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Chen Y, Huang Z, Feng L, Zou W, Kong D, Zhu D, Dai G, Zhao W, Zhang Y, Luo M. Deep Learning-Based Reconstruction Improves the Image Quality of Low-Dose CT Colonography. Acad Radiol 2024; 31:3191-3199. [PMID: 38290889 DOI: 10.1016/j.acra.2024.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
RATIONALE AND OBJECTIVES To evaluate the image quality of low-dose CT colonography (CTC) using deep learning-based reconstruction (DLR) compared to iterative reconstruction (IR). MATERIALS AND METHODS Adults included in the study were divided into four groups according to body mass index (BMI). Routine-dose (RD: 120 kVp) CTC images were reconstructed with IR (RD-IR); low-dose (LD: 100kVp) images were reconstructed with IR (LD-IR) and DLR (LD-DLR). The subjective image quality was rated on a 5-point scale by two radiologists independently. The parameters for objective image quality included noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The Friedman test was used to compare the image quality among RD-IR, LD-IR and LD-DLR. The KruskalWallis test was used to compare the results among different BMI groups. RESULTS A total of 270 volunteers (mean age: 47.94 years ± 11.57; 115 men) were included. The effective dose of low-dose CTC was decreased by approximately 83.18% (5.18mSv ± 0.86 vs. 0.86mSv ± 0.05, P < 0.001). The subjective image quality score of LD-DLR was superior to that of LD-IR (3.61 ± 0.56 vs. 2.70 ± 0.51, P < 0.001) and on par with the RD- IR's (3.61 ± 0.56 vs. 3.74 ± 0.52, P = 0.486). LD-DLR exhibited the lowest noise, and the maximum SNR and CNR compared to RD-IR and LD-IR (all P < 0.001). No statistical difference was found in the noise of LD-DLR images between different BMI groups (all P > 0.05). CONCLUSION Compared to IR, DLR provided low-dose CTC with superior image quality at an average radiation dose of 0.86mSv, which may be promising in future colorectal cancer screening.
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Affiliation(s)
- Yanshan Chen
- Department of Radiology, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Department of Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu 210002, China (Y.C.)
| | - Zixuan Huang
- Department of Radiology, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Department of Radiology, Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, Guangdong 510095, China (Z.H.)
| | - Lijuan Feng
- Department of Radiology, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Department of Radiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China (L.F.)
| | - Wenbin Zou
- Department of Radiology, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.)
| | - Decan Kong
- Department of Radiology, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.)
| | - Dongyun Zhu
- Department of Radiology, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.)
| | - Guochao Dai
- Medical Imaging Center, the First People's Hospital of Kashi Area, Kashi, Xinjiang 844000, China (G.D.)
| | - Weidong Zhao
- Department of Radiology, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China (W.Z.)
| | - Yuanke Zhang
- School of Computer Science, Qufu Normal University, Rizhao, Shandong 276826, China (Y.Z.)
| | - Mingyue Luo
- Department of Radiology, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.); Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China (Y.C., Z.H., L.F., W.Z., D.K., D.Z., M.L.).
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Eltorai AEM, McKinney SE, Rockenbach MABC, Karuppiah S, Bizzo BC, Andriole KP. Primary care provider perspectives on the value of opportunistic CT screening. Clin Imaging 2024; 112:110210. [PMID: 38850710 DOI: 10.1016/j.clinimag.2024.110210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/10/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Clinical adoption of AI applications requires stakeholders see value in their use. AI-enabled opportunistic-CT-screening (OS) capitalizes on incidentally-detected findings within CTs for potential health benefit. This study evaluates primary care providers' (PCP) perspectives on OS. METHODS A survey was distributed to US Internal and Family Medicine residencies. Assessed were familiarity with AI and OS, perspectives on potential value/costs, communication of results, and technology implementation. RESULTS 62 % of respondents (n = 71) were in Family Medicine, 64.8 % practiced in community hospitals. Although 74.6 % of respondents had heard of AI/machine learning, 95.8 % had little-to-no familiarity with OS. The majority reported little-to-no trust in AI. Reported concerns included AI accuracy (74.6 %) and unknown liability (73.2 %). 78.9 % of respondents reported that OS applications would require radiologist oversight. 53.5 % preferred OS results be included in a separate "screening" section within the Radiology report, accompanied by condition risks and management recommendations. The majority of respondents reported results would likely affect clinical management for all queried applications, and that atherosclerotic cardiovascular disease risk, abdominal aortic aneurysm, and liver fibrosis should be included within every CT report regardless of reason for examination. 70.5 % felt that PCP practices are unlikely to pay for OS. Added costs to the patient (91.5 %), the healthcare provider (77.5 %), and unknown liability (74.6 %) were the most frequently reported concerns. CONCLUSION PCP preferences and concerns around AI-enabled OS offer insights into clinical value and costs. As AI applications grow, feedback from end-users should be considered in the development of such technology to optimize implementation and adoption. Increasing stakeholder familiarity with AI may be a critical prerequisite first step before stakeholders consider implementation.
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Affiliation(s)
- Adam E M Eltorai
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Suzannah E McKinney
- Data Science Office, Mass General Brigham, Boston, MA, United States of America
| | | | - Saby Karuppiah
- Department of Family Medicine, HCA Healthcare, Kansas City, MO, United States of America
| | - Bernardo C Bizzo
- Data Science Office, Mass General Brigham, Boston, MA, United States of America
| | - Katherine P Andriole
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Data Science Office, Mass General Brigham, Boston, MA, United States of America.
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Chawla T, Hurrell C, Keough V, Lindquist CM, Mohammed MF, Samson C, Sugrue G, Walsh C. Canadian Association of Radiologists Practice Guidelines for Computed Tomography Colonography. Can Assoc Radiol J 2024; 75:54-68. [PMID: 37411043 DOI: 10.1177/08465371231182975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Colon cancer is the third most common malignancy in Canada. Computed tomography colonography (CTC) provides a creditable and validated option for colon screening and assessment of known pathology in patients for whom conventional colonoscopy is contraindicated or where patients self-select to use imaging as their primary modality for initial colonic assessment. This updated guideline aims to provide a toolkit for both experienced imagers (and technologists) and for those considering launching this examination in their practice. There is guidance for reporting, optimal exam preparation, tips for problem solving to attain high quality examinations in challenging scenarios as well as suggestions for ongoing maintenance of competence. We also provide insight into the role of artificial intelligence and the utility of CTC in tumour staging of colorectal cancer. The appendices provide more detailed guidance into bowel preparation and reporting templates as well as useful information on polyp stratification and management strategies. Reading this guideline should equip the reader with the knowledge base to perform colonography but also provide an unbiased overview of its role in colon screening compared with other screening options.
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Affiliation(s)
- Tanya Chawla
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Valerie Keough
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris M Lindquist
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohammed F Mohammed
- Abdominal Radiology Section, Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Caroline Samson
- Département de Radiologie, Radio-oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Quebec, Canada
| | - Gavin Sugrue
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia Walsh
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
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Pooler BD, Kim DH, Matkowskyj KA, Newton MA, Halberg RB, Grady WM, Hassan C, Pickhardt PJ. Natural History of Colorectal Polyps Undergoing Longitudinal in Vivo CT Colonography Surveillance. Radiology 2024; 310:e232078. [PMID: 38289210 PMCID: PMC10831482 DOI: 10.1148/radiol.232078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 02/01/2024]
Abstract
Background The natural history of colorectal polyps is not well characterized due to clinical standards of care and other practical constraints limiting in vivo longitudinal surveillance. Established CT colonography (CTC) clinical screening protocols allow surveillance of small (6-9 mm) polyps. Purpose To assess the natural history of colorectal polyps followed with CTC in a clinical screening program, with histopathologic correlation for resected polyps. Materials and Methods In this retrospective study, CTC was used to longitudinally monitor small colorectal polyps in asymptomatic adult patients from April 1, 2004, to August 31, 2020. All patients underwent at least two CTC examinations. Polyp growth patterns across multiple time points were analyzed, with histopathologic context for resected polyps. Regression analysis was performed to evaluate predictors of advanced histopathology. Results In this study of 475 asymptomatic adult patients (mean age, 56.9 years ± 6.7 [SD]; 263 men), 639 unique polyps (mean initial diameter, 6.3 mm; volume, 50.2 mm3) were followed for a mean of 5.1 years ± 2.9. Of these 639 polyps, 398 (62.3%) underwent resection and histopathologic evaluation, and 41 (6.4%) proved to be histopathologically advanced (adenocarcinoma, high-grade dysplasia, or villous content), including two cancers and 38 tubulovillous adenomas. Advanced polyps showed mean volume growth of +178% per year (752% per year for adenocarcinomas) compared with +33% per year for nonadvanced polyps and -3% per year for unresected, unretrieved, or resolved polyps (P < .001). In addition, 90% of histologically advanced polyps achieved a volume of 100 mm3 and/or volume growth rate of 100% per year, compared with 29% of nonadvanced and 16% of unresected or resolved polyps (P < .001). Polyp volume-to-diameter ratio was also significantly greater for advanced polyps. For polyps observed at three or more time points, most advanced polyps demonstrated an initial slower growth interval, followed by a period of more rapid growth. Conclusion Small colorectal polyps ultimately proving to be histopathologically advanced neoplasms demonstrated substantially faster growth and attained greater overall size compared with nonadvanced polyps. Clinical trial registration no. NCT00204867 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Dachman in this issue.
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Affiliation(s)
- B. Dustin Pooler
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - David H. Kim
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Kristina A. Matkowskyj
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Michael A. Newton
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Richard B. Halberg
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - William M. Grady
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Cesare Hassan
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Perry J. Pickhardt
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
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Taylor SA. CT Colonography Reporting and Data System Version 2023: Updated, Robust, and Relevant. Radiology 2024; 310:e233169. [PMID: 38289211 DOI: 10.1148/radiol.233169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Stuart A Taylor
- From the UCL Centre for Medical Imaging, Division of Medicine, 2nd Floor Charles Bell House, 43-45 Foley St, London W1W 7TY, England
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Yee J, Dachman A, Kim DH, Kobi M, Laghi A, McFarland E, Moreno C, Park SH, Pickhardt PJ, Plumb A, Pooler BD, Zalis M, Chang KJ. CT Colonography Reporting and Data System (C-RADS): Version 2023 Update. Radiology 2024; 310:e232007. [PMID: 38289209 DOI: 10.1148/radiol.232007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation.
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Affiliation(s)
- Judy Yee
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Abraham Dachman
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - David H. Kim
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Mariya Kobi
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Andrea Laghi
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Elizabeth McFarland
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Courtney Moreno
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Seong Ho Park
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Perry J. Pickhardt
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Andrew Plumb
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - B Dustin Pooler
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Michael Zalis
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
| | - Kevin J Chang
- From the Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (J.Y.); Department of Radiology, University of Chicago, Chicago, Ill (A.D.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.K., P.P., B.D.P.); Department of Radiology, Columbia University Irving Medical Center, New York, NY (M.K.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy (A.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (E.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (C.M.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Imaging, University College London, London, United Kingdom (A.P.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.Z.); and Department of Radiology, Boston University Medical Center, Boston, Mass (K.J.C.)
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Dachman AH. To Wait or to Act: How CT Colonography Can Improve Management of Colorectal Polyps. Radiology 2024; 310:e232975. [PMID: 38289208 DOI: 10.1148/radiol.232975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Abraham H Dachman
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC2026, Chicago, IL 60637
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8
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Broadhurst PJ, Gibbons E, Knowles AE, Copson JE. Prevalence of Incidental Extraspinal Findings on MR Imaging of the Lumbar Spine in Adults: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2023; 45:113-118. [PMID: 38164532 PMCID: PMC10756571 DOI: 10.3174/ajnr.a8065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Low back pain is common worldwide. MR imaging may identify extraspinal findings that are not related to the proposed clinical question. The prevalence of extraspinal incidental findings and their clinical significance has not been well-established. PURPOSE This review aimed to evaluate the prevalence of extraspinal findings on MR imaging of the lumbar spine in adults and the prevalence of clinically significant incidental findings. DATA SOURCES A systematic search of MEDLINE and EMBASE was performed, including studies published before June 14, 2023. STUDY SELECTION Studies presenting a prevalence of extraspinal findings in patients 16 years of age or older were included. DATA ANALYSIS A random effects meta-analysis was used to generate composite prevalence measures of extraspinal findings, patients with extraspinal findings, and clinically significant findings. DATA SYNTHESIS Sixteen studies were included in this meta-analysis, with a total of 19,593 patients and 6,006 extraspinal incidental findings. The overall prevalence of extraspinal findings was 19.9% (95% CI, 11.1%-30.7%). Overall, 26.7% of patients had an extraspinal finding identified (95% CI, 14.8%-40.6%). The most common subgroup of extraspinal findings was genitourinary findings in males (27.1%; 95% CI, 25.6%-28.8%). Data from 8 studies demonstrated the prevalence of clinically significant findings at 5.4% (95% CI, 3.2%-8.1%). LIMITATIONS Retrospective populations with small numbers of participants in clinically relevant subgroups may result in heterogeneity and imprecision within composite outcome measures. CONCLUSIONS Extraspinal findings are common, detected in more than one-quarter of patients. Five percent of findings are clinically significant and may require further action.
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Affiliation(s)
- Philip J Broadhurst
- From the Department of Radiology (P.J.B.), Wythenshawe Hospital, Manchester, UK
| | - Eileen Gibbons
- Department of Medicine (E.G.), Salford Royal Hospital, Manchester, UK
| | - Amy E Knowles
- Barts Health London National Health Service Trust (A.E.K.), London, UK
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9
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Pooler BD, Kim DH, Matkowskyj KA, Newton MA, Halberg RB, Grady WM, Hassan C, Pickhardt PJ. Growth rates and histopathological outcomes of small (6-9 mm) colorectal polyps based on CT colonography surveillance and endoscopic removal. Gut 2023; 72:2321-2328. [PMID: 37507217 PMCID: PMC10822024 DOI: 10.1136/gutjnl-2022-326970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND AIMS The natural history of small polyps is not well established and rests on limited evidence from barium enema studies decades ago. Patients with one or two small polyps (6-9 mm) at screening CT colonography (CTC) are offered CTC surveillance at 3 years but may elect immediate colonoscopy. This practice allows direct observation of the growth of subcentimetre polyps, with histopathological correlation in patients undergoing subsequent polypectomy. DESIGN Of 11 165 asymptomatic patients screened by CTC over a period of 16.4 years, 1067 had one or two 6-9 mm polyps detected (with no polyps ≥10 mm). Of these, 314 (mean age, 57.4 years; M:F, 141:173; 375 total polyps) elected immediate colonoscopic polypectomy, and 382 (mean age 57.0 years; M:F, 217:165; 481 total polyps) elected CTC surveillance over a mean of 4.7 years. Volumetric polyp growth was analysed, with histopathological correlation for resected polyps. Polyp growth and regression were defined as volume change of ±20% per year, with rapid growth defined as +100% per year (annual volume doubling). Regression analysis was performed to evaluate predictors of advanced histology, defined as the presence of cancer, high-grade dysplasia (HGD) or villous components. RESULTS Of the 314 patients who underwent immediate polypectomy, 67.8% (213/314) harboured adenomas, 2.2% (7/314) with advanced histology; no polyps contained cancer or HGD. Of 382 patients who underwent CTC surveillance, 24.9% (95/382) had polyps that grew, while 62.0% (237/382) remained stable and 13.1% (50/382) regressed in size. Of the 58.6% (224/382) CTC surveillance patients who ultimately underwent colonoscopic resection, 87.1% (195/224) harboured adenomas, 12.9% (29/224) with advanced histology. Of CTC surveillance patients with growing polyps who underwent resection, 23.2% (19/82) harboured advanced histology vs 7.0% (10/142) with stable or regressing polyps (OR: 4.0; p<0.001), with even greater risk of advanced histology in those with rapid growth (63.6%, 14/22, OR: 25.4; p<0.001). Polyp growth, but not patient age/sex or polyp morphology/location were significant predictors of advanced histology. CONCLUSION Small 6-9 mm polyps present overall low risk to patients, with polyp growth strongly associated with higher risk lesions. Most patients (75%) with small 6-9 mm polyps will see polyp stability or regression, with advanced histology seen in only 7%. The minority of patients (25%) with small polyps that do grow have a 3-fold increased risk of advanced histology.
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Affiliation(s)
- B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kristina A Matkowskyj
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- William S Middleton Memorial Veterans Hospital and Clinics, Madison, Wisconsin, USA
| | - Michael A Newton
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Statistics, College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Richard B Halberg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William M Grady
- Department of Medicine, Division of Gastroentrology, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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10
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Komut S, Afşarlar ÇE. A Comprehensive Analysis of the Radiation Exposure and the Diagnostic Benefit of PanCT in Pediatric Cases with Multiple Trauma. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1228. [PMID: 37512040 PMCID: PMC10384405 DOI: 10.3390/medicina59071228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The primary objective of this study was to obtain quantitative data, taking into account the amount of radiation exposure, about the clinical and diagnostic benefit obtained from panCT in pediatric trauma cases. Thus, we aim to create greater awareness in all physicians and primarily emergency medicine physicians regarding correct selection in terms of the patient group where this effective radiological method is to be applied, and to protect children from the adverse effects of radiation. Materials and Methods: The computed tomography (CT) images were retrieved from the hospital radiological archive system (PACS). The effective dose (Ed) was calculated using the standardized method including the tissue weighted parameters. The radiological pathologies determined as a result of CT imaging of the cases were categorized according to clinical significance in accordance with the Modified CT Colonography Reporting and Data System (C-RADS). Results: The data for a total of 268 patients were analyzed, comprising 89 (33.2%) females and 179 (66.8%) males with a mean age of 8.81 ± 5.21 years. The mean Ed was determined to be 18.14 ± 10.44 mSv. The Ed was determined to be statistically significantly higher in the 1-5 years age group than in the 15-18 years age group (p = 0.024). A statistically significant difference was determined between the age groups in terms of the pathologies determined (p = 0.028). Conclusions: In order to prevent performing unnecessary CT imaging, trauma teams in Emergency Departments (ED) should work in harmony and individual decision-making should be based on the severity of the trauma mechanism, the severity of the predicted injury, and the clinical status of the injured child.
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Affiliation(s)
- Seval Komut
- Department of Emergency Medicine, Faculty of Medicine, Hitit University, Çorum 19040, Turkey
| | - Çağatay Evrim Afşarlar
- Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Çorum 19040, Turkey
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11
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Sakai CM, Ueda SKN, Caiado AHM, Ribeiro IB, Marinho FRT, de Rezende DT, Bustamante-Lopez LA, Nahas SC, de Moura DTH, de Moura EGH. A Head-to-Head Comparison of Computed Tomography Colonography, Optical Colonoscopy, and Colon Endoscopic Capsule for the Detection of Polyps After Partial Colectomy or Rectosigmoidectomy for Colorectal Cancer: A Pilot Study. Cureus 2023; 15:e38410. [PMID: 37273390 PMCID: PMC10232294 DOI: 10.7759/cureus.38410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 06/06/2023] Open
Abstract
Background and objective Optical colonoscopy is the gold standard method for the diagnosis of colorectal cancer (CRC) and it allows for biopsy and resection, as well as documentation of synchronous lesions. CT colonography (CTC) and colon endoscopic capsule (CEC) are also recommended as alternative minimally invasive or non-invasive procedures. Prospective studies comparing these three approaches are scarce in the current literature. In light of this, the aim of this pilot study was to compare the efficacy of polyp detection between these three methods in patients with a history of curative surgical resection of CRC. Methods Patients were consecutively recruited and all procedures were sequentially conducted on the same day. The primary endpoint was the detection rate of polyps, whereas secondary endpoints were the detection of polyps according to size and location, and the adverse events caused by these procedures. Results A total of 21 patients were consecutively included and all of them underwent all three interventions. No adverse events, local recurrences, or metachronous lesions were detected. In two cases with elevated carcinoembryonic antigen (CEA), CTC unveiled distant metastasis. Optical colonoscopy registered a mean of 0.4 polyp >6 mm and 1.3 polyps <6 mm per patient. CTC unveiled only 0.5 polyp >6 mm/patient and no smaller lesions were documented, whereas findings for the colon capsule comprised an average of 0.4 polyps >6 mm and 0.7 polyps <6 mm per patient. Statistical difference was not demonstrated, except for virtual colonoscopy in terms of the total number of polyps detected in comparison to optical colonoscopy. Conclusions Optical colonoscopy showed superior results in comparison to virtual colonoscopy while there was no statistical difference in comparison to colon capsule. Notwithstanding occasional difficulties, all three techniques were well tolerated. Hence, decisions concerning the use of each diagnostic method should be based on their availability, professional expertise, contraindications, and patient preferences.
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Affiliation(s)
- Christiano Makoto Sakai
- Department of Gastroenterology, Faculty of Medicine, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | - Serli Kiyomi Nakao Ueda
- Department of Radiology, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | | | - Igor Braga Ribeiro
- Department of Gastroenterology, Faculty of Medicine, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | | | | | - Leonardo A Bustamante-Lopez
- Department of Gastroenterology, Faculty of Medicine, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | - Sergio C Nahas
- Colorectal Surgery, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
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12
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Fowler KJ. Gastrointestinal Imaging: What Has Shaped and What Will Shape Our Field Going Forward. Radiology 2023; 307:e223251. [PMID: 36916893 DOI: 10.1148/radiol.223251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Kathryn J Fowler
- From the Department of Diagnostic Radiology, Division of Body Imaging, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122
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13
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Pickhardt PJ. Incidentalomas at abdominal imaging. Br J Radiol 2023; 96:20211167. [PMID: 34767479 PMCID: PMC9975518 DOI: 10.1259/bjr.20211167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 01/27/2023] Open
Abstract
As all radiologists are well aware, cross-sectional abdominal imaging tests such as CT, MR, and ultrasound generally include organs and structures that are not directly related to the clinical indication for obtaining the examination. As a result, unsuspected additional findings or "incidentalomas" must be handled in a responsible manner that balances any need for reporting and management against the potential harms that may result from such actions. The majority of abdominal incidentalomas detected at imaging will not cause downstream harm to the patient, unless perhaps the radiologist unleashes an unnecessary work-up cascade that results in patient anxiety, inconvenience, added costs, or complications. Applying the principle of primum non-nocere, an argument can be made for not even reporting incidental imaging findings that have an exceedingly low likelihood of clinical relevance, such as small, simple-appearing sporadic cysts that are commonly seen in many abdominal organs. The situation becomes more challenging, however, when "likely benign" yet indeterminate lesions are encountered. At some threshold, which is difficult to precisely define for all cases, further action may be indicated, be it imaging follow-up to confirm resolution or stability, more definitive imaging characterization, or even tissue sampling. For more concerning or ominous incidentalomas, the need for further work-up will be more clear cut.
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Affiliation(s)
- Perry J. Pickhardt
- The University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
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14
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Forrest A, Afshari S, Franssen N, Ali N. Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:257-262. [PMID: 36136159 DOI: 10.1007/s00261-022-03678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Abdominal ultrasound is a cost-effective method for screening for hepatocellular carcinoma (HCC) in high-risk individuals. Currently, at many institutions the protocol for obtaining HCC screening ultrasounds includes a traditional examination of the right upper quadrant, including the pancreas and right kidney. There is no consensus on the role of imaging of extra-hepatic structures and there are limited data describing the frequency and clinical significance of incidental findings discovered during HCC screening. The purpose of this retrospective study is to assess the prevalence and significance of extra-hepatic incidental findings during HCC screening ultrasounds. METHODS A single-center retrospective review of all right upper quadrant HCC screening ultrasounds identified 432 HCC screening ultrasounds performed on 294 adults over a 2.5-year period. Findings in all organs evaluated were recorded. Any incidental finding was classified as minor, moderate, or major clinical significance. RESULTS At least one extra-hepatic finding was documented in 57.4% of examinations. The most common extra-hepatic findings occurred in the gallbladder (40.3%), most commonly gallstones (25.4%). Four moderate clinically significant incidental findings were recorded (0.9%). Only one of these incidental findings required specific imaging follow up (0.2%). No major clinical significance incidental findings were identified. CONCLUSIONS Potentially clinically significant incidental findings during ultrasound HCC screenings are rare. Incidental findings identified on HCC screening did not result in significant additional follow-up imaging or interventions.
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Affiliation(s)
- Allison Forrest
- University of Vermont Medical Center, Burlington, VT, USA. .,Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA.
| | - Sam Afshari
- University of Vermont Medical Center, Burlington, VT, USA
| | | | - Naiim Ali
- University of Vermont Medical Center, Burlington, VT, USA
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15
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Single CT Appointment for Double Lung and Colorectal Cancer Screening: Is the Time Ripe? Diagnostics (Basel) 2022; 12:diagnostics12102326. [PMID: 36292015 PMCID: PMC9601268 DOI: 10.3390/diagnostics12102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Annual screening of lung cancer (LC) with chest low-dose computed tomography (CT) and screening of colorectal cancer (CRC) with CT colonography every 5 years are recommended by the United States Prevention Service Task Force. We review epidemiological and pathological data on LC and CRC, and the features of screening chest low-dose CT and CT colonography comprising execution, reading, radiation exposure and harm, and the cost effectiveness of the two CT screening interventions. The possibility of combining chest low-dose CT and CT colonography examinations for double LC and CRC screening in a single CT appointment is then addressed. We demonstrate how this approach appears feasible and is already reasonable as an opportunistic screening intervention in 50–75-year-old subjects with smoking history and average CRC risk. In addition to the crucial role Computer Assisted Diagnosis systems play in decreasing the test reading times and the need to educate radiologists in screening chest LDCT and CT colonography, in view of a single CT appointment for double screening, the following uncertainties need to be solved: (1) the schedule of the screening CT; (2) the effectiveness of iterative reconstruction and deep learning algorithms affording an ultra-low-dose CT acquisition technique and (3) management of incidental findings. Resolving these issues will imply new cost-effectiveness analyses for LC screening with chest low dose CT and for CRC screening with CT colonography and, especially, for the double LC and CRC screening with a single-appointment CT.
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16
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Pickhardt PJ. Value-added Opportunistic CT Screening: State of the Art. Radiology 2022; 303:241-254. [PMID: 35289661 PMCID: PMC9083232 DOI: 10.1148/radiol.211561] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022]
Abstract
Opportunistic CT screening leverages robust imaging data embedded within abdominal and thoracic scans that are generally unrelated to the specific clinical indication and have heretofore gone largely unused. This incidental imaging information may prove beneficial to patients in terms of wellness, prevention, risk profiling, and presymptomatic detection of relevant disease. The growing interest in CT-based opportunistic screening relates to a confluence of factors: the objective and generalizable nature of CT-based body composition measures, the emergence of fully automated explainable AI solutions, the sheer volume of body CT scans performed, and the increasing emphasis on precision medicine and value-added initiatives. With a systematic approach to body composition and other useful CT markers, initial evidence suggests that their ability to help radiologists assess biologic age and predict future adverse cardiometabolic events rivals even the best available clinical reference standards. Emerging data suggest that standalone "intended" CT screening over an unorganized opportunistic approach may be justified, especially when combined with established cancer screening. This review will discuss the current status of opportunistic CT screening, including specific body composition markers and the various disease processes that may be impacted. The remaining hurdles to widespread clinical adoption include generalization to more diverse patient populations, disparate technical settings, and reimbursement.
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Affiliation(s)
- Perry J. Pickhardt
- From the Department of Radiology, The University of Wisconsin School
of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave,
Madison, WI 53792-3252
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Elton DC, Turkbey EB, Pickhardt PJ, Summers RM. A deep learning system for automated kidney stone detection and volumetric segmentation on noncontrast CT scans. Med Phys 2022; 49:2545-2554. [PMID: 35156216 PMCID: PMC10407943 DOI: 10.1002/mp.15518] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Early detection and size quantification of renal calculi are important for optimizing treatment and preventing severe kidney stone disease. Prior work has shown that volumetric measurements of kidney stones are more informative and reproducible than linear measurements. Deep learning-based systems that use abdominal noncontrast computed tomography (CT) scans may assist in detection and reduce workload by removing the need for manual stone volume measurement. Prior to this work, no such system had been developed for use on noisy low-dose CT or tested on a large-scale external dataset. METHODS We used a dataset of 91 CT colonography (CTC) scans with manually marked kidney stones combined with 89 CTC scans without kidney stones. To compare with a prior work half the data was used for training and half for testing. A set of CTC scans from 6185 patients from a separate institution with patient-level labels were used as an external validation set. A 3D U-Net model was employed to segment the kidneys, followed by gradient-based anisotropic denoising, thresholding, and region growing. A 13 layer convolutional neural network classifier was then applied to distinguish kidney stones from false positive regions. RESULTS The system achieved a sensitivity of 0.86 at 0.5 false positives per scan on a challenging test set of low-dose CT with many small stones, an improvement over an earlier work that obtained a sensitivity of 0.52. The stone volume measurements correlated well with manual measurements (r 2 = 0.95 $r^2 = 0.95$ ). For patient-level classification, the system achieved an area under the receiver-operating characteristic of 0.95 on an external validation set (sensitivity = 0.88, specificity = 0.91 at the Youden point). A common cause of false positives were small atherosclerotic plaques in the renal sinus that simulated kidney stones. CONCLUSIONS Our deep-learning-based system showed improvements over a previously developed system that did not use deep learning, with even higher performance on an external validation set.
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Affiliation(s)
- Daniel C. Elton
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182, USA
| | - Evrim B. Turkbey
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182, USA
| | - Perry J. Pickhardt
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
| | - Ronald M. Summers
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892-1182, USA
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18
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Ward JM, Horvat N, Gollub MJ. Extracolonic findings at CT colonography in an oncological hospital setting. Clin Imaging 2022; 86:98-102. [DOI: 10.1016/j.clinimag.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022]
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Thorén F, Johnsson ÅA, Hellström M, Båth M. EXTRACOLONIC FINDINGS-IDENTIFICATION AT LOW-DOSE CTC. RADIATION PROTECTION DOSIMETRY 2021; 195:188-197. [PMID: 33855447 PMCID: PMC8507454 DOI: 10.1093/rpd/ncab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/07/2021] [Indexed: 06/12/2023]
Abstract
In contrast to optical colonoscopy, computed tomography colonography (CTC) has the ability to reveal pathology outside of the colon. While identification of colorectal lesions at CTC requires only limited radiation dose, the detection of abnormalities in extracolonic soft tissue requires more radiation. The purpose of this study was to investigate the influence of ultra-low-dose (ULD) CTC on the detection and characterisation of extracolonic findings. In a prospective study 49 patients with colorectal symptoms were examined with CTC adding a ULD series (mean effective dose 0.9 ± 0.4 mSv) to the normal unenhanced standard dose (SD) series (mean effective dose 3.6 ± 1.2 mSv). Five radiologists individually and blindly evaluated the ULD, followed by evaluation of the SD after ≥9 weeks (median 35 weeks). A ViewDEX-based examination protocol was used, including a confidence scale and a graded assessment of need for follow-up according to the CTC Reporting and Data System (C-RADS E0-E4). The reference findings comprised the combined information from CTC (ULD, SD and contrast-enhanced CTC series) and a 4-year radiological and clinical follow-up. For the overall detection of reference findings (E2-E4) we found a statistically significant difference in favour of SD. This, however, was not the case when looking at classification of possibly important/important reference findings (E3-E4). Our results suggest that CTC with ULD (0.9 mSv) is comparable to SD (3.6 mSv) for identification of clinically relevant extracolonic pathology, but there is a large inter-observer variability.
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Affiliation(s)
| | - Åse A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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20
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KOMUT E. Extraspinal incidental findings and reporting rates at lumbar spine magnetic resonance imaging: more than a spinal examination? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.941211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Roth CJ, Clunie DA, Vining DJ, Berkowitz SJ, Berlin A, Bissonnette JP, Clark SD, Cornish TC, Eid M, Gaskin CM, Goel AK, Jacobs GC, Kwan D, Luviano DM, McBee MP, Miller K, Hafiz AM, Obcemea C, Parwani AV, Rotemberg V, Silver EL, Storm ES, Tcheng JE, Thullner KS, Folio LR. Multispecialty Enterprise Imaging Workgroup Consensus on Interactive Multimedia Reporting Current State and Road to the Future: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2021; 34:495-522. [PMID: 34131793 PMCID: PMC8329131 DOI: 10.1007/s10278-021-00450-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Abstract
Diagnostic and evidential static image, video clip, and sound multimedia are captured during routine clinical care in cardiology, dermatology, ophthalmology, pathology, physiatry, radiation oncology, radiology, endoscopic procedural specialties, and other medical disciplines. Providers typically describe the multimedia findings in contemporaneous electronic health record clinical notes or associate a textual interpretative report. Visual communication aids commonly used to connect, synthesize, and supplement multimedia and descriptive text outside medicine remain technically challenging to integrate into patient care. Such beneficial interactive elements may include hyperlinks between text, multimedia elements, alphanumeric and geometric annotations, tables, graphs, timelines, diagrams, anatomic maps, and hyperlinks to external educational references that patients or provider consumers may find valuable. This HIMSS-SIIM Enterprise Imaging Community workgroup white paper outlines the current and desired clinical future state of interactive multimedia reporting (IMR). The workgroup adopted a consensus definition of IMR as “interactive medical documentation that combines clinical images, videos, sound, imaging metadata, and/or image annotations with text, typographic emphases, tables, graphs, event timelines, anatomic maps, hyperlinks, and/or educational resources to optimize communication between medical professionals, and between medical professionals and their patients.” This white paper also serves as a precursor for future efforts toward solving technical issues impeding routine interactive multimedia report creation and ingestion into electronic health records.
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Affiliation(s)
| | | | - David J Vining
- Department of Abdominal Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Seth J Berkowitz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre - University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jean-Pierre Bissonnette
- Departments of Radiation Oncology and Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Shawn D Clark
- University of Miami Hospitals and Clinics, Miami, FL, USA
| | - Toby C Cornish
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monief Eid
- eHealth & Digital Transformation Agency, Ministry of Health, Riyadh, Saudi Arabia
| | - Cree M Gaskin
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | | | | | - David Kwan
- Health Technology and Information Management, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Damien M Luviano
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Morgan P McBee
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | | | - Abdul Moiz Hafiz
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ceferino Obcemea
- Radiation Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Anil V Parwani
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Veronica Rotemberg
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Erik S Storm
- Department of Radiology and Medical Education, Salem VA Medical Center, Salem, VA, USA
| | - James E Tcheng
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA
| | | | - Les R Folio
- Lead CT Radiologist, NIH Clinical Center, Bethesda, MD, USA
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22
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Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:1978-1998. [PMID: 34003220 DOI: 10.1001/jama.2021.4417] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the US. OBJECTIVE To systematically review the effectiveness, test accuracy, and harms of screening for CRC to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2015, to December 4, 2019; surveillance through March 26, 2021. STUDY SELECTION English-language studies conducted in asymptomatic populations at general risk of CRC. DATA EXTRACTION AND SYNTHESIS Two reviewers independently appraised the articles and extracted relevant study data from fair- or good-quality studies. Random-effects meta-analyses were conducted. MAIN OUTCOMES AND MEASURES Colorectal cancer incidence and mortality, test accuracy in detecting cancers or adenomas, and serious adverse events. RESULTS The review included 33 studies (n = 10 776 276) on the effectiveness of screening, 59 (n = 3 491 045) on the test performance of screening tests, and 131 (n = 26 987 366) on the harms of screening. In randomized clinical trials (4 trials, n = 458 002), intention to screen with 1- or 2-time flexible sigmoidoscopy vs no screening was associated with a decrease in CRC-specific mortality (incidence rate ratio, 0.74 [95% CI, 0.68-0.80]). Annual or biennial guaiac fecal occult blood test (gFOBT) vs no screening (5 trials, n = 419 966) was associated with a reduction of CRC-specific mortality after 2 to 9 rounds of screening (relative risk at 19.5 years, 0.91 [95% CI, 0.84-0.98]; relative risk at 30 years, 0.78 [95% CI, 0.65-0.93]). In observational studies, receipt of screening colonoscopy (2 studies, n = 436 927) or fecal immunochemical test (FIT) (1 study, n = 5.4 million) vs no screening was associated with lower risk of CRC incidence or mortality. Nine studies (n = 6497) evaluated the test accuracy of screening computed tomography (CT) colonography, 4 of which also reported the test accuracy of colonoscopy; pooled sensitivity to detect adenomas 6 mm or larger was similar between CT colonography with bowel prep (0.86) and colonoscopy (0.89). In pooled values, commonly evaluated FITs (14 studies, n = 45 403) (sensitivity, 0.74; specificity, 0.94) and stool DNA with FIT (4 studies, n = 12 424) (sensitivity, 0.93; specificity, 0.85) performed better than high-sensitivity gFOBT (2 studies, n = 3503) (sensitivity, 0.50-0.75; specificity, 0.96-0.98) to detect cancers. Serious harms of screening colonoscopy included perforations (3.1/10 000 procedures) and major bleeding (14.6/10 000 procedures). CT colonography may have harms resulting from low-dose ionizing radiation. It is unclear if detection of extracolonic findings on CT colonography is a net benefit or harm. CONCLUSIONS AND RELEVANCE There are several options to screen for colorectal cancer, each with a different level of evidence demonstrating its ability to reduce cancer mortality, its ability to detect cancer or precursor lesions, and its risk of harms.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nora B Henrikson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Paula R Blasi
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Wood L, Martin C, Polly D, Luchsinger S, Takahashi T. Incidental extraspinal imaging findings on adult EOS full body radiographs: prevalence and clinical importance. BMC Med Imaging 2021; 21:83. [PMID: 34001001 PMCID: PMC8127196 DOI: 10.1186/s12880-021-00607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to review our institutional experience with the EOS machine in order to identify the incidence and clinical significance of incidental extraspinal findings (IESF) in an adult spinal deformity population. Methods Our institutional database was queried for all full-length standing radiographs generated by the EOS machine. Dictations were reviewed and the number of incidental extraspinal findings were classified using a previously described system. All findings related to the spine were excluded. A subset of electronic medical records were reviewed to determine further workup for individual findings of suspected clinical significance. Results Original database query based on radiology reports returned a total of 1857 EOS studies. Duplicate studies, studies without the entire body, and patients with more than 1 study during the search period were excluded. 503 patient studies (55.5% female, mean age 59-years-old, range 18 to 91-years-old) met inclusion criteria. The overall rate of incidental extraspinal findings in our study was 60.4% (304 findings in 503 patients). Most findings were classified as Minor. The rate of Major and Moderate findings was 4.8%. The final rate of clinically significant incidental extraspinal findings was 0.8% and included 3 presumed metastatic lesions in long bones and 1 pulmonary nodule. Conclusion To our knowledge this is the first study that reports the rate of incidental extraspinal findings on full body EOS studies. We report a low rate (0.8%) of clinically significant incidental extraspinal findings which is lower than that of CT or MRI. Further research is warranted in comparing EOS and standard radiography.
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Affiliation(s)
- Lily Wood
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christopher Martin
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David Polly
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Samuel Luchsinger
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Takashi Takahashi
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA.
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Liu JJ, Xue HD, Liu W, Yan J, Pan WD, Li B, Xu K, Wang Y, Li P, Xiao Y, Jin ZY. CT colonography with spectral filtration and advanced modeled iterative reconstruction in the third-generation dual-source CT: image quality, radiation dose and performance in clinical utility. Acad Radiol 2021; 28:e127-e136. [PMID: 32434689 DOI: 10.1016/j.acra.2020.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate image quality, radiation dose and its diagnostic performance in clinical utility of CT colonography (CTC) applying spectral filtration and advanced modeled iterative reconstruction (ADMIRE) techniques in third-generation dual-source CT. MATERIALS AND METHODS A total of 125 patients for screening or diagnostic purposes underwent CTC at 120kVp standard dose (120kVp-STD) with filtered-back projection reconstruction (FBP) in supine position, then at a tin-filtered 150 kVp low dose (Sn150kVp-LD) and a tin-filtered 100 kVp ultra-low dose (Sn100kVp-ULD) with ADMIRE reconstruction in prone position. Radiation metrics were recorded. Objective and subjective image qualities were compared, and the diagnostic performance was assessed for both colonic and extracolonic findings using CTC reporting and data system (C-RADS). RESULTS The effective dose was significantly lower for Sn150kVp-LD and Sn100kVp-ULD than 120kVp-STD protocol, resulting in 22.5% and 87.5% reductions (1.55±0.30 and 0.25±0.07 mSv vs. 2.00±0.52 mSv; both p<0.01), respectively. Image noise and signal-to-noise ratio were improved significantly for Sn150kVp-LD with ADMIRE compared with 120kVp-STD, both of which had similar excellent 2D and 3D subjective image quality with equivalent diagnostic performance. Sn100kVp-ULD with ADMIRE had decreased subjective image quality and significant different C-RADS extracolonic-score (E-score) compared with 120kVp-STD, however, C-RADS colonic-score (C-score) of that showed no significantly difference. CONCLUSION Sn150kVp and Sn100kVp with ADMIRE reconstruction provide an alternative low dose CTC strategy and could be feasible in clinical screening or diagnostic scenarios.
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Affiliation(s)
- Jing-Juan Liu
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Wei Liu
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China.
| | - Jing Yan
- Siemens Medical System, 201318, Shanghai, China
| | - Wei-Dong Pan
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Bin Li
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Kai Xu
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Ping Li
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
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Njølstad T, Young VS, Drolsum A, Dormagen JB, Hofstad B, Schulz A. Is there need for routine CT colonography after CT-verified uncomplicated diverticulitis of the sigmoid colon? Eur J Radiol Open 2021; 8:100341. [PMID: 33898653 PMCID: PMC8053813 DOI: 10.1016/j.ejro.2021.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 10/25/2022] Open
Abstract
Background Following an episode of acute diverticulitis, surgical guidelines commonly advise routine colonic follow-up to rule out underlying malignancy. However, as a CT of the abdomen is frequently performed during clinical work-up, the routine need for colonic follow-up has become debated. Purpose To evaluate the need for routine CT colonography after an episode of CT-verified uncomplicated sigmoid diverticulitis to rule out underlying colorectal malignancy. Material and methods This study retrospectively evaluated 312 patients routinely referred to colonic evaluation by CT colonography following an episode of acute diverticulitis. Patients were excluded if lacking diagnostic CT of the abdomen at time of diagnosis, if presenting with atypical colonic involvement, or if CT findings were suggestive of complicated disease (e.g., abscess or perforation). CT colonography exams were routinely reviewed by experienced abdominal radiology consultants on the day of the procedure. If significant polyps were detected, or if colorectal malignancy could not be excluded, patients were referred to same-day optical colonoscopy. For these patients, medical records were reviewed for optical colonoscopy results and histology reports if applicable. Results Among 223 patients with CT-verified uncomplicated sigmoid diverticulitis, no patients were found to have underlying colorectal malignancy. 27 patients were referred to optical colonoscopy based on CT colonography findings. 18 patients consequently underwent polypectomy, all with either hyperplastic or adenomatous histology. Conclusions This study indicates that routine colonic evaluation by CT colonography following an episode of CT-verified uncomplicated sigmoid diverticulitis may be unwarranted, and should arguably be reserved for patients with protracted or atypical clinical course.
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Affiliation(s)
- Tormund Njølstad
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Victoria Solveig Young
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anders Drolsum
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Johann Baptist Dormagen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Bjørn Hofstad
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
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26
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Lambe G, Hughes P, Rice L, McDonnell C, Murphy M, Judge C, Guiney M. The bowel and beyond: extracolonic findings from CT colonography. Ir J Med Sci 2021; 191:909-914. [PMID: 33761095 PMCID: PMC7988374 DOI: 10.1007/s11845-021-02595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/09/2021] [Indexed: 10/25/2022]
Abstract
CT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519-526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313-318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.
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Affiliation(s)
- Gerard Lambe
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland.
| | - Peter Hughes
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Louise Rice
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Caoimhe McDonnell
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Mark Murphy
- Radiology Department, The Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ciaran Judge
- Gastroenterology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Michael Guiney
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
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PPV and Detection Rate of mt-sDNA Testing, FIT, and CT Colonography for Advanced Neoplasia: A Hierarchic Bayesian Meta-Analysis of the Noninvasive Colorectal Screening Tests. AJR Am J Roentgenol 2021; 217:817-830. [PMID: 33703913 DOI: 10.2214/ajr.20.25416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Noninvasive tests for colorectal cancer (CRC) screening and prevention limit the need for invasive colonoscopy to follow up positive test results. However, the relative performance characteristics of available noninvasive tests have not yet been adequately compared. OBJECTIVE. We performed a systematic review and meta-analysis to compare the diagnostic performance of the available noninvasive CRC screening tests, including multitarget stool DNA (mt-sDNA) testing, fecal immunochemical testing (FIT), and CT colonography (CTC), with an emphasis on comparison of PPV and detection rate (DR) for advanced neoplasia (AN; encompassing cases of advanced adenomas and CRC). EVIDENCE ACQUISITION. After systematic searches of MEDLINE and Google Scholar databases, 10 mt-sDNA, 27 CTC, and 88 FIT published screening studies involving 25,132, 33,493, and 2,355,958 asymptomatic adults, respectively, were included. Meta-analysis with hierarchic Bayesian modeling was conducted in accordance with Cochrane Collaboration and PRISMA guidelines to determine test positivity rates (TPRs) leading to optical colonoscopy, as well as PPVs and DRs for both AN and CRC. Different positivity thresholds were considered for FIT and CTC. EVIDENCE SYNTHESIS. Point estimates (with 95% credible intervals) from pooled Bayesian meta-analysis combining all thresholds for FIT and stratifying CTC results by a polyp size threshold of 6 mm or larger (CTC6) and 10 mm or larger (CTC10) were calculated. TPR was 13.5% (10.9-16.6%) for mt-sDNA testing, 6.4% (5.8-7.2%) for FIT, 13.4% (11.4-15.6%) for CTC6, and 6.6% (5.2-7.7%) for CTC10. AN PPV was 26.9% (95% credible interval, 21.8-33.2%) for mt-sDNA testing, 31.8% (29.3-34.5%) for FIT, 34.4% (27.2-41.0%) for CTC6, and 61.0% (54.0-70.0%) for CTC10. CRC PPV was 2.4% (1.5-3.9%) for mt-sDNA testing, 4.9% (4.3-5.3%) for FIT, 3.5% (2.5-4.8%) for CTC6, and 6.0% (4.3-8.0%) for CTC10. The DR for AN was 3.4% (95% credible interval, 2.5-4.8%) for mt-SDNA, 2.0% (1.8-2.3%) for FIT, 4.8% (4.0-6.5%) for CTC6, and 4.0% (3.0-4.6%) for CTC10. When FIT is restricted to a lower threshold (< 10 μg Hb/g feces), its performance profile is similar to that of mt-sDNA testing, although available data are limited. AN PPV odds ratios (relative to CTC10 as the reference) were 0.24 (95% credible interval, 0.17-0.33) for mt-sDNA testing, 0.30 (0.24-0.45) for FIT, and 0.33 (0.25-0.47) for CTC6. CONCLUSION. Among noninvasive CRC screening tests, CTC with a polyp size threshold of 10 mm or larger most effectively targets AN, preserving detection while also decreasing unnecessary colonoscopies compared with mt-sDNA testing and FIT. CLINICAL IMPACT. CTC performed with a polyp size threshold for colonoscopy referral set at 10 mm or larger represents the most effective and efficient noninvasive screening test for CRC prevention and detection.
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Pickhardt PJ, Graffy PM, Perez AA, Lubner MG, Elton DC, Summers RM. Opportunistic Screening at Abdominal CT: Use of Automated Body Composition Biomarkers for Added Cardiometabolic Value. Radiographics 2021; 41:524-542. [PMID: 33646902 DOI: 10.1148/rg.2021200056] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal CT is a frequently performed imaging examination for a wide variety of clinical indications. In addition to the immediate reason for scanning, each CT examination contains robust additional data on body composition that generally go unused in routine clinical practice. There is now growing interest in harnessing this additional information. Prime examples of cardiometabolic information include measurement of bone mineral density for osteoporosis screening, quantification of aortic calcium for assessment of cardiovascular risk, quantification of visceral fat for evaluation of metabolic syndrome, assessment of muscle bulk and density for diagnosis of sarcopenia, and quantification of liver fat for assessment of hepatic steatosis. All of these relevant biometric measures can now be fully automated through the use of artificial intelligence algorithms, which provide rapid and objective assessment and allow large-scale population-based screening. Initial investigations into these measures of body composition have demonstrated promising performance for prediction of future adverse events that matches or exceeds the best available clinical prediction models, particularly when these CT-based measures are used in combination. In this review, the concept of CT-based opportunistic screening is discussed, and an overview of the various automated biomarkers that can be derived from essentially all abdominal CT examinations is provided, drawing heavily on the authors' experience. As radiology transitions from a volume-based to a value-based practice, opportunistic screening represents a promising example of adding value to services that are already provided. If the potentially high added value of these objective CT-based automated measures is ultimately confirmed in subsequent investigations, this opportunistic screening approach could be considered for intentional CT-based screening. ©RSNA, 2021.
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Affiliation(s)
- Perry J Pickhardt
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Peter M Graffy
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Alberto A Perez
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Meghan G Lubner
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Daniel C Elton
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Ronald M Summers
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
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CT colonography's role in the COVID-19 pandemic: a safe(r), socially distanced total colon examination. Abdom Radiol (NY) 2021; 46:486-490. [PMID: 32748251 PMCID: PMC7398602 DOI: 10.1007/s00261-020-02674-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/12/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022]
Abstract
Purpose To describe the favorable procedural profile of CT colonography (CTC) during the COVID-19 pandemic. Conclusion Postponement of cancer screening due to COVID-19 has resulted in a backlog of individuals needing to undergo structural examination of the colon. The experience during the initial COVID-19 surge with urgent evaluation of the colon for transplant patients prior to transplant suggests that CTC can be done in a lower risk manner as compared to other structural examinations. The procedural profile of CTC is advantageous during this pandemic as maintaining social distancing and preserving healthcare supplies including PPE are of paramount importance. CTC is an important option to utilize in the screening armamentarium to allow effective screening of average risk asymptomatic individuals in the COVID-19 era.
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Belloni E, Tentoni S, Fiorina I, Bortolotto C, Bottinelli O, Cellina M, Gibelli D, Rosti C, Preda L, Calliada F, Scagnelli P. Reported and Unreported Potentially Important Incidental Findings in Urgent Nonenhanced Abdominal CT for Renal Colic. Med Princ Pract 2021; 30:355-360. [PMID: 33721865 PMCID: PMC8436713 DOI: 10.1159/000515852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/14/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the study was to retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings (PIFs) in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHODS One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January to December 2017 on adult patients from the emergency department with the specific request of urgent evaluation for renal colic, searching for PIFs. RESULTS The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported PIFs between the original report and re-evaluation was significant (p < 0.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the 3 shifts in the original report and in re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopathies, and liver nodules. CONCLUSIONS Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to underreport PIFs even in the urgent setting because of the possible consequences on the patient's health and in order to avoid legal issues, while at the same time satisfying the need for timely and efficient reporting.
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Affiliation(s)
- Elena Belloni
- Department of Radiology, Civil Hospital, Vigevano, Italy
- *Elena Belloni,
| | - Stefania Tentoni
- Institute of Applied Mathematics and Information Technologies “Enrico Magenes”, National Research Council, Pavia, Italy
| | - Ilaria Fiorina
- Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chandra Bortolotto
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Olivia Bottinelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Michaela Cellina
- Radiology Unit, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Daniele Gibelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Rosti
- Department of Radiology, Civil Hospital, Vigevano, Italy
| | - Lorenzo Preda
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabrizio Calliada
- Radiology Unit, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Department of Radiology, IRCCS Fondazione Mondino, Pavia, Italy
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Pickhardt PJ, Graffy PM, Weigman B, Deiss-Yehiely N, Hassan C, Weiss JM. Diagnostic Performance of Multitarget Stool DNA and CT Colonography for Noninvasive Colorectal Cancer Screening. Radiology 2020; 297:120-129. [PMID: 32779997 DOI: 10.1148/radiol.2020201018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundMultitarget stool DNA (mt-sDNA) screening has increased rapidly since simultaneous approval by the U.S. Food and Drug Administration and Centers for Medicare and Medicaid Services in 2014, whereas CT colonography screening remains underused and is not covered by Centers for Medicare and Medicaid Services.PurposeTo report postapproval clinical experience with mt-sDNA screening for colorectal cancer (CRC) and compare results with CT colonography screening at the same center.Materials and MethodsIn this retrospective cohort study, asymptomatic adults underwent clinical mt-sDNA screening during a 5-year interval (2014-2019). Electronic medical records were searched to verify test results and document subsequent optical colonoscopy and histopathologic findings. A similar analysis was performed for CT colonography screening during a 15-year interval (2004-2019), with consideration of thresholds for positivity of both 6-mm and 10-mm polyp sizes. χ2 or two-sample t tests were used for group comparisons.ResultsA total of 3987 asymptomatic adult patients (mean age, 64 years ± 9 [standard deviation]; 2567 women) underwent mt-sDNA screening and 9656 patients (mean age, 57 years ± 8; 5200 women) underwent CT colonography. Test-positive rates for mt-sDNA and for 6-mm- and 10-mm-threshold CT colonography were 15.2%, 16.4%, and 6.7%, respectively. Optical colonoscopy follow-up rates for positive results of mt-sDNA and 6-mm- and 10-mm-threshold CT colonography were 13.1%, 12.3%, and 5.9%, respectively. Positive predictive values (PPVs) for any neoplasm 6 mm or greater, advanced neoplasia, and CRC for mt-sDNA were 54.2%, 22.7%, and 1.9% respectively; for 6-mm-threshold CT colonography, PPVs were 76.8%, 44.3%, and 2.7%; for 10-mm-threshold CT colonography, PPVs were 84.5%, 75.2%, and 5.2%, respectively (P < .001 for mt-sDNA vs CT colonography for all except 6-mm CRC at CT colonography). For mt-sDNA versus 6-mm-threshold CT colonography, overall detection rates for advanced neoplasia were 2.7% and 5.0%, respectively (P < .001); corresponding detection rates for CRC were 0.23% and 0.31%, respectively (P = .43).ConclusionThe detection rates of advanced neoplasia at CT colonography screening were greater than those of multitarget stool DNA. Detection rates were similar for colorectal cancer.© RSNA, 2020See also the editorial by Yee in this issue.
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Affiliation(s)
- Perry J Pickhardt
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Peter M Graffy
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Benjamin Weigman
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Nimrod Deiss-Yehiely
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Cesare Hassan
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
| | - Jennifer M Weiss
- From the Department of Radiology (P.J.P., P.M.G., B.W.) and the Department of Medicine (N.D.Y., J.M.W.), University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (C.H.)
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Obmann MM, An C, Schaefer A, Sun Y, Wang ZJ, Yee J, Yeh BM. Improved Sensitivity and Reader Confidence in CT Colonography Using Dual-Layer Spectral CT: A Phantom Study. Radiology 2020; 297:99-107. [PMID: 32720868 DOI: 10.1148/radiol.2020200032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Limited cathartic preparations for CT colonography with fecal tagging can improve patient comfort but may result in nondiagnostic examinations from poorly tagged stool. Dual-energy CT may overcome this limitation by improving the conspicuity of the contrast agent, but more data are needed. Purpose To investigate whether dual-energy CT improves polyp detection in CT colonography compared with conventional CT at different fecal tagging levels in vitro. Materials and Methods In this HIPAA-compliant study, between December 2017 and August 2019, a colon phantom 30 cm in diameter containing 60 polyps of different shapes (spherical, ellipsoid, flat) and size groups (5-9 mm, 11-15 mm) was constructed and serially filled with simulated feces tagged with four different iodine concentrations (1.26, 2.45, 4.88, and 21.00 mg of iodine per milliliter), then it was scanned with dual-energy CT with and without an outer fat ring to simulate large body size (total diameter, 42 cm). Two readers independently reviewed conventional 120-kVp CT and 40-keV monoenergetic dual-energy CT images to record the presence of polyps and confidence (three-point scale.) Generalized estimating equations were used for sensitivity comparisons between conventional CT and dual-energy CT, and a Wilcoxon signed-rank test was used for reader confidence. Results Dual-energy CT had higher overall sensitivity for polyp detection than conventional CT (58.8%; 95% confidence interval [CI]: 49.7%, 67.3%; 564 of 960 polyps vs 42.1%; 95% CI: 32.1%, 52.8%; 404 of 960 polyps; P < .001), including with the fat ring (48% and 31%, P < .001). Reader confidence improved with dual-energy CT compared with conventional images on all tagging levels (P < .001). Interrater agreement was substantial (κ = 0.74; 95% CI: 0.70, 0.77). Conclusion Compared with conventional 120-kVp CT, dual-energy CT improved polyp detection and reader confidence in a dedicated dual-energy CT colonography phantom, especially with suboptimal fecal tagging. © RSNA, 2020.
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Affiliation(s)
- Markus M Obmann
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94117 (M.M.O., C.A., A.S., Y.S., Z.J.W., B.M.Y.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY (J.Y.)
| | - Chansik An
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94117 (M.M.O., C.A., A.S., Y.S., Z.J.W., B.M.Y.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY (J.Y.)
| | - Amanda Schaefer
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94117 (M.M.O., C.A., A.S., Y.S., Z.J.W., B.M.Y.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY (J.Y.)
| | - Yuxin Sun
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94117 (M.M.O., C.A., A.S., Y.S., Z.J.W., B.M.Y.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY (J.Y.)
| | - Zhen J Wang
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94117 (M.M.O., C.A., A.S., Y.S., Z.J.W., B.M.Y.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY (J.Y.)
| | - Judy Yee
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94117 (M.M.O., C.A., A.S., Y.S., Z.J.W., B.M.Y.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY (J.Y.)
| | - Benjamin M Yeh
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94117 (M.M.O., C.A., A.S., Y.S., Z.J.W., B.M.Y.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY (J.Y.)
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Ponnatapura J, Lalwani N. Imaging of Colorectal Cancer: Screening, Staging, and Surveillance. Semin Roentgenol 2020; 56:128-139. [PMID: 33858639 DOI: 10.1053/j.ro.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Janardhana Ponnatapura
- Department of Radiology, Wake Forest University Baptist Hospital Sciences, Medical Center Bovlevard, Winston-Salem, NC.
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, VA
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Ricci ZJ, Kobi M, Flusberg M, Yee J. CT Colonography in Review With Tips and Tricks to Improve Performance. Semin Roentgenol 2020; 56:140-151. [PMID: 33858640 DOI: 10.1053/j.ro.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zina J Ricci
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
| | - Mariya Kobi
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Milana Flusberg
- Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Judy Yee
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Rethinking prostate cancer screening: could MRI be an alternative screening test? Nat Rev Urol 2020; 17:526-539. [PMID: 32694594 DOI: 10.1038/s41585-020-0356-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
In the past decade rigorous debate has taken place about population-based screening for prostate cancer. Although screening by serum PSA levels can reduce prostate cancer-specific mortality, it is unclear whether the benefits outweigh the risks of false-positive results and overdiagnosis of insignificant prostate cancer, and it is not recommended for population-based screening. MRI screening for prostate cancer has the potential to be analogous to mammography for breast cancer or low-dose CT for lung cancer. A number of potential barriers and technical challenges need to be overcome in order to implement such a programme. We discuss different approaches to MRI screening that could address these challenges, including abbreviated MRI protocols, targeted MRI screening, longer rescreening intervals and a multi-modal screening pathway. These approaches need further investigation, and we propose a phased stepwise research framework to ensure proper evaluation of the use of a fast MRI examination as a screening test for prostate cancer.
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Update on Flexible Sigmoidoscopy, Computed Tomographic Colonography, and Capsule Colonoscopy. Gastrointest Endosc Clin N Am 2020; 30:569-583. [PMID: 32439089 DOI: 10.1016/j.giec.2020.02.009] [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: 02/08/2023]
Abstract
This article reviews alternative colorectal cancer (CRC) screening tests, including flexible sigmoidoscopy (FS), computed tomography (CT) colonography, and colon capsule endoscopy. FS has abundant and convincing evidence supporting its use for CRC screening and is a commonly used CRC test worldwide. CT colonography has demonstrated convincing results for CRC screening, but concerns regarding cost, accuracy for flat or sessile neoplasia, reproducibility, extracolonic findings, and lack of coverage have limited its use and development. Colon capsule endoscopy has demonstrated encouraging results for polyp detection in average-risk individuals, but is not approved for CRC screening at the current time.
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Parsa N, Vemulapalli KC, Rex DK. Performance of radiographic imaging after incomplete colonoscopy for nonmalignant causes in clinical practice. Gastrointest Endosc 2020; 91:1371-1377. [PMID: 32032619 DOI: 10.1016/j.gie.2020.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS CT colonography (CTC) or barium enema are commonly ordered to complete colorectal imaging after an incomplete colonoscopy. We evaluated the sensitivity of radiographic studies performed for this purpose in clinical practice outside clinical trials. METHODS Adult patients referred to an expert endoscopist for incomplete colonoscopy because of a redundant colon or a difficult sigmoid and who underwent previous radiographic imaging between July 2001 and July 2019 were identified. None of the patients had a malignant obstruction as the cause of incomplete colonoscopy. Data on polyp size, location, and pathology were obtained from colonoscopy and radiology reports. Polyps identified on imaging and colonoscopy were matched based on polyp size and location. RESULTS Among 769 patients referred for incomplete colonoscopy, we identified 65 with a radiographic examination performed within 36 months of colonoscopy at our center. Per-patient sensitivity for CTC was suboptimal (70%) and was very low for barium enema (26.7%). Per-polyp sensitivity for both CTC and barium enema was poor (23.8% and 7.6%). Quality of the examination did not seem to affect procedure sensitivity. CONCLUSIONS Radiographic imaging after incomplete colonoscopy for reasons other than malignant obstruction had poor sensitivity for polyps. Patients with incomplete colonoscopies should be considered for repeat colonoscopy by an expert.
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Affiliation(s)
- Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri, USA
| | - Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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An JY, Unsdorfer KML, Weinreb JC. BI-RADS, C-RADS, CAD-RADS, LI-RADS, Lung-RADS, NI-RADS, O-RADS, PI-RADS, TI-RADS: Reporting and Data Systems. Radiographics 2020; 39:1435-1436. [PMID: 31498744 DOI: 10.1148/rg.2019190087] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Julie Y An
- From the Department of Medicine, Summa Health Systems-Akron City Hospital, Akron, Ohio (J.Y.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (K.M.L.U.); and Department of Radiology, Yale University School of Medicine, New Haven, Conn (J.C.W.)
| | - Kyle M L Unsdorfer
- From the Department of Medicine, Summa Health Systems-Akron City Hospital, Akron, Ohio (J.Y.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (K.M.L.U.); and Department of Radiology, Yale University School of Medicine, New Haven, Conn (J.C.W.)
| | - Jeffrey C Weinreb
- From the Department of Medicine, Summa Health Systems-Akron City Hospital, Akron, Ohio (J.Y.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (K.M.L.U.); and Department of Radiology, Yale University School of Medicine, New Haven, Conn (J.C.W.)
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Preoperative CT Colonography in Partially Obstructed Colon Cancer, and its Benefit in Surgical Management. Int Surg 2020. [DOI: 10.9738/intsurg-d-14-00293.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and aims
Stenotic colorectal carcinoma impending obstruction (SCRCIO) is a frequently encountered situation complicating 10% to 19% of colorectal cancers. This group of patients cannot undergo complete colonoscopic assessment. The aim of this study is to examine the accuracy of computed tomographic colonography (CTC) as preoperative assessment of the colon of patients with SCRCIO and to measure the effect on the surgical decision.
Materials and methods
This was a prospective study, from September 2009 through December 2012, on a cohort of symptomatic adult patients with SCRCIO. Patients underwent CTC evaluation after failed conventional colonoscopy (CC), followed by a follow-up endoscopic examination 3–6 months after surgical treatment.
Results
Twenty-nine patients with an average age of 55 were included in this study; the majority of stenotic masses were located in the sigmoid colon. Preoperative CTC matched the colonoscopy location of the stenotic masses (17 patients). CTC sensitivity per stenotic lesion detection was 100% and 92.5% for the location. Sensitivity was 100% for synchronous lesions, and CTC changed surgical plan in 17% of the patients.
Conclusion
CTC presented high sensitivity, specificity and accuracy for the identification of colonic lesions of any size. Preoperative CTC may possibly become the diagnostic procedure of choice for SCRCIO patients. It enables surgeons to evaluate the entire colon, minimizing the possibility of surgical re-intervention if there is a finding of synchronous neoplastic lesions at postoperative follow-up endoscopy.
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Mang T, Bräuer C, Gryspeerdt S, Scharitzer M, Ringl H, Lefere P. Electronic cleansing of tagged residue in CT colonography: what radiologists need to know. Insights Imaging 2020; 11:47. [PMID: 32170498 PMCID: PMC7070139 DOI: 10.1186/s13244-020-00848-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
CT colonography (CTC) is the radiological examination of choice for the diagnosis of colorectal neoplasia. Faecal tagging is considered a mandatory part of bowel preparation. However, the colonic mucosa, obscured by tagged residue, is not accessible to endoluminal 3D views and requires time-consuming 2D evaluation. Electronic cleansing (EC) software algorithms can overcome this limitation by digitally subtracting tagged residue from the colonic lumen. Ideally, this enables a seamless 3D endoluminal evaluation. Despite this benefit, EC is a potential source of a wide range of artefacts. Accurate EC requires proper CTC examination technique and faecal tagging. The digital subtraction process has been shown to affect the relevant morphological features of both colonic anatomy and colonic lesions, if submerged under faecal residue. This article summarises the potential effects of EC on CTC imaging, the consequences for reporting and patient management, and strategies to avoid pitfalls. Furthermore, potentially negative effects on clinical reporting and patient management are shown, and problem-solving techniques, as well as recommendations for the appropriate use of EC techniques, are presented. Radiologists using EC should be familiar with EC-related effects on polyp size and also with correct measurement techniques.
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Affiliation(s)
- Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
| | - Christian Bräuer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Stefaan Gryspeerdt
- Department of Radiology, AZ Delta, Bruggesteenweg 90, B-8800, Roeselare, Belgium
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Helmut Ringl
- Department of Radiology, Danube Hospital Vienna, Langobardenstrasse 122, A-1220, Wien, Austria
| | - Philippe Lefere
- Department of Radiology, AZ Delta, Bruggesteenweg 90, B-8800, Roeselare, Belgium
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Traditional Serrated Adenomas on CT Colonography: International Multicenter Experience With This Rare Colorectal Neoplasm. AJR Am J Roentgenol 2020; 214:355-361. [DOI: 10.2214/ajr.19.21882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Kaminski MF, Robertson DJ, Senore C, Rex DK. Optimizing the Quality of Colorectal Cancer Screening Worldwide. Gastroenterology 2020; 158:404-417. [PMID: 31759062 DOI: 10.1053/j.gastro.2019.11.026] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 12/14/2022]
Abstract
Screening, followed by colonoscopic polypectomy (or surgery for malignant lesions), prevents incident colorectal cancer and mortality. However, there are variations in effective application of nearly every aspect of the screening process. Screening is a multistep process, and failure in any single step could result in unnecessary morbidity and mortality. Awareness of variations in operator- and system-dependent performance has led to detailed, comprehensive recommendations in the United States and Europe on how colonoscopy screening should be performed and measured. Likewise, guidance has been provided on quality assurance for nonprimary colonoscopy-based screening programs, including strategies to maximize adherence. Quality improvement is now a validated science, and there is clear evidence that higher quality prevents incident cancer and cancer death. Quality must be addressed at the levels of the system, provider, and individuals, to maximize the benefits of screening for any population. We review the important aspects of measuring and improving the quality of colorectal cancer screening.
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Affiliation(s)
- Michael F Kaminski
- Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland; Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Douglas J Robertson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont; The Geisel School of Medicine at Dartmouth and The Dartmouth Institute, Hanover, New Hampshire
| | - Carlo Senore
- Epidemiology and Screening Unit-CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
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Mankowski Gettle L, Kim DH, Pickhardt PJ. Anorectal pitfalls in computed tomography colonography. Abdom Radiol (NY) 2019; 44:3606-3624. [PMID: 31432213 DOI: 10.1007/s00261-019-02186-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a wide array of pathological lesions seen in the anorectal region with CT colonography (CTC), much of which is unique to this location. Many relatively common findings in the anorectal region are typically benign, but can be misinterpreted as malignant. There are also technique-related pitfalls that can impede accurate diagnosis of anorectal findings at CTC. Understanding common and uncommon lesions in the anorectal region as well as recognizing technical pitfalls will optimize interpretation of CTC and decrease the number of missed cancers and false positives. This review will systematically cover that they key pitfalls confronting the radiologist at CTC interpretation of the anorectal region, primarily dividing them into those related to underlying anatomy and those related to technique. Tips for how to effectively handle these potential pitfalls will also be discussed.
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Affiliation(s)
- Lori Mankowski Gettle
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/380 Clinical Science Center, Madison, WI, 53792, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/380 Clinical Science Center, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/380 Clinical Science Center, Madison, WI, 53792, USA.
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Ahmad A, Nettleton J, Hotston M, Bradley A, Maskell G. Incidental urological findings in patients undergoing computed tomography colonography for investigation of suspected colorectal cancer. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819847070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the rate of incidental urological findings in patients undergoing computed tomography (CT) colonography/CT colonoscopy (CTC) for investigation of suspected colorectal cancer. Methods: Retrospective analysis of patients undergoing CTC between January 2011 and December 2013. All patients with new incidental urological findings were included with their type and number of urological findings. These were stratified as per the colonography reporting and data system (C-RADS) criteria, and a note made of any further imaging, intervention and histology where appropriate. Results: Within the time period, n = 1891 CTCs were undertaken. Of these, n = 333 (17.6%) had an incidental urological finding and n = 41 of these patients had dual incidental urological pathologies. In total, n = 49 had significant pathology which required monitoring, further imaging, and medical or surgical intervention; n = 12 required further imaging. In n = 1, the imaging result led to a decision to operate and in n = 9 the results excluded the need for surgical intervention; n = 24 underwent operative intervention. The rates of incidental urological findings were similar to those quoted in literature. Conclusion: Our study demonstrates a 17.6% rate of incidental urological findings. Of all findings, 13.1% were deemed significant to warrant further investigation or intervention, and 7.2% of patients with urological findings required intervention. CTCs can adequately image renal masses and further imaging of renal masses did not change management. Level of evidence: 4
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Affiliation(s)
- Adnan Ahmad
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Jeremy Nettleton
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Matthew Hotston
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Alison Bradley
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
| | - Giles Maskell
- Department of Urology and Radiology, Royal Cornwall Hospital, UK
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45
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Radiology Report Template Optimization at an Academic Medical Center. AJR Am J Roentgenol 2019; 213:1008-1014. [DOI: 10.2214/ajr.19.21451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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46
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The yield and patient factors associated with CT colonography C-RADS results in a non-screening patient population. Abdom Radiol (NY) 2019; 44:2971-2977. [PMID: 31197463 DOI: 10.1007/s00261-019-02099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the proportion of diagnostic computed tomography colonography (CTC) Reporting and Data System (C-RADS) categories in a non-screening population, and which patient factors are associated with a positive CTC (C2-4), a non-diagnostic CTC (C0), and potentially relevant extracolonic findings (ECF, E3-4). METHODS Diagnostic CTCs performed at a single academic center from 2017 to 2018 were retrospectively reviewed. For each examination, the indications, age, sex, admission status, and C-RADS categories were recorded. Multivariate logistic regression was performed of patient demographic factors and clinical indications, with adjusted odds ratios (OR) and 95% confidence intervals. RESULTS 1373 CTCs were included. The mean age was 66.4 ± 13 years (range 24-97). There were 782 women and 75 inpatients. The number of CTCs reported as C0-C4 were 194/1373 (14.1%), 970/1373 (70.6%), 77/1373 (5.6%), 86/1373 (6.3%), and 46/1373 (3.4%), respectively, and 134/1373 (9.8%), 960/1373 (69.9%), 173/1373 (12.6%), and 106/1373 (7.7%) CTCs were reported as E1-4, respectively. Factors that demonstrated the strongest associations were as follows: with C2-4, age groups 50-79 (OR 2.8, 95% confidence interval 1.4-6.1), 80-89 (6.2, 2.9-14.5) and ≥ 90 (7.6, 2.0-29.1), and inpatients (3.4, 1.8-6.4); with C0, age groups 50-79 (5.9, 2.2-24.4), 80-89 (9.8, 3.4-41.8), and ≥ 90 (22.5, 5.8-113.0), incomplete colonoscopy (3.2, 2.0-5.1) and melena or gastrointestinal bleeding (4.1, 1.8-9.4); and with E3-4, age groups 50-79 (1.6, 1.0-2.9), 80-89 (2.0, 1.1-3.9), and ≥ 90 (3.2, 1.2-8.8), and inpatients (2.3, 1.3-3.9). CONCLUSION Older age is increasingly associated with a positive test, a non-diagnostic test and potentially relevant ECF. Inpatients are also associated with positive tests and E3-4 findings. Symptoms are not strongly associated with a positive CTC.
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Abstract
CLINICAL PROBLEM Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality. Most colorectal cancers derive from benign precursor lesions, so-called adenomatous polyps, over a long period of time. Colorectal cancer screening is based on the detection of precancerous polyps and early stage CRC in asymptomatic individuals to reduce CRC incidence and mortality. The protective effect of screening programs can be improved by increasing the screening rates. PRACTICAL RECOMMENDATIONS Apart from the established examinations, CT colonography (CTC) has been proposed as an optional test for colorectal cancer screening. The detection rates of CTC for large polyps and cancer are similar to the ones of colonoscopy and superior to stool-based tests. CTC is therefore the radiological test of choice for the detection of colorectal neoplasia. It has replaced double contrast barium enema for almost all indications. As a minimally invasive procedure, CTC has a high safety profile and good patient acceptance. The evaluation of extracolonic organs in addition to the colon can increase examination efficacy. The option to choose CTC as a CRC screening test has the potential to increase the overall screening rates.
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48
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Sammut S, Leung V, Cook N, Clarke P, Balasubramaniam R, Britton I. Quantitative and qualitative assessment of a coding system for reporting CT colonography. Clin Radiol 2019; 74:561-567. [DOI: 10.1016/j.crad.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
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Positive Predictive Value for Colorectal Lesions at CT Colonography: Analysis of Factors Impacting Results in a Large Screening Cohort. AJR Am J Roentgenol 2019; 213:W1-W8. [PMID: 30973775 DOI: 10.2214/ajr.18.20686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. The purpose of this study is to evaluate factors affecting the positive predictive value (PPV) for detecting colorectal lesions at CT colonography (CTC), using optical colonoscopy (OC) as the reference standard for concordance. MATERIALS AND METHODS. Consecutive CTC studies from a single screening program interpreted as positive for at least one detected colorectal lesion 6 mm or larger and sent for subsequent OC were analyzed according to per-polyp and per-patient results. Univariable and multivariable analysis of multiple input factors was performed. RESULTS. Of 1650 studies (median patient age, 59.7 years; 877 men and 773 women) with 2688 total CTC-detected lesions 6 mm or larger, the overall PPVs were 88.8% (2386/2688) by polyp and 90.8% (1499/1650) by patient. The by-polyp PPV was significantly higher for polypoid (91.2%; 1793/1965) versus flat or nonpolypoid (79.4%; 459/578) lesions (p < 0.0001). Overall per-patient PPVs were 72.3% (1193/1650) for any neoplasia 6 mm or larger and 38.8% (641/1650) for advanced neoplasia. PPVs for advanced neoplasia increased by CTC Reporting and Data System category: 5.8% (45/781) for C2, 67.1% (511/762) for C3, and 79.4% (85/107) for C4. PPVs for cancer also increased by CTC Reporting and Data System category: 0% (0/781) for C2, 2.2% (17/762) for C3, and 52.3% (56/107) for C4. On multivariable regression analysis, polyp morphologic type (flat vs polypoid) and diagnostic confidence were the strongest predictors of CTC-OC concordance. CTC PPV results are somewhat underestimated because 28.8% (87/302) of CTC-OC-discordant results were categorized as likely OC false-negatives at consensus review. CONCLUSION. Concordance between CTC and OC is high for relevant colorectal polyps and masses. Unlike stool-based tests that provide only a binary positive or negative result, CTC can specify the nature of the positive findings, resulting in much greater specificity and risk stratification for patient management decisions.
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50
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Utano K, Takayanagi D, Nagata K, Aizawa M, Endo S, Nemoto T, Nemoto D, Isohata N, Lefor AK, Togashi K. A novel volume-reduced CT colonography regimen using hypertonic laxative (polyethylene glycol with ascorbic acid): randomized controlled trial. Eur Radiol 2019; 29:5236-5246. [PMID: 30903329 DOI: 10.1007/s00330-019-06127-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study is to investigate the feasibility of bowel preparation using a hypertonic laxative (polyethylene glycol with ascorbic acid, PEG + Asc) for CT colonography (CTC) and to examine the volume limit of laxative. METHODS In one institution, patients who met the indications for CTC were enrolled and randomly assigned to CTC with regimen A (800 ml PEG + Asc), B (600 ml PEG + Asc), or C (400 ml PEG + Asc). Sodium diatrizoate was given orally for fecal tagging. On the previous day, patients ate low-residue meals and took the assigned lavage solution after dinner. A reader blinded to the preparation graded residual stool/fluid and fecal tagging quality in six segments of the colorectum. The primary outcome was a proportion of colon segments without stool. One hundred twenty segments in 20 patients with each regimen were needed to show a non-inferiority margin of 15%, assuming 85% of no stool. RESULTS A total of 360 segments in 60 patients were analyzed. There were 83% of segments with no stool in regimen A, 89% in regimen B, and 88% in regimen C. Using the delta method, the 95% confidence interval of the risk difference (6.7%) between regimens A and B was - 2.2% to 15.6%, and the risk difference (5.0%) between regimens A and C was - 4.1% to 14%, both within the non-inferiority margin. Residual fluid and fecal tagging quality were also within the non-inferiority margin. No adverse events occurred. CONCLUSIONS A novel CTC regimen using hypertonic laxative demonstrated optimal colon cleansing effectiveness even with the lowest volume of laxative (UMIN000022851). KEY POINTS • A novel CTC regimen using a hypertonic laxative is feasible. • The lowest volume of laxative provides excellent colon imaging. • However, the lowest volume of laxative did not improve patient acceptance.
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Affiliation(s)
- Kenichi Utano
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Daisuke Takayanagi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Koichi Nagata
- Division of Screening Technology, National Cancer Center, Tokyo, Japan
| | - Masato Aizawa
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Tetsutaro Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Noriyuki Isohata
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, 969-3492, Japan.
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