Aktuelle Standards der MR-Kolonographie

T. C. Lauenstein; S. G. Rühm; J. F. Debatin

doi:10.1055/s-2003-37824

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2003; 175(3): 334-341
DOI: 10.1055/s-2003-37824

Übersicht

Aktuelle Standards der MR-Kolonographie

State of the Art of MR ColonoscopyT. C. Lauenstein¹ , S. G. Rühm¹ , J. F. Debatin¹

¹Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen

Abstract

Zusammenfassung

Voraussetzung für die Prävention des kolorektalen Karzinoms ist eine zuverlässige Früherkennung, die neben hoher diagnostischer Genauigkeit auch durch eine hohe Patientenakzeptanz gekennzeichnet sein sollte. Die MR-Kolonographie erfüllt diese Voraussetzungen: Mit einer Sensitivität und Spezifität von über 90 % für die Detektion kolorektaler Polypen > 10 mm ist die Untersuchung genau. Nicht-Invasivität, fehlende Strahlenexposition und eine schmerzfreie Untersuchung bedingen eine hohe Patientenakzeptanz. Letztere kann durch den Einsatz neu entwickelter Untersuchungsstrategien, die eine bislang notwendige Darmsäuberung überflüssig machen, z. B. durch Stuhlverfärbung (fecal tagging), weiter gesteigert werden. Diese Übersichtsarbeit beschreibt die der MR-Kolonographie zugrunde liegenden Techniken sowie erste Ergebnisse der „fecal tagging” Konzepte.

Abstract

MR colonoscopy is suitable for colorectal cancer screening. This imaging modality is non-invasive, has no harmful side effects and provides a high diagnostic accuracy. MR colonoscopy has been found to be highly sensitive and specific in detecting colorectal lesions > 10 mm in size. Since colonic polyps are difficult to differentiate from residual stool, colonic cleansing has been unavoidable but reduces patient acceptance. Cleansing of the bowel can be avoided if the signal of stool is rendered different from its surrounding. This can be achieved by adding an agent to the food that tags the feces (fecal tagging). This article describes current techniques of MR colonoscopy as well as first results with fecal tagging.

Key words

MR colonoscopy - colorectal carcinoma - screening examination - fecal tagging

Full Text

References

Literatur

1 Silverberg E, Boring C C, Squires T S. Cancer statistics, 1990. CA Cancer J Clin. 1990; 40 9-26
2 Landis S H, Murray T, Bodden S, Wingo P A. Cancer statistics, 1988. CA Cancer J Clin. 1998; 48 6-29
3 O'Brien M J, Winawer S J, Zauber A G, Gottlieb L S, Sternberg S S, Diaz B. et al . The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990; 98 371-379
4 Winawer S J, Zauber A G, Ho M N, O'Brien M J, Gottlieb L S, Sternberg S S. et al . Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993; 329 1977-1981
5 Vernon S W. Participation in colorectal cancer screening. J Natl Cancer Inst. 1997; 98 1406-1422
6 Centers for Disease Control . Screening for colorectal cancer - United States. MMWR. 1999; 48 116-121
7 Frommer D J. What's new in colorectal cancer screening?. J Gastroenterol and Hepatol. 1998; 13 528-533
8 Rex D K, Rahmani E Y, Haseman J H, Lemmel G T, Kaster S, Buckley J S. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997; 112 17-23
9 Lieberman D. Colon cancer screening: beyond efficacy. Gastroenterology. 1994; 106 803-807
10 Lee P Y, Fletcher W S, Sullivan E S, Vetto J T. Colorectal cancer in young patients: characteristics and outcome. Am Surg. 1994; 60 607-612
11 Lieberman D A, Smith F W. Screening for colon malignancy with colonoscopy. Am J Gastroenterol. 1991; 86 946-951
12 Angtuaco T L, Banaad-Omiotek G D, Howden C W. Differing attitudes toward virtual and conventional colonoscopy for colorectal cancer screening: surveys among primary care physicians and potential patients. Am J Gastroenterol. 2001; 96 887-893
13 Fenlon H M, Nunes D P, Schroy P C, Barish M A, Clarke P D, Ferrucci J T. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med. 1999; 341 1496-1503
14 Fletcher J G, Johnson C D, Welch T J, MacCarty R L, Ahlquist D A, Reed J E. et al . Optimization of CT colonography technique: prospective trial in 180 patients. Radiology. 2000; 216 704-711
15 Becker C R, Schatzl M, Feist H, Bauml A, Bruning R, Schopf U J. et al . Radiation exposure during CT examination of thorax and abdomen. Comparison of sequential, spiral and electron beam computed tomography. Radiologe. 1998; 38 726-729
16 Hara A K, Johnson C D, Reed J E, Ehman R L, Ilstrup D M. Colorectal polyp detection with CT colonography: two-versus three-dimensional techniques. Radiology. 1996; 200 49-54
17 Fenlon H M, Clarke P D, Ferrucci J T. Virtual colonoscopy: imaging features with colonoscopic correlation. Am J Roentgenol. 1998; 170 1303-1309
18 Rogalla P, Meiri N. CT colonography: data acquisition and patient preparation techniques. Semin Ultrasound CT MR. 2001; 22 405-412
19 Murphy K J, Brunberg J A, Cohan R H. Adverse reactions to gadolinium contrast media: a review of 36 cases. Am J Roentgenol. 1996; 167 847-849
20 Prince M R, Arnoldus C, Frisoli J K. Nephrotoxicity of high-dose gadolinium compared with iodinated contrast. J Magn Reson Imaging. 1996; 6 162-166
21 Luboldt W, Bauerfeind P, Steiner P, Fried M, Krestin G P, Debatin J F. Preliminary assessment of three-dimensional magnetic resonance imaging for various colonic disorders. Lancet. 1997; 349 1288-1291
22 Luboldt W, Steiner P, Bauerfeind P, Pelkonen P, Debatin J F. Detection of mass lesions with MR colonography. Radiology. 1998; 207 59-65
23 Luboldt W, Bauerfeind P, Wildermuth S, Marincek B, Fried M, Debatin J F. Colonic masses: detection with MR colonography. Radiology. 2000; 216 383-388
24 Saar B, Heverhagen J T, Obst T, Berthold L D, Kopp I, Klose K J. et al . Magnetic resonance colonography and virtual magnetic resonance colonoscopy with the 1.0-T system: a feasibility study. Invest Radiol. 2000; 35 521-526
25 Pappalardo G, Polettini E, Frattaroli F M, Casciani E, D'Orta C, D'Amato M. et al . Magnetic resonance colonography versus conventional colonoscopy for the detection of colonic endoluminal lesions. Gastroenterology. 2000; 119 300-304
26 Luboldt W, Bauerfeind P, Pelkonen P, Steiner P, Krestin G P, Debatin J F. 3D-MRI Of the colon: methods and initial results. Fortschr Röntgenstr. 1997; 167 252-256
27 Lauenstein T C, Herborn C U, Vogt F M, Gohde S C, Debatin J F, Ruehm S G. Dark lumen MR-colonograph: initial experience. Fortschr Röntgenstr. 2001; 173 785-789
28 Morrin M M, Farrell R J, Kruskal J B, Reynolds K, McGee J B, Raptopoulos V. Utility of intravenously administered contrast material at CT colonography. Radiology. 2000; 217 765-771
29 Marcos H B, Semelka R C. Evaluation of Crohn's disease using half-fourier RARE and gadolinium-enhanced SGE sequences: initial results. Magn Reson Imaging. 2000; 18 263-268
30 Lomas D J, Sood R R, Graves M J, Miller R, Hall N R, Dixon A K. Colon Carcinoma: MR imaging with CO₂ enema. Radiology. 2001; 219 558-562
31 Morrin M M, Hochman M G, Farrell R J, Marquesuzaa H, Rosenberg S, Edelman R R. Colonography using colonic distention with air as the contrast material. Am J Roentgenol. 2001; 176 144-146
32 Villavicencio R T, Rex D X. Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy. Semin Gastrointest Dis. 2000; 11 185-193
33 Hofstad B, Vatn M H, Andersen S N, Huitfeldt H S, Rognum T, Larsen S. et al . Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years. Gut. 1996; 39 449-456
34 Elwood M J, Ali G, Schlup M T, McNoe B, Barbezat G O, North F. et al . Flexible sigmoidoscopy or colonoscopy for colorectal screening: a randomized trial of performance and acceptability. Cancer Detection and Prevention. 1995; 19 337-347
35 Weishaupt D, Patak M A, Fröhlich J, Rühm S G, Debatin J F. Faecal tagging to avoid colonic cleaning before MRI colonography. Lancet. 1999; 354 835-836
36 Lauenstein T, Holtmann G, Schoenfelder D, Bosk S, Ruehm S G, Debatin J F. MR colonography without colonic cleansing: a new strategy to improve patient acceptance. Am J Roentgenol. 2001; 177 823-827
37 Lauenstein T C, Goehde S C, Ruehm S G, Holtmann G, Debatin J F. MR Colonography with Barium-based Fecal Tagging: Initial Clinical Experience. Radiology. 2002; 223 248-254
38 Javors B R, Applbaum Y, Gerard P. Severe allergic reaction: an unusual complication of barium enema. Gastrointest Radiol. 1984; 9 357-358
39 Sodickson D K, McKenzie C A, Ohliger M A, Yeh E N, Price M D. Recent advances in image reconstruction, coil sensitivity calibration, and coil array design for SMASH and generalized parallel MRI. MAGMA. 2002; 13 158-163
40 Weiger M, Pruessmann K P, Boesiger P. 2D-SENSE for faster 3D-MRI. MAGMA. 2002; 14 10-19

Dr. med. T. C. Lauenstein

Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum
Essen

Hufelandstraße 55

45122 Essen

Email: thomas.lauenstein@uni-essen.de