计算机断层扫描虚拟结肠镜检查用于筛查无症状成年人的结直肠肿瘤。

Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.

作者信息

Pickhardt Perry J, Choi J Richard, Hwang Inku, Butler James A, Puckett Michael L, Hildebrandt Hans A, Wong Roy K, Nugent Pamela A, Mysliwiec Pauline A, Schindler William R

机构信息

Department of Radiology, National Naval Medical Center, Bethesda, Md, USA.

出版信息

N Engl J Med. 2003 Dec 4;349(23):2191-200. doi: 10.1056/NEJMoa031618. Epub 2003 Dec 1.

DOI:10.1056/NEJMoa031618

PMID:14657426

Abstract

BACKGROUND

We evaluated the performance characteristics of computed tomographic (CT) virtual colonoscopy for the detection of colorectal neoplasia in an average-risk screening population.

METHODS

A total of 1233 asymptomatic adults (mean age, 57.8 years) underwent same-day virtual and optical colonoscopy. Radiologists used the three-dimensional endoluminal display for the initial detection of polyps on CT virtual colonoscopy. For the initial examination of each colonic segment, the colonoscopists were unaware of the findings on virtual colonoscopy, which were revealed to them before any subsequent reexamination. The sensitivity and specificity of virtual colonoscopy and the sensitivity of optical colonoscopy were calculated with the use of the findings of the final, unblinded optical colonoscopy as the reference standard.

RESULTS

The sensitivity of virtual colonoscopy for adenomatous polyps was 93.8 percent for polyps at least 10 mm in diameter, 93.9 percent for polyps at least 8 mm in diameter, and 88.7 percent for polyps at least 6 mm in diameter. The sensitivity of optical colonoscopy for adenomatous polyps was 87.5 percent, 91.5 percent, and 92.3 percent for the three sizes of polyps, respectively. The specificity of virtual colonoscopy for adenomatous polyps was 96.0 percent for polyps at least 10 mm in diameter, 92.2 percent for polyps at least 8 mm in diameter, and 79.6 percent for polyps at least 6 mm in diameter. Two polyps were malignant; both were detected on virtual colonoscopy, and one of them was missed on optical colonoscopy before the results on virtual colonoscopy were revealed.

CONCLUSIONS

CT virtual colonoscopy with the use of a three-dimensional approach is an accurate screening method for the detection of colorectal neoplasia in asymptomatic average-risk adults and compares favorably with optical colonoscopy in terms of the detection of clinically relevant lesions.

摘要

背景

我们评估了计算机断层扫描（CT）虚拟结肠镜检查在平均风险筛查人群中检测结直肠肿瘤的性能特征。

方法

共有1233名无症状成年人（平均年龄57.8岁）在同一天接受了虚拟结肠镜检查和光学结肠镜检查。放射科医生使用三维腔内显示在CT虚拟结肠镜检查中初步检测息肉。对于每个结肠段的初次检查，结肠镜检查医生不知道虚拟结肠镜检查的结果，这些结果在随后的任何复查之前才告知他们。以最终的、未设盲的光学结肠镜检查结果作为参考标准，计算虚拟结肠镜检查的敏感性和特异性以及光学结肠镜检查的敏感性。

结果

虚拟结肠镜检查对直径至少10mm的腺瘤性息肉的敏感性为93.8%，对直径至少8mm的息肉为93.9%，对直径至少6mm的息肉为88.7%。光学结肠镜检查对这三种大小息肉的敏感性分别为87.5%、91.5%和92.3%。虚拟结肠镜检查对腺瘤性息肉的特异性，对于直径至少10mm的息肉为96.0%，对于直径至少8mm的息肉为92.2%，对于直径至少6mm的息肉为79.6%。有两个息肉是恶性的；两者均在虚拟结肠镜检查中被检测到，其中一个在虚拟结肠镜检查结果公布之前的光学结肠镜检查中被漏诊。