects assessed on the patient experience questionnaire. RESULTS The mean residual stool (0.90 of three) and fluid burden (1.05 of four) scores for PEG were similar to those for magnesium citrate (0.96 [P = .58] and 0.98 [P = .48], respectively). However, the mean fecal and fluid tagging scores were significantly better for PEG (0.48 and 0.28, respectively) than for magnesium citrate (1.52 [P < .01] and 1.28 [P < .01], respectively). Mean residual fluid attenuation was higher for PEG (765 HU) than for magnesium citrate (443 HU, P = .01), and mean interpretation time was shorter for PEG (14.8 minutes) than for magnesium citrate (18.0 minutes, P = .04). Tolerance ratings were not significantly different between preparations. CONCLUSION Reduced-volume PEG and magnesium citrate bowel preparations demonstrated adequate cleansing effectiveness for CT colonography, with better tagging and shorter interpretation time observed in the PEG group. Adequate polyp detection was maintained but requires further validation because of the small number of clinically important polyps.
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Affiliation(s)
- Alexander W Keedy
- Department of Radiology, University of California, San Francisco, San Francisco Veterans Affairs Medical Center, VAMC, San Francisco, CA 94143, USA
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A simplified approach to virtual colonoscopy using different intestinal preparations: preliminary experience with regard to quality, accuracy and patient acceptability. Radiol Med 2011; 116:749-58. [DOI: 10.1007/s11547-011-0661-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/28/2010] [Indexed: 01/22/2023]
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CT colonography with limited bowel preparation for the detection of colorectal neoplasia in an FOBT positive screening population. ACTA ACUST UNITED AC 2011; 35:661-8. [PMID: 19888629 PMCID: PMC2980629 DOI: 10.1007/s00261-009-9586-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose Aim was to evaluate the accuracy of computed tomography colonography (CTC) for detection of colorectal neoplasia in a Fecal Occult Blood Test (FOBT) positive screening population. Methods In three different institutions, consecutive FOBT positives underwent CTC after laxative free iodine tagging bowel preparation followed by colonoscopy with segmental unblinding. Each CTC was read by two experienced observers. For CTC and for colonoscopy the per-polyp sensitivity and per-patient sensitivity and specificity were calculated for detection of carcinomas, advanced adenomas, and adenomas. Results In total 22 of 302 included FOBT positive participants had a carcinoma (7%) and 137 had an adenoma or carcinoma ≥10 mm (45%). CTC sensitivity for carcinoma was 95% with one rectal carcinoma as false negative finding. CTC sensitivity for advanced adenomas was 92% (95% CI: 88–96) vs. 96% (95% CI: 93–99) for colonoscopy (P = 0.26). For adenomas and carcinomas ≥10 mm the CTC per-polyp sensitivity was 93% (95% CI: 89–97) vs. 97% (95% CI: 94–99) for colonoscopy (P = 0.17). The per-patient sensitivity for the detection of adenomas and carcinomas ≥10 mm was 95% (95% CI: 91–99) for CTC vs. 99% (95% CI: 98–100) for colonoscopy (P = 0.07), while the per-patient specificity was 90% (95% CI: 86–95) and 96% (95% CI: 94–99), respectively (P < 0.001). Conclusion CTC with limited bowel preparation performed in an FOBT positive screening population has high diagnostic accuracy for the detection of adenomas and carcinomas and a sensitivity similar to that of colonoscopy for relevant lesions.
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Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection--systematic review and meta-analysis. Radiology 2011; 259:393-405. [PMID: 21415247 DOI: 10.1148/radiol.11101887] [Citation(s) in RCA: 291] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis of published studies assessing the sensitivity of both computed tomographic (CT) colonography and optical colonoscopy (OC) for colorectal cancer detection. MATERIALS AND METHODS Analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The primary data source was the results of a detailed PubMed search from 1994 to 2009. Diagnostic studies evaluating CT colonography detection of colorectal cancer were assessed by using predefined inclusion and exclusion criteria, in particular requiring both OC and histologic confirmation of disease. Studies that also included a mechanism to assess true-positive versus false-negative diagnoses at OC (eg, segmental unblinding) were used to calculate OC sensitivity. Assessment and data extraction were performed independently by two authors. Potential bias was ascertained by using Quality Assessment of Diagnostic Accuracy Studies guidelines. Specific CT colonography techniques were cataloged. Forest plots of per-patient sensitivity were produced on the basis of random-effect models. Potential bias across primary studies was assessed by using the I(2) statistic. Original study authors were contacted for data clarification when necessary. RESULTS Forty-nine studies provided data on 11,151 patients with a cumulative colorectal cancer prevalence of 3.6% (414 cancers). The sensitivity of CT colonography for colorectal cancer was 96.1% (398 of 414; 95% confidence interval [CI]: 93.8%, 97.7%). No heterogeneity (I(2) = 0%) was detected. No cancers were missed at CT colonography when both cathartic and tagging agents were combined in the bowel preparation. The sensitivity of OC for colorectal cancer, derived from a subset of 25 studies including 9223 patients, was 94.7% (178 of 188; 95% CI: 90.4%, 97.2%). A moderate degree of heterogeneity (I(2) = 50%) was present. CONCLUSION CT colonography is highly sensitive for colorectal cancer, especially when both cathartic and tagging agents are combined in the bowel preparation. Given the relatively low prevalence of colorectal cancer, primary CT colonography may be more suitable than OC for initial investigation of suspected colorectal cancer, assuming reasonable specificity. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101887/-/DC1.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA.
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Decreased-Purgation CT Colonography: State of the Art. CURRENT COLORECTAL CANCER REPORTS 2011. [DOI: 10.1007/s11888-010-0085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This article provides basic information about computed tomographic colonography (CTC) and reviews the preparation, methods, and tools required for the procedure. The clinical uses for CTC (screening/diagnosis of colon cancer and colonic obstruction) are outlined, and its accuracy and validity are compared with other diagnostic methods. A summary of the benefits and risks of the test are presented and the current practicalities for implementation are addressed.
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Affiliation(s)
- Ancil K Philip
- Department of General Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-7375, USA
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Slater A, North M, Hart M, Ferrett C. Gas insufflation of minimal preparation CT of the colon reduces false-positives. Br J Radiol 2011; 85:346-50. [PMID: 21224295 DOI: 10.1259/bjr/20678489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Minimal preparation CT of the colon (MPCT colon) is used for investigation of suspected colorectal cancer in frail and/or elderly patients who would be expected to tolerate laxative bowel preparation poorly. Although it has good sensitivity for colorectal cancer it has a poor specificity. We wished to investigate whether distension of the colon with carbon dioxide alone would reduce the number of false-positives, but without making the test arduous or excessively uncomfortable. METHODS 134 patients were recruited and underwent MPCT colon with gas insufflation and antispasmodics. Results were compared with a cohort of 134 patients undergoing standard protocol MPCT colon. The numbers of false-positives were compared, as was reader confidence. All trial patients were given a questionnaire documenting their experience. RESULTS The number of false-positives was 15% in the control group and 5% in the trial group; this difference was statistically significant, (p=0.01). Reader confidence was increased in the trial group. Patient tolerance was good, with 95% saying they would have the test again. CONCLUSION Use of gas insufflation and antispasmodics reduces the false-positives from 15% to 5% without adversely affecting patient tolerance.
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Affiliation(s)
- A Slater
- John Radcliffe Hospital, Headley Way, Headington, Oxford, UK.
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Behrens C, Eddy R, Stevenson G, Audet L, Mathieson J. Bowel Preparation Regimen for Computed Tomography Colonography. Can Assoc Radiol J 2010; 61:280-5. [DOI: 10.1016/j.carj.2009.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 12/19/2022] Open
Abstract
Purpose This study was designed to determine whether a reduction in oral contrast dose and a change in timing of administration will result in less residual material in the colonic lumen. Method We retrospectively assessed, in a blinded fashion, the amount and nature of residual material in the colon in 40 patients who received computed tomography colonography. Half of the cohort received the standard bowel-preparation regimen, whereas a sex- and age-matched test arm received the modified regimen. A scoring system that consisted of metrics to quantify the nature and extent of residual fluid and solid material was defined. Image analysis was conducted with the investigators blinded to the group assignment of each patient. Three different trained observers independently reviewed and scored the 6 colonic segments in supine and prone positions for each patient in the cohort. In cases in which interobserver discrepancies existed, the observers reanalyzed the images together to come to an agreement on scores. Results The new bowel-preparation regimen resulted in significantly less “sticky coat” ( P < .005), a problematic phenomenon in which the colonic mucosa is covered in a thin coating of residual contrast and fecal material. There was no difference in the amount of residual fluid. Fewer masses of stool were noted with the new preparation, but this was not found to be statistically significant. Conclusion A new bowel-preparation regimen that consisted of lower quantities of contrast administered earlier in the day preceding computed tomography colonography resulted in a lower incidence of adherent contrast and fecal matter. The reduction of this “sticky coat” problem not only improved radiologic analysis of the colon but may permit same-day therapy via colonoscopy if indicated on imaging.
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Affiliation(s)
- Carola Behrens
- Department of Radiology, Victoria Hospitals, Victoria, British Columbia, Canada
| | - Richard Eddy
- Department of Radiology, Victoria Hospitals, Victoria, British Columbia, Canada
| | - Giles Stevenson
- Department of Radiology, Victoria Hospitals, Victoria, British Columbia, Canada
| | - Louise Audet
- Department of Radiology, Victoria Hospitals, Victoria, British Columbia, Canada
| | - John Mathieson
- Department of Radiology, Victoria Hospitals, Victoria, British Columbia, Canada
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Davis W, Nisbet P, Hare C, Cooke P, Taylor SA. Non-laxative CT colonography with barium-based faecal tagging: is additional phosphate enema beneficial and well tolerated? Br J Radiol 2010; 84:120-5. [PMID: 20959374 DOI: 10.1259/bjr/23626544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the efficacy and tolerance of an additional phosphate enema prior to non-laxative CT colonography (CTC). METHODS 71 patients (mean age 80 years, 28 male, 43 female) underwent non-laxative CTC following 4 oral doses of diluted 2% w/w barium sulphate. Patients were invited to self-administer a phosphate enema 2 h before CTC. An experienced observer graded the volume of retained stool (1 (nil) to 4 (>75% bowel circumference coated)), retained fluid ((1 (nil) to 4 (>50% circumference obscured)), retained stool tagging quality (1 (untagged) to 5 (≥75% to 100%) tagged) and confidence a polyp ≥6 mm could be excluded (yes/no) for each of six colonic segments. Tolerance of the enema was assessed via questionnaire. Data were analysed between those using and not using the enema by Mann-Whitney and Fisher's exact test. 18/71 patients declined the enema. RESULTS There was no reduction in residual stool volume with enema use compared with non-use either overall (mean score 2.6 vs 2.7, p = 0.76) or in the left colon (mean 2.3 vs 2.4, p = 0.47). Overall tagging quality was no different (mean score 4.4 vs 4.3, p = 0.43). There was significantly more retained left colonic fluid post enema (mean score 1.9 vs 1.1, p<0.0001), and diagnostic confidence in excluding polyps was significantly reduced (exclusion not possible in 35% segments vs 21% without enema, p = 0.006). Of 53 patients, 30 (56%) found the enema straightforward to use, but 4 (8%) found it unpleasant. CONCLUSION Phosphate enema use prior to non-laxative CTC leads to greater retained fluid, reducing diagnostic confidence, and is not recommended.
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Affiliation(s)
- W Davis
- Department of Specialist Radiology, University College Hospital, London, UK
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Liedenbaum MH, Denters MJ, Zijta FM, van Ravesteijn VF, Bipat S, Vos FM, Dekker E, Stoker J. Reducing the oral contrast dose in CT colonography: evaluation of faecal tagging quality and patient acceptance. Clin Radiol 2010; 66:30-7. [PMID: 21147296 DOI: 10.1016/j.crad.2010.06.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 05/17/2010] [Accepted: 06/02/2010] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the minimal iodine contrast medium load necessary for an optimal computed tomography colonography tagging quality. MATERIALS AND METHODS Faecal occult blood test positive patients were randomly selected for one of three iodine bowel preparations: (1) 3 × 50 ml meglumine ioxithalamate (45 g iodine), (2) 4 × 25 ml meglumine ioxithalamate (30 g iodine); or (3) 3 × 25 ml (22.5 g iodine) meglumine ioxithalamate. Two experienced readers assessed the tagging quality per colonic segment on a five-point scale and the presence of adherent stool. Also semi-automatic homogeneity measurements were performed. Patient acceptance was assessed with questionnaires. RESULTS Of 70 eligible patients, 45 patients participated (25 males, mean age 62 years). Each preparation group contained 15 patients. The quality of tagging was insufficient (score 1-2) in 0% of segments in group 1; 4% in group 2 (p<0.01 versus group 1); and 5% in group 3 (p=0.06 versus group 1). In group 1 in 11% of the segments adherent stool was present compared with 49% in group 2 and 41% in group 3 (p<0.01, group 2 and 3 versus group 1). Homogeneity was 85, 102 (p<0.01), and 91 SD HU (p=0.26) in groups 1, 2, and 3, respectively. In group 1 two patients experienced no burden after contrast agent ingestion compared to one patient in group 2 and nine patients in group 3 (p=0.017). CONCLUSION A dose of 3 × 50 ml meglumine ioxithalamate is advisable for an optimal tagging quality despite beneficial effects on the patient acceptance in patients receiving a lower dose.
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Affiliation(s)
- M H Liedenbaum
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
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Eliahou R, Azraq Y, Carmi R, Mahgerefteh SY, Sosna J. Dual-Energy Based Spectral Electronic Cleansing in Non-Cathartic Computed Tomography Colonography: An Emerging Novel Technique. Semin Ultrasound CT MR 2010; 31:309-14. [DOI: 10.1053/j.sult.2010.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ozel B, Pickhardt PJ, Kim DH, Schumacher C, Bhargava N, Winter TC. Accuracy of routine nontargeted CT without colonography technique for the detection of large colorectal polyps and cancer. Dis Colon Rectum 2010; 53:911-8. [PMID: 20485005 DOI: 10.1007/dcr.0b013e3181d5de13] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To assess the accuracy of routine contrast-enhanced computed tomography for the detection of large colorectal polyps and cancer. METHODS The study group consisted of 100 patients who underwent abdominal computed tomography and optical colonoscopy evaluation before any treatment or intervention. Invasive colorectal carcinoma and large polyps (>or=10mm) were found at colonoscopy in 29 and 16 patients, respectively. Computed tomography studies with oral and IV contrast were retrospectively reviewed as 5-mm thick sections in standard soft tissue windows by 3 readers. The readers scored each segment for polyp or cancer utilizing a 5-point scale for receiver operating characteristic analysis. RESULTS By-patient sensitivity/specificity for cancer detection for each reader was 69.0%/88.7%, 65.5%/84.5%, and 82.8%/77.5%, respectively. Pooled sensitivity, specificity, and accuracy for cancer was 72.4%, 83.6%, and 80.3%, respectively. The empiric area under the receiver operating characteristic curves for the readers ranged from 0.775 to 0.857. By-patient sensitivity for large polyps was poor with a pooled sensitivity of 14.5%. CONCLUSIONS Standard computed tomography not tailored to colorectal investigation was moderately effective for detecting invasive cancers, but insensitive for large polyps. Unsuspected cancer should be a part of the standard search pattern for routine computed tomography interpretation, but more advanced colonography techniques are necessary for detecting large polyps.
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Affiliation(s)
- Bora Ozel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792-3252, USA.
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Grant LA, Griffin N, Shaw A. Two-year audit of computed tomographic colonography in a teaching hospital: are we meeting the standard? Colorectal Dis 2010; 12:373-9. [PMID: 19292776 DOI: 10.1111/j.1463-1318.2009.01824.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to determine whether adopting the published recommendations has led to successful implementation of computed tomographic colonography (CTC) in a teaching hospital setting outside the context of a clinical trial. METHOD An audit of all the CTC examinations between April 2005 and June 2007 was conducted to determine the following: adequacy of bowel preparation, CTC indications and findings (compared with available colonoscopy), complications and experience of reporting radiologist. RESULTS The most common indications for the 111 CTC patients reviewed included exclusion of synchronous colonic tumours, incomplete colonoscopy and altered bowel habit. Only 16% of ascending colon/caecal segments was clear of faecal or fluid contamination. The rectum and sigmoid colon were free of contamination in 78% and 74% of cases respectively. Appropriately trained radiologists reported 91% of studies. Thirty-two percent of studies were normal. The most common positive findings were diverticular disease or a rectal tumour. Sensitivity, specificity and positive predictive value were 89%, 94% and 90% respectively (all polyps) with a sensitivity of 98.5% for lesions > 5 mm in size. Twenty-five percent of patients had extra colonic abnormalities. There were no recorded complications. CONCLUSION Our CTC practice is within accepted published guidelines. Bowel preparation is suboptimal in a significant proportion of cases and faecal tagging is being implemented.
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Affiliation(s)
- L A Grant
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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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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Rosenberg JA, Rubin DT. Performance of CT colonography in clinical trials. Gastrointest Endosc Clin N Am 2010; 20:193-207. [PMID: 20451810 DOI: 10.1016/j.giec.2010.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The amount of data accumulated in trials of CT colonography (CTC) has greatly increased in the past decade. The information from these studies is shaping clinical practice and public health policy regarding screening for colorectal cancer (CRC). This article examines the performance of CTC in clinical trials for individuals at average risk and increased risk for CRC. It also addresses the efficacy of CTC after incomplete colonoscopy, when colon preparations are reduced or eliminated, and in academic versus nonacademic environments. The data suggest that CTC is effective especially for the detection of larger lesions and when more advanced imaging technology is used.
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Affiliation(s)
- Jonathan A Rosenberg
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 4076, Chicago, IL 60637-1463, USA
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Abstract
Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique, test characteristics, acceptance, safety, cost-effectiveness, follow-up strategy, and extracolonic findings. In summary, CTC technique is still evolving, and further research is needed to clarify the role of automated colonic insufflation, smooth-muscle relaxants, intravenous and oral contrast, software rendering, and patient positioning. Currently, full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%, with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy, especially in patients who have never undergone either procedure. CTC is generally safe, although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness, most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present, the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today, in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue, with multi-detector row CT scanners allowing thinner collimation and higher resolution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.
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Guerrisi A, Marin D, Laghi A, Di Martino M, Iafrate F, Iannaccone R, Catalano C, Passariello R. Diagnostic accuracy of translucency rendering to differentiate polyps from pseudopolyps at 3D endoluminal CT colonography: a feasibility study. LA RADIOLOGIA MEDICA 2010; 115:758-70. [DOI: 10.1007/s11547-010-0538-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/30/2009] [Indexed: 11/30/2022]
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CT colonography with decreased purgation: balancing preparation, performance, and patient acceptance. AJR Am J Roentgenol 2010; 193:1531-9. [PMID: 19933644 DOI: 10.2214/ajr.09.2342] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Reduction or elimination of catharsis with fecal tagging enhances the tolerability of CT colonography (CTC) and may increase compliance with colorectal cancer (CRC) screening recommendations. We systematically reviewed studies that prospectively evaluated performance and patient satisfaction with decreased-purgation CTC and with optical colonoscopy. CONCLUSION The nine studies reviewed showed moderate-to-good performance for decreased-purgation CTC; however, data are limited, and study design and data presentation are inconsistent. Further study of decreased-purgation CTC and standardization of terminology are needed.
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Coccetta M, Migliaccio C, La Mura F, Farinella E, Galanou I, Delmonaco P, Spizzirri A, Napolitano V, Cattorini L, Milani D, Cirocchi R, Sciannameo F. Virtual colonoscopy in stenosing colorectal cancer. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2009; 3:11. [PMID: 19900286 PMCID: PMC2777911 DOI: 10.1186/1750-1164-3-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Accepted: 11/09/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Between 5 and 10% of the patients undergoing a colonoscopy cannot have a complete procedure mainly due to stenosing neoplastic lesion of rectum or distal colon. Nevertheless the elective surgical treatment concerning the stenosis is to be performed after the pre-operative assessment of the colonic segments upstream the cancer. The aim of this study is to illustrate our experience with the Computed Tomographic Colonography (CTC) for the pre-operative assessment of the entire colon in the patients with stenosing colorectal cancers. METHODS From January 2005 till March 2009, we observed and treated surgically 43 patients with stenosing colorectal neoplastic lesions. All patients did not tolerate the pre-operative colonoscopy. For this reason they underwent a pre-operative CTC in order to have a complete assessment of the entire colon. All patients underwent a follow-up colonoscopy 3 months after the surgical treatment. The CTC results were compared with both macroscopic examination of the specimen and the follow-up coloscopy. RESULTS The pre-operative CTC showed four synchronous lesions in four patients (9.3% of the cases). The macroscopic examination of the specimen revealed three small sessile polyps (3-4 mm in diameter) missed in the pre-operative assessment near the stenosing colorectal cancer. The follow-up colonoscopy showed four additional sessile polyps with a diameter between 3-11 mm in three patients. Our experience shows that CTC has a sensitivity of 83,7%. CONCLUSION In patients with stenosing colonic lesions, CTC allows to assess the entire colon pre-operatively avoiding the need of an intraoperative colonoscopy. More synchronous lesions are detected and treated at the time of the elective surgery for the stenosing cancer avoiding further surgery later on.
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Affiliation(s)
- Marco Coccetta
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Carla Migliaccio
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Francesco La Mura
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Eriberto Farinella
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Ioanna Galanou
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Pamela Delmonaco
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Alessandro Spizzirri
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Vincenzo Napolitano
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Lorenzo Cattorini
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Diego Milani
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
| | - Francesco Sciannameo
- Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy
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