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Moreno CC, Weiss PS, Jarrett TL, Roberts DL, Mittal PK, Votaw JR. Patient Preferences Regarding Colorectal Cancer Screening: Test Features and Cost Willing to Pay Out of Pocket. Curr Probl Diagn Radiol 2015; 45:189-92. [PMID: 26774952 DOI: 10.1067/j.cpradiol.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/12/2015] [Indexed: 12/26/2022]
Abstract
The purpose of this investigation was to evaluate whether test features would make an individual more or less likely to undergo colorectal cancer screening and how much an individual would be willing to pay out of pocket for a screening test. The methods include an administration of a survey to consecutive adult patients of a general medicine clinic. The survey consisted of Likert-scale questions assessing the patients' likelihood of choosing a screening test based on various test characteristics. Additional questions measured the patients' age, race, gender, and maximum out-of-pocket cost they would be willing to pay. Chi-square tests were used to assess the associations between the likelihood questions and the various demographic characteristics. In results, survey response rate was 88.8% (213 of 240). Respondents were 48.4% female (103 of 213), 51.6% male (110 of 213), 82.6% White (176 of 213), 11.3% African-American (24 of 213), and 6.1% other (13 of 213). Risk of internal injury and light exposure to radiation were the least desirable test features. Light sedation was the only test feature that most respondents (54.8%) indicated would make them likely or very likely to undergo a colorectal cancer screening test. The vast majority of respondents (86.8%) were willing to pay less than $200 out of pocket for a colorectal cancer screening test. There was no statistically significant difference in the responses of males and females, or in the responses of individuals of different races or different ages regarding test features, or the amount individuals were willing to pay for a screening test. To conclude, survey results suggest that patient education emphasizing the low complication rate of computed tomographic colonography (CTC), the minimal risks associated with the low-level radiation exposure resulting from CTC, and the benefits of a sedation-free test (eg, no risk of sedation-related complication and no need for a driver) may increase patient acceptance of CTC. Additionally, an out-of-pocket cost of <$200 would be preferable from the patient perspective.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA.
| | - Paul S Weiss
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Thomas L Jarrett
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - David L Roberts
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Pardeep K Mittal
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA
| | - John R Votaw
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA
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Lin OS, Kozarek RA, Gluck M, Jiranek GC, Koch J, Kowdley KV, Irani S, Nguyen M, Dominitz JA. Preference for colonoscopy versus computerized tomographic colonography: a systematic review and meta-analysis of observational studies. J Gen Intern Med 2012; 27:1349-60. [PMID: 22700393 PMCID: PMC3445696 DOI: 10.1007/s11606-012-2115-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 04/03/2012] [Accepted: 04/13/2012] [Indexed: 12/13/2022]
Abstract
In recent years, colorectal cancer (CRC) screening using computerized tomographic colonography (CTC) has attracted considerable attention. In order to better understand patient preferences for CTC versus colonoscopy, we performed a systematic review and meta-analysis of the available literature. Data sources included published studies, abstracts and book chapters, in any language, with publication dates from 1995 through February 2012, and with prospective or retrospective enrollment of diagnostic or screening patients who had undergone both procedures and explicit assessment of their preference for colonoscopy versus CTC. A predefined algorithm identified eligible studies using computer and hand searches performed by two independent investigators. We used a mixed effects model to pool preference differences (defined as the proportion of subjects who preferred CTC minus the proportion who preferred colonoscopy for each study). Twenty-three studies met inclusion criteria, totaling 5616 subjects. In 16 of these studies, patients preferred CTC over colonoscopy, while colonoscopy was preferred in three studies. Due to the high degree of heterogeneity, an overall pooled preference difference was not calculated. Stratified analysis revealed that studies published in radiology journals (preference difference 0.590 [95 % CI 0.485, 0.694]) seemed more likely than studies in gastroenterology (0.218 [-0.015-0.451]) or general medicine journals (-0.158 [-0.389-0.072]) to report preference for CTC (p<0.001). Studies by radiology authors showed a trend towards stronger preference for CTC compared with studies by gastroenterology authors. Symptomatic patients expressed no preference, but screening patients preferred CTC. There was no difference in preferences between studies using "masked" and "unmasked" preference ascertainment methods. Three studies featuring limited bowel preparations for CTC reported marked preference for CTC. There was no evidence of publication bias, while cumulative and exclusion analysis did not show any temporal trend or dominant study. Limitations included data heterogeneity and preference ascertainment limitations. In conclusion, most included studies reported preference for CTC. On stratified analysis, screening patients preferred CTC while diagnostic patients showed no preference. Studies published in radiology journals showed significantly stronger preference for CTC compared with studies in gastroenterology or general medicine journals.
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Affiliation(s)
- Otto S Lin
- C3-Gas, Gastroenterology Section, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA.
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CT colonography in patients who have undergone sigmoid colostomy: a feasibility study. AJR Am J Roentgenol 2011; 197:W653-7. [PMID: 21940536 DOI: 10.2214/ajr.10.6225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the technical feasibility of CT colonography of patients who have undergone sigmoid colostomy after abdominoperineal resection. MATERIALS AND METHODS Seven men and 11 women (mean age, 57.2 ± 14.5 [SD] years) who had undergone abdominoperineal resection with sigmoid colostomy for rectal cancer were included. Colonic cleansing and fecal tagging were performed with magnesium citrate and 5% weight/volume barium. A conventional small rectal catheter with a retention balloon was introduced into the colonic stoma. An inflated balloon (15-25 mL) was positioned several centimeters beneath the skin. The interposed tissue acted as the mechanism for preventing balloon expulsion during colonic insufflation with carbon dioxide. Unenhanced right decubitus and contrast-enhanced supine images were obtained. Air-fluid leak, balloon expulsion, complications, and colonic distention evaluated on a 4-point scale in which 1 was the worst and 4 the best and mucosal coverage were assessed. RESULTS Examinations were performed uneventfully for all but one patient, who had temporary air and fluid leakage. The mean amount of carbon dioxide used was 2.64 ± 0.64 L. In the right decubitus position, the mean distention grade of each colonic segment was 2.7 ± 1.1 (sigmoid), 3.4 ± 0.6 (descending), 3.6 ± 0.5 (transverse), 3.6 ± 0.5 (ascending), and 3.7 ± 0.5 (cecum). In the supine position the mean grades were 2.7 ± 1.2, 3.1 ± 0.7, 3.7 ± 0.5, 3.7 ± 0.5, and 3.8 ± 0.4. Four patients (22.2%) had segments not adequately visualized in either position owing to luminal collapse; all of these segments were in the sigmoid colon. Three patients (16.7%) had areas submerged under fecal matter in both positions, but these areas were evaluable because of fecal tagging or IV contrast enhancement. CONCLUSION CT colonographic examination through a sigmoid stoma was technically feasible with currently available instruments, but further improvements in technique are needed.
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Howard K, Salkeld G, Pignone M, Hewett P, Cheung P, Olsen J, Clapton W, Roberts-Thomson IC. Preferences for CT colonography and colonoscopy as diagnostic tests for colorectal cancer: a discrete choice experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:1146-52. [PMID: 22152186 PMCID: PMC3466595 DOI: 10.1016/j.jval.2011.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 05/16/2011] [Accepted: 07/03/2011] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Computed tomography colonography (CTC) is an alternative diagnostic test to colonoscopy for colorectal cancer and polyps. The aim of this study was to determine test characteristics important to patients and to examine trade-offs in attributes that patients are willing to accept in the context of the diagnosis of colorectal cancer. METHODS A discrete choice study was used to assess preferences of patients with clinical indications suspicious of colorectal cancer who experienced both CTC and colonoscopy as part of a diagnostic accuracy study in South Australia. Results were analyzed by using a mixed logit model and presented as odds ratios (ORs) for preferring CTC over colonoscopy. RESULTS Colonoscopy was preferred over CTC as the need for a second procedure after CTC increased (OR of preferring CTC to colonoscopy = 0.013), as the likelihood of missing cancers or polyps increased (OR of preferring CTC to colonoscopy = 0.62), and as CTC test cost increased (OR of preferring CTC to colonoscopy = 0.65-0.80). CTC would be preferred to colonoscopy if a minimal bowel preparation was available (OR = 1.7). Some patients were prepared to trade off the diagnostic and therapeutic advantage of colonoscopy for a CTC study with a less intensive bowel preparation. Preferences also varied significantly with sociodemographic characteristics. CONCLUSIONS Despite CTC's often being perceived as a preferred test, this may not always be the case. Informed decision making for diagnostic tests for colorectal cancer should include discussion of the benefits, downsides, and uncertainties associated with alternative tests, as patients are willing and able to make trade-offs between what they perceive as the advantages and disadvantages of these diagnostic tests.
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Affiliation(s)
- Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, Australia.
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Analysis of barriers to and patients' preferences for CT colonography for colorectal cancer screening in a nonadherent urban population. AJR Am J Roentgenol 2010; 195:393-7. [PMID: 20651195 DOI: 10.2214/ajr.09.3500] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate patients' barriers against colorectal cancer screening tests and to assess patients' preferences and cost influences for CT colonography (CTC) in a nonadherent urban subpopulation. SUBJECTS AND METHODS Patients who had been offered colorectal cancer screening but were nonadherent were asked to participate in this questionnaire study. Patients' demographic information was obtained, and patients' reasons for not being screened were explored. Subjects were given an information sheet that described a CTC procedure and then were asked about their willingness to undergo CTC and about other relevant factors, such as fees. RESULTS One hundred seventy-five patients were invited to participate; 53 declined and 54 did not respond, which left 68 subjects to be included in the analysis. After being informed about CTC screening, most (83%) subjects stated that they would be willing to undergo a CTC study. However, 70% stated that they would not be willing to pay out-of-pocket fees if insurance did not cover the study, and even among the 30% who were willing to pay the fees, the average amount they were willing to pay (mean, $244; median, $150) was well below currently charged rates. CONCLUSION Our study suggests that most nonadherent patients would be willing to undergo CTC as long as out-of-pocket fees are reasonable.
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Rosenberg JA, Rubin DT. Performance of CT colonography in clinical trials. Gastrointest Endosc Clin N Am 2010; 20:193-207. [PMID: 20451810 DOI: 10.1016/j.giec.2010.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The amount of data accumulated in trials of CT colonography (CTC) has greatly increased in the past decade. The information from these studies is shaping clinical practice and public health policy regarding screening for colorectal cancer (CRC). This article examines the performance of CTC in clinical trials for individuals at average risk and increased risk for CRC. It also addresses the efficacy of CTC after incomplete colonoscopy, when colon preparations are reduced or eliminated, and in academic versus nonacademic environments. The data suggest that CTC is effective especially for the detection of larger lesions and when more advanced imaging technology is used.
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Affiliation(s)
- Jonathan A Rosenberg
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 4076, Chicago, IL 60637-1463, USA
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Juchems MS, Ernst A, Johnson P, Virmani S, Brambs HJ, Aschoff AJ. Electronic colon-cleansing for CT colonography: diagnostic performance. ACTA ACUST UNITED AC 2009; 34:359-64. [PMID: 18343970 DOI: 10.1007/s00261-008-9386-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate whether an electronic-colonic-cleansing (ECC) algorithm is beneficial for the diagnostic performance compared to a CT colonography (CTC) evaluation without electronic cleansing in tagged datasets. METHODS Two blinded readers evaluated CTC datasets from 79 patients with 153 colorectal polyps confirmed by optical colonoscopy. Cases were read in a randomized order with and without the use of electronic colon-cleansing software. Per-polyp sensitivity, per-polyp/per-patient specificity and reading times (with and without ECC) have been calculated and reported. RESULTS Per-polyp sensitivity for polyps >6 mm without using ECC was 60.4% (Reader 1: 59.7%, Reader 2: 61.1%), while polyps >10 mm were detected with a sensitivity of 58.3% (Reader 1: 66.7%, Reader 2: 50%). On electronically cleansed datasets, the sensitivity was 73.6% (Reader 1: 76.4%; Reader 2: 70.8%) for polyps >6 mm and 83.3% (Reader 1: 83.3%; Reader 2: 83.3%), respectively. Per-patient specificity was 75% without using cleansing (Reader 1: 68%, Reader 2: 82%) and 81.5% using ECC (Reader 1: 86%, Reader 2: 77%). CONCLUSION Reading CTC cases using ECC software improves sensitivity in detecting clinically relevant colorectal polyps.
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Affiliation(s)
- Markus S Juchems
- Department for Diagnostic and Interventional Radiology, University Hospitals Ulm, Ulm, Germany.
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Lin OS. Less stick, more carrot: measuring and improving patient satisfaction with endoscopic procedures. Gastrointest Endosc 2009; 69:892-5. [PMID: 19327475 DOI: 10.1016/j.gie.2008.07.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 07/31/2008] [Indexed: 01/25/2023]
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Nagata K, Näppi J, Cai W, Yoshida H. Minimum-invasive early diagnosis of colorectal cancer with CT colonography: techniques and clinical value. ACTA ACUST UNITED AC 2008; 2:1233-46. [DOI: 10.1517/17530059.2.11.1233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ozsunar Y, Coskun G, Delibaş N, Uz B, Yükselen V. Diagnostic accuracy and tolerability of contrast enhanced CT colonoscopy in symptomatic patients with increased risk for colorectal cancer. Eur J Radiol 2008; 71:513-8. [PMID: 18597964 DOI: 10.1016/j.ejrad.2008.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 05/26/2008] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We compared the accuracy and tolerability of intravenous contrast enhanced spiral computed tomography colonography (CTC) and optical colonoscopy (OC) for the detection of colorectal neoplasia in symptomatic patients for colorectal neoplasia. METHODS A prospective study was performed in 48 patients with symptomatic patients with increased risk for colorectal cancer. Spiral CTC was performed in supine and prone positions after colonic cleansing. The axial, 2D MPR and virtual endoluminal views were analyzed. Results of spiral CTC were compared with OC which was done within 15 days. The psychometric tolerance test was asked to be performed for both CTC and colonoscopy after the procedure. RESULTS Ten lesions in 9 of 48 patients were found in CTC and confirmed with OC. Two masses and eight polyps, consisted of 1 tubulovillous, 1 tubular, 2 villous adenoma, 4 adenomatous polyp, 4 adenocarcinoma, were identified. Lesion prevalence was 21%. Sensitivity, specificity, accuracy, positive and negative predictive values were found 100%, 87%, 89%, 67% and 100%, respectively. Psychometric tolerance test showed that CTC significantly more comfortable comparing with OC (p=0.00). CTC was the preferred method in 37% while OC was preferred in 6% of patients. In both techniques, the most unpleasant part was bowel cleansing. CONCLUSION Contrast enhanced CTC is a highly accurate method in detecting colorectal lesions. Since the technique was found to be more comfortable and less time consuming compare to OE, it may be preferable in management of symptomatic patients with increased risk for colorectal cancer.
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Affiliation(s)
- Yelda Ozsunar
- Department of Radiology, School of Medicine, Adnan Menderes University, Aydin, Turkey.
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Juchems MS, Ernst AS, Brambs HJ, Aschoff AJ. Computer-aided detection in computer tomography colonography: a review. ACTA ACUST UNITED AC 2008; 2:487-95. [DOI: 10.1517/17530059.2.5.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Replacing Barium Enema with CT Colonography in Patients Older Than 70 Years: The Importance of Detecting Extracolonic Abnormalities. AJR Am J Roentgenol 2007; 189:1104-11. [PMID: 17954647 DOI: 10.2214/ajr.07.2026] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Rajapaksa RC, Macari M, Bini EJ. Racial/ethnic differences in patient experiences with and preferences for computed tomography colonography and optical colonoscopy. Clin Gastroenterol Hepatol 2007; 5:1306-12. [PMID: 17689294 DOI: 10.1016/j.cgh.2007.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Racial/ethnic minorities are less likely than whites to undergo colorectal cancer (CRC) screening. Although computed tomography colonography (CTC) is a less invasive alternative to optical colonoscopy (OC), it is not known whether CTC will increase acceptance of CRC screening in minorities. METHODS Patients undergoing OC for clinically indicated reasons had CTC followed by same-day OC. After the sedation from the OC had worn off, a questionnaire was administered to assess pain, discomfort, bloating, embarrassment, anxiety, and patient satisfaction using a 10-point scale (1 = least, 10 = greatest). RESULTS Of the 272 patients enrolled, there were 134 whites, 71 blacks, 53 Hispanics, and 14 who self-identified their race/ethnicity as other. Although the proportion of subjects who preferred CTC over OC was not significantly different (52.9% vs 47.1%, P = .36), racial/ethnic minorities were significantly less likely than whites to prefer CTC over OC (whites, 65.7%; blacks, 45.1%; Hispanics, 35.8%; and other, 35.7%; P < .001). Racial/ethnic minorities were less satisfied with CTC (whites, 8.4 +/- 1.7; blacks, 7.8 +/- 1.7; Hispanics, 7.4 +/- 1.8; and other, 7.5 +/- 2.1; P = .001) and were significantly less willing to undergo CTC again in the future (whites, 95.5%; blacks, 80.3%; Hispanics, 84.9%; and other, 85.7%; P = .006). CONCLUSIONS Compared with white patients, OC is better tolerated and is preferred over CTC for evaluation of the colon among racial/ethnic minorities. Although CTC is less invasive than OC, our findings suggest that CTC is unlikely to overcome racial/ethnic disparities in CRC screening.
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Affiliation(s)
- Roshini C Rajapaksa
- Division of Gastroenterology, New York University School of Medicine, New York, New York, USA
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Aschoff AJ, Ernst AS, Brambs HJ, Juchems MS. CT colonography: an update. Eur Radiol 2007; 18:429-37. [PMID: 17899101 DOI: 10.1007/s00330-007-0764-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 07/25/2007] [Accepted: 08/24/2007] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Andrik J Aschoff
- Diagnostic and Interventional Radiology, University Hospitals of Ulm, Steinhoevelstr. 9, 89070, Ulm, Germany.
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Langhorst J, Kühle CA, Ajaj W, Nüfer M, Barkhausen J, Michalsen A, Dobos GJ, Lauenstein TC. MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: diagnostic accuracy and patient acceptance. Inflamm Bowel Dis 2007; 13:1001-8. [PMID: 17352384 DOI: 10.1002/ibd.20140] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The purpose of this pilot study was to assess the diagnostic accuracy of MR colonography (MRC) without bowel cleansing regarding its ability to quantify inflammatory bowel disease (IBD). In addition, patient acceptance was compared with conventional colonoscopy (CC). METHODS In all, 29 patients with IBD (17 ulcerative colitis; 12 Crohn's disease) were included. While CC was performed after bowel cleansing as the gold standard, MRC was based on a fecal tagging technique and performed 48-72 hours prior to CC. The presence of inflammation in each of 7 ileocolonic segments was rated for every procedure. Patients evaluated both modalities and dedicated aspects of the examination according to a 10-point-scale (1 = good, 10 = poor acceptance). Furthermore, preferences for future examinations were investigated. RESULTS Inflammatory segments were found by means of CC in 23 and by MRC in 14 patients. Overall sensitivity and specificity of MRC in a segment-based detection were 32% and 88%, respectively. Concerning severely inflamed segments, sensitivity increased to 53% for MRC. Overall acceptance of CC was significantly higher compared to MRC (mean value (mv) for MRT = 6.0; CC = 4.1; P = 0.003). For MRC, the placement of the rectal tube (mv = 7.3), and for CC bowel purgation (mv = 6.5), were rated as the most unpleasant. A total of 67% of patients voted for CC as the favorable tool for future examinations. CONCLUSIONS The presented data indicate that 'fecal tagging MRC' is not suitable for an adequate quantification of inflammatory diseases of the large bowel. Furthermore, overall acceptance of endoscopic colonoscopy was superior to MRC.
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Affiliation(s)
- Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Germany.
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Kinner S, Kuehle CA, Langhorst J, Ladd SC, Nuefer M, Zoepf T, Barkhausen J, Gerken G, Lauenstein TC. MR colonography vs. optical colonoscopy: comparison of patients’ acceptance in a screening population. Eur Radiol 2007; 17:2286-93. [PMID: 17522866 DOI: 10.1007/s00330-007-0643-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 02/28/2007] [Accepted: 03/22/2007] [Indexed: 12/01/2022]
Abstract
The aim of this study was to compare optical colonoscopy to fecal-tagging-based MR colonography in a screening population in terms of comfort and acceptance ratings as well as for future preferences as colorectal cancer screening examinations. Two hundred eighty-four asymptomatic patients (mean age 59 years) underwent MRC and OC within 4 weeks. While MRC was based on a fecal tagging technique, OC was performed after bowel cleansing. For OC, sedatives and analgesics were used. Patients evaluated both modalities and certain aspects of the examination according to a 10-point-scale with higher scores denoting a worse experience. Furthermore, preferences for future examinations were evaluated. No significant difference was noted for the overall acceptance of OC (mean value 3.0) and MRC (mean value 3.4). For MRC, the placement of the rectal tube was rated as the most unpleasant part, whereas bowel purgation was regarded most inconvenient for OC. Patients aged 55 years and older perceived most aspects less unpleasant than younger patients. Of the patients, 46% preferred MRC for future screening examinations (OC: 44%). OC and MRC have comparable general acceptance levels in a screening population. Especially for patients declining endoscopy as a screening method MRC may evolve as an attractive alternative.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Bowel preparation for CT-colonography: comparison of two different cleansing protocols. Eur J Radiol 2006; 60:460-4. [PMID: 17055683 DOI: 10.1016/j.ejrad.2006.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 08/04/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Comparison of cleansing effects and colonic distension observed with two polyethyleneglycol-solution (PEG) containing bowel preparation techniques prior to CT-colonography (CTC). MATERIALS AND METHODS One hundred and three patients that received CTC in our institution were retrospectively evaluated. Fifty-one patients received preparation 1 (BP1; based on a GoLytely formulation+bisacodyl), 52 preparation 2 (BP2; based on a NuLytely formulation+bisacodyl). On multi-planar-reformatted (MPR) images, fluid residuals and colon distension were assessed in five colonic segments, from the ascending colon to the rectum. RESULTS On average, significantly (p<0.001) lower fluid residuals were assesses when using BP2 regardless of the patient position. In prone position, a significantly lower fluid level was observed in the sigmoid using bowel preparation 2. The average maximum diameter measured for the whole colon was 5.2+/-0.6 cm in prone position and 4.8+/-0.6 cm in the supine position in BP1 (p<0.01). In BP2 the average maximum diameter measured for the whole colon was 5.3+/-0.6 cm in prone position and 4.7+/-0.5 cm in supine position, respectively (p<0.001). CONCLUSION Overall, lower fluid residuals were scored using BP2. In both preparation groups we achieved better colonic distension in prone position. We were not able to distend the sigmoid better when insufflating air during patient repositioning.
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