Virtual CT Colonography Versus Lower Endoscopy in Detection of Colorectal Lesions.

Document Type : Original Article

Authors

1 Faculty of Medicine- Sohag University.

2 Department of Chest Diseases, Faculty of Medicine, Sohag University

3 Faculty of Medicine- Sohag University

4 Faclty of medicine-sohag university

5 faculty of medicine- sohag university

Abstract

Colorectal cancer is the third most common cancer and the second leading cause of cancer-related death in Western countries. As with other malignancies, screening and early detection is fundamental for successful management of colorectal cancer. Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. CT colonography is being increasingly applied as a routine screening method for the detection of colorectal cancer in last few years as it is more convenient and less invasive than colonoscopy. In addition, it has an upper hand in diagnosis of small lesions less than 10mm  (Choi, et al., 2011).
Patients and methods:This prospective double blind comparative study will be conducted on 23 patients with colorectal symptoms and signs as altered bowel habits, bleeding per rectum, abdominal pain, weight loss, unexplained fatigue and loss of appetite.An informed written consent was obtained from all patients and approval of the faculty research ethics committee was obtained.
Results:  Total of 108 colonic lesions were analyzed in 23 patient; Seven colonic masses were diagnosed in 6 patients, 41 polyps in 8 patients and 60 diverticulae in 5 patients.
Six patients had incomplete colonoscopy. Of them, 2 patients had a large polypoidal mass that prevents further colonoscopic introduction. Using CT colonography we were able to evaluate those polypoidal masses. Moreover, we could complete the examination and evaluation of the proximal colon and one of them had a polypoidal sigmoid colon mass and showed another proximal annular mass.
Four patients presented with colonic obstruction and good preparation to the proximal parts of the colon failed, So completing the colonoscopy was difficult. After  undergoing CT colonography, 2 patients were normal and 2 patients had annular masses causing proximal obstruction and marked distension.
ConclusionCT Colonography (Virtual Colonoscopy) is a reliable tool and more sensitive for detecting colonic mass lesions larger than 5 mm, polyps larger than 5 mm, strictures and diverticulosis. CTC is of value in evaluating the colonic segment lying proximal to colonic cancers including those with occlusive growths or strictures. Contrast-enhanced CTC is also useful in identifying extra-colonic findings.Virtual Colonoscopy is a good screening tools for malignant or premalignant lesions in patients presented with colorectal symptoms.

References

1-      Barish MA, Soto JA, Ferrucci JT. Consensus on current clinical practice of virtual colonoscopy. AJR Am J Roentgenol 2005;184:786–92
2-      Brown G, Kirkham A, Williams GT, et al: High-resolution MRI of the anatomy important in total mesorectal excision of the rectum.  AJR  2004; 182:431-439.
3-      Burling D, Taylor SA, Halligan S, et al. Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation. AJR Am J Roentgenol 2006;186:96 103.
4-      Charanjeet Singh. colon tumours outlines, 2003-2011.
5-      Charanjeet Singh. colon tumours outlines, 2003-2012.
6-      Chen JS, Hsieh PS, Chiang JM, et al. Clinical outcome of signet ring cell carcinoma and mucinous adenocarcinoma of the colon. Chang Gung Med J 2010;33:51-7. 
 
7-      Dachman AH,Kuniyoshi JK, Boyle CM, et al. CTcolonography with three dimensional problem solving for detection of colonic polyps. AJR Am J Roentgenol 1998;171:989–95.
8-      Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Handbook, 7th edition. New York: Springer, 2010:173-206.
9-      Fenlon HM, Clarke PD, Ferrucci JT. Virtual colonoscopy: imaging features with colonoscopic correlation. AJR Am J Roentgenol 1998;170:1303–9.
10-              Fletcher JG, Johnson CD, Krueger WR, et al. Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastatic disease, local recurrence, and metachronous neoplasia in colorectal carcinoma. AJR Am J Roentgenol 2002;178:283–90.
11 - Gluecker TM, Johnson CD, Wilson LA, et al. Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 2003;124:911–6.
12-         Halligan S, Altman DG, Taylor SA, et al. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta analysis, and proposed minimum data set for study level reporting. Radiology 2005;237:893–904.
13-         Hamilton SR, Aaltonen LA: World Health Organization classification of tumours. Pathology and genetics, tumours of the digestive system, IARC Press, 2000.
14-Hamilton SR, Bosman FT, Boffetta P, et al. Carcinoma of the colon and rectum. In: WHO Classification of Tumours of the Digestive System. Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. Lyon: IARC Press, 2010:134-46.
15-Iannaccone R, Laghi A, Catalano C, et al. Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology 2004;127:1300–11.
16-Isaacson PG: Lymphoproliferative disorders of the gastrointestinal tract In Pathology of the gastrointestinal tract, second edition, Ming SC, Goldman H.
17-J.G. Fletcher, Fargol Booya, C. Daniel Johnson, David Ahlquist. Curr Opin Gastroenterol. 2005;21(1):90-98. 
 
18-Juchems MS, Fleiter TR, Pauls S, Schmidt SA, Brambs HJ, Aschoff AJ. CT colonography: comparison of a colon dissection display versus 3D endoluminal view for the detection of polyps. Eur Radiol 2006;16:68–72.
19-Laghi A. Virtual colonoscopy: clinical application. Eur Radiol 2005;15(Suppl 4):D138–41.
20-Laks S, Macari M, Bini EJ. Positional change in colon polyps at CT colonography. Radiology 2004;231:761–6.
21- Lefere P, Gryspeerdt S, Baekelandt M, Dewyspelaere J, van Holsbeeck B. Diverticular disease in CT colonography. Eur Radiol 2003;13(Suppl 4):L62–74.
22-Leopoldo S, Lorena B, Cinzia A, et al. Two subtypes of mucinous adenocarcinoma of the colorectum: clinicopathological and genetic features. Ann Surg Oncol 2008;15:1429-39. 
23-Macari M, Bini EJ, Jacobs SL, Lange N, Lui YW. Filling defects at CT colonography: pseudo- and diminutive lesions (the good), polyps (the bad), flat lesions, masses, and carcinomas (the ugly). Radiographics 2003;23:1073–91.
24-Macari M, Bini EJ, Xue X, et al. Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection.Radiology 2002;224:383–92 
25-Macari M, Bini EJ. CT colonography: where have we been and where are we going? Radiology 2005;237:819–33.
26-Macari M, Milano A, Lavelle M, Berman P, Megibow AJ. Comparison of time-efficient CT colonography with two- and three-dimensional colonic evaluation for detecting colorectal polyps. AJR Am J Roentgenol 2000;174:1543–9.
27-Makino T, Tsujinaka T, Mishima H, et al. Primary signet-ring cell carcinoma of the colon and rectum: report of eight cases and review of 154 Japanese cases. Hepatogastroenterology 2006;53:845-9. 
28-Mang T, Maier A, Plank C, Mueller-Mang C, Herold C, Schima W. Pitfalls in Multi–Detector Row CT Colonography: A Systematic Approach. RadioGraphics 2007; 27:431–454.
29- Ming SC, Goldman H: Pathology of the gastrointestinal tract, second edition, Philadelphia, 1998, Williams and Wilkins.
30-Morrin MM, Farrell RJ, Kruskal JB, Reynolds K, McGee JB, Raptopoulos V. Utility of intravenously administered contrast material at CT colonography. Radiology 2000;217:765–71.
31- Neri E, Giusti P, Battolla L, et al. Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology, 2002;223:615–9.
32-Owen DA, Kelly JK: Atlas of gastrointestinal pathology, Philadelphia, 1994, Saunders, p170
33- PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003;349:2191–200.
34-Pickhardt PJ. Translucency rendering in 3D endoluminal CTcolonography: a useful tool for increasing polyp specificity and decreasing interpretation time. AJR Am J Roentgenol 2004;183:429–36
35- BJ, Fujii T, Cairns A, et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet 2000;355:1211–4.
36-Rockey DC, Paulson E, Niedzwiecki D, et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 2005;365:305–11.
37-Rogalla P, Lembcke A, Ruckert JC, et al. Spasmolysis at CT colonography: butyl scopolamine versus glucagon. Radiology 2005;236:184–8.
38-Royster AP, Fenlon HM, Clarke PD, Nunes DP, Ferrucci JT. CT colonoscopy of colorectal neoplasms: two-dimensional and three dimensional virtual-reality techniques with colonoscopic correlation. AJR Am J Roentgenol 1997;169:1237–42.
39- Sosna J, Blachar A, Amitai M, et al. Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology 2006;239:457–63.
40-Stoker J, Bartram CI, Halligan S: Imaging of the posterior pelvic floor. Eur Radiol  2002; 12:779-788.
41-Summers RM, Yao J, Pickhardt PJ, et al. Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population. Gastroenterology 2005;129:1832–44.
42-Svensson MH, Svensson E, Lasson A, Hellstrom M. Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease. Radiology 2002;222:337–45.
43-Taylor SA, Halligan S, Bartram CI. CT colonography: methods, pathology and pitfalls. Clin Radiol 2003;58:179–90.
44- Taylor SA, Halligan S, Goh V, Morley S, Atkin W, Bartram CI. Optimizing bowel preparation for multidetector row CT colonography: effect of Citramag and Picolax. Clin Radiol 2003;58:723–32.
45-Taylor SA, Halligan S, Saunders BP, et al. Use of multidetector-row CT colonography for detection of colorectal neoplasia in patients referred via the Department of Health “2-week-wait” initiative. Clin Radiol 2003;58:855–61.
46- Thirunavukarasu P, Sathaiah M, Singla S, et al. Medullary carcinoma of the large intestine: a population based analysis. Int J Oncol 2010;37:901 7.
47- Thomas Mang, Anno Graser, Wolfgang Schima, Andrea Maier: CT colonography: Techniques, indications, findings. European Journal of Radiology 61 (2007) 388–399.
48- van Gelder RE, Birnie E, Florie J, et al. CT colonography and colonoscopy: assessment of patient preference in a 5-week follow-up study. Radiology 2004;233:328–37.
49- Verhulst J, Ferdinande L, Demetter P, et al. Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta analysis. J Clin Pathol 2012;65:381-8.  
50- Vos FM, van Gelder RE, Serlie IW, et al. Three-dimensional display modes for CT colonography: conventional3Dvirtual colonoscopy versus unfolded cube projection. Radiology 2003;228:878–85.
51-Winawer SJ, Stewart ET, Zauber AG, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 2000;342:1766–72.
52-Yee J, Kumar NN, Hung RK, Akerkar GA, Kumar PR, Wall SD. Comparison of supine and prone scanning separately and in combination at CT colonography. Radiology 2003;226:653–61.
53- Yoshida H, Dachman AH. CAD techniques, challenges, and controversies in computed tomographic colonography. Abdom Imaging 2005;30:26–41.
54- Zalis ME, Barish MA, Choi JR, et al. CT colonography reporting and data system: a consensus proposal. Radiology 2005;236:3–9.
Sohag Medical Journal
Volume 22, Issue 1
January 2018
Pages 53-64

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