RSS-Feed abonnieren
DOI: 10.1055/s-2003-41584
Colonoscopy and Multidetector-Array Computed-Tomographic Colonography: Detection Rates and Feasibility
Publikationsverlauf
Submitted 7 March 2003
Accepted after Revision 16 March 2003
Publikationsdatum:
20. August 2003 (online)
![](https://www.thieme-connect.de/media/endoscopy/200309/lookinside/thumbnails/10.1055-s-2003-41584-1.jpg)
Background and Study Aims: Computed-tomographic (CT) colonography has been introduced as a minimally invasive colon examination for the detection of colorectal neoplasms. The aim of this study was to compare the performance characteristics of multidetector-array CT colonography (MDCTC) and conventional colonoscopy in a prospective, blinded design.
Patients and Methods: Sixty-six symptomatic patients, 75 patients undergoing polyp and cancer surveillance, and seven patients undergoing preoperative colonoscopy due to colorectal cancer (CRC) were examined with MDCTC and subsequent colonoscopy. The gold standard was colonoscopy. If MDCTC was positive and the first-pass colonoscopy was negative, a second-pass colonoscopy served as the gold standard.
Results: Complete colonoscopy was achieved in 91 % of the patients, while technically satisfying MDCTC was obtained in 76 % of the patients (P < 0.01), insufficient air distension in the sigmoid colon being the main problem. MDCTC and colonoscopy both detected all 11 carcinomas. Overall detection rates for polypoid lesions 6 mm or larger in size were 81 % (95 % CI, 70 % to 90 %) for MDCTC and 87 % (95 % CI, 77 % to 94 %) for colonoscopy (P = 0.52), with a significant difference with regard to the detection of polyps 6 - 9 mm in size in favor of colonoscopy (P = 0.008). The specificity of MDCTC at a 6-mm level was 97 % (95 % CI, 92 % to 99 %).
Conclusions: MDCTC and colonoscopy show equal overall sensitivity for the detection of polypoid lesions 6 mm or larger in size, but more patients are inadequately examined when MDCTC is used.
References
- 1 Silverberg E, Boring C C, Squires T S. Cancer statistics, 1990. CA Cancer J Clin. 1990; 40 9-26
- 2 Winawer S J, Stewart E T, Zauber A G. et al . A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med. 2000; 342 1766-1772
- 3 Kewenter J, Brevinge H, Engaras B. et al . The yield of flexible sigmoidoscopy and double-contrast barium enema in the diagnosis of neoplasms in the large bowel in patients with a positive Hemoccult test. Endoscopy. 1995; 27 159-163
- 4 Hall C, Dorricott N J, Donovan I A. et al . Colon perforation during colonoscopy: surgical versus conservative management. Br J Surg. 1991; 78 542-544
- 5 Jentschura D, Raute M, Winter J. et al . Complications in endoscopy of the lower gastrointestinal tract: therapy and prognosis. Surg Endosc. 1994; 8 672-676
- 6 Cirocco W C, Rusin L C. Factors that predict incomplete colonoscopy. Dis Colon Rectum. 1995; 38 964-968
- 7 Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc. 2001; 53 620-627
- 8 Dafnis G, Ekbom A, Pahlman L. et al . Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden. Gastrointest Endosc. 2001; 54 302-309
- 9 Wexner S D, Forde K A, Sellers G. et al . How well can surgeons perform colonoscopy?. Surg Endosc. 1998; 12 1410-1414
- 10 Hara A K, Johnson C D, Reed J E. et al . Detection of colorectal polyps with CT colography: initial assessment of sensitivity and specificity. Radiology. 1997; 205 59-65
- 11 Fenlon H M, Nunes D P, Clarke P D. et al . Colorectal neoplasm detection using virtual colonoscopy: a feasibility study. Gut. 1998; 43 806-811
- 12 Morrin M M, Kruskal J B, Farrell R J. et al . Endoluminal CT colonography after an incomplete endoscopic colonoscopy. AJR Am J Roentgenol. 1999; 172 913-918
- 13 Fenlon H M, McAneny D B, Nunes D P. et al . Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon. Radiology. 1999; 210 423-428
- 14 Neri E, Giusti P, Battolla L. et al . Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology. 2002; 223 615-619
- 15 Morrin M M, Farrell R J, Raptopoulos V. et al . Role of virtual computed tomographic colonography in patients with colorectal cancers and obstructing colorectal lesions. Dis Colon Rectum. 2000; 43 303-311
- 16 Kronborg O. Colon polyps and cancer. Endoscopy. 2002; 34 69-72
- 17 Fenlon H M, Nunes D P, Schroy P C. et al . A Comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med. 1999; 341 1496-1503
- 18 Yee J, Akerkar G A, Hung R K. et al . Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. Radiology. 2001; 219 685-692
- 19 Mackenzie S, Vallance R, O'Dwyer P J. Virtual colonoscopy [letter]. N Engl J Med. 2000; 342 737-739
- 20 Pescatore P, Glucker T, Delarive J. et al . Diagnostic accuracy and interobserver agreement of CT colonography (virtual colonoscopy). Gut. 2000; 47 126-130
- 21 Rex D K, Vining D, Kopecky K K. An initial experience with screening for colon polyps using spiral CT with and without CT colography (virtual colonoscopy). Gastrointest Endosc. 1999; 50 309-313
- 22 Rex D K, Cutler C S, Lemmel G T. et al . Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997; 112 24-28
- 23 Rogalla P, Meiri N, Ruckert J C. et al . Colonography using multislice CT. Eur J Radiol. 2000; 36 81-85
- 24 Laghi A, Iannaccone R, Carbone I. et al . Computed tomographic colonography (virtual colonoscopy): blinded prospective comparison with conventional colonoscopy for the detection of colorectal neoplasia. Endoscopy. 2002; 34 441-446
- 25 Ginnerup B P, Christiansen T E, Mortensen F V. et al . Bowel cleansing methods prior to CT colonography. Acta Radiol. 2002; 43 306-311
- 26 Macari M, Milano A, Lavelle M. et al . Comparison of time-efficient CT colonography with two- and three-dimensional colonic evaluation for detecting colorectal polyps. AJR Am J Roentgenol. 2000; 174 1543-1549
- 27 Grainger R G, Allison D J. Diagnostic radiology: an Anglo-American textbook of imaging. Edinburgh; Churchill Livingstone 1992 2nd ed
- 28 Church J M. Endoscopy of the colon, rectum and anus. Tokyo; Igaku-Shoin 1995
- 29 Church J M. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy: timing is the key!. Dis Colon Rectum. 1998; 41 1223-1225
- 30 Altman D G. Practical statistics for medical research. London; Chapman and Hall 1991
- 31 Mendelson R M, Foster N M, Edwards J T. et al . Virtual colonoscopy compared with conventional colonoscopy: a developing technology. Med J Aust. 2000; 173 472-475
- 32 Gluecker T, Meuwly J Y, Pescatore P. et al . Effect of investigator experience in CT colonography. Eur Radiol. 2002; 12 1405-1409
- 33 Hara A K, Johnson C D, MacCarty R L. et al . CT colonography: single- versus multi-detector row imaging. Radiology. 2001; 219 461-465
- 34 Gluecker T, Dorta G, Keller W. et al . Performance of multidetector computed tomography colonography compared with conventional colonoscopy. Gut. 2002; 51 207-211
- 35 Macari M, Bini E J, Xue X. et al . Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection. Radiology. 2002; 224 383-392
- 36 Johnson C D, Dachman A H. CT colonography: the next colon screening examination?. Radiology. 2000; 216 331-341
- 37 Shinya H, Wolff W I. Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg. 1979; 190 679-683
B. Ginnerup Pedersen
Dept. of Radiology, Aarhus Amtssygehus · Aarhus University Hospital
Tage Hansensgade 2 · 8000 Aarhus C · Denmark
Fax: + 45-8949-7718
eMail: ginnerup-kelsen@dadlnet.dk