#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The role of CT colonography in large bowel investigation


Authors: H. Straková 1;  Ľ. Straka 2
Authors‘ workplace: Radiodiagnostické oddělení, Uherskohradišťská nemocnice a.  s., Uherské Hradiště 1;  Gastroenterologická ambulance, Uherskohradišťská nemocnice a.  s., Uherské Hradiště 2
Published in: Gastroent Hepatol 2018; 72(1): 66-72
Category: Digestive Endoscopy: Original Article
doi: https://doi.org/10.14735/amgh201866

Overview

CT colonography (CTC, virtual colonoscopy) is a non-invasive colonic imaging method that uses computed tomography (CT) with advanced graphic software to create two-and three-dimensional images of the colon. CTC is indicated mainly for the diagnosis of colorectal neoplasia in cases where conventional colonoscopy is incomplete or contraindicated, as well as in cases where the patient finds conventional colonoscopy intolerable or refuses conventional colonoscopy. Compared to a barium enema, CTC has higher sensitivity for the detection of colorectal neoplasia and has similar or lower levels of radiation exposure. Sensitivity for the detection of polyps ≥ 6 mm is similar to that of conventional colonoscopy. Intravenous injection of iodine contrast media is usually not required; therefore, CTC is safe in patients with iodine allergy or chronic renal failure. Both adequate bowel cleansing and distension are essential to ensure optimal examinations, which are then assessed by radiologists and reported using the standardized C-RADS classification system (CT colonography reporting and data system). CTC does not cover all conventional colonoscopy indications; for instance, CTC is not recommended for the diagnosis of colon inflammatory conditions (including inflammatory bowel disease) or familial polyposis syndromes, and it has low diagnostic value for anal pathologies. CTC is not the official primary method for colorectal cancer screening in the Czech Republic. The aim of this paper is to discuss CTC specifics and indications.

Key words:
CT colonography – virtual colonoscopy – polyp – colorectal cancer – screening – colonoscopy

Submitted:
24. 5. 2017

Accepted:
26. 9. 2017

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.


Sources

1. Bartušek D, Falt P, Tachecí I et al. Alternativní vyšetření tlustého střeva. In: Falt P, Urban O, Vítek P et al. Koloskopie. Praha: Grada Publishing, a. s. 2015: 285–296.

2. Levine MS, Yee J. History, evolution, and current status of radiologic imaging tests for colorect-al cancer screening. Radiology 2014; 273 (2 Suppl): S160–S180. doi: 10.1148/radiol.14140 531.

3. Neri E, Halligan S, Helström M et al. The second ESGAR consensus statement on CT colonography. Eur Radiol 2013; 23 (3): 720–729. doi: 10.1007/s00330-012-2632-x.

4. Lambert L, Šimáková L. Přínos CT kolografie v klinické praxi. Vnitř Lék 2017; 63 (3): 183–187.

5. Pickhardt PJ, Kim DH. CT colonography: pitfalls in interpretation. Radiol Clin North Am 2013; 51 (1): 69–88. doi: 10.1016/j.rcl.2012.09. 005.

6. Johnson CD, Chen MH, Toledano AY. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008; 359 (12): 1207–1217. doi: 10.1056/NEJMoa0800 996.

7. Pickhardt PJ, Choi JR, Hwang I. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003; 349 (23): 2191–2200. doi: 10.1056/NEJMoa031618.

8. Morrin M, Fenlon H. Guidelines for use of CT colonography (CTC) as a part of the national colorectal screening programme in Ireland. [online]. Available from: http: //www.radiology.ie/wp-content/uploads/2012/01/Guidelines-for-Use-of-CT-Colonography-CTC-as-Part-of-the-National-Colorectal-Screening-Programme-in-Ireland1.pdf.

9. Spada C, Stoker J, Alarcon O et al. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Endoscopy 2014; 46 (10): 897–915. doi: 10.1055/s-0034-1378092.

10. Mulder SA, Kranse R, Damhuis RA et al. Prevalence and prognosis of synchronous colorectal cancer: a Dutch population-based study. Cancer Epidemiol 2011; 35 (5): 442–447. doi: 10.1016/j.canep.2010.12.007.

11. Pickhardt PJ, Hassan C, Halligan S et al. Colorectal cancer: CT colonography and colonoscopy for detection – systematic review and meta-analysis. Radiology 2011; 259 (2): 393–405. doi: 10.1148/radiol.11101887.

12. Atkin W, Dadswell E, Wooldrage K et al. Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet 2013; 381 (9873): 1194–1202. doi: 10.1016/ S0140-6736 (12) 62186-2.

13. Dachman AH, Yee J. The challenges of CT colonography reimbursement. J Am Coll Radiol 2013; 10 (12): 937–942. doi: 10.1016/j.jacr.2013.09.014.

14. Park SH, Kim SY, Lee SS et al. Sensitivity of CT colonography for nonpolypoid colorectal lesions interpreted by human readers and with computer-aided detection. AJR Am J Roentgenol 2009; 193 (1): 70–78. doi: 10.2214/AJR.08. 2234.

15. Pickhardt PJ, Nugent PA, Choi JR et al. Flat colorectal lesions in asymptomatic adults: implications for screening with CT virtual colonoscopy. Am J Roentgenol 2004; 183: 1343–1347. 10.2214/ajr.183.5.1831343.

16. Sakamoto T, Mitsuzaki K, Utsunomiya D et al. Detection of flat colorectal polyps at screening CT colonography in comparison with conventional polypoid lesions. Acta Radiol 2012; 53 (7): 714–719. doi: 10.1258/ar.2012.110 685.

17. Berrington de Gonzales A, Kim KP, Yee J. CT colonography: perforation rates and potential radiation risks. Gastrointest Endosc Clin N Am 2010; 20 (2): 279–291. doi: 10.1016/j.giec. 2010. 02.003.

18. Plumb AA, Ghanouni A, Rees CJ et al. Patient experience of CT colonography and colonoscopy after fecal occult blood test in a national screening programme. Eur Radiol 2017; 27 (3): 1052–1063. doi: 10.1007/s00330-016-4428-x.

19. Ramos C, De Jesús-Caraballo J, Toro DH et al. Is barium enema an adequate diagnostic test for the evaluation of patients with positive fecal occult blood? Bol Asoc Med P R 2009; 101 (2): 23–28.

20. Halligan S, Wooldrage K, Dadswell E et al. Computed tomographic colonography versus barium enema for diagnosis of colorectal cancer or large polyps in symptomatic patients (SIGGAR): a multicentre randomised trial. Lancet 2013; 381 (9873): 1185–1193. doi: 10.1016/S0140-6736 (12) 62124-2.

21. Věstník MZČR 11-2003. [online]. Available from: https: //www.mzcr.cz/Legislativa/dokumenty/vestnik_3662_1782_11.html.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Article was published in

Gastroenterology and Hepatology

Issue 1

2018 Issue 1

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#