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Bhatnagar G, Mallett S, Beable R, Greenhalgh R, Ilangovan R, Lambie H, Mainta E, Patel U, Porté F, Sidhu H, Gupta A, Higginson A, Slater A, Tolan D, Zealley I, Halligan S, Taylor SA. Influence of diffusion weighted imaging and contrast enhanced T1 sequences on the diagnostic accuracy of magnetic resonance enterography for Crohn's disease. Eur J Radiol 2024; 175:111454. [PMID: 38598964 DOI: 10.1016/j.ejrad.2024.111454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To evaluate the additional diagnostic benefit of diffusion weighted imaging (DWI) and contrast enhanced (CE) images during MR enterography (MRE) of Crohn's disease. METHODS Datasets from 73 patients (mean age 32; 40 male) (28 new-diagnosis, 45 relapsed) were read independently by two radiologists selected from a pool of 13. Radiologists interpreted datasets using three sequential sequence blocks: (1) T2 weighted and steady state free precession gradient echo (SSFP) images alone (T2^); (2) T2 weighted and SSFP images with DWI (T2 + DWI^) and; (3) T2 weighted images, SSFP, DWI and post-contrast enhanced (CE) T1 images (T2 + DWI + CE^), documenting presence, location, and activity of small bowel disease. For each sequence block, sensitivity and specificity (readers combined) was calculated against an outcome-based construct reference standard. RESULTS 59/73 patients had small bowel disease. Per-patient sensitivity for disease detection was essentially identical (80 % [95 % CI 72, 86], 81 % [73,87], and 79 % [71,86] for T2^, T2 + DWI^and T2 + DWI + CE^respectively). Specificity was identical (82 % [64 to 92]). Per patient sensitivity for disease extent was 56 % (47,65), 56 % (47,65) and 52 % (43 to 61) respectively, and specificity was 82 % (64 to 92) for all blocks. Sensitivity for active disease was 97 % (90,99), 97 % (90,99) and 98 % (92,99), and specificity was also comparable between all sequence combination reads. Results were consistent across segments and newly diagnosed/relapse patients. CONCLUSION There is no additional diagnostic benefit of adding either DWI or CE to T2 FSE and SSFP sequences for evaluating small bowel Crohn's disease, suggesting MRE protocols can be simplified safely.
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Affiliation(s)
- Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Richard Beable
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rebecca Greenhalgh
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | | | - Hannah Lambie
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Evgenia Mainta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Uday Patel
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - François Porté
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Harbir Sidhu
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK; Department of Surgery and Cancer, Imperial College London, Exhibition Rd, South Kensington, London SW7 2BX, UK
| | - Anthony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, Charles Bell House, 43-45 Foley Street W1W 7TS, UK.
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Rengo M, Tiberia F, Vicini S, Bellini D, Celestre M, Trionfera G, Laghi A, Carbone I. CT colonography: can we achieve an adequate bowel preparation without diet restriction? Eur Radiol 2023; 33:5184-5192. [PMID: 36806568 PMCID: PMC10289920 DOI: 10.1007/s00330-023-09471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To evaluate if an adequate bowel preparation for CT colonography, can be achieved without diet restriction, using a reduced amount of cathartic agent and fecal tagging. To investigate the influence of patients' characteristics on bowel preparation and the impact on patients' compliance. METHODS In total, 1446 outpatients scheduled for elective CT colonography were prospectively enrolled. All patients had the same bowel preparation based on a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) the day before the exam and a fecal tagging agent (60 ml of hyperosmolar oral iodinated agent) the day of the exam. No dietary restrictions were imposed before the exam. The bowel preparation was evaluated using a qualitative and quantitative score. Patients were grouped by age, gender, and presence of diverticula in both scores. Patients' compliance has been evaluated with a questionnaire after the end of the exam and with a phone-calling interview the day after the exam. RESULTS According to the qualitative score, adequate bowel preparation was achieved in 1349 patients (93.29%) and no statistical differences were observed among the subgroups of patients. Quantitative scores demonstrated that colon distension was significantly better in younger patients and without diverticula. A good patients' compliance was observed and most patients (96.5%) were willing to repeat it. CONCLUSIONS The lack of diet restriction does not affect the quality of CTC preparation and good patient's compliance could potentially increase the participation rate in CRC screening programs. KEY POINTS • An adequate quality bowel preparation for CT colonography can be achieved without diet restriction, using a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) and fecal tagging (60 ml of hyperosmolar oral iodinated agent). • A bowel preparation based on the combination of a reduced amount of cathartic agent and fecal tagging, without diet restriction, allows obtaining good quality in more than 90% of patients. • The bowel preparation scheme proposed reduces the distress and discomfort experienced by the patients improving adherence to CTC.
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Affiliation(s)
- Marco Rengo
- Department of Medico-Surgical Sciences and Biotechnologies, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy.
| | - Filippo Tiberia
- Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Simone Vicini
- Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Davide Bellini
- Department of Medico-Surgical Sciences and Biotechnologies, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Michela Celestre
- Diagnostic Imaging Unit, Valmontone Hospital, Via Dei Lecci, Valmontone, RM, Italy
| | - Gianfranco Trionfera
- Diagnostic Imaging Unit, Valmontone Hospital, Via Dei Lecci, Valmontone, RM, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Radiology Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Via Di Grottarossa 1035, 00189, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Academic Diagnostic Imaging Unit, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
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Bhatnagar G, Mallett S, Quinn L, Beable R, Bungay H, Betts M, Greenhalgh R, Gupta A, Higginson A, Hyland R, Ilangovan R, Lambie H, Mainta E, Patel U, Pilcher J, Plumb A, Porté F, Sidhu H, Slater A, Tolan D, Zealley I, Halligan S, Taylor S. Interobserver variation in the interpretation of magnetic resonance enterography in Crohn's disease. Br J Radiol 2022; 95:20210995. [PMID: 35195444 DOI: 10.1259/bjr.20210995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate interobserver variability for diagnosis of disease presence and extent of small bowel and colonic Crohn's disease using MR enterography (MRE). METHODS Data from the first 73 consecutive patients (mean age 32, 33F, 28 new diagnosis, 45 suspected relapse) recruited to a multicentre, prospective diagnostic accuracy trial evaluating MRE for small bowel Crohn's disease were each read independently by three (from a pool of 20) radiologists. Radiologists documented presence and segmental location of small bowel Crohn's disease and recorded morphological mural/extramural parameters for involved segments. Per patient percentage agreement for disease presence and extent were calculated against an outcome-based construct reference standard (averaged between pairs of readers). Prevalence-adjusted bias-adjusted κ (PABAK) was calculated. RESULTS Agreement for small bowel disease presence for new diagnosis/relapsed patients was 68%(κ = 0.36)/ 78% (κ = 0.56) and 43%(κ = 0.14)/ 53% for disease extent (κ = 0.07), respectively. For disease presence, all three radiologists agreed correctly with the reference standard in 41/59 (69%) of patients with small bowel involvement, and in 8/14 (57%) cases of without small bowel disease. Agreement was highest for multisegment disease, greater than 5 cm in length, with mural thickness>6 mm, and increased mural T2 signal. Agreement for colonic disease presence was 61% (κ = 0.21 fair agreement) for new diagnosis/ 60% (κ = 0.20, slight agreement) for relapsed patients. CONCLUSION There is a reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed Crohn's disease, and patients with suspected relapse, respectively. Agreement is lower for disease extent. ADVANCES IN KNOWLEDGE There is reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed (68%) Crohn's disease, and patients with suspected relapse (78%). Agreement is lower for disease extent (43% new diagnosis and 53% suspected relapse).
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Affiliation(s)
- Gauraang Bhatnagar
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard Beable
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Helen Bungay
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Margaret Betts
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Rebecca Greenhalgh
- Department of Radiology, St George's University Hospitals NHS Trust, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Anthony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel Hyland
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Hannah Lambie
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Evgenia Mainta
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Uday Patel
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - James Pilcher
- Department of Radiology, St George's University Hospitals NHS Trust, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - François Porté
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Harbir Sidhu
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
| | - Stuart Taylor
- Centre for Medical Imaging, Charles Bell House, University College London, London, UK
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Influence of oral contrast type and volume on patient experience and quality of luminal distension at MR Enterography in Crohn's disease: an observational study of patients recruited to the METRIC trial. Eur Radiol 2022; 32:5075-5085. [PMID: 35243523 PMCID: PMC9279188 DOI: 10.1007/s00330-022-08614-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/03/2022]
Abstract
Objectives To compare the distention quality and patient experience of oral mannitol and polyethylene glycol (PEG) for MRE. Methods This study is a retrospective, observational study of a subset of patients enrolled in a multicentre, prospective trial evaluating the diagnostic accuracy of MRE for small bowel Crohn’s. Overall and segmental MRE small bowel distention, from 105 patients (64 F, mean age 37) was scored from 0 = poor to 4 = excellent by two experienced observers (68 [65%] mannitol and 37 [35%] PEG). Additionally, 130 patients (77 F, mean age 34) completed a questionnaire rating tolerability of various symptoms immediately and 2 days after MRE (85 [65%] receiving mannitol 45 [35%] receiving PEG). Distension was compared between agents and between those ingesting ≤ 1 L or > 1 L of mannitol using the test of proportions. Tolerability grades were collapsed into “very tolerable,” “moderately tolerable,” and “not tolerable.” Results Per patient distension quality was similar between agents (“excellent” or “good” in 54% [37/68] versus 46% [17/37]) with mannitol and PEG respectively. Jejunal distension was significantly better with mannitol compared to PEG (40% [27/68] versus 14% [5/37] rated as excellent or good respectively). There was no significant difference according to the volume of mannitol ingested. Symptom tolerability was comparable between agents, although fullness following MRE was graded as “very tolerable” in 27% (12/45) of patients ingesting PEG, verses 44% (37/84) ingesting mannitol, difference 17% (95% CI 0.6 to 34%). Conclusion Mannitol-based solutions and PEG generally achieve comparable distension quality and side effect profiles, although jejunal distension is better quality with mannitol. Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol. Key Points • Mannitol-based and PEG-based oral preparation agents generally achieve comparable distension quality for MRE with the exception of the jejunum which is better distended with mannitol. • Mannitol-based and PEG-based oral preparation agents used for MRE have similar side effect profiles. • Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08614-9.
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Value of bowel preparation techniques for prostate MRI: a preliminary study. Abdom Radiol (NY) 2021; 46:4002-4013. [PMID: 33770222 PMCID: PMC8286932 DOI: 10.1007/s00261-021-03046-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022]
Abstract
Background Bowel preparation before multiparametric MRI (mpMRI) of the prostate is performed widely, despite contradictory or no evidence for efficacy. Purpose To investigate the value of hyoscine N-butylbromide (HBB), microenema (ME) and ‘dietary restrictions’ (DR) for artifact reduction and image quality (IQ) in mpMRI of the prostate. Study type Retrospective. Population Between 10/2018 and 02/2020 treatment-naïve men (median age, 64.9; range 39.8–87.3) who underwent mpMRI of the prostate were included. The total patient sample comprised of n = 180 patients, who received either HBB, ME, were instructed to adhere to DR, or received a combination of those measures prior to the MR scan. Field strength/sequence T2-weighted imaging (T2w), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) scanned on two 3T systems. Assessment A radiologist specialized in urogenital imaging (R1) and a senior radiology resident (R2) visually assessed IQ parameters on transversal T2w, DWI and ADC maps on a 5-point Likert-like scale. Statistical tests Group comparison between IQ parameters was performed on reader level using Kruskal–Wallis and Mann–Whitney U tests. Binary univariate logistic regression analysis was used to assess independent predictors of IQ. Interrater agreement was assessed using Intraclass Correlation Coefficient (ICC). Results ‘DWI geometric distortion’ was significantly more pronounced in the HBB+/ME−/DR− (R1, 3.6 and R2, 4.0) as compared to the HBB−/ME+/DR− (R1, 4.2 and R2, 4.6) and HBB+/ME+/DR− (R1, 4.3 and R2, 4.7) cohort, respectively. Parameters ‘DWI IQ’ and ‘Whole MRI IQ’ were rated similarly by both readers. ME was a significant independent predictor of ‘good IQ’ for the whole MRI for R1 [b = 1.09, OR 2.98 (95% CI 1.29, 6.87)] and R2 [b = 1.01, OR 2.73 (95% CI 1.24, 6.04)], respectively. Data conclusion ME seems to significantly improve image quality of DWI and the whole mpMRI image set of the prostate. HBB and DR did not have any benefit.
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Taylor SA, Mallett S, Bhatnagar G, Morris S, Quinn L, Tomini F, Miles A, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Murray CD, Plumb AA, Pollok RC, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study. Health Technol Assess 2020; 23:1-162. [PMID: 31432777 DOI: 10.3310/hta23420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Magnetic resonance enterography and enteric ultrasonography are used to image Crohn's disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn's disease was compared. OBJECTIVE To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn's disease. DESIGN Prospective multicentre cohort study. SETTING Eight NHS hospitals. PARTICIPANTS Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn's disease or with established Crohn's disease and suspected relapse. INTERVENTIONS Magnetic resonance enterography and ultrasonography. MAIN OUTCOME MEASURES The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn's disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease extent, and sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. RESULTS Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn's disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn's disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn's disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn's disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn's disease presence and extent were similar in the two cohorts. For colonic Crohn's disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn's disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. LIMITATIONS Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. CONCLUSIONS Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn's disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn's disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN03982913. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Florian Tomini
- Applied Health Research, University College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Peter John Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Ilan Jacobs
- Independent patient representative, c/o Centre for Medical Imaging, University College London, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Ao Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew Slater
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
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Biscaldi E, Barra F, Leone Roberti Maggiore U, Ferrero S. Other imaging techniques: Double-contrast barium enema, endoscopic ultrasonography, multidetector CT enema, and computed tomography colonoscopy. Best Pract Res Clin Obstet Gynaecol 2020; 71:64-77. [PMID: 32698994 DOI: 10.1016/j.bpobgyn.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
Double-contrast barium enema (DCBE), transrectal endoscopic ultrasonography (REU), multidetector computerized tomography enema (MDCT-e), and computed tomography colonoscopy (CTC) have been successfully used for the diagnosis of bowel endometriosis. DCBE provides a complete overview of the entire colon and allows detecting cecal nodules. The accuracy of DCBE is operator dependent and, thus, it may have low specificity. It does not allow identifying the cause of the mass effect. DCBE requires the administration of barium and exposure to radiation. REU precisely estimates the distance between the rectosigmoid nodule and the anal verge. However, it allows investigating only the distal part of rectosigmoid, it misses anterior pelvic lesions, and it has poor sensitivity for the diagnosis of endometriomas. MDCT-e is accurate and reproducible in diagnosing intestinal endometriosis and in assessing its characteristics: the largest diameter of the nodule, the distance between the distal part of the nodule and the anal verge, and depth of infiltration of endometriosis in the intestinal wall. MDCT-e requires the administration of iodinated contrast medium (CM) and the exposure to radiations. CTC has good performance in the diagnosis of rectosigmoid endometriosis. It allows estimating the degree of intestinal stenosis CTC, and the distance between the intestinal endometriotic nodule and the anal verge. It requires exposure to radiations, and it may require the administration of an iodinated CM.
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Affiliation(s)
- Ennio Biscaldi
- Department of Radiology, Galliera Hospital, via Mura delle Cappuccine 14, Genova, 16128, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | | | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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A quantitative validation of segmented colon in virtual colonoscopy using image moments. Biomed J 2020; 43:74-82. [PMID: 32200958 PMCID: PMC7090282 DOI: 10.1016/j.bj.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022] Open
Abstract
Background Evaluation of segmented colon is one of the challenges in Computed Tomography Colonography (CTC). The objective of the study was to measure the segmented colon accurately using image processing techniques. Methods This was a retrospective study, and the Institutional Ethical clearance was obtained for the secondary dataset. The technique was tested on 85 CTC dataset. The CTC dataset of 100–120 kVp, 100 mA, and ST (Slice Thickness) of 1.25 and 2.5 mm were used for empirical testing. The initial results of the work appear in the conference proceedings. Post colon segmentation, three distance measurement techniques, and one volumetric overlap computation were applied in Euclidian space in which the distances were measured on MPR views of the segmented and unsegmented colons and the volumetric overlap calculation between these two volumes. Results The key finding was that the measurements on both the segmented and the unsegmented volumes remain same without much difference noticed. This was statistically proved. The results were validated quantitatively on 2D MPR images. An accuracy of 95.265±0.4551% was achieved through volumetric overlap computation. Through pairedt−test, at α=5%, statistical values were p=0.6769, and t=0.4169 which infer that there was no much significant difference. Conclusion The combination of different validation techniques was applied to check the robustness of colon segmentation method, and good results were achieved with this approach. Through quantitative validation, the results were accepted at α=5%.
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Martínez-Sapiña Llanas M, Otero Muinelo S, Crespo García C. TC rectal pathology: Findings at CT-colonography. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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TC Rectal Pathology: Findings at CT-Colonography. RADIOLOGIA 2017; 60:208-216. [PMID: 29169607 DOI: 10.1016/j.rx.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the spectrum of benign and malignant rectal diseases, their findings on CT colonography, and their management. CONCLUSION Although CT colonography is not the first choice for the study of rectal disease, it is indicated in cases where optical colonoscopy is contraindicated or cannot be completed. Rectal lesions can go undetected because this anatomic area is difficult to evaluate; for this reason, it is essential to ensure optimal preparation and distension, moderate balloon insufflation, and careful 2D and 3D navigation with knowledge of the spectrum of rectal disease and its CT colonography signs.
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The effect of without using anisodamine during CT enterography on image quality, diagnostic performance and latent side effects. Clin Imaging 2017; 48:106-112. [PMID: 29059545 DOI: 10.1016/j.clinimag.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/17/2017] [Accepted: 09/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine whether no anisodamine injection before CTE was feasible without impairing image quality and diagnostic performance. MATERIALS The change of mural thickness and luminal diameter were compared between using and no using anisodamine. The diagnostic performance of small-bowel disease was analyzed and compared. RESULTS No motion artifact was detected in two groups. There was no significant difference regarding the change of luminal diameter and mural thickness (all P>0.05). The diagnostic accuracy of small-bowel disease was no significant difference (P=0.63). CONCLUSION Lack of anisodamine injection before CTE did not impair image quality and diagnostic performance compared with CTEs performed with anisodamine injection.
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Liu JY, Chen LD, Xu JB, Wu H, Ye JN, Zhang XH, Xie XY, Wang W, Lu MD. Transabdominal Ultrasound Colonography for Detection of Colorectal Neoplasms: Initial Clinical Experience. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2174-2181. [PMID: 28684185 DOI: 10.1016/j.ultrasmedbio.2017.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/04/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
We investigated the feasibility of using ultrasound colonography (USC) to visualize the healthy colon and rectum and detect colorectal polyps. Eight healthy volunteers underwent USC after standard bowel preparation. The feasibility and image quality of USC in different segments were evaluated. Then, USC was conducted on eight patients with known colonic neoplasms using colonoscopy as the reference standard. For volunteers, USC examinations were successfully performed on four (50.0%) ascending, three (37.5%) transverse and eight (100%) descending colons, as well as all sigmoid colons and rectums. One of four (25.0%) ascending, two of eight (25.0%) descending and all sigmoid colons and rectums were well visualized and free of artifacts. For patients, colonoscopy revealed that eight patients had 17 neoplasms in the distal sigmoid colon and rectum, which included 3 lesions ≤5 mm, 3 lesions 6-9 mm and 11 lesions ≥10 mm. USC visualized 12 of 17 (70.6%) neoplasms. Lesion detection by USC was 0% (0/3), 33.3% (1/3) and 100% (11/11) for neoplasms ≤5, 6-9 mm and ≥10 mm in size. USC can visualize the sigmoid colon and rectum well and detect distal sigmoid and rectal neoplasms ≥10 mm in diameter.
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Affiliation(s)
- Jin-Ya Liu
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li-Da Chen
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian-Bo Xu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hui Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin-Ning Ye
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin-Hua Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Ming-De Lu
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Hepatobiliary Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Lambert L, Lambertova A, Danes J, Grusova G. Computed Tomography Colonography Phantom: Construction, Validation and Literature Review. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e31069. [PMID: 27882202 PMCID: PMC5116225 DOI: 10.5812/iranjradiol.31069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/12/2015] [Accepted: 10/10/2015] [Indexed: 12/02/2022]
Abstract
Background Several dedicated computed tomography (CT) colonography phantoms have been described previously. Objectives To compare their pros and cons and describe the construction of a dedicated phantom that can be easily manufactured. Materials and Methods We found 15 different phantom designs by literature search and compared their advantages and disadvantages based on their description and images. We tested various materials for density and mechanical properties and constructed a phantom from polypropylene pipes (30 mm and 50 mm in diameter, 52 cm in length). Haustral folds were created by heat shaping and 39 intermediate sessile polyps with a target size of 6-10 mm and two flat lesions were created from silicone. Nine polyps were attached to a fold. The model was placed in a 30-cm barrel filled with water to simulate attenuation of human body. Attenuation of polyps was compared to intermediate polyps found in patients. Results None of the earlier colonic phantoms found in the literature incorporated all the properties that would ensure both reproducibility and validity of the model (including a rigid wall, density of the wall and polyps similar to human colon, at least two levels of distension and durability). In the present phantom, the average size of sessile polyps was 8.6 ± 0.9 mm and their density was 53 ± 24 HU. We found no significant difference in polyp density between simulated polyps in the phantom and polyps in human subjects (P = 0.70). All polyps, with the exception of one flat lesion, were detected by computer aided detection. Conclusion We constructed and validated a CT colonography phantom with correct density allowing performance of reproducible experiments.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- Corresponding author: Lukas Lambert, Department of Radiology, General University Hospital in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic. Tel: +420-224962232, Fax: +420-224963048, E-mail:
| | - Alena Lambertova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jan Danes
- Department of Radiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Gabriela Grusova
- Fourth department of Internal Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Woodbridge L, Wylie P. Current Issues in Computed Tomography Colonography. Semin Ultrasound CT MR 2016; 37:331-8. [DOI: 10.1053/j.sult.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Zhao SB, Wan H, Fu HY, Liu ZX, Wang QS, Ji L, Li ZS, Bai Y. Quantitative assessment of the effect of position changes during colonoscopy withdrawal. J Dig Dis 2016; 17:357-65. [PMID: 27028973 DOI: 10.1111/1751-2980.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although trials assessing the effectiveness of position changes during colonoscopy withdrawal have been reported, there has been no agreement whether such position changes actually improve the polyp detection rate (PDR) or adenoma detection rate (ADR). This article aimed to address this issue by performing a systematic review. METHODS Relevant studies from databases including PubMed, EMBASE and the Cochrane Library and Science Citation Index were retrieved. Two reviewers independently identified potentially relevant studies. Outcome measures were PDR, ADR and bowel distention. RESULTS Eight studies were included, of which seven were randomized controlled trials (RCTs). A non-randomized controlled trial and all four cross-over RCTs reported significant improvement in PDR, ADR and bowel distention with position change during colonoscopic withdrawal, while three parallel-group RCTs did not confirm its effectiveness. CONCLUSIONS The conflicting results of high-quality trials indicate that the effectiveness of position change during colonoscopy withdrawal on PDR, ADR and bowel distension is uncertain. Thus, position change during colonoscopy withdrawal should not be routinely applied until future studies demonstrate its efficacy.
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Affiliation(s)
- Sheng Bing Zhao
- Student Brigade, Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hui Wan
- Education Office, Graduate School, Second Military Medical University, Shanghai, China
| | - Hong Yu Fu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhen Xiu Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, Jiangsu Province, China
| | - Qing Song Wang
- Student Brigade, Second Military Medical University, Shanghai, China
| | - Lei Ji
- Student Brigade, Second Military Medical University, Shanghai, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Scalise P, Mantarro A, Pancrazi F, Neri E. Computed tomography colonography for the practicing radiologist: A review of current recommendations on methodology and clinical indications. World J Radiol 2016; 8:472-483. [PMID: 27247713 PMCID: PMC4882404 DOI: 10.4329/wjr.v8.i5.472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/23/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most relevant causes of morbidity and mortality in Western societies. CRC screening is actually based on faecal occult blood testing, and optical colonoscopy still remains the gold standard screening test for cancer detection. However, computed tomography colonography (CT colonography) constitutes a reliable, minimally-invasive method to rapidly and effectively evaluate the entire colon for clinically relevant lesions. Furthermore, even if the benefits of its employment in CRC mass screening have not fully established yet, CT colonography may represent a reasonable alternative screening test in patients who cannot undergo or refuse colonoscopy. Therefore, the purpose of our review is to illustrate the most updated recommendations on methodology and the current clinical indications of CT colonography, according to the data of the existing relevant literature.
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Barber JL, Lozinsky AC, Kiparissi F, Shah N, Watson TA. Detecting inflammation in the unprepared pediatric colon - how reliable is magnetic resonance enterography? Pediatr Radiol 2016; 46:646-52. [PMID: 26867608 DOI: 10.1007/s00247-015-3538-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pediatric inflammatory bowel disease frequently affects the colon. MR enterography is used to assess the small bowel but it also depicts the colon. OBJECTIVE To compare the accuracy of MR enterography and direct visualization at endoscopy in assessing the colon in pediatric inflammatory bowel disease. MATERIALS AND METHODS We included children with inflammatory bowel disease who had undergone both MR enterography and endoscopy, and we restrospectively assessed the imaging and endoscopic findings. We scored the colonic appearance at MR using a total colon score. We then compared scores for the whole colon and for its individual segments with endoscopy and histology. RESULTS We included 15 children. An elevated MR colonic segmental score predicted the presence of active inflammation on biopsy with a specificity of 90% (95% confidence interval [CI] 79.5-96.2%) and sensitivity of 60% (CI 40.6-77.3%); this compares reasonably with the predictive values for findings at colonoscopy - specificity 85% (CI 73.4-92.9%) and sensitivity 53.3% (CI 34.3%-71.6%). Accuracy did not change significantly with increasing bowel distension. CONCLUSION MR-derived scores had comparable accuracy to those derived during visualization at colonoscopy for detecting biopsy-proven inflammation in our patient group. MR enterography might prove useful in guiding biopsy or monitoring treatment response. Collapse of a colonic segment did not impair assessment of inflammation.
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Affiliation(s)
- Joy L Barber
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Adriana Chebar Lozinsky
- Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Fevronia Kiparissi
- Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Neil Shah
- Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tom A Watson
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
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The Current Role of Radiologic and Endoscopic Imaging in the Diagnosis and Follow-Up of Colonic Diverticular Disease. AJR Am J Roentgenol 2016; 207:15-24. [PMID: 27082846 DOI: 10.2214/ajr.16.16138] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Colonic diverticular disease is among the most prevalent conditions in Western society and is a common cause for outpatient visits and hospitalizations. The role of imaging is in evolution, but it has proven useful in confirming clinically suspected disease, assessing severity and complications, and directing patient management. CONCLUSION This review focuses on the current role of radiologic and endoscopic imaging in distinct clinical scenarios of diverticular disease, with emphasis on diverticulitis and its follow-up.
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Alazmani A, Hood A, Jayne D, Neville A, Culmer P. Quantitative assessment of colorectal morphology: Implications for robotic colonoscopy. Med Eng Phys 2016; 38:148-54. [PMID: 26762775 DOI: 10.1016/j.medengphy.2015.11.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/16/2015] [Accepted: 11/15/2015] [Indexed: 01/14/2023]
Abstract
This paper presents a method of characterizing the distribution of colorectal morphometrics. It uses three-dimensional region growing and topological thinning algorithms to determine and visualize the luminal volume and centreline of the colon, respectively. Total and segmental lengths, diameters, volumes, and tortuosity angles were then quantified. The effects of body orientations on these parameters were also examined. Variations in total length were predominately due to differences in the transverse colon and sigmoid segments, and did not significantly differ between body orientations. The diameter of the proximal colon was significantly larger than the distal colon, with the largest value at the ascending and cecum segments. The volume of the transverse colon was significantly the largest, while those of the descending colon and rectum were the smallest. The prone position showed a higher frequency of high angles and consequently found to be more torturous than the supine position. This study yielded a method for complete segmental measurements of healthy colorectal anatomy and its tortuosity. The transverse and sigmoid colons were the major determinant in tortuosity and morphometrics between body orientations. Quantitative understanding of these parameters may potentially help to facilitate colonoscopy techniques, accuracy of polyp spatial distribution detection, and design of novel endoscopic devices.
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Affiliation(s)
- A Alazmani
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | - A Hood
- Academic Surgical Unit, St. James's University Hospital, Leeds LS9 7TF, UK
| | - D Jayne
- Academic Surgical Unit, St. James's University Hospital, Leeds LS9 7TF, UK
| | - A Neville
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - P Culmer
- Institute of Engineering Systems and Design, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
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East JE, Saunders BP, Burling D, Tam E, Boone D, Halligan S, Taylor SA. Mechanisms of hyoscine butylbromide to improve adenoma detection: A case-control study of surface visualization at simulated colonoscope withdrawal. Endosc Int Open 2015; 3:E636-41. [PMID: 26716127 PMCID: PMC4683134 DOI: 10.1055/s-0034-1392771] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Antispasmodics may improve mucosal visualization during colonoscope withdrawal, potentially improving polyp and adenoma detection. Meta-analysis and case-control studies suggest a 9 % to 13 % relative increase in adenoma and polyp detection. We aimed to assess the impact of hyoscine butylbromide on the expected visualization during colonoscope withdrawal using a CT colonography (CTC) simulation. PATIENTS AND METHODS Datasets from a previous CTC study examining the effect of antispasmodic were re-analyzed with customised CTC software, adjusted to simulate a standard colonoscopic view. Eighty-six patients received intravenous (IV) hyoscine butylbromide 20 mg, 40 mg or no antispasmodic. Main outcome measurements at unidirectional flythrough, simulating colonoscope withdrawal, were percentage colonic surface visualization, numbers and sizes of unseen areas, and colonic length. RESULTS Use of antispasmodic was associated with a significant relative increase in percentage surface visualization of 2.6 % to 3.9 %, compared with no antispasmodic, P < 0.006. Total numbers of missed areas and intermediate sized (300 - 1000 mm(2)) missed areas were significantly decreased, by approximately 20 %. There were no differences between the 20-mg and 40-mg doses. Mean colonic length (161 - 169 cm) was unchanged by antispasmodic. CONCLUSIONS IV hyoscine butylbromide at simulated colonoscope withdrawal was associated with significant increases in surface visualization, which might explain up to half the improvement in adenoma detection seen in clinical studies.
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Affiliation(s)
- James E. East
- Translational Gastroenterology Unit, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Wolfson Unit for Endoscopy, St. Mark’s Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom,Corresponding author James E. East, FRCP Translational Gastroenterology UnitExperimental Medicine DivisionNuffield Dept of Clinical MedicineUniversity of OxfordJohn Radcliffe HospitalHeadley WayHeadington, Oxford, OX3 9DUUnited Kingdom+44 (0)1865 228753+44 (0)1865 228763
| | - Brian P. Saunders
- Wolfson Unit for Endoscopy, St. Mark’s Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom
| | - David Burling
- Intestinal Imaging Centre, St. Mark’s Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom
| | - Emily Tam
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom,Department of Radiology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Wexham Street, Slough, Berkshire, SL2 4HL
| | - Darren Boone
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom
| | - Steve Halligan
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom
| | - Stuart A. Taylor
- Department of Specialist Radiology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom
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Narayanan S, Kalra N, Bhatia A, Wig J, Rana S, Bhasin D, Vaiphei K, Khandelwal N. Staging of colorectal cancer using contrast-enhanced multidetector computed tomographic colonography. Singapore Med J 2015; 55:660-6. [PMID: 25630322 DOI: 10.11622/smedj.2014182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Preoperative staging is essential for the optimal treatment and surgical planning of colorectal cancers. This study was aimed to evaluate the accuracy of colorectal cancer staging done using contrast-enhanced multidetector computed tomographic colonography (CEMDCTC). METHODS We recruited 25 patients with 28 proven colorectal cancers. A 16-slice multidetector computed tomography scanner was used to generate two-dimensional multiplanar reformatted sagittal, coronal and oblique coronal images, and three-dimensional virtual colonography (endoluminal) images. Axial and reformatted views were analysed, and TNM staging was done. Patients underwent surgery and conventional colonoscopy, and surgical histopathological correlation was obtained. RESULTS The diagnostic accuracies for TNM colorectal cancer staging were 92.3% for T staging, 42.3% for N staging and 96.1% for M staging using CEMDCTC. There was excellent positive correlation for T staging between CEMDCTC and both surgery (κ-value = 0.686) and histopathology (κ-value = 0.838) (p < 0.0001), and moderate positive correlation for N staging between CEMDCTC and surgery (κ-value = 0.424; p < 0.0001). The correlation between CEMDCTC and histopathology for N staging was poor (κ-value = 0.186; p < 0.05); the negative predictive value was 100% for lymph node detection. Moderate positive correlation was seen for M staging between CEMDCTC and both surgery (κ-value = 0.462) and histopathology (κ-value = 0.649). No false negatives were identified in any of the M0 cases. CONCLUSION CEMDCTC correlated well with pathologic T and M stages, but poorly with pathologic N stage. It is an extremely accurate tool for T staging, but cannot reliably distinguish between malignant lymph nodes and enlarged reactive lymph nodes.
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Affiliation(s)
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
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Patrick JL, Bakke JR, Bannas P, Kim DH, Lubner MG, Pickhardt PJ. Objective volumetric comparison of room air versus carbon dioxide for colonic distention at screening CT colonography. ACTA ACUST UNITED AC 2015; 40:231-6. [PMID: 25081924 DOI: 10.1007/s00261-014-0206-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To objectively compare colonic distention at CT colonography (CTC) achieved with manual room air vs. automated low-pressure carbon dioxide (CO2) using a novel automated volumetric quality assessment tool. METHODS Volumetric analysis was retrospectively performed on CTC studies in 300 asymptomatic adults using an automated quality assessment tool (V3D Colon [beta version], Viatronix). Colonic distention was achieved with room air self-administered to tolerance via hand-held pump (mean number of pumps, 39 ± 32) in 150 individuals (mean age, 59 years; 98 men, 51 women) and via continuous low-pressure automated infusion of CO2 in 150 individuals (mean age, 57 years; 89 men, 61 women). CTC studies in supine and prone position were assessed to determine total colonic volume (luminal gas and fluid). The colonic length along the automated centerline was also recorded to enable calculation of length-adjusted colonic volumes. RESULTS The mean total colonic volume (±SD) for individuals receiving room air and CO2 distention was 1809 ± 514 and 2223 ± 686 mL, respectively (p < 0.01). The prone position was better distended in 78.7% (118/150) of cases using room air; whereas, the supine was better in 66.0% (99/150) of CO2 cases (p < 0.01). Using a volume threshold of 2000 mL, 49 (32.7%) of room air cases and 92 (61.3%) of CO2 cases were above this cut-off. The mean length-adjusted colonic volume (mL/cm) for the room air and CO2 techniques was 9.9 ± 2.4 and 11.6 ± 2.6 mL/cm (p < 0.01). CONCLUSIONS Using automated volumetry allowed quantitative analyses of colonic volumes and objectively confirmed that continuous low-pressure CO2 provides greater overall colonic distention than the manual room air technique at CTC. The supine position demonstrated better distention with CO2, whereas the prone position was better distended with the room air technique.
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Affiliation(s)
- James L Patrick
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA
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Prabhakar N, Kalra N, Bhasin DK, Rana SS, Gupta V, Singh R, Khandelwal N. Comparison of CT colonography with conventional colonoscopy in patients with ulcerative colitis. Acad Radiol 2015; 22:296-302. [PMID: 25435187 DOI: 10.1016/j.acra.2014.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/21/2014] [Accepted: 09/26/2014] [Indexed: 02/01/2023]
Abstract
RATIONALE AND OBJECTIVE Patients with ulcerative colitis require recurrent conventional colonoscopy (CC) to define the extent of the disease. Computed tomography (CT) colonography (CTC) can be used as an alternative technique for studying the colon in these patients. The purpose of the study was to compare the findings of CTC to CC in patients with ulcerative colitis. MATERIALS AND METHODS Twenty patients proven to have ulcerative colitis on biopsy and in clinical remission state were enrolled in the study. They underwent CTC and CC within 1 week of each test. The investigators performing CTC and CC were blinded to the findings of each other. The chi-square test, kappa test, sensitivity, and specificity were used to compare the findings on CTC and CC. In addition, patient acceptance for both the procedures was compared. RESULTS Sensitivity and specificity on CTC for detecting granular appearance were 81.0% and 73.8%, respectively, and for pseudopolyps were 82.1% and 84.5%, respectively. Good correlation was seen between CTC and CC for detection of granular appearance and pseudopolyps. Loss of haustral folds, wall thickening, pericolonic vascularity, and pericolonic lymph nodes seen on CTC were found to correlate with intraluminal findings seen on CC. Patient acceptance for CTC was better than that for CC. CONCLUSIONS CTC can be used for evaluating patients with ulcerative colitis who are in remission.
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Affiliation(s)
- Nidhi Prabhakar
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosis, PGIMER, Chandigarh 160012, India.
| | | | | | - Vikas Gupta
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Rajinder Singh
- Department of General Surgery, PGIMER, Chandigarh, India
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Colonic distention at CT colonography: randomized evaluation of both IV hyoscine butylbromide and automated carbon dioxide insufflation. AJR Am J Roentgenol 2015; 204:76-82. [PMID: 25539240 DOI: 10.2214/ajr.14.12772] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the efficacy of IV hyoscine butylbromide as a bowel relaxant and automated carbon dioxide insufflation in CT colonography in terms of colonic distention and perceived burden. SUBJECTS AND METHODS; Two hundred twenty-four participants were randomly allocated to one of four groups: control (no bowel relaxant and IV saline placebo before CT colonography with manual carbon dioxide insufflation), hyoscine butylbromide (IV hyoscine butylbromide before examination with manual carbon dioxide insufflation), automated (no bowel relaxant before examination with automated carbon dioxide insufflation), and combined (hyoscine butylbromide before examination with automated carbon dioxide insufflation). The degree of colonic distention on a 4-point scale, examination time, and participants' satisfaction, as measured by their responses to a questionnaire, were assessed. RESULTS The mean distention grades of all the colonic segments and both positions were 3.22 in the control group, 3.28 in the hyoscine butylbromide group, 3.77 in the automated group, and 3.74 in the combined group. Compared with manual carbon dioxide insufflation, automated carbon dioxide insufflation significantly improved the clinical adequacy of colonic distention and shortened examination time. No statistically significant difference was seen in the clinical adequacy of distention between participants who received hyoscine butylbromide and those who did not, or in examination time. Overall, the participants' experiences were not different. CONCLUSION Colonic distention was statistically significantly improved by automated carbon dioxide insufflation, but not by the administration of hyoscine butylbromide. The participants' tolerance was similar in each group.
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Levine MS, Yee J. History, evolution, and current status of radiologic imaging tests for colorectal cancer screening. Radiology 2015; 273:S160-80. [PMID: 25340435 DOI: 10.1148/radiol.14140531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer screening is thought to be an effective tool with which to reduce the mortality from colorectal cancer through early detection and removal of colonic adenomas and early colon cancers. In this article, we review the history, evolution, and current status of imaging tests of the colon-including single-contrast barium enema, double-contrast barium enema, computed tomographic (CT) colonography, and magnetic resonance (MR) colonography-for colorectal cancer screening. Despite its documented value in the detection of colonic polyps, the double-contrast barium enema has largely disappeared as a screening test because it is widely perceived as a labor-intensive, time-consuming, and technically demanding procedure. In the past decade, the barium enema has been supplanted by CT colonography as the major imaging test in colorectal cancer screening in the United States, with MR colonography emerging as another viable option in Europe. Although MR colonography does not require ionizing radiation, the radiation dose for CT colonography has decreased substantially, and regular screening with this technique has a high benefit-to-risk ratio. In recent years, CT colonography has been validated as an effective tool for use in colorectal cancer screening that is increasingly being disseminated.
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Affiliation(s)
- Marc S Levine
- From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (M.S.L.); and Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (J.Y.)
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Sakamoto T, Utsunomiya D, Mitsuzaki K, Matsuda K, Kawakami M, Yamamura S, Urata J, Arakawa A, Yamashita Y. Colonic distention at screening CT colonography: role of spasmolytic agents and body habitus. Kurume Med J 2014; 61:9-15. [PMID: 25400236 DOI: 10.2739/kurumemedj.ms64002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sufficient colonic dilation is important when using CT colonography (CTC) for colorectal cancer screening. We investigated the effect of antispasmodic agents and the patient body habitus on the degree of colonic dilation in screening CTC.We assessed the effect of clinical characteristics [age, gender, body mass index (BMI), and the presence of diverticula] and the use of antispasmodics on colonic distention in 140 patients who underwent CTC for colorectal cancer screening. The CTC was performed in both the supine- and prone positions. Seventy patients received antispasmodics prior to CT examination and the other 70 did not. Colonic distention was scored using a 5-point scale: 1=collapsed, 2=poorly visualized, 3=visualized but underdistended, 4=acceptable, and 5=excellent. Images scored as 4 or 5 were considered to be of diagnostic quality. The mean visual evaluation score was significantly higher in the supine- than the prone position (4.2±0.5 vs. 4.0±0.5, p<0.01). For the supine position, only the use of antispasmodic was statistically associated with sufficient colonic dilation by univariate logistic analysis (odds ratio=2.365, p=0.03). For the prone position, age, BMI, and the use of antispasmodic were statistically associated with sufficient colonic dilation by multivariate analysis. The odds ratio of these parameters was 0.955 (p=0.02), 0.874 (p=0.03), and 2.391 (p=0.02), respectively.We obtained sufficient colonic dilation with an antispasmodic for CTC in both positions. Younger age and a lower BMI were also associated with better colonic dilation in the prone position.
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Taylor S, Mallett S, Bhatnagar G, Bloom S, Gupta A, Halligan S, Hamlin J, Hart A, Higginson A, Jacobs I, McCartney S, Morris S, Muirhead N, Murray C, Punwani S, Rodriguez-Justo M, Slater A, Travis S, Tolan D, Windsor A, Wylie P, Zealley I. METRIC (MREnterography or ulTRasound in Crohn's disease): a study protocol for a multicentre, non-randomised, single-arm, prospective comparison study of magnetic resonance enterography and small bowel ultrasound compared to a reference standard in those aged 16 and over. BMC Gastroenterol 2014; 14:142. [PMID: 25110044 PMCID: PMC4134460 DOI: 10.1186/1471-230x-14-142] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/13/2022] Open
Abstract
Background Crohn’s disease (CD) is a lifelong, relapsing and remitting inflammatory condition of the intestine. Medical imaging is crucial for diagnosis, phenotyping, activity assessment and detecting complications. Diverse small bowel imaging tests are available but a standard algorithm for deployment is lacking. Many hospitals employ tests that impart ionising radiation, of particular concern to this young patient population. Magnetic resonance enterography (MRE) and small bowel ultrasound (USS) are attractive options, as they do not use ionising radiation. However, their comparative diagnostic accuracy has not been compared in large head to head trials. METRIC aims to compare the diagnostic efficacy, therapeutic impact and cost effectiveness of MRE and USS in newly diagnosed and relapsing CD. Methods METRIC (ISRCTN03982913) is a multicentre, non-randomised, single-arm, prospective comparison study. Two patient cohorts will be recruited; those newly diagnosed with CD, and those with suspected relapse. Both will undergo MRE and USS in addition to other imaging tests performed as part of clinical care. Strict blinding protocols will be enforced for those interpreting MRE and USS. The Harvey Bradshaw index, C-reactive protein and faecal calprotectin will be collected at recruitment and 3 months, and patient experience will be assessed via questionnaires. A multidisciplinary consensus panel will assess all available clinical and imaging data up to 6 months after recruitment of each patient and will define the standard of reference for the presence, localisation and activity of disease against which the diagnostic accuracy of MRE and USS will be judged. Diagnostic impact of MRE and USS will be evaluated and cost effectiveness will be assessed. The primary outcome measure is the difference in per patient sensitivity between MRE and USS for the correct identification and localisation of small bowel CD. Discussion The trial is open at 5 centres with 46 patients recruited. We highlight the importance of stringent blinding protocols in order to delineate the true diagnostic accuracy of both imaging tests and discuss the difficulties of diagnostic accuracy studies in the absence of a single standard of reference, describing our approach utilising a consensus panel whilst minimising incorporation bias. Trial registration METRIC - ISRCTN03982913 – 05.11.13.
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Affiliation(s)
- Stuart Taylor
- Center for Medical Imaging, University College London, 250 Euston Rd, London NW1 2PG, UK.
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Lung P, Burling D, Kallarackel L, Muckian J, Ilangovan R, Gupta A, Marshall M, Shorvon P, Halligan S, Bhatnagar G, Bassett P, Taylor S. Implementation of a new CT colonography service: 5 Year experience. Clin Radiol 2014; 69:597-605. [DOI: 10.1016/j.crad.2014.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 11/25/2022]
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Flor N, Ceretti AP, Mezzanzanica M, Rigamonti P, Peri M, Tresoldi S, Soldi S, Mangiavillano B, Sardanelli F, Cornalba GP. Impact of contrast-enhanced computed tomography colonography on laparoscopic surgical planning of colorectal cancer. ACTA ACUST UNITED AC 2014; 38:1024-32. [PMID: 23512572 DOI: 10.1007/s00261-013-9996-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the impact of contrast-enhanced computed tomography colonography (CE-CTC) on laparoscopic surgery planning in patient with stenosing colorectal cancer. MATERIALS AND METHODS Sixty-nine patients with endoscopically proven colorectal cancer underwent CE-CTC, after incomplete conventional colonoscopy. Two experienced radiologists evaluated site, length, and TNM staging of colorectal cancers on three-dimensional double contrast enema-like views, 2D axial and multiplanar reconstructions. All the patients underwent colorectal resection and surgery bulletin, pathology of surgical specimens, and radiological follow-up at about 8 months were used as reference standard. RESULTS The detection rate of colorectal cancer was 100 % (75/75); CE-CTC allowed for a diagnosis of a synchronous colorectal cancer in five patients (7 %). CE-CTC correctly judged the site of the lesions in all the cases; clinically significant localization errors at conventional colonoscopy were noted in 3 out of 69 patients (4 %). Additional colonic polyps greater than 6 mm in diameter were found in 21 out of 69 patients (30 %); in two patients (3 %) the surgeon performed an enlarged colectomy to include synchronous polyps proximal to colorectal cancer. Sensitivity, specificity, PPV, NPV, and accuracy were for T1-T2 vs. T3-T4: 96 %, 71 %, 92 %, 87 %, and 91 %, respectively; for N: 94 %, 42 %, 64 %, 86 %, and 70 %; for M: 100 %, 100 %, 83 %, 100 %, and 97 %. There were no complications associated with CE-CTC. CONCLUSION Information given by CE-CTC concerning colorectal cancer location and synchronous colonic cancers and polyps changed the laparoscopic surgical strategy in almost 14 % of patients.
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Affiliation(s)
- Nicola Flor
- Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via A di Rudinì 8, 20142, Milan, Italy,
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Rousset P, Peyron N, Charlot M, Chateau F, Golfier F, Raudrant D, Cotte E, Isaac S, Réty F, Valette PJ. Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography--initial results. Radiology 2014; 273:117-24. [PMID: 24828001 DOI: 10.1148/radiol.14132803] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To prospectively determine the accuracy of 3.0-T magnetic resonance (MR) enterography in the preoperative assessment of deep infiltrating endometriosis (DIE) lesions located in the bowel above the rectosigmoid junction. MATERIALS AND METHODS Institutional review board approval for this study was obtained, and each patient gave written informed consent. Over 18 months, patients with known pelvic DIE who were scheduled for surgery were recruited. Consecutive patients suspected of having bowel endometriosis above the rectosigmoid junction underwent 3.0-T MR enterography. Two blinded readers independently performed a systematic analysis of nine bowel segments above the rectosigmoid junction. MR images were compared with surgical and pathologic findings. Efficacy parameters were calculated with 95% confidence intervals (CIs). Interobserver agreement was assessed with κ statistics. RESULTS Among the 43 patients enrolled in this study, 33 underwent surgery and were included in the final analyses. Sixteen (48%) patients had bowel DIE lesions located above the rectosigmoid junction at surgery and histopathologic examination. Twenty-six lesions were analyzed, including four ileal, two ileocecal, three cecal, three appendicular, and 14 sigmoid colon lesions. For the diagnosis of these lesions, MR imaging showed sensitivities of 92% (95% confidence interval [CI]: 81.7, 100) for reader 1 and 96% (95% CI: 87.1, 100) for reader 2 and specificities of 100% (95% CI: 98.8, 100) for both readers. The κ value was 0.97. CONCLUSION These results show 3.0-T MR enterography is accurate in the preoperative diagnosis and mapping of bowel DIE lesions located above the rectosigmoid junction. Online supplemental material is available for this article.
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Affiliation(s)
- Pascal Rousset
- From Lyon 1 Claude Bernard University, Lyon, France (P.R., N.P., F.G., D.R., E.C., P.J.V.); and Departments of Radiology (P.R., N.P., M.C., F.C., F.R., P.J.V.), Obstetrics and Gynecology (F.G., D.R.), Oncologic and General Surgery (E.C.), and Pathology (S.I.), Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
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Kanazawa H, Utano K, Kijima S, Sasaki T, Miyakura Y, Horie H, Nakamura Y, Sugimoto H. A comparative study of degree of colorectal distention with manual air insufflation or automated CO2 insufflation at CT colonography as a preoperative examination. Jpn J Radiol 2014; 32:274-81. [DOI: 10.1007/s11604-014-0306-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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Tsurumaru D, Kawanami S, Nishimuta Y, Miyasaka M, Asayama Y, Honda H. Contrast-Enhanced CT Colonography Features of Rectal Carcinoid Tumors. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/act.2014.32005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Evaluation of Crohn’s disease activity: Initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin. Eur Radiol 2013; 24:277-87. [DOI: 10.1007/s00330-013-3010-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/30/2013] [Accepted: 08/16/2013] [Indexed: 02/06/2023]
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Abstract
Misinterpretation at CT colonography (CTC) can result in either a colorectal lesion being missed (false-negative) or a false-positive diagnosis. This review will largely focus on potential missed lesions-and ways to avoid such misses. The general causes of false-negative interpretation at CTC can be broadly characterized and grouped into discrete categories related to suboptimal study technique, specific lesion characteristics, anatomic location, and imaging artifacts. Overlapping causes further increase the likelihood of missing a clinically relevant lesion. In the end, if the technical factors of bowel preparation, colonic distention, and robust CTC software are adequately addressed on a consistent basis, and the reader is aware of all the potential pitfalls at CTC, important lesions will seldom be missed.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA.
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Lauridsen C, Lefere P, Gerke O, Hageman S, Karstoft J, Gryspeerdt S. Comparison of the diagnostic performance of CT colonography interpreted by radiologists and radiographers. Insights Imaging 2013; 4:491-7. [PMID: 23765729 PMCID: PMC3731471 DOI: 10.1007/s13244-013-0260-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/01/2013] [Accepted: 05/14/2013] [Indexed: 12/13/2022] Open
Abstract
Objective To compare computed tomographic colonography (CTC) performance of four trained radiographers with the CTC performance of two experienced radiologists. Methods Four radiographers and two radiologists interpreted 87 cases with 40 polyps ≥6 mm. Sensitivity, specificity, and positive predictive value (PPV) were assessed on a per-patient basis. On a per-polyp basis, sensitivity was calculated according to the respective size categories (polyps ≥6 mm as well as polyps ≥10 mm). Results Overall per-patient sensitivity for polyps ≥6 mm was 76.2 % (95 % CI 61.4–91.0) and 76.2 % (95 % CI 61.7–90.6), for the radiographers and radiologists, respectively. Overall per-patient specificity for polyps ≥6 mm were 81.4 % (95 % CI 73.7–89.2) and 81.1 % (95 % CI 73.8–88.3) for the radiographers and the radiologists, respectively. For the radiographers, overall per-polyp sensitivity was 60.3 % (95 % CI 50.3–70.3) and 60.7 % (95 % CI 42.2–79.2) for polyps ≥6 mm and ≥10 mm, respectively. For the radiologists, overall per polyp sensitivity was 59.2 % (95 % CI 46.4–72.0) and 69.0 % (95 % CI 48.1–89.6) for polyps ≥6 mm and ≥10 mm, respectively. Conclusion Radiographers with training in CT colonographic evaluation achieved sensitivity and specificity in polyp detection comparable with that of experienced radiologists. Main messages • The diagnostic accuracy of trained radiographers was comparable to that of experienced radiologists. • The use of radiographers in reading CTC examinations is acceptable, however radiologists would still be necessary for the evaluation of extracolonic findings. • Skilled non-radiologists may play a vital role as a second reader of intraluminal findings or by performing quality control of examinations before patient dismissal.
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Affiliation(s)
- Carsten Lauridsen
- Bachelor`s Degree Programme in Radiography Department of Technology Faculty of Health and Technology, Metropolitan University College, Sigurdsgade 26, 2200, Copenhagen N., Denmark,
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Hampshire T, Roth HR, Helbren E, Plumb A, Boone D, Slabaugh G, Halligan S, Hawkes DJ. Endoluminal surface registration for CT colonography using haustral fold matching. Med Image Anal 2013; 17:946-58. [PMID: 23845949 PMCID: PMC3807796 DOI: 10.1016/j.media.2013.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 04/16/2013] [Accepted: 04/18/2013] [Indexed: 12/30/2022]
Abstract
Novel haustral fold matching algorithm. Achieves 96.1% mean accuracy over 1743 reference points in 17 CTC datasets. New initialisation to non-rigid intensity-based surface registration method. Full method shows 6.0 mm mean error. Use of initialisation shows significant improvement (p < 0.001).
Computed Tomographic (CT) colonography is a technique used for the detection of bowel cancer or potentially precancerous polyps. The procedure is performed routinely with the patient both prone and supine to differentiate fixed colonic pathology from mobile faecal residue. Matching corresponding locations is difficult and time consuming for radiologists due to colonic deformations that occur during patient repositioning. We propose a novel method to establish correspondence between the two acquisitions automatically. The problem is first simplified by detecting haustral folds using a graph cut method applied to a curvature-based metric applied to a surface mesh generated from segmentation of the colonic lumen. A virtual camera is used to create a set of images that provide a metric for matching pairs of folds between the prone and supine acquisitions. Image patches are generated at the fold positions using depth map renderings of the endoluminal surface and optimised by performing a virtual camera registration over a restricted set of degrees of freedom. The intensity difference between image pairs, along with additional neighbourhood information to enforce geometric constraints over a 2D parameterisation of the 3D space, are used as unary and pair-wise costs respectively, and included in a Markov Random Field (MRF) model to estimate the maximum a posteriori fold labelling assignment. The method achieved fold matching accuracy of 96.0% and 96.1% in patient cases with and without local colonic collapse. Moreover, it improved upon an existing surface-based registration algorithm by providing an initialisation. The set of landmark correspondences is used to non-rigidly transform a 2D source image derived from a conformal mapping process on the 3D endoluminal surface mesh. This achieves full surface correspondence between prone and supine views and can be further refined with an intensity based registration showing a statistically significant improvement (p < 0.001), and decreasing mean error from 11.9 mm to 6.0 mm measured at 1743 reference points from 17 CTC datasets.
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Affiliation(s)
- Thomas Hampshire
- Centre for Medical Image Computing, University College London, Gower Street, London WC1E 6BT, UK.
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Intravenous contrast enhanced computed tomography colonoscopy in children with suspected colonic polyps. Eur J Radiol 2013; 82:905-12. [PMID: 23332642 DOI: 10.1016/j.ejrad.2012.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnostic performance of intravenous contrast enhanced computed tomographic colonoscopy (IVCTC) in the diagnosis of clinically suspected colorectal polyps in children, using conventional colonoscopy (CC) as the gold standard. METHODS This was a prospective study conducted between July 2008 and June 2010. 30 pediatric patients with history of rectal bleeding and clinically suspected to have colorectal polyps were enrolled. All of the patients underwent IVCTC followed by CC. 30 IVCTC and 31 CC were performed in 30 patients. The findings of IVCTC were compared with those of CC. Statistical analysis was performed to obtain diagnostic performance values of IVCTC on per polyp (sensitivity and positive predictive value) and per patient (sensitivity, specificity, positive predictive value and negative predictive value) basis. RESULTS By IVCTC, 63 polyps were detected in 28 patients of which 53 polyps were eligible for inclusion in the statistical analysis. 60 polyps were detected by CC in 28 patients of which 50 polyps were eligible for inclusion in the statistical analysis. The per polyp sensitivity and positive predictive values were 94% and 88.6% respectively. The per patient sensitivity, specificity, positive predictive value, and negative predictive values were 96.4, 50, 96.4, and 50% respectively. Twenty polyps, in 10 patients, were visualized only after intravenous contrast administration of which 5 polyps, in 5 patients, were likely to have been missed in the absence of the intravenous contrast injection as these polyps were submerged in fluid. Four patients would have had a false negative CTC examination if the intravenous contrast had not been injected; while in another patient, the number of polyps would have been underestimated. CONCLUSION CTC is capable of serving as a safe and efficient non-invasive tool for evaluating children with clinically suspected colorectal polyps. Administration of intravenous contrast improves the sensitivity of polyp detection on CTC.
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The second ESGAR consensus statement on CT colonography. Eur Radiol 2012; 23:720-9. [PMID: 22983280 PMCID: PMC3563960 DOI: 10.1007/s00330-012-2632-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 03/18/2012] [Accepted: 04/01/2012] [Indexed: 12/14/2022]
Abstract
Objective To update quality standards for CT colonography based on consensus among opinion leaders within the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Material and methods A multinational European panel of nine members of the ESGAR CT colonography Working Group (representing six EU countries) used a modified Delphi process to rate their level of agreement on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval. Results The panel elaborated 86 statements. In the final round the panelists achieved complete consensus in 71 of 86 statements (82 %). Categories including the highest proportion of statements with excellent Cronbach's internal reliability were colon distension, scan parameters, use of intravenous contrast agents, general guidelines on patient preparation, role of CAD and lesion measurement. Lower internal reliability was achieved for the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading, and reporting. Conclusion The recommendations of the consensus should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating. Key Points • Computed tomographic colonography is the optimal radiological method of assessing the colon • This article reviews ESGAR quality standards for CT colonography • This article is aimed to provide CT-colonography guidelines for practising radiologists • The recommendations should help radiologists who are starting/updating their CTC services
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de Haan MC, Boellaard TN, Bossuyt PM, Stoker J. Colon distension, perceived burden and side-effects of CT-colonography for screening using hyoscine butylbromide or glucagon hydrochloride as bowel relaxant. Eur J Radiol 2012; 81:e910-6. [PMID: 22683196 DOI: 10.1016/j.ejrad.2012.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Compare colonic distension and perceived burden of CT-colonography between participants receiving hyoscine butylbromide (buscopan) and glucagon hydrochloride as bowel relaxant. MATERIALS AND METHODS Data were collected within a screening trial. Participants received 20mg buscopan intravenously or 1mg of glucagon intravenously (if buscopan contra-indicated). Colon distension per segment was assessed using a 4-point scale (prone and supine). Data on perceived burden of CT-colonography were collected using a questionnaire two weeks after the examination. Outcome measures between groups were compared using propensity score matching. We used a stratified Wilcoxon-Mann-Whitney test statistic for quantitative and Cochran-Mantel-Haenszel statistics for categorical variables. RESULTS 541 participants were included: 336 (62%) received buscopan and 205 received glucagon. All buscopan recipients had an adequately distended colon, compared to 96% in the glucagon group (RR 7.31, 95% CI: 1.61-33.28). More glucagon recipients scored the insufflation as rather or extremely burdensome (25% vs. 16%; overall mean score 2.7 vs. 2.4; p<0.001) and more found the entire CT-colonography rather or extremely burdensome (14% vs. 7%; 2.2 vs. 1.9; p=0.001). Most frequently reported side effects were a dry mouth in the buscopan group (15%) and nausea in the glucagon group (13%). CONCLUSION Compared to glucagon, premedication with buscopan results in significantly more adequately distended colons and a less burdensome procedure. When buscopan can be used, it is the preferred bowel relaxant.
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Affiliation(s)
- Margriet C de Haan
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Pendsé DA, Taylor SA. Complications of CT colonography: a review. Eur J Radiol 2012; 82:1159-65. [PMID: 22595505 DOI: 10.1016/j.ejrad.2012.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/23/2022]
Abstract
Since its inception, one of the main advantages of computed tomography colonography (CTC) over colonoscopy has been its assumed superior safety profile. However CTC is not without complication and adverse events are well described. Although the risks of insufflation, bowel preparation, contrast media and radiation dose are very small, they are not insignificant. This review discusses the potential hazards and complications associated with the technique, and discuss precautions, which may lessen the risk of occurrence.
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Affiliation(s)
- D A Pendsé
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK.
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Buccicardi D, Grosso M, Caviglia I, Gastaldo A, Carbone S, Neri E, Bartolozzi C, Quadri P. CT colonography: patient tolerance of laxative free fecal tagging regimen versus traditional cathartic cleansing. ACTA ACUST UNITED AC 2012; 36:532-7. [PMID: 20959977 DOI: 10.1007/s00261-010-9650-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of our prospective study was to compare patient tolerance of laxative free fecal tagging regimen (LFT) versus traditional cathartic cleansing (TC). MATERIALS AND METHODS 264 patients, at average risk for development of colorectal cancer (105 men and 159 women; mean age 62 years ± 5 SD), underwent 32 rows CT colonography. Patients were alternatively placed into 2 study groups: Group 1 (n = 132) followed TC and Group 2 (n = 132) LFT. TC protocol consisted of no fiber diet and Phospho-lax(®) 80 mL in 2 L of water the day before imaging. LFT protocol consisted of no fiber diet and ingestion with meals of 30 mL of water-soluble iodinated contrast agent (Gastrografin(®)) for 2 days before imaging. No frank laxative drugs were administered. All studies were reviewed in a combined fashion, primary 2D followed by 3D endoluminal and dissected views. After the examination all patients were asked to provide a feedback about tolerance to the each bowel preparation. The first 30 patients of each group were also investigated with optical colonoscopy (OC) used as gold standard to confirm our diagnosis (Group 1* and Group 2*). CONCLUSIONS LFT reduces discomfort and seems to improve diagnostic accuracy of CTC.
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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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Boellaard TN, de Haan MC, Venema HW, Stoker J. Colon distension and scan protocol for CT-colonography: an overview. Eur J Radiol 2011; 82:1144-58. [PMID: 22154604 DOI: 10.1016/j.ejrad.2011.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/31/2011] [Indexed: 12/18/2022]
Abstract
This article reviews two important aspects of CT-colonography, namely colonic distension and scan parameters. Adequate distension should be obtained to visualize the complete colonic lumen and optimal scan parameters should be used to prevent unnecessary radiation burden. For optimal distension, automatic carbon dioxide insufflation should be performed, preferably via a thin, flexible catheter. Hyoscine butylbromide is - when available - the preferred spasmolytic agent because of the positive effect on insufflation and pain/burden and its low costs. Scans in two positions are required for adequate distension and high polyp sensitivity and decubitus position may be used as an alternative for patients unable to lie in prone position. The great intrinsic contrast between air or tagging and polyps allows the use of low radiation dose. Low-dose protocol without intravenous contrast should be used when extracolonic findings are deemed unimportant. In patients suspected for colorectal cancer, normal abdominal CT scan protocols and intravenous contrast should be used in supine position for the evaluation of extracolonic findings. Dose reduction can be obtained by lowering the tube current and/or voltage. Tube current modulation reduces the radiation dose (except in obese patients), and should be used when available. Iterative reconstructions is a promising dose reducing tool and dual-energy CT is currently evaluated for its applications in CT-colonography. This review also provides our institution's insufflation procedure and scan parameters.
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Affiliation(s)
- Thierry N Boellaard
- Department of Radiology, Academic Medical Center, University of Amsterdam, PB 22660, 1100 DD Amsterdam, The Netherlands.
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Almond LM, Bowley DM, Karandikar SS, Roy-Choudhury SH. Role of CT colonography in symptomatic assessment, surveillance and screening. Int J Colorectal Dis 2011; 26:959-66. [PMID: 21424390 DOI: 10.1007/s00384-011-1178-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION When 'whole colonic imaging' is indicated, clinicians must decide between optical colonoscopy, barium enema and CT colonography (CTC). CTC is a relatively new technique which has become increasingly accessible in the UK over the past 5 years. As radiologists have gained experience and scanning parameters have standardised, there have been substantial improvements in both the accuracy and safety of CTC. METHODS We review evidence from observational studies and randomised trials, and draw on expert opinion, to provide a comprehensive discussion of the current role of CTC in both symptomatic and asymptomatic individuals. CONCLUSIONS The emergence of CTC could soon entirely obviate the need for barium enema. CTC now has a complementary role alongside colonoscopy in symptomatic patients and a possible future role in colorectal cancer screening in the UK.
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Affiliation(s)
- L Maximilian Almond
- Department of Colorectal Surgery, Heart of England NHS Foundation Trust, Birmingham, Birmingham, UK.
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MORTON AJ, VARNEY CR, EKIRI AB, GROSCHE A. Cardiovascular effects of N-butylscopolammonium bromide and xylazine in horses. Equine Vet J 2011:117-22. [DOI: 10.1111/j.2042-3306.2011.00400.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wylie PN, Burling D. CT colonography: what the gastroenterologist needs to know. Frontline Gastroenterol 2011; 2:96-104. [PMID: 28839590 PMCID: PMC5517201 DOI: 10.1136/fg.2009.000380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2010] [Indexed: 02/04/2023] Open
Affiliation(s)
- Peter N Wylie
- Radiology Department, Royal Free Hospital, London, UK
| | - David Burling
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
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Comparing hyoscine and drotaverine effects on colon in CT colonography. Open Med (Wars) 2011. [DOI: 10.2478/s11536-010-0065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractHyoscine and drotaverine effectiveness was compared for the purposes of achieving optimum distension following insufflation in CT colonography. The in vitro effects of hyoscine and drotaverine on tone and contractility of SM preparations isolated from different areas of human colon were studied by isometric registration of contractile activity. Both medications have a relaxing effect on SM preparations and inhibit their spontaneous contractions. The drotaverine-induced effects were reliably more marked than the hyoscine-induced ones. CT colonography was performed in 70 patients who were injected with equal doses of either hyoscine (n=32) or drotaverine (n=38). The degree of drug-induced distension in both groups was determined by measuring the lumen of the colon on a 2D reconstruction. In most colon areas the width of the distended lumen was greater in the drotaverine-treated patients. We concluded that drotaverine can be used as a means to facilitate colonic distension.
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Slater A, North M, Hart M, Ferrett C. Gas insufflation of minimal preparation CT of the colon reduces false-positives. Br J Radiol 2011; 85:346-50. [PMID: 21224295 DOI: 10.1259/bjr/20678489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Minimal preparation CT of the colon (MPCT colon) is used for investigation of suspected colorectal cancer in frail and/or elderly patients who would be expected to tolerate laxative bowel preparation poorly. Although it has good sensitivity for colorectal cancer it has a poor specificity. We wished to investigate whether distension of the colon with carbon dioxide alone would reduce the number of false-positives, but without making the test arduous or excessively uncomfortable. METHODS 134 patients were recruited and underwent MPCT colon with gas insufflation and antispasmodics. Results were compared with a cohort of 134 patients undergoing standard protocol MPCT colon. The numbers of false-positives were compared, as was reader confidence. All trial patients were given a questionnaire documenting their experience. RESULTS The number of false-positives was 15% in the control group and 5% in the trial group; this difference was statistically significant, (p=0.01). Reader confidence was increased in the trial group. Patient tolerance was good, with 95% saying they would have the test again. CONCLUSION Use of gas insufflation and antispasmodics reduces the false-positives from 15% to 5% without adversely affecting patient tolerance.
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Affiliation(s)
- A Slater
- John Radcliffe Hospital, Headley Way, Headington, Oxford, UK.
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Hafeez R, Punwani S, Pendse D, Boulos P, Bloom S, Halligan S, Taylor SA. Derivation of a T2-weighted MRI total colonic inflammation score (TCIS) for assessment of patients with severe acute inflammatory colitis-a preliminary study. Eur Radiol 2010; 21:366-77. [PMID: 20803202 DOI: 10.1007/s00330-010-1934-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 07/19/2010] [Accepted: 07/21/2010] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To derive an MRI score for assessing severity, therapeutic response and prognosis in acute severe inflammatory colitis. METHODS Twenty-one patients with acute severe colitis underwent colonic MRI after admission and again (n = 16) after median 5 days of treatment. Using T2-weighted images, two radiologists in consensus graded segmental haustral loss, mesenteric and mural oedema, mural thickness, and small bowel and colonic dilatation producing a total colonic inflammatory score (TCIS, range 6-95). Pre- and post-treatment TCIS were compared, and correlated with CRP, stool frequency, and number of inpatient days (therapeutic response marker). Questionnaire assessment of patient worry, satisfaction and discomfort graded 1 (bad) to 7 (good) was administered RESULTS Admission TCIS correlated significantly with CRP (Kendall's tau=0.45, 95% confidence interval [CI] 0.11-0.79, p = 0.006), and stool frequency (Kendall's tau 0.39, 95% CI 0.14-0.64, p = 0.02). TCIS fell after treatment (median [22 range 15-31]) to median 20 [range 8-25], p = 0.01. Admission TCIS but not CRP or stool frequency was correlated with length of inpatient stay (Kendall's tau 0.40, 95% CI 0.11-0.69, p = 0.02). Patients reported some discomfort (median score 4) during MRI. CONCLUSIONS MRI TCIS falls after therapy, correlates with existing markers of disease severity, and in comparison may better predict therapeutic response.
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Affiliation(s)
- Rehana Hafeez
- Department of Surgery, University College London Hospitals NHS Trust, London, UK
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