Florie Jasper, Jensch Sebastiaan, Nievelstein Rutger A J, Bartelsman Joep F, Baak Lubbertus C, van Gelder Rogier E, Haberkorn Brigitte, van Randen Adrienne, van der Ham Michiel M, Snel Pleun, van der Hulst Victor P M, Bossuyt Patrick M M, Stoker Jaap
Department of Radiology, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
Radiology. 2007 Apr;243(1):122-31. doi: 10.1148/radiol.2431052088. Epub 2007 Feb 28.
To prospectively evaluate the diagnostic performance of magnetic resonance (MR) colonography by using limited bowel preparation in patients with polyps of 10 mm or larger in diameter in a population at increased risk for colorectal cancer, with optical colonoscopy as the reference standard.
The institutional review boards of all three hospitals approved the study. All patients provided written informed consent. In this multicenter study, patients undergoing colonoscopy because of a personal or family history of colorectal cancer or adenomatous polyps were included. Two blinded observers independently evaluated T1- and T2-weighted MR colonographic images obtained with limited bowel preparation (bright-lumen fecal tagging) for the presence of polyps. The limited bowel preparation consisted of a low-fiber diet, with ingestion of lactulose and an oral gadolinium-based contrast agent (with all three major meals) starting 48 hours prior to imaging. Results were verified with colonoscopic outcomes. Patient sensitivity, patient specificity, polyp sensitivity, and interobserver agreement for lesions of 10 mm or larger were calculated for both observers individually and combined.
Two hundred patients (mean age, 58 years; 128 male patients) were included; 41 patients had coexistent symptoms. At colonoscopy, 12 patients had 22 polyps of 10 mm or larger. Per-patient sensitivity was 58% (seven of 12) for observer 1, 67% (eight of 12) for observer 2, and 75% (nine of 12) for both observers combined for polyps of 10 mm or larger. Per-patient specificity was 95% (178 of 188) for observer 1, 97% (183 of 188) for observer 2, and 93% (175 of 188) for both observers combined. Per-polyp sensitivity was 55% (12 of 22) for observer 1, 50% (11 of 22) for observer 2, and 77% (17 of 22) for both observers combined. Interobserver agreement was 93% for identification of patients with lesions of 10 mm or larger.
In patients at increased risk for colorectal cancer, specificity of MR colonography by using limited bowel preparation was high, but sensitivity was modest.
以光学结肠镜检查为参考标准，前瞻性评估在结直肠癌风险增加人群中，对直径10mm及以上息肉患者采用有限肠道准备的磁共振（MR）结肠成像的诊断性能。
所有三家医院的机构审查委员会均批准了该研究。所有患者均提供了书面知情同意书。在这项多中心研究中，纳入了因个人或家族结直肠癌或腺瘤性息肉病史而接受结肠镜检查的患者。两名盲法观察者独立评估通过有限肠道准备（亮腔粪便标记）获得的T1加权和T2加权MR结肠成像图像中息肉的存在情况。有限肠道准备包括低纤维饮食，在成像前48小时开始摄入乳果糖和口服钆基对比剂（三餐均服用）。结果通过结肠镜检查结果进行验证。分别计算并汇总两名观察者对10mm及以上病变的患者敏感性、患者特异性、息肉敏感性和观察者间一致性。
纳入200例患者（平均年龄58岁；男性患者128例）；41例患者有共存症状。在结肠镜检查中，12例患者有22个直径10mm及以上的息肉。观察者1对10mm及以上息肉的患者敏感性为58%（12例中的7例），观察者2为67%（12例中的8例），两名观察者汇总为75%（12例中的9例）。观察者1的患者特异性为95%（188例中的178例），观察者2为97%（188例中的183例），两名观察者汇总为93%（188例中的175例）。观察者1的息肉敏感性为55%（22例中的12例），观察者2为50%（22例中的11例），两名观察者汇总为77%（22例中的17例）。对于识别10mm及以上病变患者，观察者间一致性为93%。
在结直肠癌风险增加的患者中，采用有限肠道准备的MR结肠成像特异性高，但敏感性一般。
