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MR Colonography with Limited Bowel Preparation Compared with Optical Colonoscopy in Patients at Increased Risk for Colorectal Cancer¹

¹ From the Departments of Radiology (J.F., S.J., R.E.v.G., B.H., A.v.R., M.M.v.d.H., J.S.), Gastroenterology and Hepatology (J.F.B.), and Clinical Epidemiology and Biostatistics (P.M.M.B.), Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands; Departments of Radiology (S.J., V.P.M.v.d.H.) and Gastroenterology and Hepatology (L.C.B.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (R.A.J.N.); and Department of Gastroenterology and Hepatology, Slotervaart Ziekenhuis, Amsterdam, the Netherlands (P.S.). From the 2005 RSNA Annual Meeting. Received December 21, 2005; revision requested February 10, 2006; revision received May 13; accepted June 5; final version accepted September 1. Supported by grant 2100.0094 from ZONMW (the Netherlands Organization for Health Research and Development). Address correspondence to J.F. (e-mail: j.florie{at}amc.uva.nl).

Purpose: To prospectively evaluate the diagnostic performance of magnetic resonance (MR) colonography by using limited bowel preparation in patients with polyps of 10 mm or larger in diameter in a population at increased risk for colorectal cancer, with optical colonoscopy as the reference standard.

Materials and Methods: The institutional review boards of all three hospitals approved the study. All patients provided written informed consent. In this multicenter study, patients undergoing colonoscopy because of a personal or family history of colorectal cancer or adenomatous polyps were included. Two blinded observers independently evaluated T1- and T2-weighted MR colonographic images obtained with limited bowel preparation (bright-lumen fecal tagging) for the presence of polyps. The limited bowel preparation consisted of a low-fiber diet, with ingestion of lactulose and an oral gadolinium-based contrast agent (with all three major meals) starting 48 hours prior to imaging. Results were verified with colonoscopic outcomes. Patient sensitivity, patient specificity, polyp sensitivity, and interobserver agreement for lesions of 10 mm or larger were calculated for both observers individually and combined.

Results: Two hundred patients (mean age, 58 years; 128 male patients) were included; 41 patients had coexistent symptoms. At colonoscopy, 12 patients had 22 polyps of 10 mm or larger. Per-patient sensitivity was 58% (seven of 12) for observer 1, 67% (eight of 12) for observer 2, and 75% (nine of 12) for both observers combined for polyps of 10 mm or larger. Per-patient specificity was 95% (178 of 188) for observer 1, 97% (183 of 188) for observer 2, and 93% (175 of 188) for both observers combined. Per-polyp sensitivity was 55% (12 of 22) for observer 1, 50% (11 of 22) for observer 2, and 77% (17 of 22) for both observers combined. Interobserver agreement was 93% for identification of patients with lesions of 10 mm or larger.

Conclusion: In patients at increased risk for colorectal cancer, specificity of MR colonography by using limited bowel preparation was high, but sensitivity was modest.

© RSNA, 2007

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				J. Florie, E. Birnie, R. E. van Gelder, S. Jensch, B. Haberkorn, J. F. Bartelsman, A. van der Sluys Veer, P. Snel, V. P. M. van der Hulst, G. J. Bonsel, et al. MR Colonography with Limited Bowel Preparation: Patient Acceptance Compared with That of Full-Preparation Colonoscopy Radiology, October 1, 2007; 245(1): 150 - 159. [Abstract] [Full Text] [PDF]