Virtual Colonoscopy: A Practical Guide

249 Pages·2010·23.196 MB·English

by  Richard M. Mendelson (auth.), P. Lefere, S. Gryspeerdt (eds.)

MEDICAL
RADIOLOGY
Diagnostic
Imaging
A. L. Baert · M. F. Reiser Virtual
H. Hricak · M. Knauth
Colonoscopy
A Practical Guide
2nd Revised Edition
P. Lefere
S. Gryspeerdt
Editors
1 3
MEDICAL RADIOLOGY
Diagnostic Imaging
EEddiittoorrss::
A. L. Baert, Leuven
M. F. Reiser, München
H. Hricak, New York
M. Knauth, Göttingen
P. Lefere · S. Gryspeerdt (Eds.)
VViirrttuuaall CCoolloonnoossccooppyy
A Practical Guide
2nd Edition
With Contributions by
Y. Arai · D. Bielen · F. Booya · D. Burling · F. Cerri · A. H. Dachman · A. H. de Vries
H. Fenlon · J. G. Fletcher · S. Gryspeerdt · L. S. Guimaraes · S. Halligan · G. Iinuma
A. Laghi · P. Lefere · A. Maier · T. Mang · B. G. McFarland · R. Mendelson · M. Miyake
N. Moriyama · K. J. Mortelé · Y. Muramatsu · D. Murphy · E. Neri · P. R. Obara
A. S. Odulate · M. Raquel Oliva · P. Pokieser · W. Schima · J. Stoker · S. A. Taylor · F. Turini
K. Uchida · J. Yee · H. Yoshida · M. E. Zalis
Foreword by
A. L. Baert
With 198 Figures in 355 Separate Illustrations, 146 in Color and 16 Tables
Philippe Lefere, MD Stefaan Gryspeerdt, MD
Stedelijk Ziekenhuis Roeselare Stedelijk Ziekenhuis Roeselare
Department of Radiology Department of Radiology
Bruggesteenweg 90 Bruggesteenweg 90
8800 Roeselare 8800 Roeselare
Belgium Belgium
Medical Radiology · Diagnostic Imaging and Radiation Oncology
Series Editors:
A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Knauth · M. Molls · C. Nieder
Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
ISBN: 978-3-540-79879-8 e-ISBN: 978-3-540-79886-6
DOI: 10.1007/978-3-540-79886-6
Springer Heidelberg Dordrecht London New York
Medical Radiology · Diagnostic Imaging and Radiation Oncology ISSN 0942-5373
Library of Congress Control Number: 2009931697
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Foreword
Rapid progress in the technique and practice of virtual colonoscopy as well as the continu-
ing clinical high interest for this radiodiagnostic procedure made this second edition, only 3
years after the publication of the fi rst edition of this successful volume, necessary.
This new edition includes the latest study results and technical developments of this
exciting noninvasive diagnostic modality for the evaluation of the colon. The technical
presentation and lay out of the text and of the many new illustrations are impeccable.
The editors were again able to ensure the collaboration of many international leaders
in the fi eld and the book offers a very comprehensive overview of all aspects and issues
of CT colonography with a focus on how to perform practically this examination, which
requires meticulous technique starting from rigorous preparation, then the conduct of
the study itself, and fi nally the interpretation of the results.
I am very much indebted to the editors and the collaborating authors for preparing
this outstanding volume in a record short time period, which enabled them to include
the latest technical advances in this rapidly evolving important radiological method. It
is highly recommended to general and gastrointestinal radiologists as well as gastro-
eneterologists as a most welcome update of their knowledge and as a practical guide in
their daily practice. I am convinced that this second edition will meet the same success
with our readership as the fi rst one.
Leuven, Belgium Albert L. Baert
Series Editor
Preface to the Second Edition
The publication of this second revised edition of the practical guide on virtual colono-
scopy less than 4 years after the publication of the fi rst edition underscores the big inter-
est for CT colonography. In the past 4 years, the promising expectations of the technique
were confi rmed by several large multicenter studies obtaining very good results for col-
orectal neoplasia detection. This was possible by establishing a state-of-the-art tech-
nique of CT colonography (CTC) in combination with image interpretation performed
by experienced teams. This updated edition confi rms the efforts of the international
CTC community to promote this technique as a widely accepted imaging technique for
exploring the colon for colorectal neoplasia. In the past 4 years, these efforts have been
focused on the development and fi ne tuning of the state-of-the-art application of CTC
in order to allow widespread implementation of a high-quality total colonic examina-
tion. All different aspects of the CTC technique are widely covered in this edition. In the
past years, it also became obvious that a structured education is mandatory in obtaining
suffi cient expertise in CTC before starting the technique in a clinical practice. This
expertise will prove invaluable for CTC to become a robust technique performed on a
high scientifi c level by a large community of radiologists. Once this goal is achieved, it
will be possible considering reimbursement of CTC and its use as tool for population-
based screening for colorectal cancer.
We are very grateful to all authors of the fi rst and second edition, who made both
issues a very rich resource of information on CT colonography and to the series editor
of this book, Professor Dr. A.L. Baert, who enabled this second revised edition.
Roeselare, Belgium Philippe Lefere
Stefaan Gryspeerdt
Preface to the First Edition
Virtual colonoscopy or computed tomographic (CT) colonography is a recent radiological
technique enabling detection of tumoral lesions in the colon. As in the past two decades
its radiological predecessor, double-contrast barium enema (DCBE), has lost most of its
adherents, CT colonography constitutes a real opportunity for gastrointestinal radiolo-
gists to play a preponderant role in the diagnosis and treatment of colorectal cancer and
the adenoma. Since its introduction by David Vining in 1994, CT colonography has very
rapidly shown its virtues as a possible substitute for DCBE. The fi rst important study on
CT colonography by Helen Fenlon from the Boston Medical Center, published in 1999 in
the New England Journal of Medicine, reporting very good lesion detection, underscored
this aspiration. Since then, CT colonography has markedly evolved by the refi nement of
existing techniques and the introduction of new ones: fecal tagging with the option of
reducing the cathartic or laxative part of the preparation, the use of carbon dioxide to
infl ate the colon, the introduction of multidetector CT scanners producing spectacular
images with isotropic resolution and reducing the examination time for the patient, the
use of ultra-low-dose scan protocols reducing the radiation burden, improvement of
the image postprocessing with fast three-dimensional functions, and computer-aided
diagnosis (CAD). These technical improvements help both the radiologist and the
patient. For the former, there is an improvement of the reading conditions, possibly
improving diagnostic accuracy; for the latter, the preparation and examination are
more comfortable.
Despite these improvements in technique, however, CT colonography has not yet
been able to break through as an acceptable tool for colorectal cancer screening. This is
because of the disappointing results in some recent large multicenter trials. Most prob-
ably suboptimal technique in preparation, colonic distension, scanning parameters, and
image postprocessing was the main cause of this failure. In fact, each of these stages
needs rigorous attention if one is to achieve optimal results like those obtained in
another momentous study, performed by Perry Pickhardt and published in the New
England Journal of Medicine in 2003. Based upon a meticulous technique of preparation
with fecal tagging, colonic infl ation, scanning parameters, and reading conditions, CT
colonography obtained better scores than optical colonoscopy in this study. Furthermore,
the examinations were interpreted by a team of radiologists experienced in CT colonog-
raphy. This brings us to another important aspect of CT colonography. As was the case
with DCBE, the degree of experience needed to adequately read and interpret CT
colonography should not be underestimated.
X Preface to the First Edition
In experienced hands, CT colonography seems to be ripe for prime-time colorectal cancer screening.
However, it is not yet ready for widespread application of screening for the aforementioned reasons. CT
colonography is now at an important crossroad, and serious efforts should be undertaken to take it to
the level of being a widely accepted screening method for colorectal cancer. To fulfi ll this goal, tremen-
dous efforts are being undertaken in both Europe and the United States to educate radiologists with
workshops, data banks, and numerous scientifi c publications.
With contributions from several leaders in the fi eld, this book, entirely dedicated to this exciting tech-
nique, sets out to be a guide for both the beginner and the experienced CT colonographer. It provides
the reader with a wealth of information on all the prerequisites to perform state-of-the-art CT
colonography.
We want to express our sincere gratitude and appreciation to all the renowned radiologists experi-
enced in CT colonography who have contributed to this volume. We also thank Professor Albert L. Baert,
who gave us the unique opportunity to edit this book and to bring it to a successful conclusion.
We hope that the reader will enjoy this work and will fi nd it a help when performing CT
colonography.
Roeselare, Belgium Philippe Lefere
Stefaan Gryspeerdt
Contents
1 Why We Do CTC: Screening for Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Richard M. Mendelson
2 The Performance of CTC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Didier Bielen
3 Starting CT Colonography in Your Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Darra Murphy, Alan O’Hare, and Helen Fenlon
4 The Eligible Patient: Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . . 37
M. Raquel Oliva, Ayodale S. Odulate, and Koenraad J. Mortele
5 Patient Preparation for CT Colonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
J. Yee
6 The Prerequisite: Faecal Tagging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Philippe Lefere and Stefaan Gryspeerdt
7 How to Get the Colon Distended? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
David Burling, Stuart Taylor, and Steve Halligan
8 Right Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Andrea Laghi
9 How to Interpret CTC Data: Evaluation of the Different
Lesion Morphologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Beth G. McFarland
10 How to Avoid Pitfalls in Imaging: Causes and Solutions
to Overcome False-Negatives and False-Positives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Stefaan Gryspeerdt and Philippe Lefere
11 3D Imaging: Invaluable for the Correct Diagnosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Ayso H. de Vries and Jaap Stoker
12 The Challenge: Detection of Early-Stage Superfi cial Colorectal Lesions . . . . . . . 153
Gen Iinuma, Mototaka Miyake, Kaori Uchida, Yasuaki Arai,
Yukio Muramatsu, and Noriyuki Moriyama
XII Contents
13 Extracolonic Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Francesca Turini, Francesca Cerri, and Emanuele Neri
14 The Future: Computer-Aided Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
H. Yoshida
15 Quality and Consistency in Reporting CT Colonography . . . . . . . . . . . . . . . . . . . . . . . 191
Abraham H. Dachman, Piotr R. Obara, and Michael E. Zalis
16 Virtual Colonoscopy: Beyond Polyp Detection? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
T. Mang, W. Schima, A. Maier, and P. Pokieser
17 Pictorial Overview of Normal Anatomy, Mimics of Disease,
and Neoplasia Using CT Colonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
J. G. Fletcher, Fargol Booya, and Luis S. Guimaraes
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247