Oncologie

, Volume 9, Issue 3, pp 204–208

Place du coloscanner et de la coloscopie chez le sujet âgé

Article
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Résumé

Durant ces dernières années, le coloscanner a bénéficié d’avancées remarquables grâce, notamment au développement des scanners volumiques et aux logiciels de post-traitement. Il s’est imposé comme une alternative non invasive et fiable pour l’exploration morphologique complète du côlon. Lorsque l’on s’adresse au sujet très âgé, la question n’est plus de dépister d’éventuels polypes qui pourraient dans un avenir lointain dégénérer en cancer, mais plutôt de diagnostiquer le cancer déjà installé, en particulier devant des signes cliniques (troubles du transit ou rectorragies). Dans ce cas, un coloscanner à l’eau qui consiste à distendre la lumière colique non plus par de l’air ou du CO2, mais par un lavement à l’eau tiède peut être réalisé avec ou sans préparation colique préalable. Cette technique a démontré un large potentiel pour la détection des lésions cancéreuses supracentimétriques (sensibilité rapportée de l’ordre de 95 %) [23], de même elle permet, dans le même temps, un bilan d’extension. Dans cet article, seront abordés successivement les aspects techniques, les résultats, les pièges, les limitations et le potentiel de chacune de ces nouvelles techniques d’exploration tomodensitométrique du côlon. Elles représentent d’ores et déjà un progrès majeur pour le dépistage et le diagnostic des cancers du côlon, en particulier chez le sujet âgé.

Mots clés

Coloscopie virtuelle Coloscanner Cancer du côlon Polypes Préparation colique Marquage des selles à la barite Outil d’aide au diagnostique 

CT colonography in elderly patients

Abstract

CT colonography, also called virtual colonoscopy, is a new imaging technique used to examine the entire colon. The results produced by such a technique depend on the quality of the bowel preparation, the inflation procedure and the types of post-processing techniques available. In frail elderly patients, localizing polyps may no longer be the issue, but rather the diagnosis of an already established cancer in order to define the best therapeutic approach. In such cases, water enema multi-row computed tomography, with or without bowel preparation, could be performed. This technique has demonstrated potential for the preoperative localization of colorectal cancer (with a reported 95% sensitivity for colorectal tumours superior to 1 cm and effectiveness in the detection of metastases). We will present the technical characteristics, clinical results, pitfalls, limitations and potential uses of these new CT techniques, which may represent major progress in the screening and diagnosis of colon cancer in elderly patients.

Keywords

Virtual colonoscopy Colonography Colon cancer Polyps Bowel preparation Fecal tagging Laxative-free bowel preparation CAD 

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Copyright information

© Springer Verlag France 2007

Authors and Affiliations

  1. 1.Service de Radiologie (Professeur-Grenier)hôpital de la Pitié-SalpêtrièreParisFrance

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