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Abdominal Radiology

, Volume 43, Issue 3, pp 523–538 | Cite as

CTC technique: methods to ensure an optimal exam

Article

Abstract

CT colonography (CTC) has demonstrated equivalent accuracy to optical colonoscopy in the detection of clinically relevant polyps and tumors but this is only possible when technique is optimized. The two most important features of a high-quality CTC are a well-prepared colon and a distended colon. This article will discuss the dietary, bowel preparation, and fecal/fluid tagging options to best prepare the colon. Strategies to optimally distend the colon will also be discussed. CT scan techniques including patient positioning and radiation dose optimization will be reviewed. With proper technique which includes sufficient bowel preparation, fecal/fluid tagging, bowel distension, and optimized scan technique, high-quality CTC examinations should become more feasible, easier to interpret, and more consistently reproducible leading to increased utilization and increased referrals.

Keywords

CT colonography Bowel preparation Colonic distension CT technique 

Notes

Compliance with ethical standards

Funding

No relevant funding information.

Conflict of interest

KJC has no conflict of interest. DHK is co-founder of VirtuoCTC, Consultant for Viatronix, Medical Advisory Board Digitalartforms, Shareholder Cellectar, and Shareholder Elucent.

Ethical approval

This article does not contain any studies with live human participants or animals performed by any of the authors.

References

  1. 1.
    Vining DJGD, Bechtold RE, Scharling ES, Grishaw EK, Shifrin RY (1994) Technical feasibility of colon imaging with helical CT and virtual reality. Am J Roentgenol 162:S104Google Scholar
  2. 2.
    Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, Dash C, Giardiello FM, Glick S, Levin TR, Pickhardt P, Rex DK, Thorson A, Winawer SJ, American Cancer Society Colorectal Cancer Advisory G, Force USM-ST, American College of Radiology Colon Cancer C (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58(3):130–160.  https://doi.org/10.3322/CA.2007.0018 CrossRefGoogle Scholar
  3. 3.
    Force USPST, Bibbins-Domingo K, Grossman DC, et al. (2016) Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA 315(23):2564–2575.  https://doi.org/10.1001/jama.2016.5989 CrossRefGoogle Scholar
  4. 4.
    Reilly T, Walker G (2004) Reasons for poor colonic preparation with inpatients. Gastroenterol Nurs 27(3):115–117CrossRefPubMedGoogle Scholar
  5. 5.
    Miller RE (1976) The clean colon. Gastroenterology 70(2):289–290PubMedGoogle Scholar
  6. 6.
    Gelfand DW, Chen MY, Ott DJ (1991) Preparing the colon for the barium enema examination. Radiology 178(3):609–613.  https://doi.org/10.1148/radiology.178.3.1847238 CrossRefPubMedGoogle Scholar
  7. 7.
    Bartram CI (1994) Bowel preparation–principles and practice. Clin Radiol 49(6):365–367CrossRefPubMedGoogle Scholar
  8. 8.
    Liedenbaum MH, Denters MJ, de Vries AH, et al. (2010) Low-fiber diet in limited bowel preparation for CT colonography: influence on image quality and patient acceptance. AJR Am J Roentgenol 195(1):W31–37.  https://doi.org/10.2214/AJR.09.3572 CrossRefPubMedGoogle Scholar
  9. 9.
    Holte K, Nielsen KG, Madsen JL, Kehlet H (2004) Physiologic effects of bowel preparation. Dis Colon Rectum 47(8):1397–1402CrossRefPubMedGoogle Scholar
  10. 10.
    Beebe TJ, Johnson CD, Stoner SM, Anderson KJ, Limburg PJ (2007) Assessing attitudes toward laxative preparation in colorectal cancer screening and effects on future testing: potential receptivity to computed tomographic colonography. Mayo Clin Proc 82(6):666–671.  https://doi.org/10.4065/82.6.666 CrossRefPubMedGoogle Scholar
  11. 11.
    Parente F, Vailati C, Bargiggia S, et al. (2015) 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl versus 4-litre polyethylene glycol as preparation for colonoscopy in chronic constipation. Dig Liver Dis 47(10):857–863.  https://doi.org/10.1016/j.dld.2015.06.008 CrossRefPubMedGoogle Scholar
  12. 12.
    Tellez-Avila FI, Murcio-Perez E, Saul A, et al. (2014) Efficacy and tolerability of low-volume (2 L) versus single- (4 L) versus split-dose (2 L + 2 L) polyethylene glycol bowel preparation for colonoscopy: randomized clinical trial. Dig Endosc 26(6):731–736.  https://doi.org/10.1111/den.12265 CrossRefPubMedGoogle Scholar
  13. 13.
    Macari M, Lavelle M, Pedrosa I, et al. (2001) Effect of different bowel preparations on residual fluid at CT colonography. Radiology 218(1):274–277.  https://doi.org/10.1148/radiology.218.1.r01ja31274 CrossRefPubMedGoogle Scholar
  14. 14.
    Administration USFaD (1/8/2014) FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation. FDA Drug Safety CommunicationGoogle Scholar
  15. 15.
    Heher EC, Thier SO, Rennke H, Humphreys BD (2008) Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation. Clin J Am Soc Nephrol 3(5):1494–1503.  https://doi.org/10.2215/CJN.02040408 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hong GS, Park SH, Kim B, et al. (2015) Simethicone to prevent colonic bubbles during CT colonography performed with polyethylene glycol lavage and iohexol tagging: a randomized clinical trial. AJR Am J Roentgenol 204(4):W429–438.  https://doi.org/10.2214/AJR.14.13024 CrossRefPubMedGoogle Scholar
  17. 17.
    Johnson DA, Barkun AN, Cohen LB, et al. (2014) Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology 147(4):903–924.  https://doi.org/10.1053/j.gastro.2014.07.002 CrossRefPubMedGoogle Scholar
  18. 18.
    Iwano T, Tominaga M, Yamashita H, Egawa T, Ueno J (2014) Experience of low volume split-dose bowel preparation for computed tomography colonography. Nihon Hoshasen Gijutsu Gakkai zasshi 70(7):676–683CrossRefPubMedGoogle Scholar
  19. 19.
    Regge D, Laudi C, Galatola G, et al. (2009) Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA 301(23):2453–2461.  https://doi.org/10.1001/jama.2009.832 CrossRefPubMedGoogle Scholar
  20. 20.
    Johnson CD, Chen MH, Toledano AY, et al. (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359(12):1207–1217.  https://doi.org/10.1056/NEJMoa0800996 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Pickhardt PJ, Choi JR, Hwang I, et al. (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349(23):2191–2200CrossRefPubMedGoogle Scholar
  22. 22.
    Cotton PB, Durkalski VL, Pineau BC, et al. (2004) Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 291(14):1713–1719.  https://doi.org/10.1001/jama.291.14.1713 CrossRefPubMedGoogle Scholar
  23. 23.
    Rockey DC, Paulson E, Niedzwiecki D, et al. (2005) Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 365(9456):305–311.  https://doi.org/10.1016/S0140-6736(05)17784-8 CrossRefPubMedGoogle Scholar
  24. 24.
    Callstrom MR, Johnson CD, Fletcher JG, et al. (2001) CT colonography without cathartic preparation: feasibility study. Radiology 219(3):693–698CrossRefPubMedGoogle Scholar
  25. 25.
    Fletcher JG, Johnson CD, Welch TJ, et al. (2000) Optimization of CT colonography technique: prospective trial in 180 patients. Radiology 216(3):704–711.  https://doi.org/10.1148/radiology.216.3.r00au41704 CrossRefPubMedGoogle Scholar
  26. 26.
    Iannaccone R, Laghi A, Catalano C, et al. (2004) Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology 127(5):1300–1311CrossRefPubMedGoogle Scholar
  27. 27.
    Kim DH, Hinshaw JL, Lubner MG, et al. (2014) Contrast coating for the surface of flat polyps at CT colonography: a marker for detection. Eur Radiol 24(4):940–946.  https://doi.org/10.1007/s00330-014-3095-z CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kim DH, Matkowskyj KA, Lubner MG, et al. (2016) Serrated polyps at CT colonography: prevalence and characteristics of the serrated polyp spectrum. Radiology 280(2):455–463.  https://doi.org/10.1148/radiol.2016151608 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Davis PL (2015) Anaphylactoid reactions to the nonvascular administration of water-soluble iodinated contrast media. AJR Am J Roentgenol 204(6):1140–1145.  https://doi.org/10.2214/AJR.15.14507 CrossRefPubMedGoogle Scholar
  30. 30.
    Boyce CJ, Vetter JR, Pickhardt PJ (2012) MDCT artifact related to the intra-scan gravitational flow of opacified luminal fluid (the “Dense Waterfall” sign). Abdom Imaging 37(2):292–296.  https://doi.org/10.1007/s00261-011-9731-z CrossRefPubMedGoogle Scholar
  31. 31.
    O’Connor SD, Summers RM, Choi JR, Pickhardt PJ (2006) Oral contrast adherence to polyps on CT colonography. J Comput Assist Tomogr 30(1):51–57CrossRefPubMedGoogle Scholar
  32. 32.
    Johnson CD, Manduca A, Fletcher JG, et al. (2008) Noncathartic CT colonography with stool tagging: performance with and without electronic stool subtraction. AJR Am J Roentgenol 190(2):361–366.  https://doi.org/10.2214/AJR.07.2700 CrossRefPubMedGoogle Scholar
  33. 33.
    Pickhardt PJ, Choi JH (2003) Electronic cleansing and stool tagging in CT colonography: advantages and pitfalls with primary three-dimensional evaluation. AJR Am J Roentgenol 181(3):799–805CrossRefPubMedGoogle Scholar
  34. 34.
    Chang KJ, Rekhi SS Jr, Anderson SW, Soto JA (2011) Fluid tagging for CT colonography: effectiveness of a 2-hour iodinated oral preparation after incomplete optical colonoscopy. J Comput Assist Tomogr 35(1):91–95.  https://doi.org/10.1097/RCT.0b013e3181f5a610 CrossRefPubMedGoogle Scholar
  35. 35.
    Neri E, Turini F, Cerri F, Vagli P, Bartolozzi C (2009) CT colonography: same-day tagging regimen with iodixanol and reduced cathartic preparation. Abdom Imaging 34(5):642–647.  https://doi.org/10.1007/s00261-008-9453-z CrossRefPubMedGoogle Scholar
  36. 36.
    Theis J, Kim DH, Lubner MG, Munoz-del-Rio A, Pickhardt PJ (2016) CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination. Abdom Radiol 41(1):10–18.  https://doi.org/10.1007/s00261-015-0595-5 CrossRefGoogle Scholar
  37. 37.
    Fletcher JG, Silva AC, Fidler JL, et al. (2013) Noncathartic CT colonography: image quality assessment and performance and in a screening cohort. AJR Am J Roentgenol 201(4):787–794.  https://doi.org/10.2214/AJR.12.9225 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Zalis ME, Blake MA, Cai W, et al. (2012) Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation. Ann Intern Med 156(10):692–702.  https://doi.org/10.7326/0003-4819-156-10-201205150-00005 CrossRefPubMedGoogle Scholar
  39. 39.
    Ghanouni A, Halligan S, Taylor SA, et al. (2014) Quantifying public preferences for different bowel preparation options prior to screening CT colonography: a discrete choice experiment. BMJ Open 4(4):e004327.  https://doi.org/10.1136/bmjopen-2013-004327 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ghanouni A, Halligan S, Taylor SA, et al. (2013) Evaluating patients’ preferences for type of bowel preparation prior to screening CT colonography: convenience and comfort versus sensitivity and specificity. Clin Radiol 68(11):1140–1145.  https://doi.org/10.1016/j.crad.2013.06.018 CrossRefPubMedGoogle Scholar
  41. 41.
    Keeling AN, Slattery MM, Leong S, et al. (2010) Limited-preparation CT colonography in frail elderly patients: a feasibility study. AJR Am J Roentgenol 194(5):1279–1287.  https://doi.org/10.2214/AJR.09.2896 CrossRefPubMedGoogle Scholar
  42. 42.
    Zalis ME, Barish MA, Choi JR, et al. (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236(1):3–9CrossRefPubMedGoogle Scholar
  43. 43.
    Fatima H, Johnson CS, Rex DK (2010) Patients’ description of rectal effluent and quality of bowel preparation at colonoscopy. Gastrointest Endosc 71(7):1244–1252.e1242.  https://doi.org/10.1016/j.gie.2009.11.053
  44. 44.
    Ben-Horin S, Bar-Meir S, Avidan B (2009) The outcome of a second preparation for colonoscopy after preparation failure in the first procedure. Gastrointest Endosc 69(3 Pt 2):626–630.  https://doi.org/10.1016/j.gie.2008.08.027 CrossRefPubMedGoogle Scholar
  45. 45.
    Kim DH, Pickhardt PJ, Taylor AJ, et al. (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357(14):1403–1412CrossRefPubMedGoogle Scholar
  46. 46.
    Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH (2006) Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol 186(6):1491–1496CrossRefPubMedGoogle Scholar
  47. 47.
    Burling D, Taylor SA, Halligan S, et al. (2006) Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation. AJR Am J Roentgenol 186(1):96–103.  https://doi.org/10.2214/AJR.04.1506 CrossRefPubMedGoogle Scholar
  48. 48.
    Saltzman HA, Sieker HO (1968) Intestinal response to changing gaseous environments: normobaric and hyperbaric observations. Ann N Y Acad Sci 150(1):31–39CrossRefPubMedGoogle Scholar
  49. 49.
    Pickhardt PJ (2006) Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 239(2):313–316CrossRefPubMedGoogle Scholar
  50. 50.
    Sosna J, Blachar A, Amitai M, et al. (2006) Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology 239(2):457–463.  https://doi.org/10.1148/radiol.2392050287 CrossRefPubMedGoogle Scholar
  51. 51.
    Bellini D, Rengo M, De Cecco CN, et al. (2014) Perforation rate in CT colonography: a systematic review of the literature and meta-analysis. Eur Radiol 24(7):1487–1496.  https://doi.org/10.1007/s00330-014-3190-1 CrossRefPubMedGoogle Scholar
  52. 52.
    Pickhardt PJ, Bakke J, Kuo J, et al. (2014) Volumetric analysis of colonic distention according to patient position at CT colonography: diagnostic value of the right lateral decubitus series. AJR Am J Roentgenol 203(6):W623–628.  https://doi.org/10.2214/AJR.13.12369 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Yee J, Hung RK, Akerkar GA, Wall SD (1999) The usefulness of glucagon hydrochloride for colonic distention in CT colonography. AJR Am J Roentgenol 173(1):169–172.  https://doi.org/10.2214/ajr.173.1.10397121 CrossRefPubMedGoogle Scholar
  54. 54.
    Morrin MM, Farrell RJ, Keogan MT, et al. (2002) CT colonography: colonic distention improved by dual positioning but not intravenous glucagon. Eur Radiol 12(3):525–530.  https://doi.org/10.1007/s003300100954 CrossRefPubMedGoogle Scholar
  55. 55.
    de Haan MC, Boellaard TN, Bossuyt PM, Stoker J (2012) Colon distension, perceived burden and side-effects of CT-colonography for screening using hyoscine butylbromide or glucagon hydrochloride as bowel relaxant. Eur J Radiol 81(8):e910–916.  https://doi.org/10.1016/j.ejrad.2012.05.020 CrossRefPubMedGoogle Scholar
  56. 56.
    Rogalla P, Lembcke A, Ruckert JC, et al. (2005) Spasmolysis at CT colonography: butyl scopolamine versus glucagon. Radiology 236(1):184–188.  https://doi.org/10.1148/radiol.2353040007 CrossRefPubMedGoogle Scholar
  57. 57.
    Chang KJ, Soto JA (2010) CT colonography: image display methods. In: Dachman A, Laghi A (eds) Atlas of virtual colonoscopy, 2nd edn. New York: Springer, pp 111–132Google Scholar
  58. 58.
    Chang KJ, Yee J (2013) Dose reduction methods for CT colonography. Abdom Imaging 38(2):224–232.  https://doi.org/10.1007/s00261-012-9968-1 CrossRefPubMedGoogle Scholar
  59. 59.
    Lim HK, Lee KH, Kim SY, et al. (2011) Does the amount of tagged stool and fluid significantly affect the radiation exposure in low-dose CT colonography performed with an automatic exposure control? Eur Radiol 21(2):345–352.  https://doi.org/10.1007/s00330-010-1922-4 CrossRefPubMedGoogle Scholar
  60. 60.
    Chang KJ, Caovan DB, Grand DJ, Huda W, Mayo-Smith WW (2013) Reducing radiation dose at CT colonography: decreasing kVp to 100 kilovolts. Radiology 266:801–811CrossRefGoogle Scholar
  61. 61.
    Chang KJ, Heisler MA, Mahesh M, Baird GL, Mayo-Smith WW (2015) CT colonography at low tube potential: using iterative reconstruction to decrease noise. Clin Radiol 70(9):981–988.  https://doi.org/10.1016/j.crad.2015.05.005 CrossRefPubMedGoogle Scholar
  62. 62.
    Lambert L, Ourednicek P, Jahoda J, Lambertova A, Danes J (2015) Model-based vs hybrid iterative reconstruction technique in ultralow-dose submillisievert CT colonography. Br J Radiol.  https://doi.org/10.1259/bjr.20140667 Google Scholar
  63. 63.
    Lubner MG, Pooler BD, Kitchin DR, et al. (2015) Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging. Eur Radiol 25(7):2089–2102.  https://doi.org/10.1007/s00330-015-3603-9 CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Nagata K, Fujiwara M, Kanazawa H, et al. (2015) Evaluation of dose reduction and image quality in CT colonography: comparison of low-dose CT with iterative reconstruction and routine-dose CT with filtered back projection. Eur Radiol 25(1):221–229.  https://doi.org/10.1007/s00330-014-3350-3 CrossRefPubMedGoogle Scholar
  65. 65.
    Yamamura S, Oda S, Imuta M, et al. (2015) Reducing the radiation dose for CT colonography: effect of Low tube voltage and iterative reconstruction. Acad Radiol.  https://doi.org/10.1016/j.acra.2015.03.009 PubMedGoogle Scholar
  66. 66.
    Li J, Udayasankar UK, Toth TL, et al. (2007) Automatic patient centering for MDCT: effect on radiation dose. AJR Am J Roentgenol 188(2):547–552.  https://doi.org/10.2214/AJR.06.0370 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyNewton-Wellesley HospitalNewtonUSA
  2. 2.The Warren Alpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Department of Radiology, E3/311 Clinical Science CenterUniversity of Wisconsin Madison School of Medicine and Public HealthMadisonUSA

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