Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-Gu, Seoul 138-736, Republic of Korea.
Radiology. 2010 Dec;257(3):697-704. doi: 10.1148/radiol.10100385. Epub 2010 Sep 27.
To determine the accuracy of contrast material-enhanced computed tomographic (CT) colonography for postoperative surveillance in colorectal cancer patients without clinical or laboratory evidence of disease recurrence.
The Institutional Review Board approved this HIPAA-compliant study and waived informed consent. Between January 2006 and December 2007, 742 consecutive patients without clinical or laboratory evidence of recurrence following curative-intent colorectal cancer surgery underwent contrast-enhanced CT colonography. Of these, 548 patients who had subsequent colonoscopy and pathologic confirmation of colonic lesions (reference standard) were included in the colonic analysis. All 742 patients were included in the extracolonic analysis. Sensitivity and specificity of CT colonography for nonanastomotic colonic lesions at least 6 mm in size and anastomotic lesions of any size, including performance according to lesion histologic type, were determined. Diagnostic yields of contrast-enhanced CT colonography for colonic cancers and for extracolonic recurrences were obtained.
CT colonography depicted all six metachronous cancers and one anastomotic recurrence within the colon in six patients (0.8%; 95% confidence interval [CI]: 0.3%, 1.8%]), for per-patient and per-lesion sensitivities of 100% (95% CIs: 64.3%, 100% and 67.8%, 100%, respectively). All cancer lesions within the colon were amenable to additional curative treatment. CT colonography per-patient and per-lesion sensitivity was 81.8% (95% CI: 60.9%, 93.3%) and 80.8% (95% CI: 64.3%, 97.2%), respectively, for advanced neoplasia and 80.0% (95% CI: 68.6%, 88.1%) and 78.5% (95% CI: 68.3%, 88.7%), respectively, for all adenomatous lesions. Negative predictive values for adenocarcinoma, advanced neoplasia, and all adenomatous lesions were 100%, 99.1%, and 97.0%, respectively. CT colonography specificity was 93.1% (95% CI: 90.4%, 95.2%). Contrast-enhanced CT colonography enabled detection of extracolonic recurrences in an additional 11 patients (1.5%; 95% CI: 0.8%, 2.7%).
Contrast-enhanced CT colonography is an accurate and practical surveillance tool following colorectal cancer surgery in patients without clinical or laboratory evidence of recurrence, allowing for simultaneous less-invasive evaluation of both colon and extracolonic organs.
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100385/-/DC1.
确定对比增强 CT 结肠成像术在无临床或实验室证据显示疾病复发的结直肠癌患者术后监测中的准确性。
本研究获得机构审查委员会批准（符合 HIPAA 标准），并豁免了知情同意。2006 年 1 月至 2007 年 12 月，742 例接受根治性结直肠癌手术后无临床或实验室复发证据的连续患者接受了对比增强 CT 结肠成像术检查。其中，548 例患者随后进行了结肠镜检查和结肠病变的病理证实（参考标准），包括在结肠分析中。所有 742 例患者均纳入了结肠外分析。确定了 CT 结肠成像术对至少 6mm 大小的非吻合结肠病变和任何大小吻合病变的准确性，包括根据病变组织学类型的表现。获得了对比增强 CT 结肠成像术对结肠癌和结肠外复发的诊断收益。
CT 结肠成像术在 6 例患者（0.8%；95%置信区间 [CI]：0.3%，1.8%）中显示了所有 6 例同时发生的癌症和 1 例吻合口复发，每位患者和每个病变的敏感性均为 100%（95%CI：64.3%，100%和 67.8%，100%）。结肠内所有癌症病变均可进行额外的治愈性治疗。CT 结肠成像术对晚期肿瘤的每位患者和每个病变的敏感性分别为 81.8%（95%CI：60.9%，93.3%）和 80.8%（95%CI：64.3%，97.2%），对所有腺瘤性病变的敏感性分别为 80.0%（95%CI：68.6%，88.1%）和 78.5%（95%CI：68.3%，88.7%）。腺癌、高级别肿瘤和所有腺瘤性病变的阴性预测值均为 100%、99.1%和 97.0%。CT 结肠成像术的特异性为 93.1%（95%CI：90.4%，95.2%）。对比增强 CT 结肠成像术还能在另外 11 例患者（1.5%；95%CI：0.8%，2.7%）中检测到结外复发。
在无临床或实验室证据显示复发的结直肠癌患者中，增强 CT 结肠成像术是一种准确且实用的监测工具，可同时对结肠和结外器官进行更具侵袭性的评估。
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100385/-/DC1.
