European Radiology

, Volume 15, Issue 10, pp 2088–2095 | Cite as

Importance of extracolonic findings at IV contrast medium-enhanced CT colonography versus those at non-enhanced CT colonography

  • Adrian Spreng
  • Peter Netzer
  • Joerg Mattich
  • Hans-Peter Dinkel
  • Peter Vock
  • Hanno Hoppe
Gastrointestinal

Abstract

To compare the clinical importance of extracolonic findings at intravenous (IV) contrast-enhanced CT colonography versus those at non-enhanced CT colonography. IV contrast medium-enhanced (n=72) and non-enhanced (n=30) multidetector CT colonography was performed in 102 symptomatic patients followed by conventional colonoscopy on the same day. The impact of extracolonic findings on further work up and treatment was assessed by a review of patient records. Extracolonic findings were divided into two groups: either leading to further work up respectively having an impact on therapy or not. A total of 303 extracolonic findings were detected. Of those, 71% (215/303) were found on IV contrast-enhanced CT, and 29% (88/303) were found on non-enhanced CT colonography. The extracolonic findings in 25% (26/102) of all patients led to further work up or had an impact on therapy. Twenty-two of these patients underwent CT colonography with IV contrast enhancement, and four without. The percentage of extracolonic findings leading to further work up or having an impact on therapy was higher for IV contrast-enhanced (31%; 22/72) than for non-enhanced (13%; 4/30) CT scans (P=0.12). IV contrast-enhanced CT colonography produced more extracolonic findings than non-enhanced CT colonography. A substantially greater proportion of findings on IV contrast-enhanced CT colonography led to further work up and treatment than did non-enhanced CT colonography.

Keywords

Extracolonic findings Virtual colonoscopy CT colonography Abdominal CT 

References

  1. 1.
    Vining DJ, Gelfand DW, Bechthold RE, Scharling ES, Grishaw EK, Shifrin RY (1994) Technical feasibility of colon imaging with helical CT and virtual reality. Am J Roentgenol 162:104Google Scholar
  2. 2.
    Yee J, Akerkar GA, Hung RK, Steinauer-Gebauer AM, Wall SD, McQuaid KR (2001) Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. Radiology 219:685–692PubMedGoogle Scholar
  3. 3.
    Pickhardt PJ, Choi R, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200CrossRefPubMedGoogle Scholar
  4. 4.
    Bruzzi JF, Moss AC, Brennan DD, MacMathuna P, Fenlon HM (2003) Efficacy of IV Buscopan as a muscle relaxant in CT colonography. Eur Radiol 13:2264–2270CrossRefPubMedGoogle Scholar
  5. 5.
    Taylor SA, Halligan S, Burling D, Morley S, Bassett P, Atkin W, Bartram CI (2004) CT colonography: effect of experience and training on reader performance. Eur Radiol 14:1025–1033CrossRefPubMedGoogle Scholar
  6. 6.
    Hoppe H, Netzer P, Spreng A, Quattropani C, Mattich J, Dinkel H-P (2004) Prospective evaluation of contrast enhanced CT colonography and conventional colonoscopy for detection of colorectal neoplasms in a single instiutional study using second-look colonoscopy with discrepant results. Am J Gastroenterol 99:1924–1935CrossRefPubMedGoogle Scholar
  7. 7.
    Ginnerup Pedersen B, Rosenkilde M, Christiansen TEM, Laurberg S (2003) Extracolonic findings at computed tomography colonography are a challenge. Gut 52:1744–1747CrossRefPubMedGoogle Scholar
  8. 8.
    Ng CS, Doyle TC, Courtney HM, Campbell GA, Freeman AH, Dixon AK (2004) Extracolonic findings in patients undergoing abdomino–pelvic CT for suspected colorectal carcinoma in the frail and disabled patient. Clin Radiol 59:421–430CrossRefPubMedGoogle Scholar
  9. 9.
    Hellstrom M, Svensson E, Lasson A (2004) Extracolonic and incidental findings on CT colonography (virtual colonoscopy). Am J Roentgenol 182:631–638Google Scholar
  10. 10.
    Edwards JT, Wood CJ, Mendelson RM, Forbes GM (2004) Extracolonic findings at virtual colonoscopy: implications for screening programs. Am J Gastroenterol 96:3009–3012CrossRefGoogle Scholar
  11. 11.
    Hara AK, Daniel Johnson C, MacCarty RL, Welch TJ (2000) Incidental extracolonic findings at CT colonography. Radiology 215:353–357PubMedGoogle Scholar
  12. 12.
    Gluecker TM, Johnson CD, Wilson LA, MacCarty RL, Welch TJ, Vanness DJ, Ahlquist DA (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124:911–916PubMedGoogle Scholar
  13. 13.
    Panicek DM, Giess CS, Schwartz LH (1997) Qualitative assessment of liver for fatty infiltration on contrast-enhanced CT: is muscle a better standard of reference than spleen? J Comput Assist Tomogr 21:699–705CrossRefPubMedGoogle Scholar
  14. 14.
    Morrin MM, Farrell RJ, Kruskal JB, Reynolds K, McGee JB, Raptopoulos V (2000) Utility of intravenously administered contrast material at CT colonography. Radiology 217:765–771PubMedGoogle Scholar
  15. 15.
    van Gelder RE, Venema HW, Serlie IW, Nio CY, Determann RM, Tipker CA, Vos FM, Glas AS, Bartelsman JF, Bossuyt PM, Lameris JS, Stoker J (2002) CT colonography at different radiation dose levels: feasibility of dose reduction. Radiology 224:25–33PubMedGoogle Scholar
  16. 16.
    Luboldt W, Mann C, Tryon CL, Vonthein R, Stueker D, Kroll M, Luz O, Claussen CD, Vogl TJ (2002) Computer-aided diagnosis in contrast-enhanced CT colonography: an approach based on contrast. Eur Radiol 12:2236–2241PubMedGoogle Scholar
  17. 17.
    Hoppe H, Quattropani C, Spreng A, Mattich J, Netzer P, Dinkel H-P (2004) Virtual Colon Dissection with CT colonography compared to axial reading and conventional colonoscopy: preliminary results. Am J Roentgenol 182:1151–1158Google Scholar
  18. 18.
    Luboldt W, Kroll M, Wetter A, Toussaint TL, Hoepffner N, Holzer K, Kluge A, Vogl TJ (2004) Phase- and size-adjusted CT cut-off for differentiating neoplastic lesions from normal colon in contrast-enhanced CT colonography. Eur Radiol 14:2228–2235CrossRefPubMedGoogle Scholar
  19. 19.
    Luboldt W, Tryon C, Kroll M, Toussaint TL, Holzer K, Hoepffner N, Vogl TJ (2005) Automated mass detection in contrast-enhanced CT colonography: an approach based on contrast and volume. Eur Radiol 15:247–253CrossRefPubMedGoogle Scholar
  20. 20.
    Ferrucci JT (2001) Colon cancer screening with virtual colonoscopy-promise, polyps, politics. Am J Roentgenol 177:975–988Google Scholar
  21. 21.
    Fletcher JG, Johnson CD, Welch TJ, MacCarty RL, Ahlquist DA, Reed JE, Harmsen WS, Wilson LA (2000) Optimization of CT colonography technique: prospective trial in 180 patients. Radiology 216:704–711PubMedGoogle Scholar
  22. 22.
    Hara AK, Johnson CD, Reed JE, Ahlquist DA, Nelson H, Ehman RL, Harmsen WS (1997) Reducing data size and radiation dose for CT colonography. Am J Roentgenol 168:1181–1184Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Adrian Spreng
    • 1
  • Peter Netzer
    • 2
  • Joerg Mattich
    • 1
  • Hans-Peter Dinkel
    • 1
  • Peter Vock
    • 1
  • Hanno Hoppe
    • 1
  1. 1.Institute of Diagnostic Radiology, InselspitalUniversity of BernBernSwitzerland
  2. 2.Department of Gastroenterology, InselspitalUniversity of BernBernSwitzerland

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