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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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Blidi S, Troise AD, Ledbetter M, Cottin S, Sturrock K, De Pascale S, Scaloni A, Fiore A. α-Dicarbonyl compounds trapping ability and antiglycative effect of high-molecular-weight brewer's spent grain melanoidins. Lebensm Wiss Technol 2023. [DOI: 10.1016/j.lwt.2023.114679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Grosu S, Wang ZJ, Obmann MM, Sugi MD, Sun Y, Yeh BM. Reduction of Peristalsis-Related Streak Artifacts on the Liver with Dual-Layer Spectral CT. Diagnostics (Basel) 2022; 12:782. [PMID: 35453830 PMCID: PMC9028529 DOI: 10.3390/diagnostics12040782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Peristalsis-related streak artifacts on the liver compromise image quality and diagnostic accuracy. Purpose: To assess dual-layer spectral-detector computed tomography (CT) image reconstructions for reducing intestinal peristalsis-related streak artifacts on the liver. Methods: We retrospectively evaluated 220 contrast-enhanced abdominal dual-energy CT scans in 131 consecutive patients (mean age: 68 ± 10 years, 120 men) who underwent routine clinical dual-layer spectral-detector CT imaging (120 kVp, 40 keV, 200 keV, virtual non-contrast (VNC), iodine images). Two independent readers evaluated bowel peristalsis streak artifacts on the liver qualitatively on a five-point Likert scale (1 = none to 5 = severe) and quantitatively by depth of streak artifact extension into the liver and measurements of Hounsfield Unit and iodine concentration differences from normal liver. Artifact severity between image reconstructions were compared by Wilcoxon signed-rank and paired t-tests. Results: 12 scans were excluded due to missing spectral data, artifacts on the liver originating from metallic foreign materials, or oral contrast material. Streak artifacts on the liver were seen in 51/208 (25%) scans and involved the left lobe only in 49/51 (96%), the right lobe only in 0/51 (0%), and both lobes in 2/51 (4%) scans. Artifact frequency was lower in iodine than in 120 kVp images (scans 18/208 vs. 51/208, p < 0.001). Artifact severity was less in iodine than in 120 kVp images (median score 1 vs. 3, p < 0.001). Streak artifact extension into the liver was shorter in iodine than 120 kVp images (mean length 2 ± 4 vs. 12 ± 5 mm, p < 0.001). Hounsfield Unit and iodine concentration differed significantly between bright streak artifacts and normal liver in 120 kVp, 40 keV, 200 keV, and VNC images (p < 0.001, each), but not in iodine images (p = 0.23). Conclusion: Intestinal peristalsis-related streak artifacts commonly affect the left liver lobe at CT and can be substantially reduced by viewing iodine dual-energy CT image reconstructions.
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Affiliation(s)
- Sergio Grosu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA; (Z.J.W.); (M.M.O.); (M.D.S.); (Y.S.)
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Zhen J. Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA; (Z.J.W.); (M.M.O.); (M.D.S.); (Y.S.)
| | - Markus M. Obmann
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA; (Z.J.W.); (M.M.O.); (M.D.S.); (Y.S.)
- Department of Radiology and Nuclear Imaging, University Hospital Basel, Petersgraben 4, 4051 Basel, Switzerland
| | - Mark D. Sugi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA; (Z.J.W.); (M.M.O.); (M.D.S.); (Y.S.)
| | - Yuxin Sun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA; (Z.J.W.); (M.M.O.); (M.D.S.); (Y.S.)
| | - Benjamin M. Yeh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA; (Z.J.W.); (M.M.O.); (M.D.S.); (Y.S.)
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Cadi M, Dieumegard B, Moussali J, Meskins C, Richa H, Lenczner G, Guigui J, Rotenberg L, Peletier S, Beges C. Optimisation de la coloscopie virtuelle. JOURNAL D'IMAGERIE DIAGNOSTIQUE ET INTERVENTIONNELLE 2021; 4:140-157. [DOI: 10.1016/j.jidi.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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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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Zhang H, Zhang H, Troise AD, Fogliano V. Melanoidins from Coffee, Cocoa, and Bread Are Able to Scavenge α-Dicarbonyl Compounds under Simulated Physiological Conditions. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:10921-10929. [PMID: 31496242 PMCID: PMC6876928 DOI: 10.1021/acs.jafc.9b03744] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Free amino residues react with α-dicarbonyl compounds (DCs) contributing to the formation of advanced glycation end products (AGEs). Phenolic compounds can scavenge DCs, thus controlling the dietary carbonyl load. This study showed that high-molecular weight cocoa melanoidins (HMW-COM), HMW bread melanoidins (HMW-BM), and especially HMW coffee melanoidins (HMW-CM) are effective DC scavengers. HMW-CM (1 mg/mL) scavenged more than 40% DCs within 2 h under simulated physiological conditions, suggesting some physiological relevance. Partial acid hydrolysis of HMW-CM decreased the dicarbonyl trapping capacity, demonstrating that the ability to react with glyoxal, methylglyoxal (MGO), and diacetyl was mainly because of polyphenols bound to macromolecules. Caffeic acid (CA) and 3-caffeoylquinic acid showed a DC-scavenging kinetic profile similar to that of HMW-CM, while mass spectrometry data confirmed that hydroxyalkylation and aromatic substitution reactions led to the formation of a stable adduct between CA and MGO. These findings corroborated the idea that antioxidant-rich indigestible materials could limit carbonyl stress and AGE formation across the gastrointestinal tract.
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Affiliation(s)
- Hao Zhang
- School
of Food Science and Technology, Jiangnan
University, Wuxi 214122, China
- Food
Quality & Design Group, Wageningen University
& Research, Wageningen NL-6708 WG, Netherlands
| | - Hui Zhang
- School
of Food Science and Technology, Jiangnan
University, Wuxi 214122, China
| | - Antonio Dario Troise
- Department
of Agricultural Sciences, University of
Naples ‘‘Federico II’’, 80055 Portici, Italy
| | - Vincenzo Fogliano
- Food
Quality & Design Group, Wageningen University
& Research, Wageningen NL-6708 WG, Netherlands
- E-mail: .
Phone: +31 317485171
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Shah R, Khoram R, Lambert JW, Sun Y, Wang ZJ, Webb EM, Yeh BM. Effect of gantry rotation speed and scan mode on peristalsis motion artifact frequency and severity at abdominal CT. Abdom Radiol (NY) 2018; 43:2239-2245. [PMID: 29450609 DOI: 10.1007/s00261-018-1497-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to understand the effect of CT gantry speed and axial vs. helical scan mode on the frequency and severity of bowel peristalsis artifacts. METHOD We retrospectively identified 150 oncologic abdominopelvic CT scans obtained on a 256 slice CT scanner: 50 scans obtained with Axial mode and 0.5-s gantry rotation time (Slow-Axial); 50 with Axial mode and 0.28-s gantry rotation time (Fast-Axial); and 50 scans with Helical mode and 0.28-s gantry rotation time (Fast-Helical). The patients included 74 women and 76 men with a mean age of 61 years (range 22-85 years). Two readers viewed all CT scans to record the presence and severity of bowel peristalsis artifact, location of artifact (stomach, duodenum/jejunum, ileum, and colon) and artifact location relative to bowel interface (gas-bowel, fluid-bowel, and gas-fluid). The severity of artifacts was recorded subjectively on a 3-point scale, and objectively based on maximum length of the artifact. RESULTS Peristalsis artifact was more commonly seen with Slow-Axial scan acquisition (37 of 50 patient scans, or 74%) than Fast-Axial (15 in 50 patient scans, or 30%, p < 0.001) and Fast-Helical (22 of 50 patient scans, or 44%, p < 0.005). The bowel segment distribution and severity of peristalsis artifacts were not significantly different between scan techniques. CONCLUSION Peristalsis artifacts are common at abdominopelvic CT scans. Fast gantry rotation speed significantly reduces the frequency of bowel peristalsis artifacts and should be a consideration when imaging of bowel and structures near bowel is critical.
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Affiliation(s)
- Rutwik Shah
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA.
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, M-372, San Francisco, CA, 94143-0628, USA.
| | - Rhanna Khoram
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Jack W Lambert
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Yuxin Sun
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Zhen J Wang
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Emily M Webb
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
| | - Benjamin M Yeh
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA
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Abstract
Significant anxiety has been expressed by some over the radiation risks associated with computed tomography (CT), particularly when it applies to a screening examination such as CT colonography. These theoretic risks are far outweighed by the significant benefits colorectal cancer screening offers. Regardless of how significant the theoretic risk of CT radiation is in the older population, the ALARA principle maintains that radiation dose should be reduced to As Low As Reasonably Achievable. This article will discuss various strategies that may be utilized to reduce radiation dose and mitigate any increase in image noise that may occur.
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Affiliation(s)
- Kevin J Chang
- Department of Radiology, Newton-Wellesley Hospital, Brown University Alpert Medical School, 2014 Washington Street, Newton, MA 02462, USA.
| | - Judy Yee
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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Abstract
CT colonography (CTC) has demonstrated equivalent accuracy to optical colonoscopy in the detection of clinically relevant polyps and tumors but this is only possible when technique is optimized. The two most important features of a high-quality CTC are a well-prepared colon and a distended colon. This article will discuss the dietary, bowel preparation, and fecal/fluid tagging options to best prepare the colon. Strategies to optimally distend the colon will also be discussed. CT scan techniques including patient positioning and radiation dose optimization will be reviewed. With proper technique which includes sufficient bowel preparation, fecal/fluid tagging, bowel distension, and optimized scan technique, high-quality CTC examinations should become more feasible, easier to interpret, and more consistently reproducible leading to increased utilization and increased referrals.
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10
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Winklhofer S, Lambert JW, Wang ZJ, Sun Y, Gould RG, Zagoria RJ, Yeh BM. Reduction of peristalsis-related gastrointestinal streak artifacts with dual-energy CT: a patient and phantom study. Abdom Radiol (NY) 2016; 41:1456-65. [PMID: 26987848 DOI: 10.1007/s00261-016-0702-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of the study was to assess the ability of rapid-kV switching (rs) dual-energy computed tomography (DECT) to reduce peristalsis-related streak artifact. METHODS rsDECT images of 100 consecutive patients (48 male, 52 female, mean age 57 years) were retrospectively evaluated in this institutional review board-approved study. Image reconstructions included virtual monochromatic 70 and 120 keV images, as well as iodine(-water) and water(-iodine) material decomposition images. We recorded the presence and severity of artifacts qualitatively (4-point scale) and quantitatively [iodine/water concentrations, Hounsfield units, gray scale values (GY)] and compared to corresponding unaffected reference tissue. Similar measures were obtained in DECT images of a peristalsis phantom. Wilcoxon signed-rank and paired t tests were used to compare results between different image reconstructions. RESULTS Peristalsis-related streak artifacts were found in 49 (49%) of the DECT examinations. Artifacts were significantly more severe in 70, 120, and water(-iodine) images than in iodine(-water) images (qualitative readout P < 0.001, each). Quantitative measurements were significantly different between the artifact and the reference tissue in 70, 120 keV, and water(-iodine) images (P < 0.001 for both HU and GY for each image reconstruction), but not significantly different in iodine(-water) images (iodine concentrations P = 0.088 and GY P = 0.111). Similar results were seen in the peristalsis DECT phantom study. CONCLUSIONS Peristalsis-related streak artifacts seen in 70, 120 keV, and water(-iodine) images are substantially reduced in iodine(-water) images at rsDECT.
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Affiliation(s)
- Sebastian Winklhofer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-372, Box 0628, San Francisco, CA, 94143-0628, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8032, Zurich, Switzerland
| | - Jack W Lambert
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-372, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-372, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Yuxin Sun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-372, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Robert G Gould
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-372, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Ronald J Zagoria
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-372, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, M-372, Box 0628, San Francisco, CA, 94143-0628, USA.
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Scalise P, Mantarro A, Pancrazi F, Neri E. Computed tomography colonography for the practicing radiologist: A review of current recommendations on methodology and clinical indications. World J Radiol 2016; 8:472-483. [PMID: 27247713 PMCID: PMC4882404 DOI: 10.4329/wjr.v8.i5.472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/23/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most relevant causes of morbidity and mortality in Western societies. CRC screening is actually based on faecal occult blood testing, and optical colonoscopy still remains the gold standard screening test for cancer detection. However, computed tomography colonography (CT colonography) constitutes a reliable, minimally-invasive method to rapidly and effectively evaluate the entire colon for clinically relevant lesions. Furthermore, even if the benefits of its employment in CRC mass screening have not fully established yet, CT colonography may represent a reasonable alternative screening test in patients who cannot undergo or refuse colonoscopy. Therefore, the purpose of our review is to illustrate the most updated recommendations on methodology and the current clinical indications of CT colonography, according to the data of the existing relevant literature.
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East JE, Saunders BP, Burling D, Tam E, Boone D, Halligan S, Taylor SA. Mechanisms of hyoscine butylbromide to improve adenoma detection: A case-control study of surface visualization at simulated colonoscope withdrawal. Endosc Int Open 2015; 3:E636-41. [PMID: 26716127 PMCID: PMC4683134 DOI: 10.1055/s-0034-1392771] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Antispasmodics may improve mucosal visualization during colonoscope withdrawal, potentially improving polyp and adenoma detection. Meta-analysis and case-control studies suggest a 9 % to 13 % relative increase in adenoma and polyp detection. We aimed to assess the impact of hyoscine butylbromide on the expected visualization during colonoscope withdrawal using a CT colonography (CTC) simulation. PATIENTS AND METHODS Datasets from a previous CTC study examining the effect of antispasmodic were re-analyzed with customised CTC software, adjusted to simulate a standard colonoscopic view. Eighty-six patients received intravenous (IV) hyoscine butylbromide 20 mg, 40 mg or no antispasmodic. Main outcome measurements at unidirectional flythrough, simulating colonoscope withdrawal, were percentage colonic surface visualization, numbers and sizes of unseen areas, and colonic length. RESULTS Use of antispasmodic was associated with a significant relative increase in percentage surface visualization of 2.6 % to 3.9 %, compared with no antispasmodic, P < 0.006. Total numbers of missed areas and intermediate sized (300 - 1000 mm(2)) missed areas were significantly decreased, by approximately 20 %. There were no differences between the 20-mg and 40-mg doses. Mean colonic length (161 - 169 cm) was unchanged by antispasmodic. CONCLUSIONS IV hyoscine butylbromide at simulated colonoscope withdrawal was associated with significant increases in surface visualization, which might explain up to half the improvement in adenoma detection seen in clinical studies.
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Affiliation(s)
- James E. East
- Translational Gastroenterology Unit, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Wolfson Unit for Endoscopy, St. Mark’s Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom,Corresponding author James E. East, FRCP Translational Gastroenterology UnitExperimental Medicine DivisionNuffield Dept of Clinical MedicineUniversity of OxfordJohn Radcliffe HospitalHeadley WayHeadington, Oxford, OX3 9DUUnited Kingdom+44 (0)1865 228753+44 (0)1865 228763
| | - Brian P. Saunders
- Wolfson Unit for Endoscopy, St. Mark’s Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom
| | - David Burling
- Intestinal Imaging Centre, St. Mark’s Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom
| | - Emily Tam
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom,Department of Radiology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Wexham Street, Slough, Berkshire, SL2 4HL
| | - Darren Boone
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom
| | - Steve Halligan
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom
| | - Stuart A. Taylor
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom
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Colonic distention at CT colonography: randomized evaluation of both IV hyoscine butylbromide and automated carbon dioxide insufflation. AJR Am J Roentgenol 2015; 204:76-82. [PMID: 25539240 DOI: 10.2214/ajr.14.12772] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the efficacy of IV hyoscine butylbromide as a bowel relaxant and automated carbon dioxide insufflation in CT colonography in terms of colonic distention and perceived burden. SUBJECTS AND METHODS; Two hundred twenty-four participants were randomly allocated to one of four groups: control (no bowel relaxant and IV saline placebo before CT colonography with manual carbon dioxide insufflation), hyoscine butylbromide (IV hyoscine butylbromide before examination with manual carbon dioxide insufflation), automated (no bowel relaxant before examination with automated carbon dioxide insufflation), and combined (hyoscine butylbromide before examination with automated carbon dioxide insufflation). The degree of colonic distention on a 4-point scale, examination time, and participants' satisfaction, as measured by their responses to a questionnaire, were assessed. RESULTS The mean distention grades of all the colonic segments and both positions were 3.22 in the control group, 3.28 in the hyoscine butylbromide group, 3.77 in the automated group, and 3.74 in the combined group. Compared with manual carbon dioxide insufflation, automated carbon dioxide insufflation significantly improved the clinical adequacy of colonic distention and shortened examination time. No statistically significant difference was seen in the clinical adequacy of distention between participants who received hyoscine butylbromide and those who did not, or in examination time. Overall, the participants' experiences were not different. CONCLUSION Colonic distention was statistically significantly improved by automated carbon dioxide insufflation, but not by the administration of hyoscine butylbromide. The participants' tolerance was similar in each group.
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14
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Levine MS, Yee J. History, evolution, and current status of radiologic imaging tests for colorectal cancer screening. Radiology 2015; 273:S160-80. [PMID: 25340435 DOI: 10.1148/radiol.14140531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer screening is thought to be an effective tool with which to reduce the mortality from colorectal cancer through early detection and removal of colonic adenomas and early colon cancers. In this article, we review the history, evolution, and current status of imaging tests of the colon-including single-contrast barium enema, double-contrast barium enema, computed tomographic (CT) colonography, and magnetic resonance (MR) colonography-for colorectal cancer screening. Despite its documented value in the detection of colonic polyps, the double-contrast barium enema has largely disappeared as a screening test because it is widely perceived as a labor-intensive, time-consuming, and technically demanding procedure. In the past decade, the barium enema has been supplanted by CT colonography as the major imaging test in colorectal cancer screening in the United States, with MR colonography emerging as another viable option in Europe. Although MR colonography does not require ionizing radiation, the radiation dose for CT colonography has decreased substantially, and regular screening with this technique has a high benefit-to-risk ratio. In recent years, CT colonography has been validated as an effective tool for use in colorectal cancer screening that is increasingly being disseminated.
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Affiliation(s)
- Marc S Levine
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (M.S.L.); and Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (J.Y.)
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Sakamoto T, Utsunomiya D, Mitsuzaki K, Matsuda K, Kawakami M, Yamamura S, Urata J, Arakawa A, Yamashita Y. Colonic distention at screening CT colonography: role of spasmolytic agents and body habitus. Kurume Med J 2014; 61:9-15. [PMID: 25400236 DOI: 10.2739/kurumemedj.ms64002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sufficient colonic dilation is important when using CT colonography (CTC) for colorectal cancer screening. We investigated the effect of antispasmodic agents and the patient body habitus on the degree of colonic dilation in screening CTC.We assessed the effect of clinical characteristics [age, gender, body mass index (BMI), and the presence of diverticula] and the use of antispasmodics on colonic distention in 140 patients who underwent CTC for colorectal cancer screening. The CTC was performed in both the supine- and prone positions. Seventy patients received antispasmodics prior to CT examination and the other 70 did not. Colonic distention was scored using a 5-point scale: 1=collapsed, 2=poorly visualized, 3=visualized but underdistended, 4=acceptable, and 5=excellent. Images scored as 4 or 5 were considered to be of diagnostic quality. The mean visual evaluation score was significantly higher in the supine- than the prone position (4.2±0.5 vs. 4.0±0.5, p<0.01). For the supine position, only the use of antispasmodic was statistically associated with sufficient colonic dilation by univariate logistic analysis (odds ratio=2.365, p=0.03). For the prone position, age, BMI, and the use of antispasmodic were statistically associated with sufficient colonic dilation by multivariate analysis. The odds ratio of these parameters was 0.955 (p=0.02), 0.874 (p=0.03), and 2.391 (p=0.02), respectively.We obtained sufficient colonic dilation with an antispasmodic for CTC in both positions. Younger age and a lower BMI were also associated with better colonic dilation in the prone position.
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van der Paardt MP, Boellaard TN, Zijta FM, Baak LC, Depla ACTM, Dekker E, Nederveen AJ, Bipat S, Stoker J. Magnetic resonance colonography with a limited bowel preparation and automated carbon dioxide insufflation in comparison to conventional colonoscopy: patient burden and preferences. Eur J Radiol 2014; 84:19-25. [PMID: 25455410 DOI: 10.1016/j.ejrad.2014.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 10/05/2014] [Accepted: 10/09/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate patient burden and preferences for MR colonography with a limited bowel preparation and automated carbon dioxide insufflation in comparison to conventional colonoscopy. METHODS Symptomatic patients were consecutively recruited to undergo MR colonography with automated carbon dioxide insufflation and a limited bowel preparation followed within four weeks by colonoscopy with a standard bowel cleansing preparation. Four questionnaires regarding burden (on a five-point scale) and preferences (on a seven-point scale) were addressed after MR colonography and colonoscopy and five weeks after colonoscopy. RESULTS Ninety-nine patients (47 men, 52 women; mean age 62.3, SD 8.7) were included. None of the patients experienced severe or extreme burden from the MR colonography bowel preparation compared to 31.5% of the patients for the colonoscopy bowel preparation. Colonoscopy was rated more burdensome (25.6% severe or extreme burden) compared to MR colonography (5.2% severe or extreme burden) (P<0.0001). When discarding the bowel preparations, the examinations were rated equally burdensome (P=0.35). The majority of patients (61.4%) preferred MR colonography compared to colonoscopy (29.5%) immediately after the examinations and five weeks later (57.0% versus 39.5%). CONCLUSION MR colonography with a limited bowel preparation and automated carbon dioxide insufflation demonstrated less burden compared to colonoscopy. The majority of patients preferred MR colonography over colonoscopy.
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Affiliation(s)
- M P van der Paardt
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - T N Boellaard
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - F M Zijta
- Department of Radiology, Medisch Centrum Haaglanden, Den Haag, The Netherlands.
| | - L C Baak
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - A C T M Depla
- Department of Gastroenterology and Hepatology, Slotervaartziekenhuis, Amsterdam, The Netherlands.
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - A J Nederveen
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - S Bipat
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - J Stoker
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
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Flor N, Ceretti AP, Mezzanzanica M, Rigamonti P, Peri M, Tresoldi S, Soldi S, Mangiavillano B, Sardanelli F, Cornalba GP. Impact of contrast-enhanced computed tomography colonography on laparoscopic surgical planning of colorectal cancer. ACTA ACUST UNITED AC 2014; 38:1024-32. [PMID: 23512572 DOI: 10.1007/s00261-013-9996-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the impact of contrast-enhanced computed tomography colonography (CE-CTC) on laparoscopic surgery planning in patient with stenosing colorectal cancer. MATERIALS AND METHODS Sixty-nine patients with endoscopically proven colorectal cancer underwent CE-CTC, after incomplete conventional colonoscopy. Two experienced radiologists evaluated site, length, and TNM staging of colorectal cancers on three-dimensional double contrast enema-like views, 2D axial and multiplanar reconstructions. All the patients underwent colorectal resection and surgery bulletin, pathology of surgical specimens, and radiological follow-up at about 8 months were used as reference standard. RESULTS The detection rate of colorectal cancer was 100 % (75/75); CE-CTC allowed for a diagnosis of a synchronous colorectal cancer in five patients (7 %). CE-CTC correctly judged the site of the lesions in all the cases; clinically significant localization errors at conventional colonoscopy were noted in 3 out of 69 patients (4 %). Additional colonic polyps greater than 6 mm in diameter were found in 21 out of 69 patients (30 %); in two patients (3 %) the surgeon performed an enlarged colectomy to include synchronous polyps proximal to colorectal cancer. Sensitivity, specificity, PPV, NPV, and accuracy were for T1-T2 vs. T3-T4: 96 %, 71 %, 92 %, 87 %, and 91 %, respectively; for N: 94 %, 42 %, 64 %, 86 %, and 70 %; for M: 100 %, 100 %, 83 %, 100 %, and 97 %. There were no complications associated with CE-CTC. CONCLUSION Information given by CE-CTC concerning colorectal cancer location and synchronous colonic cancers and polyps changed the laparoscopic surgical strategy in almost 14 % of patients.
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Affiliation(s)
- Nicola Flor
- Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via A di Rudinì 8, 20142, Milan, Italy,
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van der Paardt MP, Sprengers AMJ, Zijta FM, Lamerichs R, Nederveen AJ, Stoker J. Noninvasive automated motion assessment of intestinal motility by continuously tagged MR imaging. J Magn Reson Imaging 2013; 39:9-16. [PMID: 23553805 DOI: 10.1002/jmri.24094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 02/05/2013] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate continuously tagged 3 Tesla MRI for monitoring glucagon-induced bowel motility changes in healthy volunteers. MATERIALS AND METHODS After standardized oral bowel preparation, 10 healthy volunteers underwent a free-breathing, continuously tagged three-dimensional (3D) dynamic fast-field-echo (FFE), at a 3.36 Hz sampling frequency. One milligram of glucagon was administered intravenously during data acquisition. Each dataset was divided into four temporal sets of 2 min (period 1 to 4). Taglines were tracked automatically using a scale spaced based algorithm. Assessment of global spectral resolution was performed for three frequency intervals: 0.008-0.300 Hz (motility), 0.300-0.400 Hz (breathing motion), and 0.400-0.533 Hz (higher order motion). Additional analyses were performed at fine spectral resolution in frequency bands of 0.033 Hz. Glucagon-induced motility changes were investigated by means of a motility index (spectral power normalized to the maximal spectral power per-volunteer), resulting in a range of 0 to 1 (no motion to maximal motion). Statistical comparison was done for period 1 and 4 (Wilcoxon-signed rank test). RESULTS After glucagon administration, a significant decrease in the motility index was found for the low- (0.008-0.300 Hz) (P < 0.0001) and high-frequency interval (0.400-0.533 Hz) (P < 0.0001). Around breathing motion frequencies, no decrease in motility index was detected. CONCLUSION Free-breathing, continuously tagged MR imaging is a noninvasive method for automated bowel motility assessment and allows for detection of drug-induced changes.
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Affiliation(s)
- Marije P van der Paardt
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Yee J, Weinstein S, Morgan T, Alore P, Aslam R. Advances in CT Colonography for Colorectal Cancer Screening and Diagnosis. J Cancer 2013; 4:200-9. [PMID: 23459511 PMCID: PMC3584833 DOI: 10.7150/jca.5858] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/07/2013] [Indexed: 12/13/2022] Open
Abstract
CT colonography (CTC) is a validated colorectal cancer test that provides an additional minimally-invasive screening option which is likely to be preferred by some patients. Important examination prerequisites include adequate colonic cleansing and distention. Tagging of residual material aids in the differentiation of true polyps from stool. Low radiation dose technique should be employed routinely for screening studies. Readers must be skilled in the use of both 2D and 3D interpretation methods.
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Affiliation(s)
- Judy Yee
- Dept. of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94121, USA
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Intravenous contrast enhanced computed tomography colonoscopy in children with suspected colonic polyps. Eur J Radiol 2013; 82:905-12. [PMID: 23332642 DOI: 10.1016/j.ejrad.2012.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnostic performance of intravenous contrast enhanced computed tomographic colonoscopy (IVCTC) in the diagnosis of clinically suspected colorectal polyps in children, using conventional colonoscopy (CC) as the gold standard. METHODS This was a prospective study conducted between July 2008 and June 2010. 30 pediatric patients with history of rectal bleeding and clinically suspected to have colorectal polyps were enrolled. All of the patients underwent IVCTC followed by CC. 30 IVCTC and 31 CC were performed in 30 patients. The findings of IVCTC were compared with those of CC. Statistical analysis was performed to obtain diagnostic performance values of IVCTC on per polyp (sensitivity and positive predictive value) and per patient (sensitivity, specificity, positive predictive value and negative predictive value) basis. RESULTS By IVCTC, 63 polyps were detected in 28 patients of which 53 polyps were eligible for inclusion in the statistical analysis. 60 polyps were detected by CC in 28 patients of which 50 polyps were eligible for inclusion in the statistical analysis. The per polyp sensitivity and positive predictive values were 94% and 88.6% respectively. The per patient sensitivity, specificity, positive predictive value, and negative predictive values were 96.4, 50, 96.4, and 50% respectively. Twenty polyps, in 10 patients, were visualized only after intravenous contrast administration of which 5 polyps, in 5 patients, were likely to have been missed in the absence of the intravenous contrast injection as these polyps were submerged in fluid. Four patients would have had a false negative CTC examination if the intravenous contrast had not been injected; while in another patient, the number of polyps would have been underestimated. CONCLUSION CTC is capable of serving as a safe and efficient non-invasive tool for evaluating children with clinically suspected colorectal polyps. Administration of intravenous contrast improves the sensitivity of polyp detection on CTC.
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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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de Haan MC, Boellaard TN, Bossuyt PM, Stoker J. Colon distension, perceived burden and side-effects of CT-colonography for screening using hyoscine butylbromide or glucagon hydrochloride as bowel relaxant. Eur J Radiol 2012; 81:e910-6. [PMID: 22683196 DOI: 10.1016/j.ejrad.2012.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Compare colonic distension and perceived burden of CT-colonography between participants receiving hyoscine butylbromide (buscopan) and glucagon hydrochloride as bowel relaxant. MATERIALS AND METHODS Data were collected within a screening trial. Participants received 20mg buscopan intravenously or 1mg of glucagon intravenously (if buscopan contra-indicated). Colon distension per segment was assessed using a 4-point scale (prone and supine). Data on perceived burden of CT-colonography were collected using a questionnaire two weeks after the examination. Outcome measures between groups were compared using propensity score matching. We used a stratified Wilcoxon-Mann-Whitney test statistic for quantitative and Cochran-Mantel-Haenszel statistics for categorical variables. RESULTS 541 participants were included: 336 (62%) received buscopan and 205 received glucagon. All buscopan recipients had an adequately distended colon, compared to 96% in the glucagon group (RR 7.31, 95% CI: 1.61-33.28). More glucagon recipients scored the insufflation as rather or extremely burdensome (25% vs. 16%; overall mean score 2.7 vs. 2.4; p<0.001) and more found the entire CT-colonography rather or extremely burdensome (14% vs. 7%; 2.2 vs. 1.9; p=0.001). Most frequently reported side effects were a dry mouth in the buscopan group (15%) and nausea in the glucagon group (13%). CONCLUSION Compared to glucagon, premedication with buscopan results in significantly more adequately distended colons and a less burdensome procedure. When buscopan can be used, it is the preferred bowel relaxant.
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Affiliation(s)
- Margriet C de Haan
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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23
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Gutzeit A, Binkert CA, Koh DM, Hergan K, von Weymarn C, Graf N, Patak MA, Roos JE, Horstmann M, Kos S, Hungerbühler S, Froehlich JM. Evaluation of the anti-peristaltic effect of glucagon and hyoscine on the small bowel: comparison of intravenous and intramuscular drug administration. Eur Radiol 2012; 22:1186-94. [PMID: 22270141 DOI: 10.1007/s00330-011-2366-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/21/2011] [Accepted: 12/05/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate prospectively duration and effectiveness of aperistalsis achieved by glucagon(GLU) or hyoscine N-butylbromide(HBB) following various administration routes. MATERIALS AND METHODS Six volunteers underwent Magnetic Resonance Imaging (MRI) after standardized oral preparation in random order five separate MR examinations with both spasmolytic agents (HBB intravenous(i.v.) or intramuscular(i.m.), GLU i.v. or i.m., and a combined scheme). The MR protocol included a sagittal 2D cross-section of the small bowel with a temporal resolution of 0.55 s acquired over 60 to 90 min. To quantify bowel motility, small bowel cross-sectional areas were summated over time. RESULTS The anti-peristaltic i.v. effects of HBB and glucagon started on average after 85 s/65 s and ended after 21 min/23.3 min, respectively. By comparison, the anti-peristaltic effects of i.m. HBB and glucagon started significantly later 5.1/11.6 min (P = 0.001; Wilcoxon signed ranks test) and lasted for 17.7/28.2 min with greater inter-individual differences (P = 0.012; Brown-Forsythe test). The combined scheme resulted in a rapid onset after 65 s with effect duration of 31 min. CONCLUSION Anti-peristaltic effects on the small bowel are drug dependant, i.e., their onset is faster and more reliable when administering i.v. than i.m.. Combining i.v. GLU with i.m. HBB provides an early onset of effect, sustained spasmolysis and the highest degree of motility impairment. KEY POINTS • Anti-persitaltic agents are widely used before various diagnostic procedures of the abdomen. • The combination of iv-glucagon with im-hyoscine provides reliable spasmolysis with early onset. • Intravenous spasmolysis is more reliable compared to intramuscular administration. • Intravenous glucagon has a prolonged spasmolytic effect compared to intravenous hyoscine.
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Affiliation(s)
- Andreas Gutzeit
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland.
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Boellaard TN, de Haan MC, Venema HW, Stoker J. Colon distension and scan protocol for CT-colonography: an overview. Eur J Radiol 2011; 82:1144-58. [PMID: 22154604 DOI: 10.1016/j.ejrad.2011.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/31/2011] [Indexed: 12/18/2022]
Abstract
This article reviews two important aspects of CT-colonography, namely colonic distension and scan parameters. Adequate distension should be obtained to visualize the complete colonic lumen and optimal scan parameters should be used to prevent unnecessary radiation burden. For optimal distension, automatic carbon dioxide insufflation should be performed, preferably via a thin, flexible catheter. Hyoscine butylbromide is - when available - the preferred spasmolytic agent because of the positive effect on insufflation and pain/burden and its low costs. Scans in two positions are required for adequate distension and high polyp sensitivity and decubitus position may be used as an alternative for patients unable to lie in prone position. The great intrinsic contrast between air or tagging and polyps allows the use of low radiation dose. Low-dose protocol without intravenous contrast should be used when extracolonic findings are deemed unimportant. In patients suspected for colorectal cancer, normal abdominal CT scan protocols and intravenous contrast should be used in supine position for the evaluation of extracolonic findings. Dose reduction can be obtained by lowering the tube current and/or voltage. Tube current modulation reduces the radiation dose (except in obese patients), and should be used when available. Iterative reconstructions is a promising dose reducing tool and dual-energy CT is currently evaluated for its applications in CT-colonography. This review also provides our institution's insufflation procedure and scan parameters.
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Affiliation(s)
- Thierry N Boellaard
- Department of Radiology, Academic Medical Center, University of Amsterdam, PB 22660, 1100 DD Amsterdam, The Netherlands.
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De Marco LM, Fischer S, Henle T. High molecular weight coffee melanoidins are inhibitors for matrix metalloproteases. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2011; 59:11417-11423. [PMID: 21961901 DOI: 10.1021/jf202778w] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
High molecular (above 10 kDa) melanoidins isolated from coffee beans of varying roasting degree were found to be efficient inhibitors for the zinc-containing matrix metalloproteases MMP-1, MMP-2, and MMP-9 with IC(50) values ranging between 0.2 and 1.1 mg/mL in vitro. The inhibitory potential increased with roasting degree. No or only slight inhibition of other zinc-containing peptidases closely related to MMPs, namely, Clostridium histolyticum collagenase and angiotensin converting enzyme, was found, indicating specific structural features of melanoidins to be responsible for the interaction with MMPs. A continuous increase on the apparent molecular weight of melanoidins as well as incorporation of phenolic substances into the melanoidin structure with progress of roasting was observed, concomitant with a significant increase in the carbon/nitrogen of the melanoidins. This suggests that the melanoidins are mainly formed by incorporation of carbohydrates and phenolic compounds onto a proteinaceous backbone. As MMP-1, MMP-2, and MMP-9 play a pivotal role in pathogenesis of colorectal cancer, studies on possible physiological effects of melanoidins are mandatory.
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Comparing hyoscine and drotaverine effects on colon in CT colonography. Open Med (Wars) 2011. [DOI: 10.2478/s11536-010-0065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractHyoscine and drotaverine effectiveness was compared for the purposes of achieving optimum distension following insufflation in CT colonography. The in vitro effects of hyoscine and drotaverine on tone and contractility of SM preparations isolated from different areas of human colon were studied by isometric registration of contractile activity. Both medications have a relaxing effect on SM preparations and inhibit their spontaneous contractions. The drotaverine-induced effects were reliably more marked than the hyoscine-induced ones. CT colonography was performed in 70 patients who were injected with equal doses of either hyoscine (n=32) or drotaverine (n=38). The degree of drug-induced distension in both groups was determined by measuring the lumen of the colon on a 2D reconstruction. In most colon areas the width of the distended lumen was greater in the drotaverine-treated patients. We concluded that drotaverine can be used as a means to facilitate colonic distension.
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Cattoni DI, Ravazzola C, Tüngler V, Wainstein DE, Chara O. Effect of intestinal pressure on fistula closure during vacuum assisted treatment: A computational approach. Int J Surg 2011; 9:662-8. [DOI: 10.1016/j.ijsu.2011.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 08/14/2011] [Accepted: 09/05/2011] [Indexed: 10/17/2022]
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Ikarashi N, Mochiduki T, Takasaki A, Ushiki T, Baba K, Ishii M, Kudo T, Ito K, Toda T, Ochiai W, Sugiyama K. A mechanism by which the osmotic laxative magnesium sulphate increases the intestinal aquaporin 3 expression in HT-29 cells. Life Sci 2010; 88:194-200. [PMID: 21094173 DOI: 10.1016/j.lfs.2010.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/28/2010] [Accepted: 11/09/2010] [Indexed: 01/21/2023]
Abstract
AIMS We have suggested that an osmotic laxative, magnesium sulphate (MgSO(4)), may act as a cathartic in a very rational manner by increasing the aquaporin 3 (AQP3) expression level and by changing osmotic pressure in the colon. In this study, we examined the mechanism by which MgSO(4) increases the intestinal AQP3 expression level by using the human colon cancer HT-29 cell line. MAIN METHODS After the addition of MgSO(4) to HT-29 cells, the expression levels of AQP3 mRNA and protein were measured using real-time RT-PCR and western blotting, respectively. The intracellular Mg(2+) concentration, adenylate cyclase (AC) activity and protein kinase A (PKA) activity were also determined. The phosphorylated cAMP response element-binding protein (CREB) expression levels were determined by western blotting. KEY FINDINGS The AQP3 mRNA expression level started to increase significantly at 1 h after MgSO(4) addition and peaked at 9 h, at a level 3 times as high as the control levels. The AQP3 protein expression level started to increase 6 h after the addition and reached a level almost twice as high as the control levels by hour 12. In the HT-29 cells treated with MgSO(4), there was a 1.4-fold increase in the intracellular Mg(2+) concentration, a 1.5-fold increase in AC activity, a 1.6-fold increase in PKA activity, and a significant increase in phosphorylation of the CREB. SIGNIFICANCE These results suggest that the AC activation caused by an increase in the intracellular Mg(2+) concentration may trigger CREB phosphorylation through PKA activation and promote AQP3 gene transcription.
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Effect of butylscopolamine on image quality in MRI of the prostate. Clin Radiol 2010; 65:460-4. [PMID: 20451013 DOI: 10.1016/j.crad.2010.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 02/05/2010] [Accepted: 02/14/2010] [Indexed: 11/21/2022]
Abstract
AIM To evaluate the impact of butylscopolamine on the quality of magnetic resonance imaging (MRI) images of the prostate. MATERIAL AND METHODS Eighty-two MRI examinations of the prostate were retrospectively analysed. MRI was performed with a combined endorectal/body phased-array coil including proton density-weighted (PD) sequence, T1-weighted turbo spin-echo (TSE)-sequence, and T2-weighted TSE-sequences. Forty milligrams of butylscopolamine was administered intramuscularly in 31 patients (im-group) and intravenously in 30 patients (iv-group). Twenty-one patients did not receive premedication with butylscopolamine (ø-group). Overall image quality, delineation of the bowel wall, and visualization of the prostate, neurovascular bundle, and pelvic lymph nodes were evaluated qualitatively using a five-point scale (from 1=excellent to 5=non-diagnostic/structure not discernible). Motion artefacts within the endorectal coil were quantified by baseline adjusted signal intensities inside the endorectal coil area. RESULTS Delineation of the bowel wall using the PD-sequence was significantly improved after both intramuscular and intravenous butylscopolamine administration (ø-group: 3.6+/-0.7; im-group: 2.9+/-0.7; iv-group: 2.9+/-0.7; p=0.001). However, there were no significant differences in motion artefacts measured within the endorectal coil (ø-group: 1.18+/-0.14; im-group: 1.15+/-0.11; iv-group: 1.12+/-0.06; p=0.39). There were also no significant differences in qualitative assessment of visualization of the prostate, neurovascular bundle, pelvic lymph nodes, and of overall image quality between the study groups. CONCLUSION : In conclusion, butylscopolamine had only a small effect on image quality and is not mandatory for MRI of the prostate.
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Hein PA, Krug LD, Romano VC, Kandel S, Hamm B, Rogalla P. Computer-aided Detection in Computed Tomography Colonography with Full Fecal Tagging: Comparison of Standalone Performance of 3 Automated Polyp Detection Systems. Can Assoc Radiol J 2010; 61:102-8. [DOI: 10.1016/j.carj.2009.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 01/25/2023] Open
Abstract
Purpose We sought to compare the performance of 3 computer-aided detection (CAD) polyp algorithms in computed tomography colonography (CTC) with fecal tagging. Methods CTC data sets of 33 patients were retrospectively analysed by 3 different CAD systems: system 1, MedicSight; system 2, Colon CAD; and system 3, Polyp Enhanced View. The polyp database comprised 53 lesions, including 6 cases of colorectal cancer, and was established by consensus reading and comparison with colonoscopy. Lesions ranged from 6-40 mm, with 25 lesions larger than 10 mm in size. Detection and false-positive (FP) rates were calculated. Results CAD systems 1 and 2 could be set to have varying sensitivities with higher FP rates for higher sensitivity levels. Sensitivities for system 1 ranged from 73%–94% for all lesions (78%–100% for lesions ≥10 mm) and, for system 2, from 64%–94% (78%–100% for lesions ≥10 mm). System 3 reached an overall sensitivity of 76% (100% for lesions ≥10 mm). The mean FP rate per patient ranged from 8–32 for system 1, from 1–8 for system 2, and was 5 for system 3. At the highest sensitivity level for all polyps (94%), system 2 showed a statistically significant lower FP rate compared with system 1 ( P = .001). When analysing lesions ≥10 mm, system 3 had significantly fewer FPs than systems 1 and 2 ( P < .012). Conclusions Standalone CTC-CAD analysis in the selected patient collective showed the 3 systems tested to have a variable but overall promising performance with respect to sensitivity and the FP rate.
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Affiliation(s)
- Patrick A. Hein
- Department of Radiology, Charité-University Hospital, Campus Mitte, Berlin, Germany
| | - Lasse D. Krug
- Department of Radiology, Charité-University Hospital, Campus Mitte, Berlin, Germany
| | - Valentina C. Romano
- Department of Radiology, Charité-University Hospital, Campus Mitte, Berlin, Germany
| | - Sonja Kandel
- Department of Radiology, Charité-University Hospital, Campus Mitte, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-University Hospital, Campus Mitte, Berlin, Germany
| | - Patrik Rogalla
- Department of Radiology, Charité-University Hospital, Campus Mitte, Berlin, Germany
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Behrens C, Stevenson G, Eddy R, Pearson D, Hayashi A, Audet L, Mathieson J. The Benefits of Computed Tomographic Colonography in Reducing a Long Colonoscopy Waiting List. Can Assoc Radiol J 2010; 61:33-40; quiz 2. [DOI: 10.1016/j.carj.2009.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 09/03/2009] [Accepted: 09/03/2009] [Indexed: 01/22/2023] Open
Abstract
Purpose The Radiology Department, Royal Jubilee Hospital, Victoria, BC, with the support of gastroenterologists and surgeons, was awarded a BC Innovation fund to run a pilot project of computed tomographic colonography to reduce an unacceptably long 2-year colonoscopy waiting list. Funds were approved in April 2007 for a 1-year project, which was completed on March 31, 2008. Methods This article describes the challenges of delivering a high-volume computed tomographic colonography program at a busy community hospital, with discussion of the results for the 2,005 patients who were examined. Results Colonoscopy was avoided in 1,462 patients whose computed tomographic studies showed no significant lesions. In the remainder of patients, only lesions larger than 5 mm were reported, with a total of 508 lesions identified in 433 patients. There were 57 cancers of which 52 were reported as either definite or possible cancers, whereas 5 were not seen on initial scans. Some of the patients with cancer had been on the colonoscopy waiting list for 2 years. In addition, there were 461 patients with significant extracolonic findings, including 84 who required urgent or semi-urgent further management for previously unsuspected conditions, such as pneumonia, aneurysms larger than 5 cm, and a range of solid renal, hepatic, and pancreatic masses. There were no procedural complications from the computed tomographic colon studies. Conclusions We have shown that it is feasible to run a high volume CTC service in a general hospital given hospital support and funding. The benefits in this group of over 2000 patients included avoidance of colonoscopy in over 70% of patients, detection of significant polyps or cancer in approximately 20% of patients, and identification of clinically important conditions in 7%–18% depending on the definition used. The estimated costs including capital, operating, and professional fees were in the range of $400.
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Affiliation(s)
- Carola Behrens
- Department of Radiology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Giles Stevenson
- Department of Radiology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Richard Eddy
- Department of Radiology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - David Pearson
- Department of Gastroenterology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Allen Hayashi
- Department of Surgery, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Louise Audet
- Department of Radiology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - John Mathieson
- Department of Radiology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
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Siewert B, Kruskal JB, Eisenberg R, Hall F, Sosna J. Quality initiatives: quality improvement grand rounds at Beth Israel Deaconess Medical Center: CT colonography performance review after an adverse event. Radiographics 2009; 30:23-31. [PMID: 19901086 DOI: 10.1148/rg.301095125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
As computed tomographic (CT) colonography is being used increasingly in clinical practice, an effective quality improvement process must be ensured. The quality improvement process is outlined for the reader by using an adverse event during CT colonography as an example. Components of this process are the approach to a sentinel event, performance of a root cause analysis, and development of strategies for minimizing errors after a serious adverse event. Important factors include indications and contraindications for the examination, proper imaging technique, training of personnel, complications of the procedure, and legal implications. Complications from CT colonography are rare. Attention must be paid to the correct technique for colonic insufflation, particularly in older patients and those who are symptomatic. Root cause analysis provides valuable tools for identification and implementation of improvements designed to avoid similar and other adverse events and to minimize damage.
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Affiliation(s)
- Bettina Siewert
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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Abstract
An examination technique adapted to comply with the demands of CT colonography is not only a basic requirement for a high-quality examination and correct ascertainment of the findings; it is also essential for far-reaching applications of this method of examination. The technique of CT colonography is based on good patient preparation with the aid of fecal tagging, adequate distension of the colon with CO(2) and acquisition of data with the patient both prone and supine in a thin-slice technique using a low-dose protocol. The different technical aspects of CT colonography are explained in this paper.
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Abstract
CT colonography (CTC), also termed virtual colonoscopy, is increasingly accepted at sites throughout the world as a new effective tool for the diagnosis and screening of colorectal carcinoma. This article presents information of related issues of bowel cleansing, stool and fluid tagging, bowel distention and multidetector CT scanning parameters. The author presents discussion of interpretation of CTC, appropriate applications of CTC and potential complications.
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Affiliation(s)
- Judy Yee
- University of California, San Francisco, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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Farraye FA, Adler DG, Chand B, Conway JD, Diehl DL, Kantsevoy SV, Kwon RS, Mamula P, Rodriguez SA, Shah RJ, Wong Kee Song LM, Tierney WM. Update on CT colonography. Gastrointest Endosc 2009; 69:393-8. [PMID: 19231482 DOI: 10.1016/j.gie.2008.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 10/09/2008] [Indexed: 02/08/2023]
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CT colonography can be an adjunct to optical colonoscopy in CRC screening. Dig Dis Sci 2009; 54:212-7. [PMID: 18612821 DOI: 10.1007/s10620-008-0360-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 06/03/2008] [Indexed: 01/22/2023]
Abstract
CT colonography or virtual colonoscopy is a fairly new modality that has the potential to play a significant role in screening for colon cancer. CT colonography is an attractive option for two specific reasons. First, it is non-invasive and, second, it obviates the need for sedation. It thus overcomes the two major drawbacks of optical colonoscopy. CT colonography cannot be a stand-alone technique for colorectal cancer screening because, unlike conventional colonoscopy, it does not possess a therapeutic option or a definite diagnostic capability. However, CT colonography can be a cost-effective complement to traditional colonoscopy if it is reasonably priced and if appropriate cut-off levels (>6 mm polyp) are used to increase its sensitivity.
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64-detector row CT cystography with virtual cystoscopy in the detection of bladder carcinoma: preliminary experience in selected patients. Radiol Med 2008; 114:52-69. [DOI: 10.1007/s11547-008-0350-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 04/10/2008] [Indexed: 10/21/2022]
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Tytgat GN. Hyoscine butylbromide - a review on its parenteral use in acute abdominal spasm and as an aid in abdominal diagnostic and therapeutic procedures. Curr Med Res Opin 2008; 24:3159-73. [PMID: 18851775 DOI: 10.1185/03007990802472700] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Being a quaternary ammonium compound derived from scopolamine, the alkaloid hyoscine butylbromide (HBB) exerts anticholinergic effects without side effects related to the central nervous system because it does not pass the blood-brain barrier. Clinical experience with this antispasmodic dates back to the 1950s and led to its registration for treating abdominal cramps/spasm and for diagnostic imaging purposes. OBJECTIVES AND SCOPE: This review focuses on the therapeutic efficacy and safety of the parenteral administration of HBB for treating biliary and renal colic and acute spasm in the genito-urinary tract. In addition, its value for diagnostic or therapeutic procedures in the abdomen, as well as for labour and palliative care, is reviewed. With the generic and trade name of the drug combined with various search terms related to the relevant clinical applications, a thorough literature search was performed in the Medline and EMBASE databases in April 2008. FINDINGS In most clinical studies, recommended doses of 20-40 mg HBB were injected, mainly intravenously. Fast pain reduction was achieved by HBB in renal colic; about 90% of the patients showed good to moderate analgesic responses after 30 min and the onset of action was noticeable within 10 min. Similarly, a pain reduction of 42-78% was observed in patients with biliary colic within 30 min after a single intravenous injection of 20 mg. In contrast, no analgesic efficacy of a single injection of 20 mg was found after surgical or shock-wave procedures in the urogenital area. Administration of HBB prior to, or during, radiological imaging distended the gastrointestinal (GI) tract in double-contrast barium and computed tomographic colonography studies and reduced motion artefacts in magnetic resonance imaging. This improved diagnostic image quality and organ visualisation. Pre-medication led to shorter and easier endoscopy in some, but not all, studies. Because of cervical relaxation, HBB shortened total labour duration with 17-67%. It also relieved pain and reduced GI secretions in terminal cancer patients with inoperable bowel obstruction. With regard to its safety profile, parenteral administration of HBB is associated with mild and self-limiting adverse events, typical for anticholinergic drugs. CONCLUSIONS These clinical results of rapid action and beneficial efficacy combined with good tolerability support the use of HBB in a range of indications related to acute abdominal spasm, in labour and palliative care and for supporting diagnostic and therapeutic abdominal procedures, where spasm may be a problem.
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Nagata K, Näppi J, Cai W, Yoshida H. Minimum-invasive early diagnosis of colorectal cancer with CT colonography: techniques and clinical value. ACTA ACUST UNITED AC 2008; 2:1233-46. [DOI: 10.1517/17530059.2.11.1233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Computed tomographic colonography is a modern technique to evaluate the colon, which may be more appealing to patients than invasive methods. The potential of this test, including current and future developments are presented in this review. The essential steps required to perform a diagnostic quality computed tomographic colonography are discussed as well as different methods of study interpretation. The current status and promising areas of future investigation are also discussed.
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Affiliation(s)
- Rizwan Aslam
- University of California San Francisco, CA, USA.
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Abstract
MR colonography is a powerful noninvasive method to image colorectal masses and inflammatory bowel disease. This article describes current techniques of MR colonography and compares its implementation at 1.5T and 3T.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Radiology, The Emory Clinic, 1365 Clifton Road, Bldg A, Suite AT-627, Atlanta, GA 30322, USA.
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Aschoff AJ, Ernst AS, Brambs HJ, Juchems MS. CT colonography: an update. Eur Radiol 2007; 18:429-37. [PMID: 17899101 DOI: 10.1007/s00330-007-0764-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 07/25/2007] [Accepted: 08/24/2007] [Indexed: 12/19/2022]
Abstract
Computed tomographic (CT) colonography (CTC)--also known as "virtual colonoscopy"--was first described more than a decade ago. As advancements in scanner technology and three-dimensional (3D) postprocessing helped develop this method to mature into a potential option in screening for colorectal cancer, the fundamentals of the examination remained the same. It is a minimally invasive, CT-based procedure that simulates conventional colonoscopy using 2D and 3D computerized reconstructions. The primary aim of CTC is the detection of colorectal polyps and carcinomas. However, studies reveal a wide performance variety in regard to polyp detection, especially for smaller polyps. This article reviews the available literature, discusses established indications as well as open issues and highlights potential future developments of CTC.
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Affiliation(s)
- Andrik J Aschoff
- Diagnostic and Interventional Radiology, University Hospitals of Ulm, Steinhoevelstr. 9, 89070, Ulm, Germany.
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Tolan DJM, Armstrong EM, Burling D, Taylor SA. Optimization of CT colonography technique: a practical guide. Clin Radiol 2007; 62:819-27. [PMID: 17662728 DOI: 10.1016/j.crad.2007.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 02/27/2007] [Accepted: 03/05/2007] [Indexed: 12/21/2022]
Abstract
In this article we provide practical advice for optimizing computed tomography colonography (CTC) technique to help ensure that reproducible, high-quality examinations are achieved. Relevant literature is reviewed and specific attention is paid to patient information, bowel cleansing, insufflation, anti-spasmodics, patient positioning, CT technique, post-procedure care and complications, as well as practical problem-solving advice. There are many different approaches to performing CTC; our aim is to not to provide a comprehensive review of the literature, but rather to present a practical and robust protocol, providing guidance, particularly to those clinicians with little prior experience of the technique.
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Affiliation(s)
- D J M Tolan
- Department of Clinical Radiology, St James's University Hospital, Leeds, West Yorkshire, UK
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Abstract
Combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, MR imaging of the gastrointestinal tract has become increasingly used clinically. Both bowel inflammation and tumor disease of the large bowel can be well visualized by means of MR colonography (MRC). This article describes current techniques of MRC and gives an overview of its clinical outcome. Special focus is directed toward the evaluation of patients' acceptance of MRC.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology and Neuroradiology, University Hospital, Hufelandstrasse 55, 45122 Essen, Germany
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Taylor SA, Laghi A, Lefere P, Halligan S, Stoker J. European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography. Eur Radiol 2007; 17:575-9. [PMID: 16967260 DOI: 10.1007/s00330-006-0407-y] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Rapid clinical dissemination of CT colonography (CTC) is occurring in parallel with continued research into technique optimisation and diagnostic performance. A need exists therefore for current guidance as to basic prerequisites for effective clinical implementation. A questionnaire detailing CTC technique, analysis, training and clinical implementation was developed by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) CTC committee and circulated to all faculty members of previous ESGAR "hands-on" CTC training courses. Responses were collated and a consensus statement produced. Of 27 invited to participate, 24 responded. Reasonable consensus was reached on bowel preparation, colonic distension, patient positioning, use of IV contrast and optimal scan parameters. Both primary 2D and primary 3D analysis were advocated equally, with some evidence that more experienced readers prefer primary 2D. Training was universally recommended, although there was no consensus regarding minimum requirements. CTC was thought superior to barium enema, although recommended for screening only in the presence of validated local experience. There was consensus that polyps 4 mm or less could be ignored assuming agreement from local gastroenterological colleagues. There is increasing consensus amongst European experts as to the current best practice in CTC.
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MESH Headings
- Advisory Committees
- Colonic Polyps/diagnostic imaging
- Colonography, Computed Tomographic/methods
- Colonography, Computed Tomographic/standards
- Colorectal Neoplasms/diagnostic imaging
- Consensus
- Contrast Media
- Europe
- Faculty, Medical
- Gastroenterology/education
- Gastroenterology/organization & administration
- Humans
- Image Processing, Computer-Assisted/methods
- Image Processing, Computer-Assisted/standards
- Injections, Intravenous
- Mass Screening/standards
- Professional Practice/standards
- Radiography, Abdominal
- Radiology, Interventional/education
- Radiology, Interventional/organization & administration
- Societies, Medical
- Surveys and Questionnaires
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Affiliation(s)
- Stuart A Taylor
- Department of Imaging, University College Hospital, 2F Podium, 235 Euston Road, London, NW1 2BU, United Kingdom.
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Minordi L, Vecchioli A, Bonomo L. Re: The value of the per oral pneumocolon in the study of the distal ileal loops—a reply. Clin Radiol 2007. [DOI: 10.1016/j.crad.2007.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tolan DJM, Armstrong EM, Bloor C, Chapman AH. Re: the value of the per oral pneumocolon in the study of the distal ileal loops. Clin Radiol 2007; 62:603; author reply 604. [PMID: 17467400 DOI: 10.1016/j.crad.2007.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 01/02/2007] [Indexed: 10/23/2022]
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