CT colonography to detect colorectal polyps: a virtual success?: Yee J, Akerkar GA, Hung RK, et al., Colorectal Neoplasia: Performance Characteristics of CT Colonography for Detection in 300 Patients, Radiology 2001;219(3):685—92

Pineau, Benoit C.; Ott, David J.
January 2003
American Journal of Gastroenterology;Jan2003, Vol. 98 Issue 1, p210
Academic Journal
The purpose of this study was to determine the sensitivity and specificity of CT colonography (CTC) to detect colorectal polyps and cancer compared with conventional colonoscopy. In this investigation, 300 patients (97% male; mean age 62.6 yr) at a university-affiliated Veterans Affair hospital were recruited to undergo CTC 2–3 h before a clinically indicated conventional colonoscopy. Colonic lavage was achieved with 10 oz of magnesium citrate and 4 L of a polyethylene glycol electrolyte lavage solution; colonic distention was performed using hand-bulb insufflation of air. Volumetric data were acquired under 60 s using a single-slice spiral CT scan of the abdomen and pelvis in the supine position, and repeated in the prone position. Lesion size at CTC was determined by measuring the largest diameter with computed calipers; polyp size at conventional colonoscopy was estimated in reference to open biopsy forceps.The study population consisted of 204 subjects undergoing evaluation of gastrointestinal symptoms and 96 for colorectal neoplasia screening. Conventional colonoscopy found a total of 532 lesions, including eight cancers. The ability of CTC to identify individual lesions, as well as patients with lesions, was proportional to the lesion size. For individual lesion detection, the overall sensitivity of CTC was 69.7%; however, the sensitivity for lesions 5–9.9 mm and those 10 mm or greater were 80.1% and 90%, respectively (82% and 94% respectively for adenomas). All eight cancers were detected. For detecting lesions of any size, the sensitivity and specificity were 90.1 and 72% respectively. CT colonography was more accurate in identifying patients with lesions 5–9.9 mm and those with lesions ≥10 mm with sensitivities of 93 and 100% respectively. The results were comparable between asymptomatic and symptomatic patients. CT colonography demonstrated 185 false-positive lesions in 113 patients, 24 ≥1 cm and 97 of 5–9.9 mm in size; it failed to detect eight polyps of size 10 mm or greater and 28 polyps measuring 5–9.9 mm. Inadequate bowel preparation appeared to be a greater factor than poor colonic distention.The authors conclude that CTC has excellent sensitivity for clinically important polyps of 10 mm or greater and can reliably detect colorectal cancers equally well in symptomatic and asymptomatic patients.


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