Macari Michael, Bini Edmund J
Department of Radiology, Division of Abdominal Imaging, NYU Medical Center, NYU School of Medicine, 560 First Ave, Suite HW 207, New York, NY 10016, USA.
Radiology. 2005 Dec;237(3):819-33. doi: 10.1148/radiol.2373041717. Epub 2005 Oct 19.
Over the past decade, computed tomographic (CT) colonography (also known as virtual colonoscopy) has been used to investigate the colon for colorectal neoplasia. Numerous clinical and technical advances have allowed CT colonography to advance slowly from a research tool to a viable option for colorectal cancer screening. However, substantial controversy remains among radiologists, gastroenterologists, and other clinicians with regard to the current role of CT colonography in clinical practice. On the one hand, all agree there is much excitement about a noninvasive imaging examination that can reliably depict clinically important colorectal lesions. However, this is tempered by results from several recent studies that show the sensitivity of CT colonography may not be as great when performed and the images interpreted by radiologists without expertise and training. The potential to miss important lesions exists; moreover, if polyps cannot be differentiated from folds and residual fecal matter, unnecessary colonoscopy will be performed. In this review, current issues will be discussed regarding colon cancer and the established and reimbursed strategies to screen for it and the past, current, and potential future role of CT colonography.
在过去十年中，计算机断层扫描（CT）结肠成像（也称为虚拟结肠镜检查）已被用于检查结肠以筛查结直肠肿瘤。众多临床和技术进步使得CT结肠成像从一种研究工具逐渐缓慢发展成为结直肠癌筛查的可行选择。然而，放射科医生、胃肠病学家和其他临床医生对于CT结肠成像在临床实践中的当前作用仍存在大量争议。一方面，所有人都认同一种能够可靠描绘临床上重要结直肠病变的非侵入性成像检查令人兴奋。然而，近期多项研究结果对此有所缓和，这些研究表明，若由缺乏专业知识和培训的放射科医生进行CT结肠成像检查并解读图像，其敏感性可能没那么高。存在漏诊重要病变的可能性；此外，如果息肉无法与褶皱及残留粪便区分开来，就会进行不必要的结肠镜检查。在本综述中，将讨论有关结肠癌以及已确立且可报销的筛查策略的当前问题，以及CT结肠成像的过去、当前和潜在的未来作用。
