CT colonography: an update

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.

[1]  Rubem Pochaczevsky,et al.  Digital subtraction bowel cleansing in CT colonography. , 2002, AJR. American journal of roentgenology.

[2]  A. Zauber,et al.  The National Polyp Study , 1990 .

[3]  F. M. Vos,et al.  Three-dimensional display modes for CT colonography: conventional 3D virtual colonoscopy versus unfolded cube projection. , 2003, Radiology.

[4]  R. Jeffrey,et al.  Display modes for CT colonography. Part II. Blinded comparison of axial CT and virtual endoscopic and panoramic endoscopic volume-rendered studies. , 1999, Radiology.

[5]  J. Yee,et al.  Patient experience and preferences toward colon cancer screening: a comparison of virtual colonoscopy and conventional colonoscopy. , 2001, Gastrointestinal endoscopy.

[6]  Padraic MacMathuna,et al.  Efficacy of IV Buscopan as a muscle relaxant in CT colonography , 2003, European Radiology.

[7]  H. Hoppe,et al.  Virtual colon dissection with CT colonography compared with axial interpretation and conventional colonoscopy: preliminary results. , 2004, AJR. American journal of roentgenology.

[8]  J. Ferrucci,et al.  Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon. , 1999, Radiology.

[9]  Forbes Gm,et al.  Patient acceptance of virtual colonoscopy. , 2000 .

[10]  Stuart A. Taylor,et al.  Computer-assisted reader software versus expert reviewers for polyp detection on CT colonography. , 2006, AJR. American journal of roentgenology.

[11]  D. Rockey,et al.  Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests. , 1998, The New England journal of medicine.

[12]  E. Paulson,et al.  Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison , 2005, The Lancet.

[13]  Guy Marchal,et al.  Computer-aided diagnosis in virtual colonography via combination of surface normal and sphere fitting methods , 2002, European Radiology.

[14]  B. Vogelstein,et al.  A genetic model for colorectal tumorigenesis , 1990, Cell.

[15]  Jacob Sosna,et al.  CT colonography in 546 patients with incomplete colonoscopy. , 2007, Radiology.

[16]  Perry J Pickhardt,et al.  Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. , 2006, AJR. American journal of roentgenology.

[17]  J R Hecht,et al.  CT colonography: value of scanning in both the supine and prone positions. , 1999, AJR. American journal of roentgenology.

[18]  Marc Baekelandt,et al.  Dietary fecal tagging as a cleansing method before CT colonography: initial results polyp detection and patient acceptance. , 2002, Radiology.

[19]  J. Malley,et al.  Computer-assisted detection of colonic polyps with CT colonography using neural networks and binary classification trees. , 2002, Medical physics.

[20]  S. Goldberg,et al.  Endoluminal CT colonography after an incomplete endoscopic colonoscopy. , 1999, AJR. American journal of roentgenology.

[21]  Mathias Cohnen,et al.  Effective doses in standard protocols for multi-slice CT scanning , 2003, European Radiology.

[22]  J. Malley,et al.  Colonic polyps: complementary role of computer-aided detection in CT colonography. , 2002, Radiology.

[23]  J. Marshall,et al.  The frequency of total colonoscopy and terminal ileal intubation in the 1990s. , 1993, Gastrointestinal endoscopy.

[24]  Stuart A. Taylor,et al.  European society of gastrointestinal and abdominal radiology (ESGAR): Consensus statement on CT colonography , 2007, European Radiology.

[25]  J G Fletcher,et al.  CT colonography without cathartic preparation: feasibility study. , 2001, Radiology.

[26]  D. Ransohoff,et al.  Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. , 2000, The New England journal of medicine.

[27]  R. Mendelson,et al.  Patient acceptance of virtual colonoscopy. , 2000, Endoscopy.

[28]  D. Ransohoff,et al.  Screening for colorectal cancer. , 1991, The New England journal of medicine.

[29]  A. Aschoff,et al.  CT colonography: comparison of a colon dissection display versus 3D endoluminal view for the detection of polyps , 2005, European Radiology.

[30]  Judy Yee,et al.  Reader training in CT colonography: how much is enough? , 2005, Radiology.

[31]  J. Shah Factors Associated with Incomplete Colonoscopy: A Population-Based Study , 2008 .

[32]  J. Yee,et al.  CT colonography reporting and data system: a consensus proposal. , 2005, Radiology.

[33]  G. Friedman,et al.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. , 1992, The New England journal of medicine.

[34]  Stuart A. Taylor,et al.  Multi-detector row CT colonography: effect of collimation, pitch, and orientation on polyp detection in a human colectomy specimen. , 2003, Radiology.

[35]  Steve Halligan,et al.  Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. , 2003, Radiology.

[36]  Joel G Fletcher,et al.  CT colonography using 360-degree virtual dissection: a feasibility study. , 2006, AJR. American journal of roentgenology.

[37]  E. Svensson,et al.  Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease. , 2002, Radiology.

[38]  D. Lieberman,et al.  Clinical practice. Screening for colorectal cancer. , 2009, The New England journal of medicine.

[39]  A. Aldridge,et al.  Histological assessment of colorectal adenomas by size. Are polyps less than 10 mm in size clinically important? , 2001, The European journal of surgery = Acta chirurgica.

[40]  J. Burdick,et al.  Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. , 2004, JAMA.

[41]  Jonathan B. Kruskal,et al.  CT colonography: colonic distention improved by dual positioning but not intravenous glucagon , 2002, European Radiology.

[42]  A. Aschoff,et al.  Bowel preparation for CT-colonography: comparison of two different cleansing protocols. , 2006, European journal of radiology.

[43]  M. Macari,et al.  Significance of missed polyps at CT colonography. , 2004, AJR. American journal of roentgenology.

[44]  D. Vining Virtual colonoscopy. , 1999, Seminars in ultrasound, CT, and MR.

[45]  Patrik Rogalla,et al.  Spasmolysis at CT colonography: butyl scopolamine versus glucagon. , 2005, Radiology.

[46]  L. Ackerman,et al.  Distribution of colonic polyps: increased incidence of proximal lesions in older patients. , 1985, Radiology.

[47]  T. J. Vogl,et al.  Automated mass detection in contrast-enhanced CT colonography: an approach based on contrast and volume , 2005, European Radiology.

[48]  P. Macmathuna,et al.  Colonic surveillance by CT colonography using axial images only , 2004, European Radiology.

[49]  L. Påhlman,et al.  Patient factors influencing the completion rate in colonoscopy. , 2005, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[50]  C. Johnson,et al.  Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps. , 2003, Gastroenterology.

[51]  J. Saurin,et al.  [Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults]. , 2004, Gastroenterologie clinique et biologique.

[52]  J. Fletcher,et al.  CT colonography using 360° virtual dissection : A feasibility study , 2006 .

[53]  James Perumpillichira,et al.  CT colonography: digital subtraction bowel cleansing with mucosal reconstruction initial observations. , 2003, Radiology.

[54]  Factors that predict incomplete colonoscopy , 1995, Diseases of the colon and rectum.

[55]  K. Kopecky,et al.  An initial experience with screening for colon polyps using spiral CT with and without CT colography (virtual colonoscopy) , 1999, Gastrointestinal endoscopy.

[56]  A. Graser,et al.  Effect of computer-aided detection as a second reader in multidetector-row CT colonography , 2007, European Radiology.

[57]  J. Jackson,et al.  Meta-Analysis: Computed Tomographic Colonography , 2005, Annals of Internal Medicine.

[58]  D. Rockey Colon imaging: computed tomographic colonography. , 2005, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[59]  S D Wall,et al.  Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. , 2001, Radiology.

[60]  J. Ferrucci,et al.  CT colonoscopy of colorectal neoplasms: two-dimensional and three-dimensional virtual-reality techniques with colonoscopic correlation. , 1997, AJR. American journal of roentgenology.

[61]  E. Neri,et al.  Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. , 2002, Radiology.

[62]  Stuart A. Taylor,et al.  CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. , 2005, Radiology.

[63]  Carlo Catalano,et al.  Feasibility of ultra-low-dose multislice CT colonography for the detection of colorectal lesions: preliminary experience , 2003, European Radiology.

[64]  A. Lavy,et al.  Diagnostic Yield and Safety of Colonoscopy in Israeli Patients in an Open Access Referral System , 2007, Journal of clinical gastroenterology.

[65]  A. Jemal,et al.  Cancer Statistics, 2006 , 2006, CA: a cancer journal for clinicians.

[66]  M. Macari,et al.  Effect of different bowel preparations on residual fluid at CT colonography. , 2001, Radiology.

[67]  A. Zauber,et al.  The national polyp study design, methods, and characteristics of patients with newly diagnosed polyps , 1992, Cancer.

[68]  A. Beck,et al.  Feasibility of MDCT Colonography in ultra-low-dose technique in the detection of colorectal lesions: comparison with high-resolution video colonoscopy. , 2004, AJR. American journal of roentgenology.

[69]  N. Hyman,et al.  A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) , 2006, Surgical Endoscopy And Other Interventional Techniques.

[70]  D W Day,et al.  Polyps and cancer of the large bowel: a necropsy study in Liverpool. , 1982, Gut.

[71]  P. Correa Epidemiology of polyps and cancer. , 1978, Major problems in pathology.

[72]  Patrick M M Bossuyt,et al.  Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer. , 2004, Gastroenterology.

[73]  M. Macari,et al.  Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection. , 2002, Radiology.

[74]  J G Fletcher,et al.  Optimization of CT colonography technique: prospective trial in 180 patients. , 2000, Radiology.

[75]  Stuart A. Taylor,et al.  CT colonography: effect of experience and training on reader performance , 2004, European Radiology.

[76]  Arie E. Kaufman,et al.  Virtual colonoscopy , 2005, CACM.

[77]  A. Zauber,et al.  Flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance? , 2004, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[78]  Steve Halligan,et al.  Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation. , 2006, AJR. American journal of roentgenology.

[79]  Philippe Lefere,et al.  CT colonography after fecal tagging with a reduced cathartic cleansing and a reduced volume of barium. , 2005, AJR. American journal of roentgenology.

[80]  A J Aschoff,et al.  A retrospective evaluation of patient acceptance of computed tomography colonography (“virtual colonoscopy”) in comparison with conventional colonoscopy in an average risk screening population , 2005, Acta radiologica.

[81]  P. Lefere,et al.  CT colonography with fecal tagging after incomplete colonoscopy , 2005, European Radiology.

[82]  Judy Yee,et al.  Comparison of supine and prone scanning separately and in combination at CT colonography. , 2003, Radiology.

[83]  Guy Marchal,et al.  Dry preparation for virtual CT colonography with fecal tagging using water-soluble contrast medium: initial results , 2003, European Radiology.

[84]  R. Ehman,et al.  Colorectal polyp detection with CT colography: two- versus three-dimensional techniques. Work in progress. , 1996, Radiology.

[85]  P. Lavin,et al.  CT colonography of colorectal polyps: a metaanalysis. , 2003, AJR. American journal of roentgenology.

[86]  A. Zauber,et al.  Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. , 1993 .

[87]  G. Marchal,et al.  Patient acceptance for CT colonography: what is the real issue? , 2002, European Radiology.

[88]  A. Hara,et al.  Virtual endoscopy: what's in a name? , 1998, AJR. American journal of roentgenology.