Article

Abdominal Imaging

, Volume 35, Issue 6, pp 661-668

Open Access This content is freely available online to anyone, anywhere at any time.

CT colonography with limited bowel preparation for the detection of colorectal neoplasia in an FOBT positive screening population

  • Marjolein H. LiedenbaumAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam Email author 
  • , Ayso H. de VriesAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam
  • , Anne F. van RijnAffiliated withDepartment of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam
  • , Helena M. DekkerAffiliated withDepartment of Radiology, Radboud University Nijmegen Medical Center
  • , François E. J. A. WillemssenAffiliated withDepartment of Radiology, Erasmus MC University Medical Center
  • , Monique E. van LeerdamAffiliated withDepartment of Gastroenterology and Hepatology, Erasmus MC University Medical Center
  • , Corine J. van MarrewijkAffiliated withDepartment of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre
  • , Paul FockensAffiliated withDepartment of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam
  • , Shandra BipatAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam
    • , Patrick M. M. BossuytAffiliated withDepartment of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center
    • , Evelien DekkerAffiliated withDepartment of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam
    • , Jaap StokerAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam

Abstract

Purpose

Aim was to evaluate the accuracy of computed tomography colonography (CTC) for detection of colorectal neoplasia in a Fecal Occult Blood Test (FOBT) positive screening population.

Methods

In three different institutions, consecutive FOBT positives underwent CTC after laxative free iodine tagging bowel preparation followed by colonoscopy with segmental unblinding. Each CTC was read by two experienced observers. For CTC and for colonoscopy the per-polyp sensitivity and per-patient sensitivity and specificity were calculated for detection of carcinomas, advanced adenomas, and adenomas.

Results

In total 22 of 302 included FOBT positive participants had a carcinoma (7%) and 137 had an adenoma or carcinoma ≥10 mm (45%). CTC sensitivity for carcinoma was 95% with one rectal carcinoma as false negative finding. CTC sensitivity for advanced adenomas was 92% (95% CI: 88–96) vs. 96% (95% CI: 93–99) for colonoscopy (P = 0.26). For adenomas and carcinomas ≥10 mm the CTC per-polyp sensitivity was 93% (95% CI: 89–97) vs. 97% (95% CI: 94–99) for colonoscopy (P = 0.17). The per-patient sensitivity for the detection of adenomas and carcinomas ≥10 mm was 95% (95% CI: 91–99) for CTC vs. 99% (95% CI: 98–100) for colonoscopy (P = 0.07), while the per-patient specificity was 90% (95% CI: 86–95) and 96% (95% CI: 94–99), respectively (P < 0.001).

Conclusion

CTC with limited bowel preparation performed in an FOBT positive screening population has high diagnostic accuracy for the detection of adenomas and carcinomas and a sensitivity similar to that of colonoscopy for relevant lesions.

Keywords

CT colonography Colorectal neoplasia Advanced adenoma Colorectal cancer FOBT