Wessling Johannes, Domagk Dirk, Lugering Norbert, Schierhorn Sebastian, Heindel Walter, Domschke Wolfram, Fischbach Roman
Department of Clinical Radiology, University of Münster, Münster, Germany.
Scand J Gastroenterol. 2005 Apr;40(4):468-76. doi: 10.1080/00365520510012055.
Early detection of precancerous or malignant lesions may be decisive for prognosis of patients with colorectal cancer. In this prospective feasibility study, multi-detector spiral computed tomography (CT) colonography was compared with conventional colonoscopy for the detection of colorectal polyps.
Seventy-eight patients underwent CT colonography (standard colonoscopy preparation, distension with room air, prone and supine position) immediately before colonoscopy. Sixty-five (83%) were asymptomatic screening subjects, while the rest had symptoms suggestive of colorectal disease. Presence, location, and size of lesions were prospectively assessed. Sensitivity, specificity, and positive and negative predictive values of CT colonography were calculated using conventional colonoscopy as the reference standard.
Conventional colonoscopy was normal in 52 patients. In 26 patients a total of 49 polyps and 3 carcinomas were identified. All three carcinomas and 39 polyps (80%) were identified by CT colonography. Seven of 7 polyps > or = 10 mm (100%), 13 of 16 polyps of 6 to 9 mm (81%), and 19 of 26 polyps < or = 5 mm (73%) in diameter were identified. Fourteen false-positive findings (10 of which were < or = 5 mm in diameter) were related to 8 patients (specificity at the patient level was 86%). In 10 patients, a total of 10 polyps were missed by CT colonography, 7 of which were < or = 5 mm in diameter.
In this feasibility study, multi-detector spiral CT colonography allows accurate detection of polyps > 5 mm in diameter, but at the expense of low specificity in the small size range.
早期发现癌前病变或恶性病变对于结直肠癌患者的预后可能具有决定性意义。在这项前瞻性可行性研究中，对多排螺旋计算机断层扫描（CT）结肠成像与传统结肠镜检查在检测结直肠息肉方面进行了比较。
78例患者在结肠镜检查前立即接受CT结肠成像检查（标准结肠镜检查准备，用室内空气扩张，俯卧位和仰卧位）。65例（83%）为无症状筛查对象，其余有提示结直肠疾病的症状。对病变的存在、位置和大小进行前瞻性评估。以传统结肠镜检查为参考标准，计算CT结肠成像的敏感性、特异性、阳性和阴性预测值。
52例患者的传统结肠镜检查结果正常。26例患者共发现49个息肉和3例癌。所有3例癌和39个息肉（80%）通过CT结肠成像被发现。直径≥10mm的7个息肉中的7个（100%）、6至9mm的16个息肉中的13个（81%）以及直径≤5mm的26个息肉中的19个（73%）被发现。14例假阳性结果（其中10个直径≤5mm）与8例患者有关（患者水平的特异性为86%）。10例患者中，CT结肠成像漏诊了总共10个息肉，其中7个直径≤5mm。
在这项可行性研究中，多排螺旋CT结肠成像能够准确检测直径>5mm的息肉，但代价是在小尺寸范围内特异性较低。
