Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients.

PURPOSE To determine the sensitivity and specificity of computed tomographic (CT) colonography for colorectal polyp and cancer detection by using colonoscopy as the reference standard. MATERIALS AND METHODS Three hundred patients underwent CT colonography followed by standard colonoscopy. Bowel preparation consisted of magnesium citrate and polyethylene glycol. After colonic air insufflation, patients underwent scanning in the supine and prone positions with 3-mm collimation during a single breath hold. The transverse CT images, sagittal and coronal reformations, and three-dimensional endoluminal images were interpreted by two radiologists independently, and then a consensus reading was performed. CT colonographic findings were correlated with standard colonoscopic and histologic findings. RESULTS The overall sensitivity and specificity of CT colonography for polyp detection were 90.1% (164 of 182) and 72.0% (85 of 118), respectively. By using direct polyp matching, the overall sensitivity was 69.7% (365 of 524). The sensitivity was 90% (74 of 82) for the detection of polyps 10 mm or larger, 80.1% (113 of 141) for polyps 5.0-9.9 mm, and 59.1% (178 of 301) for polyps smaller than 5 mm. The sensitivity was 94% (64 of 68) for the detection of adenomas 10 mm or larger, 82% (72 of 88) for adenomas 5.0-9.9 mm, and 66.9% (95 of 142) for adenomas smaller than 5 mm. CT colonography was used to identify all eight carcinomas. CONCLUSION CT colonography has excellent sensitivity for the detection of clinically important colorectal polyps and cancer.

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

[2]  J. Potter,et al.  A description of age, sex, and site distributions of colon carcinoma in three geographic areas , 1996, Cancer.

[3]  E T Stewart,et al.  A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. , 2000, The New England journal of medicine.

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

[5]  A. D. De Roos,et al.  Colon polyps and carcinomas: prospective comparison of the single- and double-contrast examination in the same patients. , 1985, Radiology.

[6]  J. Ferrucci,et al.  A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. , 1999, The New England journal of medicine.

[7]  L M Schuman,et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. , 1993, The New England journal of medicine.

[8]  D. Rex,et al.  Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. , 1997, Gastroenterology.

[9]  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.

[10]  S D Wall,et al.  The usefulness of glucagon hydrochloride for colonic distention in CT colonography. , 1999, AJR. American journal of roentgenology.

[11]  G. Cooper,et al.  A national population‐based study of incidence of colorectal cancer and age. Implications for screening in older Americans , 1995, Cancer.

[12]  T. Muto,et al.  The evolution of cancer of the colon and rectum , 1974, Cancer.

[13]  M. Macari,et al.  Comparison of time-efficient CT colonography with two- and three-dimensional colonic evaluation for detecting colorectal polyps. , 2000, AJR. American journal of roentgenology.

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

[15]  R. Jeffrey,et al.  Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. , 1999, Radiology.

[16]  H. Bussey,et al.  ÆTIOLOGY OF ADENOMA—CARCINOMA SEQUENCE IN LARGE BOWEL , 1978, The Lancet.

[17]  J. Rakela,et al.  Hepatitis C after orthotopic liver transplantation. , 1997, Gastroenterology.

[18]  A. Hara,et al.  Detection of colorectal polyps with CT colography: initial assessment of sensitivity and specificity. , 1997, Radiology.

[19]  E. Haglind,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 , 1995, Endoscopy.

[20]  C. Mulrow,et al.  Colorectal cancer screening: clinical guidelines and rationale. , 1997, Gastroenterology.

[21]  Taylor Murray,et al.  Cancer statistics, 2000 , 2000, CA: a cancer journal for clinicians.

[22]  J. Waye,et al.  Total colonoscopy: is it always possible? , 1991, Gastrointestinal endoscopy.

[23]  D. Lubowski,et al.  Bisacodyl reduces the volume of polyethylene glycol solution required for bowel preparation , 1994, Diseases of the colon and rectum.

[24]  D. Rex,et al.  Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. , 1997, Gastroenterology.

[25]  D. Lieberman,et al.  Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. , 2000, The New England journal of medicine.

[26]  P. Glasziou,et al.  A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult. , 1998, BMJ.

[27]  J J Smith,et al.  Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. , 1991, Gastroenterology.

[28]  C. Johnson,et al.  CT colonography of the unprepped colon: An early feasibility study of "virtual preparation" , 2000 .

[29]  K R Hoffmann,et al.  CT colonography with three-dimensional problem solving for detection of colonic polyps. , 1998, AJR. American journal of roentgenology.

[30]  D. Lieberman How to screen for colon cancer. , 1998, Annual review of medicine.

[31]  G. Stevenson,et al.  Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem. , 1994, Radiology.