1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
AJR Am J Roentgenol. 2013 Oct;201(4):787-94. doi: 10.2214/AJR.12.9225.
Cathartic bowel preparation is a major barrier for colorectal cancer screening. We examined noncathartic CT colonography (CTC) quality and performance using four similar bowel-tagging regimens in an asymptomatic screening cohort.
This prospective study included 564 asymptomatic subjects who underwent noncathartic CTC without dietary modification but with 21 g of barium with or without iodinated oral contrast material (four regimens). The quality of tagging with oral agents was evaluated. A gastrointestinal radiologist evaluated examinations using primary 2D search supplemented by electronic cleansing (EC) and 3D problem solving. Results were compared with complete colonoscopy findings after bowel purgation and with retrospective unblinded evaluation in 556 of the 564 (99%) subjects.
Of the 556 subjects, 7% (37/556) and 3% (16/556) of patients had 52 and 20 adenomatous polyps ≥ 6 and ≥ 10 mm, respectively. The addition of iodine significantly improved the percentage of labeled stool (p ≤ 0.0002) and specificity (80% vs 89-93%, respectively; p = 0.046). The overall sensitivity of noncathartic CTC for adenomatous polyps ≥ 6 mm was 76% (28/37; 95% CI, 59-88%), which is similar to the sensitivity of the iodinated regimens with most patients (sensitivity: 231 patients, 74% [14/19; 95% CI, 49-91%]; 229 patients, 80% [12/15; 95% CI, 52-96%]). The negative predictive value was 98% (481/490), and the lone cancer was detected (0.2%, 1/556). EC was thought to improve conspicuity of 10 of 21 visible polyps ≥ 10 mm.
In this prospective study of asymptomatic subjects, the per-patient sensitivity of noncathartic CTC for detecting adenomas ≥ 6 mm was approximately 76%. Inclusion of oral iodine contrast material improves examination specificity and the percentage of labeled stool. EC may improve polyp conspicuity.
通便肠道准备是结直肠癌筛查的主要障碍。我们在无症状筛查队列中使用四种相似的肠道标记方案，检查非通便 CT 结肠成像术（CTC）的质量和性能。
这项前瞻性研究纳入了 564 名无症状受试者，他们接受了非通便 CTC 检查，没有饮食改变，但使用了 21 g 钡剂和/或碘口服对比剂（四种方案）。评估了口服药物标记的质量。一位胃肠放射科医生使用主要的 2D 搜索补充电子清洁（EC）和 3D 问题解决来评估检查结果。结果与肠道灌洗后的全结肠镜检查结果以及 564 名（99%）受试者中的 556 名的回顾性非盲评估进行了比较。
在 556 名受试者中，7%（37/556）和 3%（16/556）的患者分别有 52 个和 20 个≥6mm 和≥10mm 的腺瘤性息肉。添加碘显著提高了标记粪便的百分比（p ≤ 0.0002）和特异性（分别为 80%和 89-93%；p = 0.046）。非通便 CTC 对≥6mm 腺瘤性息肉的总体敏感性为 76%（28/37；95%可信区间，59-88%），与碘剂方案的大多数患者的敏感性相似（敏感性：231 例患者，74%[14/19；95%可信区间，49-91%]；229 例患者，80%[12/15；95%可信区间，52-96%]）。阴性预测值为 98%（481/490），唯一的癌症是检测到的（0.2%，1/556）。EC 被认为改善了 21 个可见息肉≥10mm 的 10 个的可见度。
在这项对无症状受试者的前瞻性研究中，非通便 CTC 检测≥6mm 腺瘤的个体敏感性约为 76%。口服碘对比剂的加入可提高检查的特异性和标记粪便的百分比。EC 可能会提高息肉的可见度。
