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Nakrour N, Neibling JE, Pathak A, Carbo A. Gastrointestinal pharmacoradiology, an updated review of medications and gastrointestinal contrasts in abdominal imaging. Abdom Radiol (NY) 2025; 50:1038-1050. [PMID: 39225719 DOI: 10.1007/s00261-024-04504-4] [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: 03/31/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024]
Abstract
The purpose of this article is to review commonly used medications in abdominal radiology including their indications, mechanisms of action, dosages, contraindications, precautions, and adverse reactions. We will clarify common inquiries and address frequently asked questions by patients and clinicians related to their use. In addition, we will explore the indications, advantages and disadvantages, dosages, and contraindications of enteric contrast agents used for CT and fluoroscopic examinations.
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Affiliation(s)
- Nour Nakrour
- Department of Radiology, John D. Dingell VA Medical Center, Detroit, MI, USA.
| | - J E Neibling
- Department of Radiology, Wayne State University School of Medicine & Detroit Medical Center, Detroit, MI, USA
| | - Avani Pathak
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Alberto Carbo
- Department of Radiology, Ochsner- LSU Health, Shreveport, LA, USA
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Woodbridge L, Wylie P. Current Issues in Computed Tomography Colonography. Semin Ultrasound CT MR 2016; 37:331-8. [PMID: 27342897 DOI: 10.1053/j.sult.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Scalise P, Mantarro A, Pancrazi F, Neri E. Computed tomography colonography for the practicing radiologist: A review of current recommendations on methodology and clinical indications. World J Radiol 2016; 8:472-483. [PMID: 27247713 PMCID: PMC4882404 DOI: 10.4329/wjr.v8.i5.472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/23/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most relevant causes of morbidity and mortality in Western societies. CRC screening is actually based on faecal occult blood testing, and optical colonoscopy still remains the gold standard screening test for cancer detection. However, computed tomography colonography (CT colonography) constitutes a reliable, minimally-invasive method to rapidly and effectively evaluate the entire colon for clinically relevant lesions. Furthermore, even if the benefits of its employment in CRC mass screening have not fully established yet, CT colonography may represent a reasonable alternative screening test in patients who cannot undergo or refuse colonoscopy. Therefore, the purpose of our review is to illustrate the most updated recommendations on methodology and the current clinical indications of CT colonography, according to the data of the existing relevant literature.
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Nagata K, Iida N, Kanazawa H, Fujiwara M, Mogi T, Mitsushima T, Lefor AT, Sugimoto H. Effect of listening to music and essential oil inhalation on patients undergoing screening CT colonography: a randomized controlled trial. Eur J Radiol 2015; 83:2172-2176. [PMID: 25452097 DOI: 10.1016/j.ejrad.2014.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To prospectively evaluate the effect of listening to music and inhaling aroma oil on patients undergoing screening computed tomography colonography. MATERIALS AND METHODS Two hundred and twenty four participants were randomly allocated to one of the four groups including: (1) combined music and aroma, (2) music alone, (3) aroma alone, and (4)control. The visual analog scale for pain and a questionnaire were used for subjective outcomes. We also used a pre-test–post-test design to compare the differences in blood pressure and heart rate as objective outcomes. RESULTS There were no statistical differences between the control group and other groups in the visual analog scale or changes in heart rate. Changes in blood pressure were similar. Participants reported good overall experiences. There were no differences in terms of overall satisfaction, pain rating, willingness to repeat the computed tomography colonography procedure in the future, or preference between colonoscopy and computed tomography colonography. More participants using music and/or aroma requested music and/or aroma during the next computed tomography colonography (P < 0.0001). CONCLUSION Although audio and olfactory intervention had little effect on perceived pain or discomfort and vital signs, participants who listened to music and inhaled aroma during the computed tomography colonography preferred music and aroma during the next computed tomography colonography.
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Affiliation(s)
- Koichi Nagata
- Department of Radiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan(1); Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan(2); Cancer Screening Technology Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan(3).
| | - Nao Iida
- Department of Radiology, Kameda Medical Center Makuhari, 1-3, Nakase, Mihama-ku, Chiba 261-8501, Japan(4).
| | - Hidenori Kanazawa
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan(2).
| | - Masanori Fujiwara
- Department of Radiology, Kameda Medical Center Makuhari, 1-3, Nakase, Mihama-ku, Chiba 261-8501, Japan(4).
| | - Tomohiro Mogi
- Department of Radiology, Kameda Medical Center Makuhari, 1-3, Nakase, Mihama-ku, Chiba 261-8501, Japan(4).
| | - Toru Mitsushima
- Department of Gastroenterology, Kameda Medical Center Makuhari, 1-3, Nakase, Mihama-ku, Chiba 261-8501, Japan(4).
| | - Alan T Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan(2).
| | - Hideharu Sugimoto
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan(2).
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Colonic distention at CT colonography: randomized evaluation of both IV hyoscine butylbromide and automated carbon dioxide insufflation. AJR Am J Roentgenol 2015; 204:76-82. [PMID: 25539240 DOI: 10.2214/ajr.14.12772] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the efficacy of IV hyoscine butylbromide as a bowel relaxant and automated carbon dioxide insufflation in CT colonography in terms of colonic distention and perceived burden. SUBJECTS AND METHODS; Two hundred twenty-four participants were randomly allocated to one of four groups: control (no bowel relaxant and IV saline placebo before CT colonography with manual carbon dioxide insufflation), hyoscine butylbromide (IV hyoscine butylbromide before examination with manual carbon dioxide insufflation), automated (no bowel relaxant before examination with automated carbon dioxide insufflation), and combined (hyoscine butylbromide before examination with automated carbon dioxide insufflation). The degree of colonic distention on a 4-point scale, examination time, and participants' satisfaction, as measured by their responses to a questionnaire, were assessed. RESULTS The mean distention grades of all the colonic segments and both positions were 3.22 in the control group, 3.28 in the hyoscine butylbromide group, 3.77 in the automated group, and 3.74 in the combined group. Compared with manual carbon dioxide insufflation, automated carbon dioxide insufflation significantly improved the clinical adequacy of colonic distention and shortened examination time. No statistically significant difference was seen in the clinical adequacy of distention between participants who received hyoscine butylbromide and those who did not, or in examination time. Overall, the participants' experiences were not different. CONCLUSION Colonic distention was statistically significantly improved by automated carbon dioxide insufflation, but not by the administration of hyoscine butylbromide. The participants' tolerance was similar in each group.
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Levine MS, Yee J. History, evolution, and current status of radiologic imaging tests for colorectal cancer screening. Radiology 2015; 273:S160-80. [PMID: 25340435 DOI: 10.1148/radiol.14140531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer screening is thought to be an effective tool with which to reduce the mortality from colorectal cancer through early detection and removal of colonic adenomas and early colon cancers. In this article, we review the history, evolution, and current status of imaging tests of the colon-including single-contrast barium enema, double-contrast barium enema, computed tomographic (CT) colonography, and magnetic resonance (MR) colonography-for colorectal cancer screening. Despite its documented value in the detection of colonic polyps, the double-contrast barium enema has largely disappeared as a screening test because it is widely perceived as a labor-intensive, time-consuming, and technically demanding procedure. In the past decade, the barium enema has been supplanted by CT colonography as the major imaging test in colorectal cancer screening in the United States, with MR colonography emerging as another viable option in Europe. Although MR colonography does not require ionizing radiation, the radiation dose for CT colonography has decreased substantially, and regular screening with this technique has a high benefit-to-risk ratio. In recent years, CT colonography has been validated as an effective tool for use in colorectal cancer screening that is increasingly being disseminated.
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Affiliation(s)
- Marc S Levine
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (M.S.L.); and Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (J.Y.)
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Sakamoto T, Utsunomiya D, Mitsuzaki K, Matsuda K, Kawakami M, Yamamura S, Urata J, Arakawa A, Yamashita Y. Colonic distention at screening CT colonography: role of spasmolytic agents and body habitus. Kurume Med J 2014; 61:9-15. [PMID: 25400236 DOI: 10.2739/kurumemedj.ms64002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sufficient colonic dilation is important when using CT colonography (CTC) for colorectal cancer screening. We investigated the effect of antispasmodic agents and the patient body habitus on the degree of colonic dilation in screening CTC.We assessed the effect of clinical characteristics [age, gender, body mass index (BMI), and the presence of diverticula] and the use of antispasmodics on colonic distention in 140 patients who underwent CTC for colorectal cancer screening. The CTC was performed in both the supine- and prone positions. Seventy patients received antispasmodics prior to CT examination and the other 70 did not. Colonic distention was scored using a 5-point scale: 1=collapsed, 2=poorly visualized, 3=visualized but underdistended, 4=acceptable, and 5=excellent. Images scored as 4 or 5 were considered to be of diagnostic quality. The mean visual evaluation score was significantly higher in the supine- than the prone position (4.2±0.5 vs. 4.0±0.5, p<0.01). For the supine position, only the use of antispasmodic was statistically associated with sufficient colonic dilation by univariate logistic analysis (odds ratio=2.365, p=0.03). For the prone position, age, BMI, and the use of antispasmodic were statistically associated with sufficient colonic dilation by multivariate analysis. The odds ratio of these parameters was 0.955 (p=0.02), 0.874 (p=0.03), and 2.391 (p=0.02), respectively.We obtained sufficient colonic dilation with an antispasmodic for CTC in both positions. Younger age and a lower BMI were also associated with better colonic dilation in the prone position.
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Lung P, Burling D, Kallarackel L, Muckian J, Ilangovan R, Gupta A, Marshall M, Shorvon P, Halligan S, Bhatnagar G, Bassett P, Taylor S. Implementation of a new CT colonography service: 5 Year experience. Clin Radiol 2014; 69:597-605. [DOI: 10.1016/j.crad.2014.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 11/25/2022]
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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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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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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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Almond LM, Bowley DM, Karandikar SS, Roy-Choudhury SH. Role of CT colonography in symptomatic assessment, surveillance and screening. Int J Colorectal Dis 2011; 26:959-66. [PMID: 21424390 DOI: 10.1007/s00384-011-1178-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION When 'whole colonic imaging' is indicated, clinicians must decide between optical colonoscopy, barium enema and CT colonography (CTC). CTC is a relatively new technique which has become increasingly accessible in the UK over the past 5 years. As radiologists have gained experience and scanning parameters have standardised, there have been substantial improvements in both the accuracy and safety of CTC. METHODS We review evidence from observational studies and randomised trials, and draw on expert opinion, to provide a comprehensive discussion of the current role of CTC in both symptomatic and asymptomatic individuals. CONCLUSIONS The emergence of CTC could soon entirely obviate the need for barium enema. CTC now has a complementary role alongside colonoscopy in symptomatic patients and a possible future role in colorectal cancer screening in the UK.
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Affiliation(s)
- L Maximilian Almond
- Department of Colorectal Surgery, Heart of England NHS Foundation Trust, Birmingham, Birmingham, UK.
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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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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: 300] [Impact Index Per Article: 21.4] [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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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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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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Nagata K, Okawa T, Honma A, Endo S, Kudo SE, Yoshida H. Full-laxative versus minimum-laxative fecal-tagging CT colonography using 64-detector row CT: prospective blinded comparison of diagnostic performance, tagging quality, and patient acceptance. Acad Radiol 2009; 16:780-9. [PMID: 19375954 DOI: 10.1016/j.acra.2008.12.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 12/24/2008] [Accepted: 12/30/2008] [Indexed: 12/18/2022]
Abstract
RATIONALE AND OBJECTIVES To compare prospectively 64-detector-row computed tomographic colonography (CTC) after a full-laxative tagging-based preparation (full preparation) with a minimum-laxative tagging-based preparation (minimum preparation) with respect to diagnostic performance in the detection of polyps, tagging quality, and patient acceptance. MATERIALS AND METHODS Consecutive 101 patients at high risk for developing colorectal cancer were alternately assigned to either a full preparation group (n = 51) or a minimum preparation group (n = 50) for fecal-tagging CTC. The full preparation consisted of administration of 2-L polyethylene glycol solution with 20 mL of sodium diatrizoate for fecal tagging. The minimum preparation consisted of ingestion of a total of 45 mL of sodium diatrizoate during the 3 days before and 10 mL of sodium picosulfate solution the night before CT. Colonoscopy was used as the reference standard. We assessed the accuracy of polyp detection and the tagging quality for each preparation. All patients were given questionnaires related to their acceptance. RESULTS Per-patient sensitivity, specificity, and positive and negative predictive values for polyps > or = 6 mm were as follows: full preparation group, 97%, 92%, 88%, and 98%, respectively; minimum preparation group, 88%, 68%, 56%, and 92%, respectively. Average visual subjective tagging scores for the full and minimum preparation groups were 94.6% and 76.1%, respectively (P < .0001). Minimum preparation was better tolerated than full preparation. CONCLUSION Although full-laxative and minimum-laxative fecal-tagging CTC yielded an equally high sensitivity in the detection of polyps > or = 6 mm, the full-laxative fecal-tagging CTC yielded a better specificity than did the minimum-laxative fecal-tagging CTC. Thus, it is desirable to offer patients an option of either full-laxative fecal-tagging CTC for highest diagnostic accuracy and ability to perform a same-day therapeutic colonoscopy without additional bowel preparation, or minimum-laxative fecal-tagging CTC for those unwilling to undergo full preparation but willing to accept moderate decrease in specificity.
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Affiliation(s)
- Koichi Nagata
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 400C, MA 02114, USA.
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18
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Optimizing the degree of distension and reducing discomfort in CT colonography by means of a microprocessor interface system for air insufflation. Open Med (Wars) 2008. [DOI: 10.2478/s11536-008-0065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe patients’ discomfort during CT colonography determines which method is used and its frequency of use. The discomfort is largely associated with the colon’s insufflation with gas. A system for an automatic room-air insufflation has been developed that ensures a continuous and steady air insufflation and an increase in colonic pressure and enables a relatively fast decompression. This system provides constant pressure monitoring and can alert the operator, if necessary. The degree of discomfort was evaluated for 36 patients, who were subjected to manual and automated air insufflation. The degree of the colonic distension achieved by the two methods was compared. The data analysis showed a significantly lower level of discomfort in patients with automated air insufflation. The degree of colonic distension was evaluated by comparing the diameters of similar segments of the colon, as well as by the subjective opinion of the operator. The distension with automated air insufflation was higher than that with manual air insufflation. In some cases there was a significant difference (P<0,05). In conclusion, the results show that the automatic insufflation of air at room temperature can be used to optimize CT colonography.
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19
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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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20
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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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21
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Iafrate F, Hassan C, Zullo A, Stagnitti A, Ferrari R, Spagnuolo A, Laghi A. CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly. Eur Radiol 2008; 18:1385-95. [PMID: 18351357 DOI: 10.1007/s00330-008-0892-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 12/13/2007] [Accepted: 01/31/2008] [Indexed: 12/18/2022]
Abstract
We prospectively assessed the feasibility and acceptance of computerized tomographic colonography (CTC) without bowel cathartic preparation in elderly patients after incomplete colonoscopy. A total of 136 patients underwent CTC without cathartic preparation. The time delay between conventional colonoscopy and CTC ranged between 3 and 20 days, depending on the clinical situation. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. CTCs were interpreted using a primary two-dimensional (2D) approach and 3D images for further characterization. Patients were interviewed before and 2 weeks after CTC to assess preparation acceptance. CTC was feasible and technically successful in all the 136 patients. Fecal tagging was judged as excellent in 113 (83%) patients and sufficient in 23 (17%). Average CT image interpretation time was 14.8 min. Six (4.4%) cases of colorectal cancer and nine (6.6%) large polyps were detected, as well as 23 (11.3%) extracolonic findings of high clinical importance. No major side effect occurred, although 25% patients reported minor side effects, especially diarrhea. Overall, 76/98 patients replied that they would be willing to repeat the test if necessary. CTC without cathartic preparation is a technically feasible and safe procedure to complete a colonic study in the elderly, prompting its use in clinical practice.
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Affiliation(s)
- F Iafrate
- Department of Radiological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy.
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22
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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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23
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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: 99] [Impact Index Per Article: 5.5] [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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24
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Re: Computed tomographic colonography (CTC) performance: one-year clinical follow-up. Clin Radiol 2007. [DOI: 10.1016/j.crad.2006.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Halligan S, Altman DG. Evidence-based Practice in Radiology: Steps 3 and 4—Appraise and Apply Systematic Reviews and Meta-Analyses. Radiology 2007; 243:13-27. [PMID: 17392245 DOI: 10.1148/radiol.2431051823] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A systematic review is performed in attempt to answer a specific research question by means of objective, unbiased evaluation of all pertinent available evidence. Component primary studies are selected on the basis of quality, and, if possible, their results are combined mathematically by using a process known as meta-analysis. While systematic review and meta-analysis are well-established methods to assess trials of therapeutic effects, they are increasingly more common in studies of diagnostic tests. In this article, the authors describe the benefits of a systematic approach over the traditional narrative review, illustrate the process, and examine some problems that are specific to systematic review and meta-analysis of diagnostic tests. They also explain how systematic review can help guide methodologic development for future research.
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Affiliation(s)
- Steve Halligan
- Department of Specialist Radiology, University College Hospital, Podium Level 2, 235 Euston Rd, London NW1 2BU, England.
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26
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Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH. Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol 2006; 186:1491-6. [PMID: 16714635 DOI: 10.2214/ajr.05.0416] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Our objective was to prospectively compare colonic distention and patient comfort at screening CT colonography (CTC) with patient-controlled room air (RA) insufflation versus automated carbon dioxide (CO2) delivery. SUBJECTS AND METHODS Two hundred eight adults undergoing CTC were randomized to RA or CO2 (104 per method). Colonic distention was prospectively assessed by segment using a 4-point scale (1 = optimal, 2 = adequate, 3 = inadequate, 4 = collapsed). Adequacy of combined supine/prone segmental evaluation was also recorded. Patients provided discomfort ratings on a 0-10 scale (0-1 = none/insignificant, 2-3 = minimal, 4-6 = intermediate, 7-10 = significant) before, during, and after the procedure. RESULTS No significant differences in segmental distention were observed in the prone position between techniques. In the supine position, CO2 resulted in significantly greater distention in the sigmoid, descending, and transverse segments (p < 0.01). After combined supine/prone assessment, two/104 (1.9%) and three/104 (2.9%) patients were judged to have an inadequately evaluated segment on RA and CO2, respectively (four sigmoid, one transverse). Mean discomfort scores for RA and CO2 were 3.97 and 5.08 during the examination (p < 0.01); 0.91 and 0.42 immediately after (p < 0.01); 0.51 and 0.25 15 min later (p < 0.05); and 0.15 and 0.04 2 hours later (p < 0.01), respectively. During active distention, 19 (18.3%) and 33 (31.7%) patients reported significant transient discomfort with RA and CO2, respectively (p < 0.05). Beyond 15 min, only two (1.9%) patients with RA and no patients with CO2 had a discomfort level higher than 3. CONCLUSION Although patient-controlled RA insufflation and automated CO2 delivery each resulted in negligible postprocedure discomfort and reliable colonic distention, CO2 was better for both categories.
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Affiliation(s)
- Theodore J Shinners
- Department of Radiology, University of Wisconsin Medical School, Clinical Science Center, 600 Highland Ave., Madison, WI 53792, USA
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27
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Dachman AH. Advice for optimizing colonic distention and minimizing risk of perforation during CT colonography. Radiology 2006; 239:317-21. [PMID: 16641349 DOI: 10.1148/radiol.2392051374] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Abraham H Dachman
- Department of Radiology, MC 2026, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA.
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28
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Affiliation(s)
- Simon E J Janes
- Colorectal Unit, Department of Surgery, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand
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29
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Fenlon H, Adams PC. The future of virtual colonography. Interview by Paul C Adams. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2006; 20:11-3. [PMID: 16432553 PMCID: PMC2538968 DOI: 10.1155/2006/926074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Helen Fenlon
- Correspondence: Dr Helen Fenlon, Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. Telephone 353-1-8032274, e-mail
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30
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Halligan S, Altman DG, Taylor SA, Mallett S, Deeks JJ, Bartram CI, Atkin W. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 2006; 237:893-904. [PMID: 16304111 DOI: 10.1148/radiol.2373050176] [Citation(s) in RCA: 241] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the methodologic quality of available data in published reports of computed tomographic (CT) colonography by performing systematic review and meta-analysis. MATERIALS AND METHODS The MEDLINE database was searched for colonography reports published between 1994 and 2003, without language restriction. The terms colonography, colography, CT colonoscopy, CT pneumocolon, virtual colonoscopy, and virtual endoscopy were used. Studies were selected if the focus was detection of colorectal polyps verified with within-subject reference colonoscopy by using key methodologic criteria based on information presented at the Fourth International Symposium on Virtual Colonoscopy (Boston, Mass). Two reviewers independently abstracted methodologic characteristics. Per-patient and per-polyp detection rates were extracted, and authors were contacted, when necessary. Per-patient sensitivity and specificity were calculated for different lesion size categories, and Forest plots were produced. Meta-analysis of paired sensitivity and specificity was conducted by using a hierarchical model that enabled estimation of summary receiver operating characteristic curves allowing for variation in diagnostic threshold, and the average operating point was calculated. Per-polyp sensitivity was also calculated. RESULTS Of 1398 studies considered for inclusion, 24 met our criteria. There were 4181 patients with a study prevalence of abnormality of 15%-72%. Meta-analysis of 2610 patients, 206 of whom had large polyps, showed high per-patient average sensitivity (93%; 95% confidence interval [CI]: 73%, 98%) and specificity (97%; 95% CI: 95%, 99%) for colonography; sensitivity and specificity decreased to 86% (95% CI: 75%, 93%) and 86% (95% CI: 76%, 93%), respectively, when the threshold was lowered to include medium polyps. When polyps of all sizes were included, studies were too heterogeneous in sensitivity (range, 45%-97%) and specificity (range, 26%-97%) to allow meaningful meta-analysis. Of 150 cancers, 144 were detected (sensitivity, 95.9%; 95% CI: 91.4%, 98.5%). Data reporting was frequently incomplete, with no generally accepted format. CONCLUSION CT colonography seems sufficiently sensitive and specific in the detection of large and medium polyps; it is especially sensitive in the detection of symptomatic cancer. Studies are poorly reported, however, and the authors propose a minimum data set for study reporting.
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Affiliation(s)
- Steve Halligan
- Department of Specialist Radiology, University College Hospital, Euston Rd, London, NW1 2BU, England
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31
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Andersen K, Vogt C, Blondin D, Beck A, Heinen W, Aurich V, Häussinger D, Mödder U, Cohnen M. Multi-detector CT-colonography in inflammatory bowel disease: prospective analysis of CT-findings to high-resolution video colonoscopy. Eur J Radiol 2005; 58:140-6. [PMID: 16337356 DOI: 10.1016/j.ejrad.2005.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 10/18/2005] [Accepted: 11/03/2005] [Indexed: 12/16/2022]
Abstract
AIM Prospective analysis of multi-detector CT-colonography (MDCTC) in patients with inflammatory bowel disease (IBD) compared to high-resolution video-endoscopy (HRVC). MATERIALS AND METHODS Twenty-one patients (mean age 49.6 years) with Crohn's disease or ulcerative colitis underwent MDCTC (Somatom Volume Zoom, Siemens, Erlangen; 1mm collimation, Pitch 8, 100 mAs, 120 kVp). HRVC was performed within 2 h after MDCTC. MDCTC was analyzed by two blinded readers. MDCTC-findings including bowel wall alterations and extraintestinal changes were compared to results of HRVC. RESULTS Over-all-sensitivity was 100% for endoluminal lesions with correct diagnosis of two cancers. Acute and chronic IBD were correctly identified by MDCTC in 63.6%, and 100%, respectively, with a specificity of 75%, and 100%. Sensitivity, specificity, positive and negative predictive values of MDCTC for diagnosis of acute and chronic disease were best for chronic disease. Sensitivity was worst for acute ulcerative colitis and specificity was worst for acute Crohn's disease. Haustral loss was seen only in ulcerative colitis. Pseudopolyps and fistulae were findings exclusive to Crohn's disease. Particularly extraintestinal findings as increased vascularization and local lymphadenopathy correlated well with endoscopic definition of acute disease. Because of the possibly more vulnerable colonic wall in acute inflammatory bowel disease, the air inflation for MDCTC should be performed most carefully to avoid any risk of colonic perforation. CONCLUSION MDCTC may help to distinguish between patients with acute and chronic IBD. Especially extraintestinal complications, tumorous as well as pseudo-tumorous lesions can be detected with high sensitivity and specificity.
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Affiliation(s)
- Kjel Andersen
- Institute of Diagnostic Radiology, University Hospital Düsseldorf, Germany.
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Abstract
CT colonography (CTC) is a promising method for colorectal cancer screening because it provides a full structural evaluation of the entire colon. It has a superior safety profile, a low rate of complications, and high patient acceptance. In addition, CTC offers the real possibility of eliminating the cathartic bowel preparation, one of the biggest obstacles to patient compliance with colorectal cancer screening. Results of CTC studies in recently published literature are extremely encouraging, demonstrating that this method of screening can detect lesions equal to or larger than 8 mm with few false-positive findings.
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Affiliation(s)
- Matthew A Barish
- Department of Radiology, 3D & Image Processing Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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33
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Burling D, Taylor SA, Halligan S. Virtual colonoscopy: current status and future directions. Gastrointest Endosc Clin N Am 2005; 15:773-95. [PMID: 16278138 DOI: 10.1016/j.giec.2005.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Virtual colonoscopy (CT colonography) is a technique whereby CT images of the cleansed and distended colon are acquired, ostensibly for detecting colonic neoplasia, although also providing additional diagnostic information from extracolonic organs. This article examines the current status of virtual colonoscopy, reviewing the technical parameters, performance characteristics, and issues surrounding implementation in routine clinical practice. Future directions for virtual colonoscopy are explored, including advances toward prepless examinations and automated interpretation.
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Affiliation(s)
- David Burling
- Intestinal Imaging Centre, St. Mark's Hospital, London, UK
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Halligan S. Systematic reviews and meta-analysis of diagnostic tests. Clin Radiol 2005; 60:977-9. [PMID: 16124979 DOI: 10.1016/j.crad.2005.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 04/26/2005] [Indexed: 01/18/2023]
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Rogalla P, Lembcke A, Rückert JC, Hein E, Bollow M, Rogalla NE, Hamm B. Spasmolysis at CT colonography: butyl scopolamine versus glucagon. Radiology 2005; 236:184-8. [PMID: 15987972 DOI: 10.1148/radiol.2353040007] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively determine if the use of butyl scopolamine or glucagon in the supine patient improves colonic distention and reduces the number of collapsed intestinal segments at computed tomographic (CT) colonography. MATERIALS AND METHODS This study had institutional review board approval; subject informed consent was not required. CT colonography was performed without the administration of an intravenous spasmolytic in 80 asymptomatic subjects (group 1; 45 women, 35 men; age range, 48-77 years; mean, 61.9 years). These subjects were matched with two groups of 80 subjects who were similar in age but were premedicated with glucagon (group 2; 41 women, 39 men; age range, 43-76 years; mean, 63.1 years) or butyl scopolamine (group 3; 43 women, 37 men; age range, 34-77 years; mean, 63.4 years). All 240 subjects were examined in the supine position with multisection CT and a section thickness of 1 mm after intravenous contrast agent administration and rectal carbon dioxide insufflation. The colon was divided into seven segments, and the colon length, total volume, radial distensibility, and number of non-distended segments were calculated for each subject and compared among the three groups. Statistical analysis was performed with analysis of variance and chi2 testing. RESULTS Mean bowel length was not significantly different among the groups. Mean colon volumes and radial distensibilities, respectively, were 1.84 L and 3.69 cm in group 1, 2.14 L and 3.98 cm in group 2, and 2.35 L and 4.23 cm in group 3; differences in colon volume and radial distensibility were significant only between group 1 and group 3 (P < .001). At CT colonography, 29 segments in 20 group 1 subjects were collapsed, 23 segments in 12 group 2 subjects were collapsed, and 11 segments in six group 3 subjects were collapsed (P = .016). CONCLUSION Premedication with butyl scopolamine or, less effectively, glucagon improves colonic distention in the supine subject.
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Affiliation(s)
- Patrik Rogalla
- Department of Radiology, Charité Campus Mitte, Universitätsmedizin Berlin, Schumannstr 20/21, 10098 Berlin, Germany.
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Spreng A, Netzer P, Mattich J, Dinkel HP, Vock P, Hoppe H. Importance of extracolonic findings at IV contrast medium-enhanced CT colonography versus those at non-enhanced CT colonography. Eur Radiol 2005; 15:2088-95. [PMID: 15965661 DOI: 10.1007/s00330-005-2798-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 04/24/2005] [Accepted: 04/29/2005] [Indexed: 12/27/2022]
Abstract
To compare the clinical importance of extracolonic findings at intravenous (IV) contrast-enhanced CT colonography versus those at non-enhanced CT colonography. IV contrast medium-enhanced (n=72) and non-enhanced (n=30) multidetector CT colonography was performed in 102 symptomatic patients followed by conventional colonoscopy on the same day. The impact of extracolonic findings on further work up and treatment was assessed by a review of patient records. Extracolonic findings were divided into two groups: either leading to further work up respectively having an impact on therapy or not. A total of 303 extracolonic findings were detected. Of those, 71% (215/303) were found on IV contrast-enhanced CT, and 29% (88/303) were found on non-enhanced CT colonography. The extracolonic findings in 25% (26/102) of all patients led to further work up or had an impact on therapy. Twenty-two of these patients underwent CT colonography with IV contrast enhancement, and four without. The percentage of extracolonic findings leading to further work up or having an impact on therapy was higher for IV contrast-enhanced (31%; 22/72) than for non-enhanced (13%; 4/30) CT scans (P=0.12). IV contrast-enhanced CT colonography produced more extracolonic findings than non-enhanced CT colonography. A substantially greater proportion of findings on IV contrast-enhanced CT colonography led to further work up and treatment than did non-enhanced CT colonography.
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Affiliation(s)
- Adrian Spreng
- Institute of Diagnostic Radiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
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Gryspeerdt S, Lefere P, Herman M, Deman R, Rutgeerts L, Ghillebert G, Baert F, Baekelandt M, Van Holsbeeck B. CT colonography with fecal tagging after incomplete colonoscopy. Eur Radiol 2005; 15:1192-202. [PMID: 15702335 DOI: 10.1007/s00330-005-2644-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Revised: 12/27/2004] [Accepted: 12/30/2004] [Indexed: 01/31/2023]
Abstract
The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann-Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.
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Affiliation(s)
- S Gryspeerdt
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium.
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Ajaj W, Veit P, Kuehle C, Joekel M, Lauenstein TC, Herborn CU. Digital subtraction dark-lumen MR colonography: Initial experience. J Magn Reson Imaging 2005; 21:841-4. [PMID: 15906327 DOI: 10.1002/jmri.20332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To evaluate image subtraction for the detection of colonic pathologies in a dark-lumen MR colonography exam. MATERIALS AND METHODS A total of 20 patients (12 males; 8 females; mean 51.4 years of age) underwent MR colonography after standard cleansing and a rectal water enema on a 1.5-T whole-body MR system. After suppression of peristaltic motion, native and Gd-contrast-enhanced three-dimensional T1-w gradient echo images were acquired in the coronal plane. Two radiologists analyzed the MR data sets in consensus on two separate occasions, with and without the subtracted images for lesion detection, and assessed the value of the subtracted data set on a five-point Likert scale (1=very helpful to 5=very unhelpful). All imaging results were compared with endoscopy. RESULTS Without subtracted images, MR-colonography detected a total of five polyps, two inflammatory lesions, and one carcinoma in eight patients, which were all verified by endoscopy. Using subtraction, an additional polyp was found, and readout time was significantly shorter (6:41 vs. 7:39 minutes; P<0.05). In two patients, endoscopy detected a flat adenoma and a polyp (0.4 cm) that were missed in the MR exam. Sensitivity and specificity without subtraction were 0.67/1.0, and 0.76/1.0 with the subtracted images, respectively. Subtraction was assessed as helpful in all exams (mean value 1.8+/-0.5; Likert scale). CONCLUSION We consider subtraction of native from contrast-enhanced dark-lumen MR colonography data sets as a beneficial supplement to the exam.
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Affiliation(s)
- Waleed Ajaj
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Iannaccone R, Laghi A, Catalano C, Mangiapane F, Lamazza A, Schillaci A, Sinibaldi G, Murakami T, Sammartino P, Hori M, Piacentini F, Nofroni I, Stipa V, Passariello R. Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology 2004; 127:1300-11. [PMID: 15520999 DOI: 10.1053/j.gastro.2004.08.025] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS We prospectively compared the performance of low-dose multidetector computed tomographic colonography (CTC) without cathartic preparation with that of colonoscopy for the detection of colorectal polyps. METHODS A total of 203 patients underwent low-dose CTC without cathartic preparation followed by colonoscopy. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. No subtraction of tagged feces was performed. Colonoscopy was performed 3-7 days after CTC. Three readers interpreted the CTC examinations separately and independently using a primary 2-dimensional approach using multiplanar reconstructions and 3-dimensional images for further characterization. Colonoscopy with segmental unblinding was used as reference standard. The sensitivity of CTC was calculated both on a per-polyp and a per-patient basis. For the latter, specificity, positive predictive values, and negative predictive values were also calculated. RESULTS CTC had an average sensitivity of 95.5% (95% confidence interval [CI], 92.1%-99%) for the identification of colorectal polyps > or =8 mm. With regard to per-patient analysis, CTC yielded an average sensitivity of 89.9% (95% CI, 86%-93.7%), an average specificity of 92.2% (95% CI, 89.5%-94.9%), an average positive predictive value of 88% (95% CI, 83.3%-91.5%), and an average negative predictive value of 93.5% (95% CI, 90.9%-96%). Interobserver agreement was high on a per-polyp basis (kappa statistic range, .61-.74) and high to excellent on a per-patient basis (kappa statistic range, .79-.91). CONCLUSIONS Low-dose multidetector CTC without cathartic preparation compares favorably with colonoscopy for the detection of colorectal polyps.
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Abstract
Colon cancer is the second leading cause of cancer-related death in the Western world. Approximately 80–90% of colon cancers develop in adenomas after mutations. The risk of encountering malignancy increases with the size of the adenomatous polyp. It is approximately 1% in adenomas <1 cm, and increases to 10% for adenomas 1–2 cm, and 20–53% for adenomas >2 cm. CT colonography (CTC) is a new technique, which allows, after bowel preparation and distension of the cleansed colon, to generate a volumetric display of the colon. Multi-detector CTC has a sensitivity of 93–100% and 70–83% for detection of polyps sized \documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts,amssymb,amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n}{<-> linotext}{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} ${\ge }$ \end{document} 10 mm and 6–9 mm, respectively. For detection of colo-rectal cancer, CTC has a sensitivity of 83–100%. CTC is especially of value in patients with incomplete colonoscopy due to stenosis or colon elongation. It reliably detects synchronous cancers proximal to occlusive colon cancers, when colonoscopy fails to evaluate the entire colon. First results of a colon cancer screening study have shown that CTC is equal or even slightly superior to conventional colonoscopy in detection of adenomatous polyps \documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts,amssymb,amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n}{<-> linotext}{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} ${\ge }$ \end{document} 8 mm. Moreover, CTC detects clinically significant extracolonic abnormalities not shown by colonoscopy. To increase the patient acceptance for wide-spread application of CTC cancer screening the issue of patient discomfort by bowel preparation and radiation exposure needs to be addressed further.
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Affiliation(s)
- Wolfgang Schima
- Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Bruzzi JF, Fenlon HM. Colonic Distention in Multi–Detector Row CT Colonography [letter]. Radiology 2004; 231:282; author reply 282-3. [PMID: 15068955 DOI: 10.1148/radiol.2311031514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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