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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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Ricci ZJ, Mazzariol FS, Kobi M, Flusberg M, Moses M, Yee J. CT Colonography: Improving Interpretive Skill by Avoiding Pitfalls. Radiographics 2020; 40:98-119. [PMID: 31809231 DOI: 10.1148/rg.2020190078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An earlier incorrect version of this article appeared online. This article was corrected on December 20, 2019.
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Affiliation(s)
- Zina J Ricci
- From the Department of Diagnostic Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467 (Z.J.R., M.K,. M.M., J.Y.); Department of Diagnostic Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY (F.S.M.); and Department of Diagnostic Radiology, Westchester County Medical Center/New York Medical College, Valhalla, NY (M.F.)
| | - Fernanda S Mazzariol
- From the Department of Diagnostic Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467 (Z.J.R., M.K,. M.M., J.Y.); Department of Diagnostic Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY (F.S.M.); and Department of Diagnostic Radiology, Westchester County Medical Center/New York Medical College, Valhalla, NY (M.F.)
| | - Mariya Kobi
- From the Department of Diagnostic Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467 (Z.J.R., M.K,. M.M., J.Y.); Department of Diagnostic Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY (F.S.M.); and Department of Diagnostic Radiology, Westchester County Medical Center/New York Medical College, Valhalla, NY (M.F.)
| | - Milana Flusberg
- From the Department of Diagnostic Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467 (Z.J.R., M.K,. M.M., J.Y.); Department of Diagnostic Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY (F.S.M.); and Department of Diagnostic Radiology, Westchester County Medical Center/New York Medical College, Valhalla, NY (M.F.)
| | - Melanie Moses
- From the Department of Diagnostic Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467 (Z.J.R., M.K,. M.M., J.Y.); Department of Diagnostic Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY (F.S.M.); and Department of Diagnostic Radiology, Westchester County Medical Center/New York Medical College, Valhalla, NY (M.F.)
| | - Judy Yee
- From the Department of Diagnostic Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467 (Z.J.R., M.K,. M.M., J.Y.); Department of Diagnostic Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY (F.S.M.); and Department of Diagnostic Radiology, Westchester County Medical Center/New York Medical College, Valhalla, NY (M.F.)
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Sangster GP, Ballard DH, Nazar M, Tsai R, Donato M, D'Agostino HB. Multimodality Imaging Review of Anorectal and Perirectal Diseases With Histological, Endoscopic, and Operative Correlation, Part I: Anatomy and Neoplasms. Curr Probl Diagn Radiol 2018; 48:494-508. [PMID: 30172447 DOI: 10.1067/j.cpradiol.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/28/2022]
Abstract
A broad spectrum of pathology affects the rectum, anus, and perineum and understanding of its relevant anatomy is important in accurate reporting, particularly in rectal cancer. In this pictorial essay, correlative imaging, endoscopic, pathologic, and operative images are presented to illustrate normal anorectal anatomy and neoplastic conditions that affect the anus and rectum. A particular case-based focus is given to rectal adenocarcinoma with pelvic MR and surgical histopathology. Additionally, carcinoid tumor, gastrointestinal stromal tumor, condylomata acuminata, squamous cell carcinoma, melanoma, and metastatic disease about the rectum and anus are reviewed.
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Affiliation(s)
- Guillermo P Sangster
- Department of Radiology, Louisiana State University Health Shreveport, Shreveport, LA.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Miguel Nazar
- Department of Radiology, Hospital Aleman, Buenos Aires, Argentina
| | - Richard Tsai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Maren Donato
- Fundación Medica de Río Negro y Neuquén. Cipolletti, Río Negro, Argentina
| | - Horacio B D'Agostino
- Department of Radiology, Louisiana State University Health Shreveport, Shreveport, LA
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Computer-based self-training for CT colonography with and without CAD. Eur Radiol 2018; 28:4783-4791. [PMID: 29796918 DOI: 10.1007/s00330-018-5480-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/23/2018] [Accepted: 04/11/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To determine whether (1) computer-based self-training for CT colonography (CTC) improves interpretation performance of novice readers; (2) computer-aided detection (CAD) use during training affects learning. METHODS Institutional review board approval and patients' informed consent were obtained for all cases included in this study. Twenty readers (17 radiology residents, 3 radiologists) with no experience in CTC interpretation were recruited in three centres. After an introductory course, readers performed a baseline assessment test (37 cases) using CAD as second reader. Then they were randomized (1:1) to perform either a computer-based self-training (150 cases verified at colonoscopy) with CAD as second reader or the same training without CAD. The same assessment test was repeated after completion of the training programs. Main outcome was per lesion sensitivity (≥ 6 mm). A generalized estimating equation model was applied to evaluate readers' performance and the impact of CAD use during training. RESULTS After training, there was a significant improvement in average per lesion sensitivity in the unassisted phase, from 74% (356/480) to 83% (396/480) (p < 0.001), and in the CAD-assisted phase, from 83% (399/480) to 87% (417/480) (p = 0.021), but not in average per patient sensitivity, from 93% (390/420) to 94% (395/420) (p = 0.41), and specificity, from 81% (260/320) to 86% (276/320) (p = 0.15). No significant effect of CAD use during training was observed on per patient sensitivity and specificity, nor on per lesion sensitivity. CONCLUSIONS A computer-based self-training program for CTC improves readers' per lesion sensitivity. CAD as second reader does not have a significant impact on learning if used during training. KEY POINTS • Computer-based self-training for CT colonography improves per lesion sensitivity of novice readers. • Self-training program does not increase per patient specificity of novice readers. • CAD used during training does not have significant impact on learning.
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Tamandl D, Mang T, Ba-Ssalamah A. Imaging of colorectal cancer - the clue to individualized treatment. Innov Surg Sci 2018; 3:3-15. [PMID: 31579761 PMCID: PMC6754048 DOI: 10.1515/iss-2017-0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/20/2018] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) is the most common gastrointestinal neoplasm and the second most common cause for cancer-related death in Europe. Imaging plays an important role both in the primary diagnosis, treatment evaluation, follow-up, and, to some extent, also in prevention. Like in the clinical setting, colon and rectal cancer have to be distinguished as two quite separate entities with different goals of imaging and, consequently, also different technical requirements. Over the past decade, there have been improvements in both more robust imaging techniques and new data and guidelines that help to use the optimal imaging modality for each scenario. For colon cancer, the continued research on computed tomography (CT) colonography (CTC) has led to high-level evidence that puts this technique on eye height to optical colonoscopy in terms of detection of cancer and polyps ≥10 mm. However, also for smaller polyps and thus for screening purposes, CTC seems to be an optimal tool. In rectal cancer, the technical requirements to perform state-of-the art imaging have recently been defined. Evaluation of T-stage, mesorectal fascia infiltration and extramural vascular invasion are the most important prognostic factors that can be identified on MRI. With this information, risk stratification both for local and distal failure is possible, enabling the clinician to tailor the optimal therapeutic approach in non-metastatic rectal cancer. Imaging of metastatic CRC is also covered, although the complex ramifications of treatment options in the metastatic setting are beyond the scope of this article. In this review, the most important recent developments in the imaging of colon and rectal cancer will be highlighted. If used in an interdisciplinary setting, this can lead to an individualized treatment concept for each patient.
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Affiliation(s)
- Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Mang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Park SH, Kim DH. CT colonography interpretation: how to maximize polyp detection and minimize overcalling. Abdom Radiol (NY) 2018; 43:539-553. [PMID: 29404639 DOI: 10.1007/s00261-018-1455-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article outlines how to achieve maximum accuracy in interpreting CT colonography (CTC) regarding colonic findings. Interpreting extracolonic findings seen on CTC is a separate diagnostic task and will not be addressed in this article. While many interpretive pitfalls are in fact related to CTC techniques, this article focuses on issues that are related to interpretive knowledge and skills, avoiding in-depth discussions on CTC techniques. Principal methods and further tips for detecting possible polyp candidates and for confirming true soft-tissue polyps will be discussed. Specific points about optimizing interpretation strategies for difficult flat polyps including sessile serrated polyp will be raised. There are numerous interpretive pitfalls regarding the colonic interpretation of CTC. Knowledge of these pitfalls will shorten the learning curve and help achieve accurate reads.
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Affiliation(s)
- Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/311, 600 Highland Ave, Madison, WI, 53792-3252, USA
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Jang JK, Park SH, Lee JS, Kim HJ, Kim AY, Ha HK. Effect of Reducing Abdominal Compression during Prone CT Colonography on Ascending Colonic Rotation during Supine-to-Prone Positional Change. Korean J Radiol 2016; 17:47-55. [PMID: 26798215 PMCID: PMC4720810 DOI: 10.3348/kjr.2016.17.1.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/06/2015] [Indexed: 01/27/2023] Open
Abstract
Objective To determine the effect of reduced abdominal compression in prone position on ascending colonic movement during supine-to-prone positional change during CT colonography (CTC). Materials and Methods Eighteen consecutive patients who had undergone prone CTC scanning with cushion blocks placed under the chest and hip/thigh to reduce abdominal compression and had confirmed sessile polyps ≥ 6 mm in the well-distended, straight, mid-ascending colon, were included. Radial location along the ascending colonic luminal circumference (°) was measured for 24 polyps and 54 colonic teniae on supine and prone CTC images. The supine-to-prone change ranging between -180° and +180° (- and + for internal and external colonic rotations, respectively), was determined. In addition, possible causes of any ascending colonic rotations were explored. Results Abdominal compression during prone CTC scanning completely disappeared with the use of cushion blocks in 17 of 18 patients. However, some degrees of ascending colonic rotation were still observed, with the radial location changes of -22° to 61° (median, 13.9°) for the polyps and similar degrees for teniae. Fifty-four percent and 56% of polyps and teniae, respectively, showed changes > 10°. The radial location change of the polyps was significantly associated with the degree of anterior shift of the small bowel and mesentery (r = 0.722, p < 0.001) and the degree of posterior displacement of the ascending colon (r = 0.566, p = 0.004) during supine-to-prone positional change. Conclusion Ascending colonic rotation upon supine-to-prone positional change during CTC, mostly in the form of external rotation, is not eliminated by removing abdominal compression in prone position.
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Affiliation(s)
- Jong Keon Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Jin Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ah Young Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Kwon Ha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Neri E, Mantarro A, Faggioni L, Scalise P, Bemi P, Pancrazi F, D'Ippolito G, Bartolozzi C. CT colonography with rectal iodine tagging: Feasibility and comparison with oral tagging in a colorectal cancer screening population. Eur J Radiol 2015; 84:1701-7. [PMID: 26032131 DOI: 10.1016/j.ejrad.2015.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate feasibility, diagnostic performance, patient acceptance, and overall examination time of CT colonography (CTC) performed through rectal administration of iodinated contrast material. MATERIALS AND METHODS Six-hundred asymptomatic subjects (male:female=270:330; mean 63 years) undergoing CTC for colorectal cancer screening on an individual basis were consecutively enrolled in the study. Out of them, 503 patients (group 1) underwent CTC with rectal tagging, of which 55 had a total of 77 colonic lesions. The remaining 97 patients (group 2) were randomly selected to receive CTC with oral tagging of which 15 had a total of 20 colonic lesions. CTC findings were compared with optical colonoscopy, and per-segment image quality was visually assessed using a semi-quantitative score (1=poor, 2=adequate, 3=excellent). In 70/600 patients (11.7%), CTC was performed twice with both types of tagging over a 5-year follow-up cancer screening program. In this subgroup, patient acceptance was rated via phone interview two weeks after CTC using a semi-quantitative scale (1=poor, 2=fair, 3=average, 4=good, 5=excellent). RESULTS Mean per-polyp sensitivity, specificity, positive and negative predictive values of CTC with rectal vs oral tagging were 96.1% (CI95% 85.4÷99.3%) vs 89.4% (CI95% 65.4÷98.1%), 95.3% (CI95% 90.7÷97.8%) vs 95.8% (CI95% 87.6÷98.9%), 86.0% (CI95% 73.6÷93.3) vs 85.0% (CI95% 61.1÷96.0%), and 98.8% (CI95% 95.3÷99.8%) vs 97.2% (CI95% 89.4÷99.5%), respectively (p>0.05). Polyp detection rates were not statistically different between groups 1 and 2 (p>0.05). Overall examination time was significantly shorter with rectal than with oral tagging (18.3±3.5 vs 215.6±10.3 minutes, respectively; p<0.0001). CONCLUSIONS Rectal iodine tagging can be an effective alternative to oral tagging for CTC with the advantages of greater patient acceptance and lower overall examination time.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Annalisa Mantarro
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Paola Scalise
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Pietro Bemi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Francesca Pancrazi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Giuseppe D'Ippolito
- Federal University of São Paulo - Sena Madureira 1500 - Vila Mariana, UNIFESP, São Paulo, SP, Brazil
| | - Carlo Bartolozzi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Schaeffer B, Johnson TR, Mang T, Kreis ME, Reiser MF, Graser A. Dual-energy CT colonography for preoperative "one-stop" staging in patients with colonic neoplasia. Acad Radiol 2014; 21:1567-72. [PMID: 25442353 DOI: 10.1016/j.acra.2014.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/19/2014] [Accepted: 07/22/2014] [Indexed: 12/15/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the benefits of dual-energy computed tomography (CT) colonography (DECTC) as a preoperative staging tool in patients with clinically suspected colorectal cancer (CRC). MATERIALS AND METHODS Twenty-two patients with colorectal neoplasia underwent preoperative abdominal DECTC on a dual-source scanner (SOMATOM Definition Flash; Siemens) operated at tube potentials of Sn140/100 kVp. Scans were evaluated for local tumor stage and the presence of synchronous intracolonic and extracolonic findings using dual-energy color-coded images. An enhancement ≥25 Hounsfield units (HU) was defined to indicate malignancy. Patients' effective doses were calculated. RESULTS Preoperative DECTC allowed for complete bowel evaluation in all patients, including subjects with stenosing CRC. DECTC revealed 22 carcinomas (mean enhancement, 47 ± 12 HU). In total, 22 synchronous intracolonic lesions were detected, including 19 adenomas (mean enhancement, 51 ± 19 HU). Benign structures showed enhancement <25 HU. Comparing DECTC to histopathology, 95% carcinomas and 71% synchronous lesions proximal to stenosing CRC could be verified. Mean estimated effective dose was 13.0 ± 5.2 mSv. CONCLUSIONS Preoperative DECTC can be used as an accurate and dose-efficient primary-staging examination. Especially after incomplete optical colonoscopy, virtual colonoscopy enables full preoperative colonic assessment on the same day. Dual-energy CT enables distinction between neoplasia and non-neoplastic findings within and outside the colon. Therefore, DECTC can be regarded as a promising "one-stop" staging examination in patients with clinically suspected CRC.
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Maciel AC, Maciel LC. Colonografia por tomografia computadorizada: um método de rastreamento conhecido porém pouco utilizado. Radiol Bras 2014; 47:V-VI. [PMID: 25741082 PMCID: PMC4337136 DOI: 10.1590/0100-3984.2014.47.3e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Antonio Carlos Maciel
- Complexo Hospitalar Santa Casa de Porto Alegre, Brasil; Hospital de Clínicas de Porto Alegre
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Kierszenbaum ML, von Atzingen AC, Tiferes DA, Alvim MV, Lopes Filho GDJ, Matos D, D'Ippolito G. CT colonography: the value of this method in the view of specialists. Radiol Bras 2014; 47:135-40. [PMID: 25741069 PMCID: PMC4337144 DOI: 10.1590/0100-3984.2013.1837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 01/08/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To map the view of surgeons on the role played by computed tomography colonography (CTC). MATERIALS AND METHODS An electronic questionnaire was sent to members of the Brazilian College of Surgeons. The questionnaire consisted of 16 multiple-choice questions about demographics and general knowledge about CTC. RESULTS The authors obtained 144 responses; 90.3% of the specialists were men, 60% with less than 30 years from graduation, 77.1% were gastrointestinal surgeons, 22.9% were general surgeons, 53.5% were involved in academic activity, and 59.7% had their professional activity in cities with more than 500,000 inhabitants. As regards the knowledge about CTC, 84.7% of the respondents knew the method, 70.8% knew how it is performed, 56.9% reported knowing the bowel preparation used for the procedure, 31.3% used the method, and 53.5% knew some CTC service in their city. About half of the respondents did not know the precise indication of the method. The method is most frequently known and used by professionals working in cities with more than 500,000 inhabitants (p < 0.005). There was a tendency of a more frequent use of the method by the professionals pursuing an academic career. CONCLUSION Despite its infrequent use in Brazil, CTC is a well known method, particularly in large urban centers and in the academic environment.
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Affiliation(s)
- Marcelo Longo Kierszenbaum
- MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista de
Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP,
Brazil
| | - Augusto Castelli von Atzingen
- PhD, MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista
de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo,
SP, Brazil
| | - Dario Ariel Tiferes
- PhD, MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista
de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), MD,
Laboratório Fleury-São Paulo, São Paulo, SP, Brazil
| | - Marcos Vinicius Alvim
- MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista de
Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP,
Brazil
| | - Gaspar de Jesus Lopes Filho
- Full Professors, Division of Surgical Gastroenterology, Escola Paulista
de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo,
SP, Brazil
| | - Délcio Matos
- Full Professors, Division of Surgical Gastroenterology, Escola Paulista
de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo,
SP, Brazil
| | - Giuseppe D'Ippolito
- Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina
- Universidade Federal de São Paulo (EPM-Unifesp), MD, Laboratório
Fleury-São Paulo, São Paulo, SP, Brazil
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Neri E, Lefere P, Gryspeerdt S, Bemi P, Mantarro A, Bartolozzi C. Bowel preparation for CT colonography. Eur J Radiol 2013; 82:1137-43. [PMID: 23485099 DOI: 10.1016/j.ejrad.2012.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/05/2012] [Indexed: 02/06/2023]
Abstract
Bowel preparation represents an essential part of CT colonography, as the accuracy of the exam is strongly related to the adequacy of colonic cleansing, and a poor bowel preparation may compromise the diagnostic quality even despite optimization of all other acquisition parameters. Residual stool and fluid in the large bowel may affect the interpretation of the exam and may increase the number of false positives and false negatives. In this regard, the majority of patients having undergone CT colonography state that bowel preparation is the most unpleasant part. Unfortunately, to date no definite consensus has been reached about the ideal bowel preparation technique, and there is great variability in preparation strategies across diagnostic centers. The purpose of this review article is to describe the development and evolution of bowel preparation techniques in order to choose the best approach for optimizing the diagnostic quality of CT colonography in each patient.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, University of Pisa, Italy.
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Reginelli A, Mandato Y, Solazzo A, Berritto D, Iacobellis F, Grassi R. Errors in the radiological evaluation of the alimentary tract: part II. Semin Ultrasound CT MR 2012; 33:308-17. [PMID: 22824121 DOI: 10.1053/j.sult.2012.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Plain abdominal radiography and computed tomographic (CT) enteroclysis are 2 essential radiological investigations in the study of gastrointestinal tract. Errors in patient preparation, execution, and interpretation may lead to severe consequences in the diagnosis and thus in patient outcome. Abdominal radiography is one of the most frequently requested radiographic examinations, and has an established role in the assessment of the acute abdomen. CT enteroclysis has revolutionized the assessment of small-bowel pathology, especially in patients with inflammatory bowel. The purpose of this article is to describe the pitfalls in the execution and interpretation of plain abdominal film and CT enteroclysis.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
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Neri E, Mang T, Hellstrom M, Mantarro A, Faggioni L, Bartolozzi C. How to read and report CTC. Eur J Radiol 2012; 82:1166-70. [PMID: 23088877 DOI: 10.1016/j.ejrad.2012.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 03/25/2012] [Indexed: 02/06/2023]
Abstract
Owing to encouraging results achieved in the clinical practice, CT colonography (CTC) is being increasingly employed for the examination of the whole colon and rectum and is quickly becoming a widely accepted diagnostic technique that is replacing double contrast barium enema and appears a promising tool for colorectal cancer screening as well. The increasing number of symptomatic and asymptomatic patients undergoing CTC for both evaluation of symptoms and colorectal cancer screening, along with the growing availability of CTC facilities in most healthcare departments and imaging centres, requires that a sufficient number of radiologists be adequately trained in performing and interpreting CTC studies. Indeed, optimal performance of CTC depends on a number of factors, including the quality of colonic preparation (e.g. laxative bowel cleansing and optimised colonic distension), the CTC image acquisition protocol used, and reading approach and specific skills of radiologists for correct detection and interpretation of colonic findings. Consequently, dedicated training and expertise is key to obtain high sensitivity in lesion detection and reduce the number of false positives, thus ensuring an optimal clinical management of patients. To this purpose, dedicated training programmes are essential to teach and standardise not only the approach to CTC reading, but also reporting of colonic findings.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, University of Pisa, 56100 Pisa, Italy.
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Neroladaki A, Breguet R, Botsikas D, Terraz S, Becker CD, Montet X. Colovesical fistula causing an uncommon reason for failure of computed tomography colonography: a case report. J Med Case Rep 2012; 6:214. [PMID: 22823906 PMCID: PMC3423059 DOI: 10.1186/1752-1947-6-214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 03/20/2012] [Indexed: 11/24/2022] Open
Abstract
Introduction Computed tomography colonography, or virtual colonoscopy, is a good alternative to optical colonoscopy. However, suboptimal patient preparation or colon distension may reduce the diagnostic accuracy of this imaging technique. Case presentation We report the case of an 83-year-old Caucasian woman who presented with a five-month history of pneumaturia and fecaluria and an acute episode of macrohematuria, leading to a high clinical suspicion of a colovesical fistula. The fistula was confirmed by standard contrast-enhanced computed tomography. Optical colonoscopy was performed to exclude the presence of an underlying colonic neoplasm. Since optical colonoscopy was incomplete, computed tomography colonography was performed, but also failed due to inadequate colon distension. The insufflated air directly accumulated within the bladder via the large fistula. Conclusions Clinicians should consider colovesical fistula as a potential reason for computed tomography colonography failure.
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Affiliation(s)
- Angeliki Neroladaki
- Department of Radiology, Geneva University Hospital, Gabrielle-Perret-Gentil, 4, 1211, Geneva 4, Switzerland.
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Mang T, Gryspeerdt S, Schima W, Lefere P. Evaluation of colonic lesions and pitfalls in CT colonography: a systematic approach based on morphology, attenuation and mobility. Eur J Radiol 2012; 82:1177-86. [PMID: 22817848 DOI: 10.1016/j.ejrad.2012.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/23/2012] [Indexed: 02/06/2023]
Abstract
Computed tomographic colonography is a reliable technique for the detection and classification of neoplastic and non-neoplastic lesions of the colon. It is based on a thin-section CT dataset of the cleansed and air-distended colon, acquired in prone and supine position. Two-dimensional and 3D projections are used in combination for image interpretation. The evaluation of CT colonography datasets is based on two steps, lesion perception to detect a polyp candidate and image interpretation to correctly characterize colonic filling defects. A thorough knowledge of the morphologic and attenuation characteristics of common colonic lesions and artifacts facilitates characterization of the findings. The purpose of this review article is to give an overview of the key CT colonographic imaging criteria to correctly characterize common colorectal lesions and to identify typical pitfalls and pseudolesions.
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Affiliation(s)
- Thomas Mang
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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von Atzingen AC, Tiferes DA, Matsumoto CA, Nunes TF, Maia MVAS, D'Ippolito G. Aspectos comuns e pseudolesões na colonografia por tomografia computadorizada: ensaio iconográfico. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000300008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A colonografia por tomografia computadorizada é um método minimamente invasivo para rastreamento de pólipos e do câncer colorretal, com complicações extremamente incomuns, sendo cada vez mais utilizada na prática clínica. Na última década, a evolução no preparo intestinal, na aquisição das imagens e no treinamento dos examinadores determinou um aumento significativo na sensibilidade do método. A interpretação das imagens é realizada por meio da análise combinada das imagens fontes bidimensionais e de diversos tipos de reconstruções tridimensionais, com sensibilidade ao redor de 96% na detecção de lesões com dimensões iguais ou maiores que 10 mm, quando analisadas por radiologistas experientes. Neste ensaio pictórico selecionamos exemplos ilustrativos das doenças e pseudolesões mais frequentemente observadas neste tipo de exame. Apresentamos exemplos de lesões polipoides e planas, benignas e malignas, moléstia diverticular dos cólons, entre outras afecções, bem como pseudolesões, entre as quais aquelas relacionadas a preparo inadequado e interpretação equivocada.
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Pagés Llinás M, Darnell Martín A, Ayuso Colella J. CT colonography: What radiologists need to know. RADIOLOGIA 2011. [DOI: 10.1016/j.rxeng.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Pagés Llinás M, Darnell Martín A, Ayuso Colella JR. [CT colonography: what radiologists need to know]. RADIOLOGIA 2011; 53:315-25. [PMID: 21696795 DOI: 10.1016/j.rx.2011.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/11/2010] [Accepted: 01/20/2011] [Indexed: 02/06/2023]
Abstract
In 2008, CT colonography was approved by the American Cancer Society as a technique for screening for colorectal cancer. This approval should be considered an important step in the recognition of the technique, which although still relatively new is already changing some diagnostic algorithms. This update about CT colonography reports the quality parameters necessary for a CT colonographic study to be diagnostic and reviews the technical innovations and colonic preparation for the study. We provide a brief review of the signs and close with a discussion of the current indications for and controversies about the technique.
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Affiliation(s)
- M Pagés Llinás
- Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Barcelona, España.
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Computed tomographic colonography in preoperative evaluation of colorectal tumors: a prospective study. Surg Endosc 2011; 25:2344-9. [PMID: 21416185 PMCID: PMC3116126 DOI: 10.1007/s00464-010-1566-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 12/22/2010] [Indexed: 12/18/2022]
Abstract
Background This study aimed to assess the usefulness of computed tomographic colonography (CTC) in preoperative evaluation of colorectal tumors and the entire bowel including endoscopically inaccessible regions. Methods Colonoscopy and CTC were performed for 49 patients. The tumor and the entire colon were assessed, and the results were compared with colonoscopy. The extraluminal findings of CTC were compared with contrast-enhanced computed tomography (CT) of the abdomen and the pelvis in 33 patients. All these patients had undergone surgery. A comparison of results for tumor node metastasis classification between CTC, CT, and histopathology was performed. Results Exploration of the entire colon was possible for 89.8% of the patients using CTC and 49.0% of the patients using colonoscopy. Bowel cleansing was assessed as worse with CTC. In the evaluation of tumor location and morphologic type, CTC was congruent with colonoscopy. Colonoscopy enabled approximate tumor size and volume to be evaluated for only 59.2% (29/49) and 30.6% (15/49) of patients, respectively, whereas CTC enabled evaluation of all 48 (100.0%) visualized tumors. Wall thickening, outer contour, and suspected infiltration of surrounding tissues and organs are impossible to determine with colonoscopy but can be determined with CTC. Using CTC, two additional tumors were found proximate to occlusive masses in endoscopically inaccessible regions. Conclusion Computed tomographic colonography is a useful method for diagnosing colorectal tumors. It allows the clinician to diagnose tumor, determine local tumor progression, and detect synchronous lesions in the large bowel including endoscopically inaccessible regions.
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Liedenbaum MH, Bipat S, Bossuyt PMM, Dwarkasing RS, de Haan MC, Jansen RJ, Kauffman D, van der Leij C, de Lijster MS, Lute CC, van der Paardt MP, Thomeer MG, Zijlstra IA, Stoker J. Evaluation of a standardized CT colonography training program for novice readers. Radiology 2010; 258:477-87. [PMID: 21177395 DOI: 10.1148/radiol.10100019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine how many computed tomographic (CT) colonography training studies have to be evaluated by novice readers to obtain an adequate level of competence in polyp detection. MATERIALS AND METHODS The study was approved by the Institutional Review Board. Informed consent was obtained from all participants. Six physicians (one radiologist, three radiology residents, two researchers) and three technicians completed a CT colonography training program. Two hundred CT colonographic examinations with colonoscopic verification were selected from a research database, with 100 CT colonographic examinations with at least one polyp 6 mm or larger. After a lecture session and short individual hands-on training, CT colonography training was done individually with immediate feedback of colonoscopy outcome. Per-polyp sensitivity was calculated for four sets of 50 CT colonographic examinations for lesions 6 mm or larger. By using logistic regression analyses, the number of CT colonographic examinations to reach 90% sensitivity for lesions 6 mm or larger was estimated. Reading times were registered. RESULTS The average per-polyp sensitivity for lesions 6 mm or larger was 76% (207 of 270) in the first set of 50 CT colonographic examinations, 77% (262 of 342) in the second (P = .96 vs first set), 80% (310 of 387) in the third (P = .67 vs first set), and 91% (261 of 288) in the fourth (P = .018). The estimated number of CT colonographic examinations for a sufficient sensitivity was 164. Six of nine readers reached this level of competence within 175 CT colonographic examinations. Reading times decreased significantly from the first to the second set of 50 CT colonographic examinations for six readers. CONCLUSION Novice CT colonography readers obtained sensitivity equal to that of experienced readers after practicing on average 164 CT colonographic studies.
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Affiliation(s)
- Marjolein H Liedenbaum
- Department of Radiology and Clinical Epidemiology and Biostatistics, Academic Medical Center Amsterdam, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Ascending colon rotation following patient positional change during CT colonography: a potential pitfall in interpretation. Eur Radiol 2010; 21:353-9. [DOI: 10.1007/s00330-010-1928-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/09/2010] [Accepted: 07/28/2010] [Indexed: 12/22/2022]
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Guerrisi A, Marin D, Laghi A, Di Martino M, Iafrate F, Iannaccone R, Catalano C, Passariello R. Diagnostic accuracy of translucency rendering to differentiate polyps from pseudopolyps at 3D endoluminal CT colonography: a feasibility study. LA RADIOLOGIA MEDICA 2010; 115:758-70. [DOI: 10.1007/s11547-010-0538-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/30/2009] [Indexed: 11/30/2022]
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Computed Tomography colonography in Preoperative Evaluation of colorectal cancer. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fisichella VA, Båth M, Allansdotter Johnsson A, Jäderling F, Bergsten T, Persson U, Mellingen K, Hellström M. Evaluation of image quality and lesion perception by human readers on 3D CT colonography: comparison of standard and low radiation dose. Eur Radiol 2009; 20:630-9. [PMID: 19760236 DOI: 10.1007/s00330-009-1601-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 07/22/2009] [Accepted: 07/30/2009] [Indexed: 10/20/2022]
Abstract
AIMS We compared the prevalence of noise-related artefacts and lesion perception on three-dimensional (3D) CT colonography (CTC) at standard and low radiation doses. METHODS Forty-eight patients underwent CTC (64 x 0.625 mm collimation; tube rotation time 0.5 s; automatic tube current modulation: standard dose 40-160 mA, low dose 10-50 mA). Low- and standard-dose acquisitions were performed in the supine position, one after the other. The presence of artefacts (cobblestone and snow artefacts, irregularly delineated folds) and the presence of polyps were evaluated by five radiologists on 3D images at standard dose, the original low dose and a modified low dose, i.e. after manipulation of opacity on 3D. RESULTS The mean effective dose was 3.9 +/- 1.3 mSv at standard dose and 1.03 +/- 0.4 mSv at low dose. The number of images showing cobblestone artefacts and irregularly delineated folds at original and modified low doses was significantly higher than at standard dose (P < 0.0001). Most of the artefacts on modified low-dose images were mild. No significant difference in sensitivity between the dose levels was found for polyps > or =6 mm. CONCLUSIONS Reduction of the effective dose to 1 mSv significantly affects image quality on 3D CTC, but the perception of > or =6 mm lesions is not significantly impaired.
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Affiliation(s)
- Valeria A Fisichella
- Department of Radiology, Sahlgrenska University Hospital, Bruna Stråket 11, 41342 Gothenburg, Sweden.
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Summerton S, Little E, Cappell MS. CT colonography: current status and future promise. Gastroenterol Clin North Am 2008; 37:161-89, viii. [PMID: 18313545 DOI: 10.1016/j.gtc.2007.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CT colonography (CTC) is an innovative technology that entails CT examination of the entire colon and computerized processing of the raw data after colon cleansing and colonic distention. CTC could potentially increase the screening rate for colon cancer because of its relative safety, relatively low expense, and greater patient acceptance, but its role in mass colon cancer screening is controversial because of its highly variable sensitivity, the inability to sample polyps for histologic analysis, and lack of therapeutic capabilities. This article reviews the CTC literature, including imaging and adjunctive techniques, radiologic interpretation, procedure indications, contraindications, risks, sensitivity, interpretation pitfalls, and controversies.
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Affiliation(s)
- Susan Summerton
- Department of Radiology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
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Mang T, Schaefer-Prokop C, Schima W, Maier A, Schober E, Mueller-Mang C, Weber M, Prokop M. Comparison of axial, coronal, and primary 3D review in MDCT colonography for the detection of small polyps: a phantom study. Eur J Radiol 2008; 70:86-93. [PMID: 18221849 DOI: 10.1016/j.ejrad.2007.11.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 10/19/2007] [Accepted: 11/27/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this phantom study is to compare the influence of the reading technique (axial images alone in comparison to 3D endoluminal, coronal, and combined 2D/3D review methods) on the sensitivity and inter-reader variability with MDCT colonography for the detection of small colonic polyps. METHODS An anthropomorphic pig colon phantom with 75 randomly distributed simulated small polyps of 2-8mm size, was distended with air and scanned in a water phantom using multidetector-row CT with 4mm x 1mm collimation. Three radiologists rated the presence of polyps on a five-point scale. Performance with axial sections alone was compared to the performance with coronal sections, virtual endoscopy (VE), and a combined 2D/3D approach. We calculated sensitivities for polyp detection and used ROC analysis for data evaluation. RESULTS There was no significant difference between the mean area under the curve (A(z)) for axial images and VE (A(z)=0.934 versus 0.932), whereas coronal images were significantly inferior (A(z)=0.876) to both. The combined 2D/3D approach yielded the best results, with an A(z) of 0.99. Differences in sensitivity between individual readers were significant in axial images (sensitivity, 75-93%, p=0.001) and coronal images (sensitivity, 69-80%, p=0.028), but became non-significant with VE (83-88%, p=0.144) and the combined 2D/3D approach (95-97%, p=0.288). CONCLUSION Evaluation of axial sections alone leads to significant differences in detection rates between individual observers. A combined 2D/3D evaluation improves sensitivities for polyp detection and reduces inter-individual differences to an insignificant level.
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Affiliation(s)
- Thomas Mang
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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