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Diagnostic accuracy of ultra-low-dose CT colonography for the detection of colorectal polyps: a feasibility study

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Abstract

Purpose

The aim of this feasibility study was to evaluate the diagnostic accuracy of ultra-low-dose CT colonography using iterative reconstruction algorithms with reference to standard colonoscopy.

Materials and methods

Prior to this study, a phantom study was performed to investigate the optimal protocol for ultra-low-dose CT colonography. A total of 206 patients with average/high risk of colorectal cancer were recruited. After undergoing full bowel preparation, the patients were scanned in the prone and supine positions with the CT conditions set to 120 kV, standard deviation 45 to 50, and an adaptive iterative reconstruction algorithm applied. Two expert readers read the images independently. The main outcome measures were the per-patient and per-polyp accuracies for the detection of polyps ≥ 10 mm, with colonoscopy results as the reference standard.

Results

Two hundred patients (102 females, mean age 67.5 years) underwent both ultra-low-dose CT colonography and colonoscopy on the same day. The mean radiation exposure dose was 0.64 ± 0.34 mSv. On colonoscopy, 39 patients had 45 polyps ≥ 10 mm (non-polypoid morphology 7), including 4 cancers. Per-patient sensitivity, specificity, and accuracy of CT colonography for polyps ≥ 10 mm were 0.74, 0.96, and 0.92 for reader one, and 0.74, 0.99, and 0.94 for reader two, respectively. Per-polyp sensitivities for polyps ≥ 10 mm were 0.73 for reader one and 0.71 for reader two. On subgroup analysis by morphology, non-polypoid polyps ≥ 10 mm were not detected by both readers.

Conclusion

Extreme ultra-low-dose CT colonography had an insufficient diagnostic performance for the detection of polyps ≥ 10 mm, because it was unable to detect non-polypoid polyps. This study showed that the problem with ultra-low-dose CT colonography was the lack of detectability of small-size polyps, especially non-polypoid polyps. To use ultra-low-dose CT colonography clinically, it is necessary to resolve the problems identified by this study.

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Acknowledgements

The authors would like to thank Rika Ishizuka of Aizu Medical Center for providing administrative support.

Funding

None.

Author information

Authors and Affiliations

  1. Radiology Section, Nagasaki Kamigoto Hospital, Minamimatsuura, Shinkamigoto, Nagasaki, Japan

    Takaaki Yasuda

  2. Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki, Japan

    Tetsuro Honda

  3. Division of Radiology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu-city, Fukushima, 969-3492, Japan

    Kenichi Utano

  4. Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan

    Takashi Kato

  5. Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan

    Kazutomo Togashi

  6. Department of Gastroenterology, Nagasaki Kamigoto Hospital, Minamimatsuura, Shinkamigoto, Nagasaki, Japan

    Shota Yamaguchi

  7. Department of Surgery, Nagasaki Kamigoto Hospital, Minamimatsuura, Shinkamigoto, Nagasaki, Japan

    Takahiro Yasaka

Authors
  1. Takaaki Yasuda
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  2. Tetsuro Honda
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  3. Kenichi Utano
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  5. Kazutomo Togashi
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  6. Shota Yamaguchi
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  7. Takahiro Yasaka
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Corresponding author

Correspondence to Kenichi Utano.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institution and with the Helsinki declaration. The study protocol was approved by the Institutional Review Board.

Informed consent

Written informed consent was obtained from all patients.

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Supplementary Information

Below is the link to the electronic supplementary material.

11604_2022_1266_MOESM1_ESM.tif

Supplementary file1 0-Is+IIa polyp, 14 mm in size, cecum, tubular adenoma. CT image at SD = 20. Flat component is recognizable around the ridge (arrow head). (TIF 4097 KB)

11604_2022_1266_MOESM2_ESM.tif

Supplementary file2 0-Is+IIa polyp, 14 mm in size, cecum, tubular adenoma. Almost no artifacts are seen, and the sessile part of the polyp is recognizable (arrow head). However, the surrounding flat component that could be seen at SD = 20 is difficult to recognize. It has been suggested that it is more difficult to depict non-polypoid components with ultra-low-dose CT colonography than with normal-dose CT colonography. (TIF 4096 KB)

11604_2022_1266_MOESM3_ESM.tif

Supplementary file3 0-Is+IIa polyp, 14 mm in size, cecum, tubular adenoma. Endoscopic image. Flat component is seen around the ridge (arrow head). (TIF 3757 KB)

Supplementary file4 (DOCX 16 KB)

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Yasuda, T., Honda, T., Utano, K. et al. Diagnostic accuracy of ultra-low-dose CT colonography for the detection of colorectal polyps: a feasibility study. Jpn J Radiol 40, 831–839 (2022). https://doi.org/10.1007/s11604-022-01266-1

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  • DOI: https://doi.org/10.1007/s11604-022-01266-1

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