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The Challenge: Detection of Early-Stage Superficial Colorectal Lesions

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Virtual Colonoscopy

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Early-stage colorectal carcinoma has been conventionally diagnosed mainly on the basis of colono-scopy and barium enema study. Particularly in Japan, where colonoscopic technique is remarkably advanced, colonoscopy is the principal modality for early detection of colorectal carcinomas. A detailed investigation on superficial type of lesions, so called “flatlesion,” has been conducted with the development of electronic video colonoscopy(Kudo 1996). More recently, detecting colorectal lesions by electronic video colon-oscopy also became possible with narrow band imaging (NBI) of mucosal capillary blood flow(Sano et al. 2006). Moreover, with the advancements of therapeutic techniques, including endoscopic submucosal dissection (ESD), simultaneous diagnosis and treatment of superficial type of lesions has been made possible(Saito et al. 2005).

The recent proliferation of multi-detector row computed tomography (MDCT) has revolutionized the efficiency of CT scanning and image enhancement (Nakajima et al. 2008). In addition, digital imaging technology has enabled three-dimensional (3D) imaging of various organs that can also be used for diagnosing gastrointestinal tract. Especially, 3D imaging of the large intestine is globally referred to as computed tomography colonography CTC. This modality has been thoroughly inves tigated with regard to its application in colorectal screening in Western countries and is now accepted worldwide for diagnosing colorectal lesions(Johnson et al. 2008). Also in Japan, CTC has been gradually admitted as an option for evaluation of colorectum in preoperative staging. For future proliferation of CTC in colorectal screening, the diagnosis of superficial type of lesions should be scrutinized and established based on Japanese experiences in the advanced colonoscopic diagnosis.

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  • Anon (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastro-intest Endosc 58:S3–S43

    Google Scholar 

  • Fujii T, Rembacken BJ, Dixon MF et al (1998) Flat adenomas in the United Kingdom: Are treatable cancers being missed? Endoscopy 30:437–443

    Article  CAS  PubMed  Google Scholar 

  • Hara AK, Johnson CD, Reed JE et al (1997) Detection of col-orectal polyps with CT colography: initial assessment of sensitivity and specificity. Radiology 205:59–65

    CAS  PubMed  Google Scholar 

  • Iinuma G, Moriyama N, Miyakawa K et al (2003) Early invasive colorectal carcinomas with submucosal invasion: ?Radio-graphic characteristics with barium double contrast. Abdom Imaging 28:492–504

    Article  CAS  PubMed  Google Scholar 

  • Iinuma G, Moriyama N, Satake M et al (2005) Vascular virtual endoluminal visualization of invasive colorectal cancer on MDCT colonography. AJR 184:1194–1198

    PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • Kudo S (1996) Early colorectal cancer, detection of depressed type of colorectal carcinomas. Igaku-Shoin, Tokyo, Japan, pp166

    Google Scholar 

  • Kudo S, Tamura S, Nakajima T et al (1995) Depressed type of colorectal cancer. Endoscopy 27:54–57

    Article  CAS  PubMed  Google Scholar 

  • Lefere PA, Gryspeerdt SS, Dewyspelaere J et al (2002) Dietary fecal tagging as a cleansing method before CT colonogra-phy: Initial results — polyp detection and patient acceptance. Radiology 224:393–403

    Article  PubMed  Google Scholar 

  • Levine MS, Rubesin SE, Laufer I et al (2000) Diagnosis of col-orectal neoplasms at double-contrast barium enema examination. Radiology 216:11–18

    CAS  PubMed  Google Scholar 

  • Matsuda T, Fujii T, Emura F et al (2004) Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 60:836–838

    Article  PubMed  Google Scholar 

  • McFarland EG, Brink JA, Loh J et al (1997) Visualization of colore ct al polyps with spiral CT colography: evaluation of processing parameters with perspe ct ive volume rendering. Radiology 205:701–707

    CAS  PubMed  Google Scholar 

  • Muto T, Bussey HJR, Morson BC (1975) The evolution of cancer of the colon and rectum. Cancer 36:2251–2270

    Article  CAS  PubMed  Google Scholar 

  • Nakajima Y, Yamada K, Imamura K et al (2008) Radiologists supply and workload: international comparison — Working Group of Japanese College of Radiology. Radiat Med 26:455–465

    Article  PubMed  Google Scholar 

  • Park S, Ha H, Kim A et al (2006) Flat polyps of the colon: detection with 16-MDCT colonography — preliminary results. AJR 186:1611–1617

    Article  PubMed  Google Scholar 

  • Park S, Lee SS, Choi EK et al (2007) Flat colorectal neoplasms: definition, importance, and visualization on CT colonogra-phy. AJR 188:953–959

    Article  PubMed  Google Scholar 

  • Pickhardt PJ (2007) Screening CT colonography: How i do it. AJR 189:290–298

    Article  PubMed  Google Scholar 

  • Pickhardt PJ, Choi JR, Hwang I et al (2004) Nonadenomatous polyps at CT colonography: prevalence, size distribution, and detection rates. Radiology 232:784–790

    Article  PubMed  Google Scholar 

  • Rex DK, Cutler CS, Lemmel GT et al (1997) Colonoscopic miss rates of adenomas determined by back-to-back colonos-copy. Gastroenterology 112:24–28

    Article  CAS  PubMed  Google Scholar 

  • Saito H, Soma Y, Koeda J et al (1995) Reduction in risk of mortality from colorectal cancer by fecal occult blood screening with immunochemical hemagglutination test; a case-control study. Int J Cancer 61:465–469

    Article  CAS  PubMed  Google Scholar 

  • Saito Y, Emura F, Matsuda T et al (2005) A new sinker-assisted endoscopic submucosal dissection method for colorectal tumors. Gastrointest Endosc 62:297–301

    Article  PubMed  Google Scholar 

  • Sano Y, Horimatsu T, Fu KI et al (2006) Magnifying observation of microvascular architecture of colorectal lesions using a narrow band imaging system. Dig Endosc 18:S44–S51

    Article  Google Scholar 

  • Shimoda T, Ikegami M, Fujisaki J, Matsui M, Aizawa S, Ishikawa. E (1989) Early colorectal carcinoma with special reference to its development de novo. Cancer 64:1138–1146

    Article  CAS  PubMed  Google Scholar 

  • Summers RM, Johnson CD, Pusanik LM et al (2001) Automated polyp detection at CT colonography: Feasibility assessment in the human population. Radiology 219:51–59

    CAS  PubMed  Google Scholar 

  • Taylor SA, Iinuma G, Saito Y et al (2008) CT colonography: computer-aided detection of morphologically flat 1 colonic carcinoma. Eur Radiol 18:1666–1673

    Article  PubMed  Google Scholar 

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The works were supported by Grants for Scientific Research Expens es for Health and Welfare Programs and the Foundation for the Promotion of Cancer Research, and by the 3rd-term Comprehensive 10-year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare.

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Iinuma, G., Miyake, M., Uchida, K., Arai, Y., Muramatsu, Y., Moriyama, N. (2010). The Challenge: Detection of Early-Stage Superficial Colorectal Lesions. In: Lefere, P., Gryspeerdt, S. (eds) Virtual Colonoscopy. Medical Radiology. Springer, Berlin, Heidelberg.

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