Kim Young Sun, Kim Nayoung, Kim Soo Young, Cho Kyoung Soo, Park Min Jung, Choi Seung Ho, Lim Seon Hee, Yim Jeong Yoon, Cho Kyung Ran, Kim Chung Hyeon, Kim Dong Hee, Kim Sun Sin, Kim Jeong Hoon, Choi Byung Inhn, Jung Hyun Chae, Song In Sung, Shin Chan Soo, Cho Sang-Heon, Oh Byung-Hee
Seoul National University Hospital, Healthcare System Gangnam Center, Healthcare Research Institute Seoul, Korea.
J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 2):e49-57. doi: 10.1111/j.1440-1746.2007.05060.x. Epub 2007 Jul 20.
The purpose of this study was to evaluate extracolonic findings that could be encountered with computed tomography colonography (CTC) using intravenous (IV) contrast material in an asymptomatic screening population.
Intravenous contrast medium-enhanced CTC was performed in 2230 asymptomatic adults (mean age, 57.5 years). Axial images were prospectively examined for extracolonic lesions. These findings were classified into three categories: potentially important findings, likely unimportant findings, and clinically unimportant findings. Potentially important extracolonic findings were defined as those which required immediate further diagnostic studies and treatment. Clinical and radiologic follow up, missed lesions and clinical outcomes were assessed using medical records (mean duration of follow up, 1.6 years).
A total of 115 new potentially important findings in 5.2% of subjects (115/2230) were found. Subsequent medical or surgical intervention was performed in 2.0% (45/2230). New extracolonic cancer was detected in 0.5% (12/2230), and the majority of them (83.3%) were not metastasized. Computed tomography colonography missed eight potentially important extracolonic findings in eight subjects (0.4%, 8/2230): 0.8-cm early-stage prostatic cancer, six adrenal mass and one intraductal papillary mucinous tumor. There were no severe life-threatening complications related to contrast medium.
Intravenous contrast-enhanced CTC could safely detect asymptomatic early-stage extracolonic malignant diseases without an unreasonable number of additional work-ups, thus reducing their morbidity or mortality.
本研究旨在评估在无症状筛查人群中，使用静脉注射（IV）造影剂的计算机断层结肠成像（CTC）可能发现的结肠外表现。
对2230名无症状成年人（平均年龄57.5岁）进行静脉造影剂增强CTC检查。对轴向图像进行前瞻性检查以发现结肠外病变。这些发现被分为三类：潜在重要发现、可能不重要发现和临床不重要发现。潜在重要的结肠外发现被定义为那些需要立即进行进一步诊断研究和治疗的发现。使用病历评估临床和影像学随访、漏诊病变及临床结局（平均随访时间1.6年）。
在5.2%的受试者（115/2230）中总共发现了115个新的潜在重要发现。2.0%（45/2230）的受试者随后接受了医学或手术干预。新发现结肠外癌症的比例为0.5%（12/2230），其中大多数（83.3%）没有发生转移。计算机断层结肠成像在8名受试者中漏诊了8个潜在重要的结肠外发现（0.4%，8/2230）：0.8厘米的早期前列腺癌、6个肾上腺肿块和1个导管内乳头状黏液性肿瘤。没有与造影剂相关的严重危及生命的并发症。
静脉造影剂增强CTC能够安全地检测无症状的早期结肠外恶性疾病，而无需进行过多额外检查，从而降低其发病率或死亡率。
