Munikrishnan Venkatesh, Gillams Alice R, Lees William R, Vaizey Carolynne J, Boulos Paul B
Department of Surgery, Royal Free and University College Medical School, London, United Kingdom.
Dis Colon Rectum. 2003 Oct;46(10):1384-90. doi: 10.1007/s10350-004-6755-2.
Multislice CT colonography is an alternative to colonoscopy. The purpose of this study was to compare multislice CT colonography with colonoscopy in the detection of colorectal polyps and cancers.
Between June 2000 and December 2001, 45 males and 35 females (median age, 68 (29-83) years) with symptoms of colorectal disease were studied prospectively. All patients underwent multislice CT colonography and colonoscopy, and the findings were compared.
Colonoscopy was incomplete in 18 (22 percent) patients because of obstructing lesions or technical difficulty, and multislice CT colonography was unsuccessful in 4 (5 percent) because of fecal residue. Colonoscopy was normal in 26 patients and detected 29 colorectal cancers and 33 polyps in 35 patients, diverticulosis in 16 patients, and colitis in 3 patients. Multislice CT colonography identified 28 of 29 colorectal cancers with one false negative and one false positive (sensitivity, 97 percent; specificity, 98 percent; positive predictive value, 96 percent; negative predictive value, 98 percent). Multislice CT colonography identified all 12 polyps measuring >or=10 mm in diameter (sensitivity, 100 percent), 5 of 6 measuring 6 to 9 mm in diameter (sensitivity, 83 percent), 8 of 15 polyps <or=5 mm (sensitivity, 53 percent), and false-positive for 8 polyps. The overall sensitivity was 74 percent and specificity 96 percent. The positive predictive value for polyps was 88 percent, and the negative predictive value was 90 percent. Multislice CT colonography also detected 5 of 16 patients with diverticulosis (sensitivity, 31 percent; specificity, 98 percent) and colitis in 2 of 3 patients (sensitivity, 67 percent; specificity, 100 percent). In ten (13 percent) patients, extracolonic findings on multislice CT colonography altered management and included five patients with colorectal liver metastases. In 15 (19 percent) patients, there were incidental findings that did not demand further investigation.
The results from this study indicate that the efficacy of multislice CT colonography in the detection of colorectal cancers and polyps >or=6 mm is similar to colonoscopy. Multislice CT colonography allows clinical staging of colorectal cancers, outlines the whole length of the colon in obstructing carcinoma when colonoscopy fails, and can identify extracolonic causes of abdominal symptoms.
多层螺旋CT结肠成像术是结肠镜检查的一种替代方法。本研究的目的是比较多层螺旋CT结肠成像术与结肠镜检查在检测结直肠息肉和癌症方面的效果。
在2000年6月至2001年12月期间，对45名男性和35名女性（年龄中位数为68（29 - 83）岁）有结直肠疾病症状的患者进行前瞻性研究。所有患者均接受了多层螺旋CT结肠成像术和结肠镜检查，并对检查结果进行比较。
由于梗阻性病变或技术困难，18名（22%）患者的结肠镜检查未完成，4名（5%）患者因粪便残留多层螺旋CT结肠成像术检查未成功。26名患者结肠镜检查结果正常，35名患者中结肠镜检查发现29例结直肠癌和33个息肉，16例患者有憩室病，3例患者有结肠炎。多层螺旋CT结肠成像术在29例结直肠癌中识别出28例，1例假阴性和1例假阳性（敏感性97%；特异性98%；阳性预测值96%；阴性预测值98%）。多层螺旋CT结肠成像术识别出所有12个直径≥10mm的息肉（敏感性100%），6个直径6至9mm的息肉中的5个（敏感性83%），15个直径≤5mm的息肉中的8个（敏感性53%），并有8个息肉出现假阳性。总体敏感性为74%，特异性为96%。息肉的阳性预测值为88%，阴性预测值为90%。多层螺旋CT结肠成像术还检测出16例憩室病患者中的5例（敏感性31%；特异性98%）和3例结肠炎患者中的2例（敏感性67%；特异性100%）。在10名（13%）患者中，多层螺旋CT结肠成像术的结肠外检查结果改变了治疗方案，其中包括5例有结直肠癌肝转移的患者。在15名（19%）患者中，有一些偶然发现无需进一步检查。
本研究结果表明，多层螺旋CT结肠成像术在检测结直肠癌和直径≥6mm的息肉方面的效果与结肠镜检查相似。多层螺旋CT结肠成像术可对结直肠癌进行临床分期，在结肠镜检查失败时能勾勒出梗阻性癌患者整个结肠的情况，并可识别腹部症状的结肠外病因。
