The second ESGAR consensus statement on CT colonography



To update quality standards for CT colonography based on consensus among opinion leaders within the European Society of Gastrointestinal and Abdominal Radiology (ESGAR).

Material and methods

A multinational European panel of nine members of the ESGAR CT colonography Working Group (representing six EU countries) used a modified Delphi process to rate their level of agreement on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval.


The panel elaborated 86 statements.

In the final round the panelists achieved complete consensus in 71 of 86 statements (82 %). Categories including the highest proportion of statements with excellent Cronbach's internal reliability were colon distension, scan parameters, use of intravenous contrast agents, general guidelines on patient preparation, role of CAD and lesion measurement.

Lower internal reliability was achieved for the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading, and reporting.


The recommendations of the consensus should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating.

Key Points

Computed tomographic colonography is the optimal radiological method of assessing the colon

This article reviews ESGAR quality standards for CT colonography

This article is aimed to provide CT-colonography guidelines for practising radiologists

The recommendations should help radiologists who are starting/updating their CTC services


Since its introduction (in 1994) [1], clinical implementation of computed tomography (CT) colonography has been governed by advances in CT technology, improvements in dedicated analysis software, development of patient preparation regimens and local diagnostic policies.

In 2007 the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus statement on CT colonography was published, detailing how best to conduct and interpret the examination [2]. That document was based on collective experience up to the beginning of 2006, and the authors represented the EU countries in which CTC underwent consistent clinical implementation (UK, Italy, Belgium and The Netherlands). Over the last 5 years expansion of the CT colonography literature has continued and several important studies, including multicentre studies, have been published [35]. These new data have provided further insight regarding optimisation of the CT colonography technique, interpretation and diagnostic capabilities. Indeed CT colonography is now recommended for colorectal cancer screening by several international groupings and is widely used to investigate patients with symptoms suggestive of colorectal cancer [6, 7]. Although recent review articles provide some guidance regarding the optimal CT colonography technique, given the evolving data [811] there is a current need to update the ESGAR consensus document.

The purpose of this article is therefore to update quality standards for CT colonography based on examination of the existing literature and expert opinion from key opinion-leaders within the European Society of Gastrointestinal and Abdominal Radiology.

Materials and methods

Consensus panel

A multinational European panel of nine members of the ESGAR CTC Working Group (comprising J.S., S.H., S.T., P.L., T.M., D.R., M.H., A.L., E.N., and representing six EU countries: Austria, Belgium, Italy, The Netherlands, Sweden and the UK) used a modified Delphi process [12, 13]. The Delphi process consists of a survey conducted in two or more rounds; the answers (or statements) collected in the first survey are modified in the second, the third, etc., to reach the maximum consensus among the experts. We rated the level of agreement among the experts on a variety of statements pertaining to the acquisition, interpretation and implementation of CT colonography. Four Delphi rounds were conducted, each at 2 months interval.

One of the panellists was chosen as the facilitator (E.N.).

In the first round the facilitator emailed a questionnaire with 22 items pertaining to panel members’ personal approaches to CTC, including items on patient preparation, data acquisition technique, image interpretation and clinical implementation (Table 1). Responses collected from all panellists were merged into a unique datasheet that served to identify areas of agreement and conflict in panellist opinion.

Table 1 Second ESGAR CT colonography consensus. Survey of the first Delphi round

In the second round, the panellists attended a 1-day, face-to-face meeting, and, on the basis of their main areas of research and expertise, were divided into four working groups (WG) as follows: bowel preparation and tagging (WG 1), insufflation and scanning protocols (WG 2), reading paradigm (WG 3) and reporting (WG 4). Each WG independently drafted a cluster of statements pertaining to their allocated subject (Table 2). Each statement was built on the basis of panelists’ expertise and available indexed literature. Each WG then presented their proposed statements to the whole panel for consideration and subsequent discussion, during which time the content and wording of statements were modified until a general consensus emerged.

Table 2 Statements elaborated by the panellists in the second Delphi round, and discussed in the third and fourth to reach the maximum consensus and Cronbach's internal reliability. Statements with score between 4 and 5 are highlighted to show the situations in which all panellists agreed on the statement but the level of support differed (i.e. “agree somewhat” versus “agree strongly”)

In the third and fourth rounds, copies of the latest statements were sent by email to panellists, who then indicated independently their level of agreement with each individual statement using a 5-point scale, as follows: 1, strongly disagree with the statement; 2, disagree somewhat with the statement; 3, undecided; 4, agree somewhat with the statement; 5, strongly agree with the statement.

After the third round the facilitator collected panellists’ ratings and determined the agreement score for each statement. If the mean score for an individual item was lower than four (maximum possible = five) the facilitator asked panelists to review the statement and attempt to reach a consensus in the fourth round.

Statistical analysis

To measure the internal consistency of panellist’s ratings for each statement, a quality analysis was performed using Cronbach's α correlation coefficient and SPSS (SPSS, Chicago, Ill.) [14]. Cronbach's α was determined after each round.

Cronbach’s α reliability coefficient normally ranges between 0 and 1. The closer the Cronbach’s α coefficient is to 1.0, the greater the internal consistency of the item. An α coefficient > 0.9 was considered excellent, α > 0.8 good, α > 0.7 acceptable, α > 0.6 questionable, α > 0.5 poor and α < 0.5 unacceptable. For the iterations, an α of 0.8 was considered a reasonable goal for internal reliability. All panellist ratings for each statement were also analysed with descriptive statistics, estimating the mean, maximum and minimum score, and their standard deviation.

A mean score of 4 was considered to represent “good” agreement between panellists, a score of 5 “complete” agreement.


Based on the questionnaire provided by the facilitator, the panel elaborated 86 statements that were collected by the facilitator and organised into nine groups, as follows: (1) rectal tube, (2) spasmolytics, (3) colon distension, (4) image acquisition, (5) patient preparation, (6) faecal tagging, (7) reading paradigm, (8) lesion measurement and (9) reporting (Table 2).

In the third round the panelists achieved complete consensus (i.e. mean score 5) in 64 of 86 statements (75 %), which improved to 71 (82 %) in the fourth round (Table 2).

Categories including the highest proportion of statements achieving excellent internal reliability (i.e. Cronbach's α value >0.7) in the final round were colon distension, scan parameters, use of intravenous contrast medium, general guidelines on patient preparation, role of CAD and lesion measurement.

Lower internal reliability was achieved for statements regarding the use of a rectal tube, spasmolytics, decubitus positioning and number of CT data acquisitions, faecal tagging, 2D vs. 3D reading and reporting. However, in the last round, no panellist scored their individual statements as less than 4 on the 5-point rating scale. This indicates that all panellists agreed on the statement but the level of support differed (i.e. “agree somewhat” versus “agree strongly”).


Full consensus was reached by our expert panel in 82 % of the statements. In the remaining statements, full consensus was not reached but all panellists achieved a “good” level of agreement. In total, the panellists completed fours rounds; the first and second rounds served to elaborate the basic statements. The third and fourth rounds contained the core of the discussion and were necessary to reach the maximum consensus possible, so creating an optimised, homogeneous opinion for each statement.

All panellists exhibited a high level of agreement for the technical performance of CTC, with clear recommendations regarding colon distension, CT parameters, use of intravenous contrast agents and patient preparation. Full agreement was also reached regarding the role of CAD and lesion measurement. These data reflect a general homogeneity of approach between panel members despite their wide geographical spread. All panel members are regular tutors on the ESGAR CTC course, which may have increased their level of agreement; there is a tendency to promote a common message during panel discussions occurring during the ESGAR CTC courses [15, 16]. Furthermore, in these areas the indexed literature is relatively mature and stable; for example available data supporting the use of automated CO2 for optimal colonic distension is relatively consistent [1720].

However, certain aspects of practice achieved less than “full” agreement. In particular, a digital rectal examination, before insertion of the rectal tube (if rectal examination had not been performed previously), was not standard practice in many centres, but was nevertheless recommended by some panellists (with a mean score 4.56). This difference could be explained by the practice to perform a digital rectal examination before CTC amongst a few of the experts involved in the consensus. Similarly, practice differed regarding the use of intravenous spasmolytics, with many administering such agents to all patients, whereas some (in Italy) only used it in selected individuals [21, 22]. Accordingly, use of spasmolytics is recommended by the majority but is not considered mandatory.

There were minor variations in recommended CT parameters between panellists but all recommended data acquistion in at least two patient positions, without any overall preference regarding the order of acquisitions (i.e. supine or prone first). The differences in CT protocols included the need for additional CT data acquisition and insufflation in cases of poor colonic distension; a minority of experts did not consider this mandatory although they agreed it should be recommended. An additional decubitus acquisition was recommended, if required, to improve the diagnostic quality of the examination [23, 24].

Although available CT technology differed among panellists, all agreed that 2.5-mm collimation was the maximum permissible (although thinner collimation is recommended when available) and use of low radiation dose protocols is to be employed when the overriding purpose of the study is the evaluation of the colonic lumen, for example as in screening [25, 26]. A low radiation dose should be considered a study in which the median effective dose is lower than 5.7 mSv, according to the results of the survey by Leidenbaum et al. [26]. For the staging of patients with known malignancy all the panellists agreed upon the use of standard-dose protocols and intravenous contrast medium [27, 28].

Substantial agreement was reached between panelists regarding the reading methods for interpretation of CT colonography. A combination of 2D and 3D reading was emphasised. Most of the panel were primary 2D readers but all recognised the importance of 3D integration, noting the range of different three-dimensional approaches available. The need for the reader to be adequately trained before interpreting CT colonography was emphasised and is strongly supported by the indexed literature [2933].

Computer-aided diagnosis was acknowledged by all panellists as a potentially useful tool for CTC interpretation, if employed in a second reader paradigm. Accordingly, the use of CAD was recommended provided that readers have already undergone adequate training in general CT colonography interpretation so that they can discriminate between true- and false-positive CAD marks appropriately [3442].

Panellists acknowledged that accurate polyp measurement is problematic for both CTC and endoscopy, with some evidence that CTC may be the superior technique [43, 44]. Despite this advantage, it is still uncertain whether a 2D or a 3D measurement should be made from CT. Moreover, the accuracy of such measurements has important clinical implications for the correct classification and risk stratification of lesions, influencing subsequent recommendations for patient management [4550]. The panel concluded that the maximal diameter of lesions should be primarily estimated using axial and MPR 2D views (which were considered to be the most reliable), avoiding a narrow CT window. Some caution should be exercised when measurements are taken using 3D perspectives given the potential for distortion generated by the three-dimensional endoluminal rendering [5155].

All panellists agreed that CTC should only be reported by a radiologist, and then only after adequate training [5659]. Motivations behind this recommendation are mainly the medico-legal implications of non-radiologists reporting CTC in EU countries. In all EU countries the radiological report is definitively validated by the radiologist despite, in a few centres, a preliminary reading being performed by a radiographer. Adequate training means having interpreted a minimum amount of colonoscopy-verified cases. Although the precise number has not yet been clearly defined, the literature shows that 175 is even not sufficient for several individuals [60, 61].

It was acknowledged that diagnostic accuracy is lower for polyps with a maximal diameter less than 6 mm [3, 4] but if detected with high confidence, and particularly if more than three in number, such polyps should still be reported. This contrasts with recommendations from the CT Colonography Reporting and Data System (C-RADS), authored by Zalis et al., where lesions less than 6 mm are considered diminutive and the recommendation is that they should not be reported [45]. The panel agreed that the patient’s risk (age, family history of colorectal cancer, previous polypectomy, etc.), as well as the number of diminutive lesions detected, should be considered in the decision to report them or not.

There was little disagreement between panellists regarding the need to calibrate the laxative effect of bowel preparation/purgation to the individual patient and potential target lesion. All panellists agreed that faecal tagging should be used routinely. Different preferences for specific laxative and tagging agents were expressed (for example sodium phosphate, magnesium citrate, polyethylene glycol for cleansing, and barium, iodine or a combination of both agents for tagging), reflecting local practice [6275].

In summary, the panel covered all important aspects regarding the practice of CTC and reached full agreement on most statements. The Consensus has been structured to give clear guidelines for the practice of CT colonography. The recommendations should be useful for both the radiologist who is starting a CTC service and for those who have already implemented the technique but whose practice may need updating in the light of recent developments.


  1. 1.

    Vining DJ, Celfand DW, Bechtold RE, Scharling ES, Grishaw EK, Shifrin RY (1994) Technical feasibility of colon imaging with helical CT and virtual reality. AJR 162:104

    Google Scholar 

  2. 2.

    Taylor SA, Laghi A, Lefere P, Halligan S, Stoker J (2007) European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography. Eur Radiol 17:575–579

    PubMed  Article  Google Scholar 

  3. 3.

    Johnson CD, Chen MH, Toledano AY et al (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359:1207–1217

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    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 17:2453–2461

    Article  Google Scholar 

  5. 5.

    Graser A, Stieber P, Nagel D et al (2009) Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 58:241–248

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Levin B, Lieberman DA, McFarland B et al (2008) American Cancer Society Colorectal Cancer Advisory Group; US Multi-Society Task Force; American College of Radiology Colon Cancer Committee. 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 58:130–160

    PubMed  Article  Google Scholar 

  7. 7.

    McFarland EG, Fletcher JG, Pickhardt P et al (2009) American College of Radiology. ACR Colon Cancer Committee white paper: status of CT colonography 2009. J Am Coll Radiol 6:756–772

    PubMed  Article  Google Scholar 

  8. 8.

    Mang T, Graser A, Schima W, Maier A (2007) CT colonography: techniques, indications, findings. Eur J Radiol 61:388-399

    PubMed  Article  Google Scholar 

  9. 9.

    Yee J, Rosen MP, Blake MA (2010) ACR Appropriateness Criteria on colorectal cancer screening. J Am Coll Radiol 7:670–678

    PubMed  Article  Google Scholar 

  10. 10.

    Cash BD (2010) Establishing a CT colonography service. Gastrointest Endosc Clin N Am 20:379–398

    PubMed  Article  Google Scholar 

  11. 11.

    Mang T, Schima W, Brownstone E et al (2011) Consensus statement of the Austrian Society of Radiology, the Austrian Society of Gastroenterology and Hepatology and the Austrian Society of Surgery on CT colonography (Virtual Colonoscopy). Rofo 183:177–184

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Graham B, Regehr G, Wright JG (2003) Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol 56:1150–1156

    PubMed  Article  Google Scholar 

  13. 13.

    Vakil N (2011) Editorial: consensus guidelines: method or madness? Am J Gastroenterol 106:225–227

    PubMed  Article  Google Scholar 

  14. 14.

    Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:3

    Article  Google Scholar 

  15. 15.

    Burling D (2010) International Collaboration for CT Colonography Standards. CT colonography standards. Clin Radiol 65:474–480

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Boone D, Halligan S, Frost R et al (2011) CT colonography: who attends training? A survey of participants at educational workshops. Clin Radiol 66:510–516

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    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 186:1491–1496

    PubMed  Article  Google Scholar 

  18. 18.

    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 186:96–103

    PubMed  Article  Google Scholar 

  19. 19.

    Kim SY, Park SH, Choi EK et al (2008) Automated carbon dioxide insufflation for CT colonography: effectiveness of colonic distention in cancer patients with severe luminal narrowing. AJR Am J Roentgenol 190:698–706

    PubMed  Article  Google Scholar 

  20. 20.

    Neri E, Laghi A, Regge D (2008) Re: Colonic perforation during screening CT colonography using automated CO2 insufflation in an asymptomatic adult. Abdom Imaging 33:748–749

    PubMed  Article  Google Scholar 

  21. 21.

    Taylor SA, Halligan S, Goh V et al (2003) Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. Radiology 229:99–108

    PubMed  Article  Google Scholar 

  22. 22.

    Rogalla P, Lembcke A, Rückert JC et al (2005) Spasmolysis at CT colonography: butyl scopolamine versus glucagon. Radiology 236:184–188

    PubMed  Article  Google Scholar 

  23. 23.

    Gryspeerdt SS, Herman MJ, Baekelandt MA, van Holsbeeck BG, Lefere PA (2004) Supine/left decubitus scanning: a valuable alternative to supine/prone scanning in CT colonography. Eur Radiol 14:768–777

    PubMed  Article  Google Scholar 

  24. 24.

    Buchach CM, Kim DH, Pickhardt PJ (2011) Performing an additional decubitus series at CT colonography. Abdom Imaging 36:538–544

    PubMed  Article  Google Scholar 

  25. 25.

    Graser A, Wintersperger BJ, Suess C, Reiser MF, Becker CR (2006) Dose reduction and image quality in MDCT colonography using tube current modulation. AJR Am J Roentgenol 187:695–701

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Liedenbaum MH, Venema HW, Stoker J (2008) Radiation dose in CT colonography–trends in time and differences between daily practice and screening protocols. Eur Radiol 18:2222–2230

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Filippone A, Ambrosini R, Fuschi M, Marinelli T, Genovesi D, Bonomo L (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography–initial experience. Radiology 231:83–90

    PubMed  Article  Google Scholar 

  28. 28.

    Mainenti PP, Cirillo LC, Camera L et al (2006) Accuracy of single phase contrast enhanced multidetector CT colonography in the preoperative staging of colo-rectal cancer. Eur J Radiol 60:453–459

    PubMed  Article  Google Scholar 

  29. 29.

    Taylor SA, Halligan S, Slater A et al (2006) Polyp detection with CT colonography: primary 3D endoluminal analysis versus primary 2D transverse analysis with computer-assisted reader software. Radiology 239:759–767

    PubMed  Article  Google Scholar 

  30. 30.

    Neri E, Vannozzi F, Vagli P, Bardine A, Bartolozzi C (2006) Time efficiency of CT colonography: 2D vs 3D visualization. Comput Med Imaging Graph 30:175–180

    PubMed  Article  Google Scholar 

  31. 31.

    Mang T, Schaefer-Prokop C, Schima W, Maier A et al (2009) Comparison of axial, coronal, and primary 3D review in MDCT colonography for the detection of small polyps: a phantom study. Eur J Radiol 70:86–93

    PubMed  Article  Google Scholar 

  32. 32.

    Mang T, Kolligs FT, Schaefer C, Reiser MF, Graser A (2011) Comparison of diagnostic accuracy and interpretation times for a standard and an advanced 3D visualisation technique in CT colonography. Eur Radiol 21:653–662

    PubMed  Article  Google Scholar 

  33. 33.

    Lostumbo A, Wanamaker C, Tsai J, Suzuki K, Dachman AH (2010) Comparison of 2D and 3D views for evaluation of flat lesions in CT colonography. Acad Radiol 17:39–47

    PubMed  Article  Google Scholar 

  34. 34.

    Baker ME, Bogoni L, Obuchowski NA et al (2007) Computer-aided detection of colorectal polyps: can it improve sensitivity of less-experienced readers? Preliminary findings. Radiology 245:140–149

    PubMed  Article  Google Scholar 

  35. 35.

    Taylor SA, Burling D, Roddie M et al (2008) Computer-aided detection for CT colonography: incremental benefit of observer training. Br J Radiol 81:180–186

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Petrick N, Haider M, Summers RM et al (2008) CT colonography with computer-aided detection as a second reader: observer performance study. Radiology 246:148–156

    PubMed  Article  Google Scholar 

  37. 37.

    Taylor SA, Charman SC, Lefere P et al (2008) CT colonography: investigation of the optimum reader paradigm by using computer-aided detection software. Radiology 246:463–471

    PubMed  Article  Google Scholar 

  38. 38.

    Regge D, Hassan C, Pickhardt PJ et al (2009) Impact of computer-aided detection on the cost-effectiveness of CT colonography. Radiology 250:488–497

    PubMed  Article  Google Scholar 

  39. 39.

    de Vries AH, Jensch S, Liedenbaum MH et al (2009) Does a computer-aided detection algorithm in a second read paradigm enhance the performance of experienced computed tomography colonography readers in a population of increased risk? Eur Radiol 19:941–950

    PubMed  Article  Google Scholar 

  40. 40.

    Fisichella VA, Jäderling F, Horvath S et al (2009) Computer-aided detection (CAD) as a second reader using perspective filet view at CT colonography: effect on performance of inexperienced readers. Clin Radiol 64:972–982

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Halligan S, Mallett S, Altman DG et al (2011) Incremental benefit of computer-aided detection when used as a second and concurrent reader of CT colonographic data: multiobserver study. Radiology 258:469–476

    PubMed  Article  Google Scholar 

  42. 42.

    Dachman AH, Obuchowski NA, Hoffmeister JW et al (2010) Effect of computer-aided detection for CT colonography in a multireader, multicase trial. Radiology 256:827–835

    PubMed  Article  Google Scholar 

  43. 43.

    Punwani S, Halligan S, Irving P et al (2008) Measurement of colonic polyps by radiologists and endoscopists: who is most accurate? Eur Radiol 18:874–881

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Jeong JY, Kim MJ, Kim SS (2008) Manual and automated polyp measurement comparison of CT colonography with optical colonoscopy. Acad Radiol 15:231–239

    PubMed  Article  Google Scholar 

  45. 45.

    Zalis ME, Barish MA, Choi JR et al (2005) Working Group on Virtual Colonoscopy. CT colonography reporting and data system: a consensus proposal. Radiology 236:3–9

    PubMed  Article  Google Scholar 

  46. 46.

    Kim DH, Pickhardt PJ, Taylor AJ (2007) Characteristics of advanced adenomas detected at CT colonographic screening: implications for appropriate polyp size thresholds for polypectomy versus surveillance. AJR Am J Roentgenol 188:940–944

    PubMed  Article  Google Scholar 

  47. 47.

    Pickhardt PJ, Hassan C, Laghi A et al (2008) Clinical management of small (6- to 9-mm) polyps detected at screening CT colonography: a cost-effectiveness analysis. AJR Am J Roentgenol 191:1509–1516

    PubMed  Article  Google Scholar 

  48. 48.

    Shah JP, Hynan LS, Rockey DC (2009) Management of small polyps detected by screening CT colonography: patient and physician preferences. Am J Med 122:687–689

    PubMed  Google Scholar 

  49. 49.

    Heresbach D, Chauvin P, Hess-Migliorretti A, Riou F, Grolier J, Josselin JM (2010) Cost-effectiveness of colorectal cancer screening with computed tomography colonography according to a polyp size threshold for polypectomy. Eur J Gastroenterol Hepatol 22:716–723

    PubMed  Article  Google Scholar 

  50. 50.

    Neri E, Faggioni L, Vagli P et al (2011) Patients' preferences about follow-up of medium size polyps detected at screening CT colonography. Abdom Imaging 36:713–717

    PubMed  Article  Google Scholar 

  51. 51.

    Pickhardt PJ, Lee AD, McFarland EG, Taylor AJ (2005) Linear polyp measurement at CT colonography: in vitro and in vivo comparison of two-dimensional and three-dimensional displays. Radiology 236:872–878

    PubMed  Article  Google Scholar 

  52. 52.

    Burling D, Halligan S, Altman DG et al (2006) Polyp measurement and size categorisation by CT colonography: effect of observer experience in a multi-centre setting. Eur Radiol 16:1737–1744

    PubMed  Article  Google Scholar 

  53. 53.

    Park SH, Choi EK, Lee SS et al (2007) Polyp measurement reliability, accuracy, and discrepancy: optical colonoscopy versus CT colonography with pig colonic specimens. Radiology 244:157–164

    PubMed  Article  Google Scholar 

  54. 54.

    Park SH, Choi EK, Lee SS et al (2008) Linear polyp measurement at CT colonography: 3D endoluminal measurement with optimized surface-rendering threshold value and automated measurement. Radiology 246:157–167

    PubMed  Article  Google Scholar 

  55. 55.

    Bethea E, Nwawka OK, Dachman AH (2009) Comparison of polyp size and volume at CT colonography: implications for follow-up CT colonography. AJR Am J Roentgenol 193:1561–1567

    PubMed  Article  Google Scholar 

  56. 56.

    Pickhardt PJ (2009) Editorial: CTC interpretation by gastroenterologists: feasible but largely impractical, undesirable, and misguided. Am J Gastroenterol 104:2932–2934

    PubMed  Article  Google Scholar 

  57. 57.

    Carpenter S (2010) Gastroenterologists should read CT colonography. Gastrointest Endosc Clin N Am 20:271–277

    PubMed  Article  Google Scholar 

  58. 58.

    Kim DH, Pickhardt PJ (2010) Radiologists should read CT colonography. Gastrointest Endosc Clin N Am 20:259–69

    PubMed  Article  Google Scholar 

  59. 59.

    Fletcher JG, Chen MH, Herman BA et al (2010) Can radiologist training and testing ensure high performance in CT colonography? Lessons From the National CT Colonography Trial. AJR Am J Roentgenol 195:117–125

    PubMed  Article  Google Scholar 

  60. 60.

    Heresbach D, Djabbari M, Riou F et al (2011) Accuracy of computed tomographic colonography in a nationwide multicentre trial, and its relation to radiologist expertise. Gut 60:658–665

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Liedenbaum MH, Bipat S, Bossuyt PM et al (2011) Evaluation of a standardized CT colonography training program for novice readers. Radiology 258:477–487

    PubMed  Article  Google Scholar 

  62. 62.

    Lefere PA, Gryspeerdt SS, Dewyspelaere J, Baekelandt M, Van Holsbeeck BG (2002) Dietary fecal tagging as a cleansing method before CT colonography: initial results polyp detection and patient acceptance. Radiology 224:393–403

    PubMed  Article  Google Scholar 

  63. 63.

    Iannaccone R, Laghi A, Catalano C et al (2004) Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology 127:1300–1311

    PubMed  Article  Google Scholar 

  64. 64.

    Gryspeerdt S, Lefere P, Herman M et al (2005) CT colonography with fecal tagging after incomplete colonoscopy. Eur Radiol 15:1192–1202

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Lefere P, Gryspeerdt S, Marrannes J, Baekelandt M, Van Holsbeeck B (2005) CT colonography after fecal tagging with a reduced cathartic cleansing and a reduced volume of barium. AJR Am J Roentgenol 184:1836–1842

    PubMed  Google Scholar 

  66. 66.

    Zalis ME, Perumpillichira JJ, Magee C, Kohlberg G, Hahn PF (2006) Tagging-based, electronically cleansed CT colonography: evaluation of patient comfort and image readability. Radiology 239:149–159

    PubMed  Article  Google Scholar 

  67. 67.

    Taylor SA, Slater A, Burling DN et al (2008) CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging. Eur Radiol 18:32–42

    PubMed  Article  Google Scholar 

  68. 68.

    Slater A, Planner A, Bungay HK, Bose P, Milburn S (2009) Three-day regimen improves faecal tagging for minimal preparation CT examination of the colon. Br J Radiol 82:545–548

    PubMed  Article  CAS  Google Scholar 

  69. 69.

    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 34:642–647

    PubMed  Article  Google Scholar 

  70. 70.

    Liedenbaum MH, de Vries AH, Gouw CI et al (2010) CT colonography with minimal bowel preparation: evaluation of tagging quality, patient acceptance and diagnostic accuracy in two iodine-based preparation schemes. Eur Radiol 20:367–376

    PubMed  Article  Google Scholar 

  71. 71.

    Campanella D, Morra L, Delsanto S et al (2010) Comparison of three different iodine-based bowel regimens for CT colonography. Eur Radiol 20:348–358

    PubMed  Article  Google Scholar 

  72. 72.

    Zueco Zueco C, Sobrido Sampedro C, Corroto JD, Rodriguez Fernández P, Fontanillo Fontanillo M (2012) CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice. Eur Radiol 22:1195–204

    PubMed  Article  Google Scholar 

  73. 73.

    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 195:31–37

    Article  Google Scholar 

  74. 74.

    Davis W, Nisbet P, Hare C, Cooke P, Taylor SA (2011) Non-laxative CT colonography with barium-based faecal tagging: is additional phosphate enema beneficial and well tolerated? Br J Radiol 84:120–125

    PubMed  Article  CAS  Google Scholar 

  75. 75.

    Liedenbaum MH, Denters MJ, Zijta FM et al (2011) Reducing the oral contrast dose in CT colonography: evaluation of faecal tagging quality and patient acceptance. Clin Radiol 66:30–37

    PubMed  Article  CAS  Google Scholar 

Download references

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Author information




Corresponding author

Correspondence to Emanuele Neri.

Rights and permissions

Open Access This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License (, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Reprints and Permissions

About this article

Cite this article

Neri, E., Halligan, S., Hellström, M. et al. The second ESGAR consensus statement on CT colonography. Eur Radiol 23, 720–729 (2013).

Download citation


  • CT colonography
  • Guidelines
  • Computed tomography
  • Colon
  • Polyps