HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pickhardt, P. J. Articles by Pfau, P. R. Search for Related Content PubMed PubMed Citation Articles by Pickhardt, P. J. Articles by Pfau, P. R.

Screening for Colorectal Neoplasia with CT Colonography: Initial Experience from the 1st Year of Coverage by Third-Party Payers¹

¹ From the Department of Radiology (P.J.P., A.J.T., D.H.K.) and Section of Gastroenterology and Hepatology (M.R., D.V.G., P.R.P.), University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252. From the 2005 RSNA Annual Meeting. Received December 9, 2005; revision requested January 27, 2006; revision received February 7; accepted March 10; final version accepted April 17. Address correspondence to P.J.P. (e-mail: pj.pickhardt{at}hosp.wisc.edu).

View larger version (16K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Flowchart of relevant findings for patients undergoing primary CT colonography at our institution over a 1-year period. Flexible sigmoidoscopy or short-interval virtual colonoscopy was performed for nondiagnostic segmental evaluation of the sigmoid or descending colon in all cases (*). Short-interval virtual colonoscopy group includes one patient who underwent incomplete optical colonoscopy (**). CTC = CT colonography, FS = flexible sigmoidoscopy, OC = optical colonoscopy, PPV = positive predictive value.

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Large colorectal polyp in asymptomatic 53-year-old man at average risk for colorectal neoplasia. (a) Still image obtained at 3D endoluminal CT colonography fly through shows a lobulated 3.5-cm mass (*) located behind a rectal fold (arrows). (b) Digital photograph obtained at optical colonoscopy performed on the same day shows the same lesion, which proved to be tubulovillous adenoma with high-grade dysplasia at histologic examination.

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Large colorectal polyp in asymptomatic 53-year-old man at average risk for colorectal neoplasia. (a) Still image obtained at 3D endoluminal CT colonography fly through shows a lobulated 3.5-cm mass (*) located behind a rectal fold (arrows). (b) Digital photograph obtained at optical colonoscopy performed on the same day shows the same lesion, which proved to be tubulovillous adenoma with high-grade dysplasia at histologic examination.

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Medium-sized colorectal polyp in asymptomatic 60-year-old man at average risk for colorectal neoplasia. (a) Schematic map of gas-filled colon automatically generated from CT scan data. The red dot indicates the location of a polyp detected at CT colonography. The green line represents the centerline for automated endoluminal navigation. Note the tortuous and elongated sigmoid colon in this case. (b) Still image obtained at 3D endoluminal CT colonography fly through shows 7-mm sessile polyp (*) located in sigmoid colon, as indicated in a. (c) Transverse 2D view confirms that the polyp identified in b is a soft tissue lesion (arrow). Correlation of positive 3D finding on 2D view is essential in all cases for avoiding false-positive diagnosis. Patient chose immediate polypectomy. (d) Digital photograph obtained at optical colonoscopy on the same day shows the same polyp, which proved to be a tubular adenoma at histologic examination. Colonoscopist believed the polyp was located in the descending colon, likely related to sigmoid tortuosity.

View larger version (115K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Medium-sized colorectal polyp in asymptomatic 60-year-old man at average risk for colorectal neoplasia. (a) Schematic map of gas-filled colon automatically generated from CT scan data. The red dot indicates the location of a polyp detected at CT colonography. The green line represents the centerline for automated endoluminal navigation. Note the tortuous and elongated sigmoid colon in this case. (b) Still image obtained at 3D endoluminal CT colonography fly through shows 7-mm sessile polyp (*) located in sigmoid colon, as indicated in a. (c) Transverse 2D view confirms that the polyp identified in b is a soft tissue lesion (arrow). Correlation of positive 3D finding on 2D view is essential in all cases for avoiding false-positive diagnosis. Patient chose immediate polypectomy. (d) Digital photograph obtained at optical colonoscopy on the same day shows the same polyp, which proved to be a tubular adenoma at histologic examination. Colonoscopist believed the polyp was located in the descending colon, likely related to sigmoid tortuosity.

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 3d: Medium-sized colorectal polyp in asymptomatic 60-year-old man at average risk for colorectal neoplasia. (a) Schematic map of gas-filled colon automatically generated from CT scan data. The red dot indicates the location of a polyp detected at CT colonography. The green line represents the centerline for automated endoluminal navigation. Note the tortuous and elongated sigmoid colon in this case. (b) Still image obtained at 3D endoluminal CT colonography fly through shows 7-mm sessile polyp (*) located in sigmoid colon, as indicated in a. (c) Transverse 2D view confirms that the polyp identified in b is a soft tissue lesion (arrow). Correlation of positive 3D finding on 2D view is essential in all cases for avoiding false-positive diagnosis. Patient chose immediate polypectomy. (d) Digital photograph obtained at optical colonoscopy on the same day shows the same polyp, which proved to be a tubular adenoma at histologic examination. Colonoscopist believed the polyp was located in the descending colon, likely related to sigmoid tortuosity.

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Medium-sized colorectal polyp in asymptomatic 60-year-old man at average risk for colorectal neoplasia. (a) Schematic map of gas-filled colon automatically generated from CT scan data. The red dot indicates the location of a polyp detected at CT colonography. The green line represents the centerline for automated endoluminal navigation. Note the tortuous and elongated sigmoid colon in this case. (b) Still image obtained at 3D endoluminal CT colonography fly through shows 7-mm sessile polyp (*) located in sigmoid colon, as indicated in a. (c) Transverse 2D view confirms that the polyp identified in b is a soft tissue lesion (arrow). Correlation of positive 3D finding on 2D view is essential in all cases for avoiding false-positive diagnosis. Patient chose immediate polypectomy. (d) Digital photograph obtained at optical colonoscopy on the same day shows the same polyp, which proved to be a tubular adenoma at histologic examination. Colonoscopist believed the polyp was located in the descending colon, likely related to sigmoid tortuosity.

View larger version (17K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: Volume of patients who underwent colonoscopy at our institution over five quarters. Bar graphs demonstrate (a) total and (b) screening volumes for both CT colonography (CTC) and optical colonoscopy (OC). Note that the total number of patients who underwent optical colonoscopy has not decreased with the increasing number of patients who underwent CT colonography. The overall number of patients screened doubled between the 1st quarters of 2004 and 2005.

View larger version (18K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: Volume of patients who underwent colonoscopy at our institution over five quarters. Bar graphs demonstrate (a) total and (b) screening volumes for both CT colonography (CTC) and optical colonoscopy (OC). Note that the total number of patients who underwent optical colonoscopy has not decreased with the increasing number of patients who underwent CT colonography. The overall number of patients screened doubled between the 1st quarters of 2004 and 2005.