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Gastrointestinal Imaging |
1 From the Departments of Radiology (J.Y., R.K.H., A.M.S.G., S.D.W.) and Gastroenterology (G.A.A., K.R.M.), Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121; and the Departments of Radiology (J.Y., R.K.H., A.M.S.G., S.D.W.) and Gastroenterology (G.A.A., K.R.M.), University of California School of Medicine, San Francisco. From the 1999 RSNA scientific assembly. Received June 15, 2000; revision requested July 24; revision received October 13; accepted December 7. Address correspondence to J.Y. (e-mail: judy.yee@radiology.ucsf.edu).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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MATERIALS AND METHODS: Three hundred patients underwent CT colonography followed by standard colonoscopy. Bowel preparation consisted of magnesium citrate and polyethylene glycol. After colonic air insufflation, patients underwent scanning in the supine and prone positions with 3-mm collimation during a single breath hold. The transverse CT images, sagittal and coronal reformations, and three-dimensional endoluminal images were interpreted by two radiologists independently, and then a consensus reading was performed. CT colonographic findings were correlated with standard colonoscopic and histologic findings.
RESULTS: The overall sensitivity and specificity of CT colonography for polyp detection were 90.1% (164 of 182) and 72.0% (85 of 118), respectively. By using direct polyp matching, the overall sensitivity was 69.7% (365 of 524). The sensitivity was 90% (74 of 82) for the detection of polyps 10 mm or larger, 80.1% (113 of 141) for polyps 5.0–9.9 mm, and 59.1% (178 of 301) for polyps smaller than 5 mm. The sensitivity was 94% (64 of 68) for the detection of adenomas 10 mm or larger, 82% (72 of 88) for adenomas 5.0–9.9 mm, and 66.9% (95 of 142) for adenomas smaller than 5 mm. CT colonography was used to identify all eight carcinomas.
CONCLUSION: CT colonography has excellent sensitivity for the detection of clinically important colorectal polyps and cancer.
Index terms: Colon, CT, 75.12115, 75.12117, 75.12119 • Colon neoplasms, 75.311 • Computed tomography (CT), image processing, 75.12117, 75.12119 • Computed tomography (CT), three-dimensional, 75.12117, 75.12119 • Images, analysis, 75.12115, 75.12117, 75.12119
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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There is a continued search for a colorectal cancer screening test that is cost-effective, safe, and acceptable to patients. Current methods used to screen for colorectal polyps and colonic cancer include fecal occult blood testing, sigmoidoscopy, colonoscopy, and double-contrast barium enema examination. The effectiveness of each modality as a screening tool remains controversial, and each method has inherent limitations. For instance, the fecal occult blood test has been shown in large prospective trials to decrease mortality due to colorectal cancer by only 16% (3) and fails to demonstrate a majority of adenomas (4–6). Flexible sigmoidoscopy allows examination of only the distal 60 cm of the colon, which limits evaluation to the descending colon, sigmoid, and rectum; inherently, lesions are missed in more than one-half of subjects who have advanced colonic adenomas located proximal to the splenic flexure but who do not have a distal index polyp (7,8).
Although standard colonoscopy is a total colonic examination that allows lesion biopsy and resection, it fails to demonstrate the entire colon in up to 5% of cases examined by an experienced gastroenterologist (9,10), and up to 20% of all adenomas are missed (11). Furthermore, there is a risk of complications associated with diagnostic and therapeutic colonoscopy, including perforation (one in 1,000), major hemorrhage (three in 1,000), and death (one in 30,000) (11–13).
Investigators in retrospective evaluations of double-contrast barium enema examination for the detection of colorectal cancer have found sensitivities of 71%–95% (14–17). However, investigators in prospective studies of double-contrast barium enema examination for colorectal cancer detection report sensitivities as low as 50%–75% in asymptomatic patients with positive fecal occult blood test results (18). A recent study (19) in which double-contrast barium enema examination was compared with colonoscopy for colonic surveillance after polypectomy found a poor detection rate of 48% for polyps 10 mm and larger, as well as a poor overall detection rate of only 39% for adenomas.
In the search for a rapid, less invasive, accurate, and well-tolerated colorectal screening test, computed tomographic (CT) colonography, or "virtual colonoscopy," has evolved quickly. Since its description by Vining et al (20) in 1994, studies have focused on the optimization of data acquisition, display, and interpretation. However, there are few published prospective clinical trials (21–23) in which the accuracy of CT colonography for colorectal polyp detection was evaluated and only two small trials (24,25) in which its effectiveness in a screening population was evaluated.
The purpose of this prospective study was to evaluate the sensitivity and specificity of CT colonography in 300 asymptomatic and symptomatic patients by using colonoscopy as the reference standard.
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MATERIALS AND METHODS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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Three hundred nineteen patients were recruited for the study from a university-affiliated Veterans Affairs hospital where there was a predominantly male population. Three hundred patients were successfully examined with both CT and standard colonoscopy. There were no postprocedural complications after either CT colonography or standard colonoscopy. Thirteen patients could not be included in the final study because they received additional bowel preparation after the CT examination but prior to the standard colonoscopy. Six patients could not be included in the final study because of technical reasons, such as CT scanner mechanical difficulty.
CT colonography was performed approximately 2–3 hours prior to standard colonoscopy. All patients were examined by using a helical CT scanner (HiSpeed CT/i; GE Medical Systems, Milwaukee, Wis). The patient was placed supine on the CT table. A rectal tube was placed, and air was insufflated to maximum patient tolerance, with an average of 30–40 bulb compressions. The scout CT image allowed rapid assessment of colonic distention. When necessary, further insufflation was performed to maximum patient tolerance before data acquisition. A subset of 115 patients received 1.0 mg of glucagon intravenously 1–2 minutes prior to scanning. The remaining patients did not receive glucagon because available information in the literature (26–28) showed no difference in colonic distention or polyp detection in patients undergoing CT colonography with glucagon versus those without glucagon. The rectal tube was removed for improved patient comfort and to prevent possible rectal lesions from being obscured. Patients were then given instructions on breath-hold techniques.
During a single breath hold, thin-section helical CT images were obtained from the top of the colon through the rectum, as determined from the scout image. CT colonographic protocol included a subsecond (800 msec) gantry rotation time with 3-mm collimation, pitch of 1.5–2.0, matrix of 512 x 512, 120 kVp, and 120–150 mA. In each case, the pitch was adjusted to limit the total scanning time to less than 60 seconds. Patients were instructed to slowly exhale if they could not maintain the entire breath hold and to take only shallow breaths if necessary until completion of scanning. The patient was then placed in the prone position, and repeat scanning was performed with the same protocol.
Image processing was performed with a computer workstation (UltraSparc I; Sun Microsystems, Mountain View, Calif) with commercially available software (NAVIGATOR; GE Medical Systems) that provided surface renderings. Image reconstruction was performed by using an interval of 1.5 mm. The processed images included sagittal and coronal two-dimensional (2D) reformatted and endoluminal images. The 2D CT reformatted images and endoluminal images were presented in a multiple-image display format. The endoluminal images viewed continuously in the interactive mode provided an endoscopiclike examination.
All images were interpreted on the computer workstation by two radiologists (J.Y., R.K.H.) independently, and subsequently a consensus reading was performed. The radiologists were blinded to the patient’s history, including whether the patient had been recruited for screening or for symptoms, and to results of standard colonoscopy and histologic analysis. The evaluation consisted of initial review of the magnified 2D transverse CT images followed by review of the endoluminal images in the interactive (fly-through) mode. Endoluminal viewing was performed in both antegrade and retrograde directions and with the patient in both supine and prone positions by using a step interval of 3 mm. The transverse and reformatted coronal and sagittal 2D CT images were displayed alongside the endoluminal images in a four-quadrant display format.
All polypoid lesions seen at CT colonography were photographed. The colon was divided into the following eight segments: rectum, sigmoid, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon, and cecum. The diameter and location of all polyps and masses were documented for each patient. A mass was considered to have CT features of a carcinoma rather than of a polyp if it had an "apple-core" appearance with a thickened infiltrated colonic wall on 2D images and luminal narrowing associated with mass on the endoluminal images. Lesion size at CT colonography was determined with computed caliper measurement of the largest diameter and was measured on the 2D images when the lesions were best seen on the 2D images, but lesion size was determined on the three-dimensional images when lesions were seen on only the three-dimensional images.
The adequacy of colonic preparation and distention was recorded according to segment. Adequacy of segmental preparation was graded according to the amount of residual fluid or debris obscuring the colonic surface: excellent, 0%; good, less than 25%; fair, 25%–50%; and poor, greater than 50%. Segmental distention was graded as excellent for more than 75% of expected maximal luminal expansion; good, 51%–75%; fair, 25%–50%; and poor, less than 25%. For the last 100 CT examinations, each radiologist also recorded interpretation times.
Immediately after CT colonography and after the patient received conscious sedation, conventional colonoscopy was performed with a video colonoscope (Olympus 140; Olympus, Melville, NY) by one of three experienced attending gastroenterologists (including G.A.A. and K.R.M.) who were unaware of the CT findings. The quality of the bowel preparation was recorded on a 1–5 scale by using an established system: 1, all mucosa was easily depicted and no fecal material other than a liquid pool was present in the rectum; 2, multiple liquid pools were present throughout the colon and easily aspirated for depiction of the mucosa; 3, multiple pools of mixed solid and liquid feces were present; 4, multiple collections of solid feces were present; 5, the procedure was abandoned because of poor preparation (29).
The colonoscope was advanced to the cecum, and polyp detection data were obtained as the scope was removed. The endoscopists provided photographic documentation of cecal landmarks and of all polyps. During the colonoscopic examination, the size and location of all polyps were recorded by using the same colonic segmental classification scheme as for CT colonography. Polyp size was estimated with direct in vivo comparison to an open jumbo biopsy forceps measuring 10 mm in length (Fig 1). All retrieved polyps were examined for gross and histologic disease.
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The performance characteristics of CT colonography for polyp and carcinoma detection were also evaluated for asymptomatic versus symptomatic patient groups. By using individual lesion matching, the sensitivity for polyp and adenoma detection was calculated, and by using by-patient comparison, the sensitivity and specificity for polyp detection was tabulated for asymptomatic and symptomatic groups. A two-tailed Fisher exact test was used to obtain P values.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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A total of 3,982 (82.9%) of 4,800 colonic segments received excellent or good grades for colonic preparation and were considered adequately cleansed; 4,233 (88.2%) of 4,800 colonic segments had excellent or good distention grades and were considered adequately distended. The mean preparation score at colonoscopy was 2.19 ± 0.79 (SD). Complete colonoscopy to the cecum was achieved in all patients. Results of colonoscopy were normal in 118 patients. In 182 patients, colonoscopy depicted 524 polyps and eight infiltrative or annular masses. Two hundred ninety-eight adenomas and eight carcinomas were confirmed at histologic examination (Table 2). The remaining polyps identified at colonoscopy represented hyperplastic polyps or normal colonic mucosa. In some cases, normal mucosa may have represented an erroneous diagnosis on the part of the endoscopist, in others the endoscopist may have missed a diminutive polyp with the biopsy forceps, and in other cases the raised polypoid lesion was histologically normal mucosal tissue.
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By using by-patient comparison, the overall sensitivity and specificity for polyp detection were 90.1% and 72.0%, respectively (Table 5). The positive predictive value was 83.3% (164 of 197), and the negative predictive value was 82.5% (85 of 103). However, the positive predictive value and negative predictive value for clinically important polyps 10 mm or larger were 81% (42 of 52) and 97.2% (241 of 248), respectively. The overall sensitivity, specificity, positive predictive value, and negative predictive value for adenoma detection by using patient comparison analysis were 93.9%, 56.6%, 62.9% (124 of 197), and 92.2% (95 of 103), respectively.
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CT colonography did not depict polyps noted at standard colonoscopy in 18 patients; four patients had missed polyps 5.0–9.9 mm, and 14 patients had missed polyps smaller than 5 mm.
The performance characteristics of CT colonography were compared between the 96 asymptomatic (screening) and 204 symptomatic subjects. No statistically significant difference in the performance characteristics of CT colonography was identified between the two groups. With direct polyp comparison, the sensitivity for polyp detection was 69.0% (100 of 145) in the screening group and 69.7% (262 of 376) in the symptomatic group (P = .25). With patient comparison, the sensitivity and specificity of CT colonography for polyp detection in the screening group were 88% (51 of 58) and 82% (31 of 38), respectively, versus 90.9% (111 of 122) and 67% (52 of 78) in the symptomatic group (P = .59 and .12 for sensitivity and specificity, respectively). In addition, no difference was seen in performance characteristics of CT colonography for adenoma detection between the two patient groups. The sensitivity for adenoma detection with direct polyp comparison was 71.9% in the screening group and 80.0% in the symptomatic group (P = .14). Similarly, no difference was found with by-patient comparison, in which the sensitivity for adenoma detection was 90.0% in the screening group and 95.6% in the symptomatic group (P = .25).
The median interpretation time for each radiologist was calculated for the last 100 patients enrolled in the study. Interpretation times included only the time for actual reading of the CT colonographic study and did not include the time for data acquisition or for data transfer to the workstation. Interpretation times were evaluated for the last 100 patients to minimize any differences in the learning experience of the two readers and to reflect interpretation times of experienced readers. The median interpretation time for radiologist 1 was 31 minutes (range, 15–45 minutes) and for radiologist 2 was 27 minutes, with a similar range of 15–40 minutes.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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CT colonography is a radiologic modality that is being evaluated as a potential new screening tool for colorectal polyps and cancer. Fenlon et al (21) have reported the largest prospective study to date; they compare CT colonography and standard colonoscopy in 100 patients at high risk for colorectal neoplasia. In their study, the sensitivity of CT colonography for polyp detection by means of direct lesion matching was 71%: 91% for polyps 10 mm or larger, 82% for polyps 6–9 mm, and 55% for polyps smaller than 5 mm. Hara et al (22) prospectively examined 70 patients at high risk. Using the less rigorous patient comparison, they found sensitivity and specificity of 75% and 90%, respectively, for the detection of adenomas 10 mm or larger, 66% and 65% for adenomas 5–10 mm, and 45% and 80% for lesions smaller than 5 mm. One novel approach to evaluating CT colonography is to interpret only the transverse and 2D reformatted CT images, saving the three-dimensional endoluminal images for problem-solving situations. In a study by Dachman et al (23) of 44 patients, this method resulted in an overall sensitivity of 50% for the detection of polyps and a sensitivity of 83% for polyps larger than 8 mm.
Of note, all three of these studies were performed in an enriched study group consisting of symptomatic and high-risk patients. In contrast, investigators in a recent smaller study (24) of 46 asymptomatic patients reported a sensitivity of 25%–60% for the detection of adenomas greater than 10 mm. Authors of another study (25) in which 44 asymptomatic patients were examined found conflicting results, with a sensitivity of 100% for polyps 7 mm or larger.
The results from studies of symptomatic and high-risk patients cannot be extrapolated to a screening population. A diagnostic screening test should be tested in a screening population, in which the prevalence of disease generally is low. Conversely, a prognostic test, which predicts the outcome of disease, is best evaluated in a diseased population. To our knowledge, our study is the first large one in which CT colonography was evaluated as a screening test for colorectal neoplasia in asymptomatic average-risk patients and high-risk symptomatic patients, which allows us to determine the performance characteristics of this test. By using both direct by-polyp comparison and by-patient comparison, our results demonstrate comparable performance characteristics of CT colonography within the two patient groups. This finding is particularly important, since the role of CT colonography in the future may be primarily to screen patients who are at low risk for colorectal neoplasia.
As a potential screening tool, CT colonography offers a distinct advantage over fecal occult blood testing and sigmoidoscopy because it potentially allows depiction of the entire colon when there is adequate bowel distention and preparation. This is important because results of several studies (7,32,33) underscore the trend that older individuals have a substantial percentage of colonic cancers beyond the reach of the sigmoidoscope. CT colonography may also be superior to barium enema examination. In a small preliminary trial of 19 patients, CT colonography and barium enema examination, respectively, revealed 91% and 64% of polyps 10 mm or larger and 95% and 52% of polyps larger than 5 mm (34).
Our study results demonstrate that CT colonography is comparable with standard colonoscopy for the detection of clinically important polyps. Although there is no consensus as to what is a clinically important polyp, it is clear that polyp size is directly related to the probability of malignancy, and a greater percentage of adenomatous polyps 10 mm or larger are malignant (7). Our sensitivity was 94% for the detection of adenomas 10 mm or larger; that is, approximately 6% of clinically important polyps were missed at CT colonography. Similarly, Rex et al (11) reported a false-negative rate of 6% for polyps 10 mm or larger in a back-to-back colonoscopic study.
Although we have addressed some of the limitations of prior prospective studies of CT colonography, limitations in our study design must be considered. First, the two radiologists in this study each interpreted the CT colonographic examinations independently, followed by a consensus reading. However, interobserver variability of the CT readings was not evaluated as a part of this study.
Second, polyp sizes recorded by the gastroenterologists were estimated by using an open jumbo biopsy forceps, which may have resulted in substantial variations from the true polyp size. Use of a graded measuring tool would allow more accurate polyp size measurements. This is especially important for lesions close to 10 mm in size.
Third, the results of our study show excellent sensitivity for clinically important polyps (10 mm or larger); however, the specificity was not optimal. In the clinically important by-patient analysis, 33 patients with normal conventional colonoscopic results had polyps at CT colonography. We have contacted these patients and will perform follow-up colonoscopy to confirm or refute the CT colonographic findings. By using by-polyp analysis, there were 185 false-positive lesions. However, the majority (161 [87%] of 185) were smaller than 10 mm, and it is not clear whether these smaller false-positive lesions would necessarily trigger performance of colonoscopy in asymptomatic individuals. Seventy-seven percent (142 of 185) of false-positive polyps were reported in colonic segments with poor distention and/or poor preparation. Inadequate bowel cleansing appeared to be more strongly related to the likelihood of finding more false-positive polyps, as well as an to increase in the number of false-negative polyps, than was poor distention.
An important area of investigation is the optimization of a bowel cleansing regimen for CT colonography. Although polyethylene glycol is highly effective at cleansing the bowel, it often leaves retained fluid in the colon. Sodium phosphate is a saline cathartic that typically leaves the colon drier and may be a preferable bowel cleansing agent for CT colonography. Another area to be investigated includes fluid or stool-tagging agents. Residual material can then be digitally subtracted from the images (35).
Finally, a complete analysis of patient tolerance of CT colonography compared with patient tolerance of conventional colonoscopy needs to be performed. This analysis was being investigated at our institution (Veterans Affairs Medical Center, San Francisco, Calif) at the time of writing of this article.
Advantages of CT colonography compared with conventional colonoscopy include a shorter procedural time, less risk to the patient, and no need for intravenous sedation. Furthermore, CT colonography may be more accurate for precise localization of lesions. Disadvantages of CT colonography at this time include the need for bowel cleansing similar to that for standard colonoscopy. Poor colonic distention or preparation limits the accuracy of CT colonography. Small lesions are more difficult to detect with CT colonography. Currently, CT colonographic interpretation is time intensive for the radiologist, and multiple cases must be reviewed for optimization of reading skills.
Upcoming technical advances in CT colonography will undoubtedly shorten the radiologist’s interpretation time and will likely further improve the performance of CT colonography. Use of multi–detector row CT scanners will allow the use of thinner collimation in an even shorter period of time, which will likely result in improved image quality with reduced motion artifact. The optimization of image display, rendering technique, and automatic navigation will also play a role. The use of carbon dioxide insufflation may provide optimal colonic distention that is easily tolerated by patients. The intravenous use of contrast material for CT colonography may allow increased specificity with this technique. Computer-aided detection of lesions may also allow increased interpretation accuracy and efficiency.
The results of our study show that CT colonography has excellent sensitivity for clinically important polyps and adenomas 10 mm or larger and can reliably depict colorectal carcinomas. No statistically significant difference was found between asymptomatic and symptomatic patients in the sensitivity of CT colonography for neoplasia detection. Larger multicenter trials are warranted for further evaluation of CT colonography as a screening method for colorectal neoplasia.
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ACKNOWLEDGMENTS |
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FOOTNOTES |
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Author contributions: Guarantors of integrity of entire study, all authors; study concepts and design, J.Y., G.A.A.; literature research, J.Y., G.A.A., R.K.H., A.M.S.G.; clinical studies, G.A.A., K.R.M., J.Y., R.K.H.; data acquisition, J.Y., G.A.A., R.K.H., K.R.M.; data analysis, all authors; statistical analysis, J.Y., G.A.A., R.K.H., K.R.M.; manuscript preparation, J.Y., G.A.A.; definition of intellectual content, all authors; manuscript editing, review, and final version approval, all authors.
J.Y. and G.A.A. contributed equally to this work.
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REFERENCES |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
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S. Halligan, D. G. Altman, S. A. Taylor, S. Mallett, J. J. Deeks, C. I. Bartram, and W. Atkin CT Colonography in the Detection of Colorectal Polyps and Cancer: Systematic Review, Meta-Analysis, and Proposed Minimum Data Set for Study Level Reporting Radiology, December 1, 2005; 237(3): 893 - 904. [Abstract] [Full Text] [PDF]
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R. Iannaccone, C. Catalano, F. Mangiapane, T. Murakami, A. Lamazza, E. Fiori, A. Schillaci, D. Marin, I. Nofroni, M. Hori, et al. Colorectal Polyps: Detection with Low-Dose Multi-Detector Row Helical CT Colonography versus Two Sequential Colonoscopies Radiology, December 1, 2005; 237(3): 927 - 937. [Abstract] [Full Text] [PDF]
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T. G. Mang, C. Schaefer-Prokop, A. Maier, E. Schober, G. Lechner, and M. Prokop Detectability of Small and Flat Polyps in MDCT Colonography Using 2D and 3D Imaging Tools: Results from a Phantom Study Am. J. Roentgenol., December 1, 2005; 185(6): 1582 - 1589. [Abstract] [Full Text] [PDF]
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M. Macari and E. J. Bini CT Colonography: Where Have We Been and Where Are We Going? Radiology, December 1, 2005; 237(3): 819 - 833. [Abstract] [Full Text] [PDF]
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D. Hartmann, B. Bassler, D. Schilling, H. E. Adamek, R. Jakobs, B. Pfeifer, A. Eickhoff, C. Zindel, J. F. Riemann, and G. Layer Colorectal Polyps: Detection with Dark-Lumen MR Colonography versus Conventional Colonoscopy Radiology, December 1, 2005; 238(1): 143 - 149. [Abstract] [Full Text] [PDF]
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J. A. Soto, M. A. Barish, and J. Yee Reader Training in CT Colonography: How Much Is Enough? Radiology, October 1, 2005; 237(1): 26 - 27. [Full Text] [PDF]
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P. J. Pickhardt, A. D. Lee, E. G. McFarland, and A. J. Taylor Linear Polyp Measurement at CT Colonography: In Vitro and in Vivo Comparison of Two-dimensional and Three-dimensional Displays Radiology, September 1, 2005; 236(3): 872 - 878. [Abstract] [Full Text] [PDF]
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A. C. Silva, A. K. Hara, J. A. Leighton, and J. P. Heppell CT Colonography with Intravenous Contrast Material: Varied Appearances of Colorectal Carcinoma RadioGraphics, September 1, 2005; 25(5): 1321 - 1334. [Abstract] [Full Text] [PDF]
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C. L. Partain, H.-P. Chan, J. G. Gelovani, M. L. Giger, J. A. Izatt, F. A. Jolesz, K. Kandarpa, K. C. P. Li, M. McNitt-Gray, S. Napel, et al. Biomedical Imaging Research Opportunities Workshop II: Report and Recommendations Radiology, August 1, 2005; 236(2): 389 - 403. [Full Text] [PDF]
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J. Yee, N. N. Kumar, S. Godara, J. A. Casamina, R. Hom, G. Galdino, P. Dell, and D. Liu Extracolonic Abnormalities Discovered Incidentally at CT Colonography in a Male Population Radiology, August 1, 2005; 236(2): 519 - 526. [Abstract] [Full Text] [PDF]
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M. E. Zalis, M. A. Barish, J. R. Choi, A. H. Dachman, H. M. Fenlon, J. T. Ferrucci, S. N. Glick, A. Laghi, M. Macari, E. G. McFarland, et al. CT Colonography Reporting and Data System: A Consensus Proposal Radiology, July 1, 2005; 236(1): 3 - 9. [Full Text] [PDF]
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S. H. Park, H. K. Ha, M.-J. Kim, K. W. Kim, A. Y. Kim, D. H. Yang, M.-G. Lee, P. N. Kim, Y. M. Shin, S.-K. Yang, et al. False-Negative Results at Multi-Detector Row CT Colonography: Multivariate Analysis of Causes for Missed Lesions Radiology, May 1, 2005; 235(2): 495 - 502. [Abstract] [Full Text] [PDF]
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 B. P. Mulhall, G. R. Veerappan, and J. L. Jackson Meta-Analysis: Computed Tomographic Colonography Ann Intern Med, April 19, 2005; 142(8): 635 - 650. [Abstract] [Full Text] [PDF]
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J. T. Ferrucci Colonoscopy: Virtual and Optical--Another Look, Another View Radiology, April 1, 2005; 235(1): 13 - 16. [Full Text] [PDF]
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A. Ozgun, E. Rollven, L. Blomqvist, S. Bremmer, R. Odh, and A. Fransson Polyp Detection with MDCT: A Phantom-Based Evaluation of the Impact of Dose and Spatial Resolution Am. J. Roentgenol., April 1, 2005; 184(4): 1181 - 1188. [Abstract] [Full Text] [PDF]
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M. A. Barish, J. A. Soto, and J. T. Ferrucci Consensus on Current Clinical Practice of Virtual Colonoscopy Am. J. Roentgenol., March 1, 2005; 184(3): 786 - 792. [Abstract] [Full Text] [PDF]
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D. J. Chung, K. C. Huh, W. J. Choi, and J. K. Kim CT Colonography Using 16-MDCT in the Evaluation of Colorectal Cancer Am. J. Roentgenol., January 1, 2005; 184(1): 98 - 103. [Abstract] [Full Text] [PDF]
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 L Bogoni, P Cathier, M Dundar, A Jerebko, S Lakare, J Liang, S Periaswamy, M E Baker, and M Macari Computer-aided detection (CAD) for CT colonography: a tool to address a growing need Br. J. Radiol., January 1, 2005; 78(suppl_1): S57 - S62. [Abstract] [Full Text] [PDF]
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R. E. van Gelder, E. Birnie, J. Florie, M. P. Schutter, J. F. Bartelsman, P. Snel, J. S. Lameris, G. J. Bonsel, and J. Stoker CT Colonography and Colonoscopy: Assessment of Patient Preference in a 5-week Follow-up Study Radiology, November 1, 2004; 233(2): 328 - 337. [Abstract] [Full Text] [PDF]
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J. Yee, S. D. Wall, and P. J. Pickhardt Invited Commentary * Author's Response RadioGraphics, November 1, 2004; 24(6): 1557 - 1559. [Full Text] [PDF]
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P. J. Pickhardt, J. R. Choi, I. Hwang, and W. R. Schindler Nonadenomatous Polyps at CT Colonography: Prevalence, Size Distribution, and Detection Rates Radiology, September 1, 2004; 232(3): 784 - 790. [Abstract] [Full Text] [PDF]
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R. E. van Gelder, H. W. Venema, J. Florie, C. Y. Nio, I. W. O. Serlie, M. P. Schutter, J. C. van Rijn, F. M. Vos, A. S. Glas, P. M. M. Bossuyt, et al. CT Colonography: Feasibility of Substantial Dose Reduction--Comparison of Medium to Very Low Doses in Identical Patients Radiology, August 1, 2004; 232(2): 611 - 620. [Abstract] [Full Text] [PDF]
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M. Macari, E. J. Bini, S. L. Jacobs, Y. W. Lui, S. Laks, A. Milano, and J. Babb Significance of Missed Polyps at CT Colonography Am. J. Roentgenol., July 1, 2004; 183(1): 127 - 134. [Abstract] [Full Text] [PDF]
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H. Hoppe, C. Quattropani, A. Spreng, J. Mattich, P. Netzer, and H.-P. Dinkel Virtual Colon Dissection with CT Colonography Compared with Axial Interpretation and Conventional Colonoscopy: Preliminary Results Am. J. Roentgenol., May 1, 2004; 182(5): 1151 - 1158. [Abstract] [Full Text] [PDF]
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 P. B. Cotton, V. L. Durkalski, B. C. Pineau, Y. Y. Palesch, P. D. Mauldin, B. Hoffman, D. J. Vining, W. C. Small, J. Affronti, D. Rex, et al. Computed Tomographic Colonography (Virtual Colonoscopy): A Multicenter Comparison With Standard Colonoscopy for Detection of Colorectal Neoplasia JAMA, April 14, 2004; 291(14): 1713 - 1719. [Abstract] [Full Text] [PDF]
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T. M. Gluecker, J. G. Fletcher, T. J. Welch, R. L. MacCarty, W. S. Harmsen, J. R. Harrington, D. Ilstrup, L. A. Wilson, K. E. Corcoran, and C. D. Johnson Characterization of Lesions Missed on Interpretation of CT Colonography Using a 2D Search Method Am. J. Roentgenol., April 1, 2004; 182(4): 881 - 889. [Abstract] [Full Text] [PDF]
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A. Filippone, R. Ambrosini, M. Fuschi, T. Marinelli, D. Genovesi, and L. Bonomo Preoperative T and N Staging of Colorectal Cancer: Accuracy of Contrast-enhanced Multi-Detector Row CT Colonography--Initial Experience Radiology, April 1, 2004; 231(1): 83 - 90. [Abstract] [Full Text] [PDF]
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M. Macari, E. J. Bini, S. L. Jacobs, S. Naik, Y. W. Lui, A. Milano, R. Rajapaksa, A. J. Megibow, and J. Babb Colorectal Polyps and Cancers in Asymptomatic Average-Risk Patients: Evaluation with CT Colonography Radiology, March 1, 2004; 230(3): 629 - 636. [Abstract] [Full Text] [PDF]
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J. T. Edwards, R. M. Mendelson, L. Fritschi, N. M. Foster, C. Wood, D. Murray, and G. M. Forbes Colorectal Neoplasia Screening with CT Colonography in Average-Risk Asymptomatic Subjects: Community-based Study Radiology, February 1, 2004; 230(2): 459 - 464. [Abstract] [Full Text] [PDF]
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 P. J. Pickhardt, J. R. Choi, I. Hwang, J. A. Butler, M. L. Puckett, H. A. Hildebrandt, R. K. Wong, P. A. Nugent, P. A. Mysliwiec, and W. R. Schindler Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults N. Engl. J. Med., December 4, 2003; 349(23): 2191 - 2200. [Abstract] [Full Text] [PDF]
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M. M. Morrin and J. T. LaMont Screening Virtual Colonoscopy -- Ready for Prime Time? N. Engl. J. Med., December 4, 2003; 349(23): 2261 - 2264. [Full Text] [PDF]
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H Herfarth and A G Schreyer The virtuosity of virtuality or how real is virtual colonography Gut, December 1, 2003; 52(12): 1662 - 1664. [Full Text] [PDF]
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B Ginnerup Pedersen, M Rosenkilde, T E M Christiansen, and S Laurberg Extracolonic findings at computed tomography colonography are a challenge Gut, December 1, 2003; 52(12): 1744 - 1747. [Abstract] [Full Text] [PDF]
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R. Iannaccone, A. Laghi, C. Catalano, J. A. Brink, F. Mangiapane, S. Trenna, F. Piacentini, and R. Passariello Detection of Colorectal Lesions: Lower-Dose Multi-Detector Row Helical CT Colonography Compared with Conventional Colonoscopy Radiology, December 1, 2003; 229(3): 775 - 781. [Abstract] [Full Text] [PDF]
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J. Sosna, M. M. Morrin, J. B. Kruskal, P. T. Lavin, M. P. Rosen, and V. Raptopoulos CT Colonography of Colorectal Polyps: A Metaanalysis Am. J. Roentgenol., December 1, 2003; 181(6): 1593 - 1598. [Abstract] [Full Text] [PDF]
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P. J. Pickhardt Three-Dimensional Endoluminal CT Colonography (Virtual Colonoscopy): Comparison of Three Commercially Available Systems Am. J. Roentgenol., December 1, 2003; 181(6): 1599 - 1606. [Abstract] [Full Text] [PDF]
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Y. W. Lui, M. Macari, G. Israel, E. J. Bini, H. Wang, and J. Babb CT Colonography Data Interpretation: Effect of Different Section Thicknesses--Preliminary Observations Radiology, December 1, 2003; 229(3): 791 - 797. [Abstract] [Full Text] [PDF]
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S. A. Taylor, S. Halligan, B. P. Saunders, P. Bassett, M. Vance, and C. I. Bartram Acceptance by Patients of Multidetector CT Colonography Compared with Barium Enema Examinations, Flexible Sigmoidoscopy, and Colonoscopy Am. J. Roentgenol., October 1, 2003; 181(4): 913 - 921. [Abstract] [Full Text] [PDF]
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S. A. Taylor, S. Halligan, C. I. Bartram, P. R. Morgan, I. C. Talbot, N. Fry, B. P. Saunders, K. Khosraviani, and W. Atkin Multi-Detector Row CT Colonography: Effect of Collimation, Pitch, and Orientation on Polyp Detection in a Human Colectomy Specimen Radiology, October 1, 2003; 229(1): 109 - 118. [Abstract] [Full Text] [PDF]
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P. J. Pickhardt, J. Yee, S. D. Wall, and K. R. McQuaid By-Patient Performance Characteristics of CT Colonography: Importance of Polyp Size Threshold Data [letter] * Dr Yee and colleagues respond: * The statistical consultant responds: Radiology, October 1, 2003; 229(1): 291 - 293. [Full Text] [PDF]
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J. T. Ferrucci Virtual Colonoscopy for Colon Cancer Screening: Further Reflections on Polyps and Politics Am. J. Roentgenol., September 1, 2003; 181(3): 795 - 797. [Full Text] [PDF]
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P. J. Pickhardt and J.-H. R. Choi Electronic Cleansing and Stool Tagging in CT Colonography: Advantages and Pitfalls with Primary Three-Dimensional Evaluation Am. J. Roentgenol., September 1, 2003; 181(3): 799 - 805. [Full Text] [PDF]
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J. Wessling, R. Fischbach, N. Meier, T. Allkemper, J. Klusmeier, K. Ludwig, and W. Heindel CT Colonography: Protocol Optimization with Multi-Detector Row CT--Study in an Anthropomorphic Colon Phantom Radiology, September 1, 2003; 228(3): 753 - 759. [Abstract] [Full Text] [PDF]
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F. M. Vos, R. E. van Gelder, I. W. O. Serlie, J. Florie, C. Y. Nio, A. S. Glas, F. H. Post, R. Truyen, F. A. Gerritsen, and J. Stoker Three-dimensional Display Modes for CT Colonography: Conventional 3D Virtual Colonoscopy versus Unfolded Cube Projection Radiology, September 1, 2003; 228(3): 878 - 885. [Abstract] [Full Text] [PDF]
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M. Macari, E. J. Bini, S. L. Jacobs, N. Lange, and Y. W. Lui Filling Defects at CT Colonography: Pseudo- and Diminutive Lesions (The Good), Polyps (The Bad), Flat Lesions, Masses, and Carcinomas (The Ugly) RadioGraphics, September 1, 2003; 23(5): 1073 - 1091. [Abstract] [Full Text] [PDF]
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J. Sosna, M. M. Morrin, J. B. Kruskal, R. J. Farrell, I. Nasser, and V. Raptopoulos Colorectal Neoplasms: Role of Intravenous Contrast-enhanced CT Colonography Radiology, July 1, 2003; 228(1): 152 - 156. [Abstract] [Full Text] [PDF]
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T. M. Gluecker, C. D. Johnson, W. S. Harmsen, K. P. Offord, A. M. Harris, L. A. Wilson, and D. A. Ahlquist Colorectal Cancer Screening with CT Colonography, Colonoscopy, and Double-Contrast Barium Enema Examination: Prospective Assessment of Patient Perceptions and Preferences Radiology, May 1, 2003; 227(2): 378 - 384. [Abstract] [Full Text] [PDF]
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J. M. E. Walsh and J. P. Terdiman Colorectal Cancer Screening: Scientific Review JAMA, March 12, 2003; 289(10): 1288 - 1296. [Abstract] [Full Text] [PDF]
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J. Yee, N. N. Kumar, R. K. Hung, G. A. Akerkar, P. R. G. Kumar, and S. D. Wall Comparison of Supine and Prone Scanning Separately and in Combination at CT Colonography Radiology, March 1, 2003; 226(3): 653 - 661. [Abstract] [Full Text] [PDF]
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M. E. Zalis, J. Perumpillichira, C. D. Frate, and P. F. Hahn CT Colonography: Digital Subtraction Bowel Cleansing with Mucosal Reconstruction— Initial Observations Radiology, March 1, 2003; 226(3): 911 - 917. [Abstract] [Full Text] [PDF]
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P. M. Bossuyt, J. B. Reitsma, D. E. Bruns, C. A. Gatsonis, P. P. Glasziou, L. M. Irwig, D. Moher, D. Rennie, H. C.W. de Vet, and J. G. Lijmer The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration Ann Intern Med, January 7, 2003; 138(1): W1 - W12. [Abstract] [Full Text] [PDF]
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 P. M. Bossuyt, J. B. Reitsma, D. E. Bruns, C. A. Gatsonis, P. P. Glasziou, L. M. Irwig, D. Moher, D. Rennie, H. C.W. de Vet, and J. G. Lijmer The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration Clin. Chem., January 1, 2003; 49(1): 7 - 18. [Abstract] [Full Text] [PDF]
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B. Levin, D. Brooks, R. A. Smith, and A. Stone Emerging Technologies in Screening for Colorectal Cancer: CT Colonography, Immunochemical Fecal Occult Blood Tests, and Stool Screening Using Molecular Markers CA Cancer J Clin, January 1, 2003; 53(1): 44 - 55. [Abstract] [Full Text] [PDF]
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R. M. Summers, A. K. Jerebko, M. Franaszek, J. D. Malley, and C. D. Johnson Colonic Polyps: Complementary Role of Computer-aided Detection in CT Colonography Radiology, November 1, 2002; 225(2): 391 - 399. [Abstract] [Full Text] [PDF]
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E. G. McFarland, T. K. Pilgram, J. A. Brink, R. A. McDermott, C. V. Santillan, P. W. Brady, J. P. Heiken, D. M. Balfe, L. B. Weinstock, E. P. Thyssen, et al. CT Colonography: Multiobserver Diagnostic Performance Radiology, November 1, 2002; 225(2): 380 - 390. [Abstract] [Full Text] [PDF]
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M. J. Siegel 2001 Plenary Session: Friday Imaging Symposium: CT Screening for Cancer RadioGraphics, November 1, 2002; 22(6): 1521 - 1523. [Full Text] [PDF]
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J. Yee CT Screening for Colorectal Cancer RadioGraphics, November 1, 2002; 22(6): 1525 - 1531. [Full Text] [PDF]
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