Department of Radiology and Research Institute of Radiology and Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Gu, Seoul 138-040, Korea.
Radiology. 2010 Mar;254(3):774-82. doi: 10.1148/radiol.09090842.
To evaluate the feasibility of using computed tomographic (CT) colonography for preoperative examination of the proximal colon after metallic stent placement in patients with acute colon obstruction caused by colorectal cancer.
Institutional review board approval was obtained, and patient informed consent was waived. Fifty patients (mean age +/- standard deviation, 58.5 years +/- 11.7), who demonstrated no postprocedural complication after successful placement of self-expandable metallic stents to treat acute colon obstruction caused by cancer, underwent CT colonography 1-43 days (median, 5 days) after stent placement. CT colonography was performed after cathartic preparation by using magnesium citrate (n = 20) or sodium phosphate (n = 3), combined with oral bisacodyl, or by using polyethylene glycol (n = 27). Fecal/fluid tagging was achieved by using 100 mL of meglumine diatrizoate. The colon was distended by means of pressure-monitored CO(2) insufflation. The sensitivity and specificity of CT colonography in evaluating the colon proximal to the stent and CT colonography-related complications were assessed. The 95% confidence intervals (CIs) were calculated for proportional data.
Per-lesion and per-patient sensitivities of CT colonography for lesions 6 mm or larger in diameter in the colon proximal to the stent were 85.7% (12 of 14 lesions; 95% CI: 58.8%, 97.2%) and 90% (nine of 10 patients; 95% CI: 57.4%, 99.9%), respectively. CT colonography depicted all synchronous cancers (two lesions) and advanced adenomas (five lesions). Per-patient specificity for lesions 6 mm and larger in the proximal colon was 85.7% (18 of 21 patients; 95% CI: 64.5%, 95.9%). CT colonography did not generate any false diagnosis of synchronous cancer. False-positive findings at CT colonography did not result in a change in surgical plan for any patients. No CT colonography-associated stent dislodgment/migration or colonic perforation occurred in any patient (95% CI: 0%, 6.2%).
CT colonography is a safe and useful method for preoperative examination of the proximal colon after metallic stent placement in patients with acute colon obstruction caused by cancer. (c) RSNA, 2010.
评估在因结直肠癌导致急性结肠梗阻的患者中，使用计算机断层（CT）结肠成像术对金属支架置入术后近端结肠进行术前检查的可行性。
本研究获得了机构审查委员会的批准，并豁免了患者的知情同意。50 例患者（平均年龄±标准差，58.5 岁±11.7 岁）在成功放置自膨式金属支架以治疗因癌症引起的急性结肠梗阻后，未出现术后并发症，在支架置入后 1-43 天（中位数，5 天）进行 CT 结肠成像术。在使用柠檬酸镁（n=20）或磷酸钠（n=3）进行通便准备后，结合口服比沙可啶或聚乙二醇（n=27）进行 CT 结肠成像术。使用 100 mL 泛影葡胺进行粪便/液体标记。通过压力监测的 CO2 充气使结肠扩张。评估 CT 结肠成像术评估支架近端结肠的准确性和 CT 结肠成像术相关并发症。计算比例数据的 95%置信区间（CI）。
支架近端结肠直径≥6mm 病变的 CT 结肠成像术的病变检出率和患者检出率分别为 85.7%（14 个病变中的 12 个；95%CI：58.8%，97.2%）和 90%（10 个患者中的 9 个；95%CI：57.4%，99.9%）。CT 结肠成像术显示了所有的同步癌（2 个病变）和高级别腺瘤（5 个病变）。支架近端结肠直径≥6mm 病变的患者特异性为 85.7%（21 个患者中的 18 个；95%CI：64.5%，95.9%）。CT 结肠成像术未产生任何同步癌的假阳性诊断。CT 结肠成像术的假阳性结果并未导致任何患者的手术计划发生改变。无支架移位/迁移或结肠穿孔等 CT 结肠成像术相关并发症发生（95%CI：0%，6.2%）。
在因结直肠癌导致急性结肠梗阻的患者中，金属支架置入术后使用 CT 结肠成像术对支架近端结肠进行术前检查是一种安全、有效的方法。（c）RSNA，2010 年。
