Noncathartic CT colonography: Image quality assessment and performance and in a screening cohort

Joel G. Fletcher, Alvin C. Silva, Jeff L. Fidler, Joseph G. Cernigliaro, Armando Manduca, Paul J. Limburg, Lynn A. Wilson, Trudy A. Engelby, Garrett Spencer, W. Scott Harmsen, Jay Mandrekar, C. Daniel Johnson

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

OBJECTIVE. Cathartic bowel preparation is a major barrier for colorectal cancer screening. We examined noncathartic CT colonography (CTC) quality and performance using four similar bowel-tagging regimens in an asymptomatic screening cohort. SUBJECTS AND METHODS. This prospective study included 564 asymptomatic subjects who underwent noncathartic CTC without dietary modification but with 21 g of barium with or without iodinated oral contrast material (four regimens). The quality of tagging with oral agents was evaluated. A gastrointestinal radiologist evaluated examinations using primary 2D search supplemented by electronic cleansing (EC) and 3D problem solving. Results were compared with complete colonoscopy findings after bowel purgation and with retrospective unblinded evaluation in 556 of the 564 (99%) subjects. RESULTS. Of the 556 subjects, 7% (37/556) and 3% (16/556) of patients had 52 and 20 adenomatous polyps ≥ 6 and ≥ 10 mm, respectively. The addition of iodine significantly improved the percentage of labeled stool (p ≤ 0.0002) and specificity (80% vs 89-93%, respectively; p = 0.046). The overall sensitivity of noncathartic CTC for adenomatous polyps ≥ 6 mm was 76% (28/37; 95% CI, 59-88%), which is similar to the sensitivity of the iodinated regimens with most patients (sensitivity: 231 patients, 74% [14/19; 95% CI, 49-91%]; 229 patients, 80% [12/15; 95% CI, 52-96%]). The negative predictive value was 98% (481/490), and the lone cancer was detected (0.2%, 1/556). EC was thought to improve conspicuity of 10 of 21 visible polyps ≥ 10 mm. CONCLUSION. In this prospective study of asymptomatic subjects, the per-patient sensitivity of noncathartic CTC for detecting adenomas ≥ 6 mm was approximately 76%. Inclusion of oral iodine contrast material improves examination specificity and the percentage of labeled stool. EC may improve polyp conspicuity.

Original languageEnglish (US)
Pages (from-to)787-794
Number of pages8
JournalAmerican Journal of Roentgenology
Volume201
Issue number4
DOIs
StatePublished - Oct 2013

Keywords

  • Bowel preparation
  • CT colonography
  • Colon cancer screening
  • Patient compliance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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