Cadi Mehdi, Cuenod Charles André, Grenier Philippe A, Saltel Aurélien, Abdulbaki Mohamed, Manceau Gilles, Karoui Mehdi
Department of Radiology, Paris Cité University, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France.
Radiologie Paris Ouest - Imagerie Cardinet, Neuilly-sur-Seine, France.
Insights Imaging. 2025 Jul 31;16(1):160. doi: 10.1186/s13244-025-02038-x.
Computed tomography colonography (CTC), also known as virtual colonoscopy, is a well-tolerated, minimally invasive and effective procedure. Used for over two decades and supported by extensive studies and meta-analyses, CTC has demonstrated performance comparable to that of optical colonoscopy (OC). However, CTC remains generally underutilized in many countries, including the United States of America; in contrast, in some countries, such as the United Kingdom, it is widely used. CTC requires bowel preparation with laxative and fecal contrast-agent tagging, followed by colonic distension with low-pressure, automated, CO insufflation. It enables detailed image analysis with postprocessing software and is highly sensitive and specific for detecting cancers and significant benign precursors ≥ 10 mm (adenomatous and sessile-serrated polyps) years before potential malignant transformation. After reviewing the state of the art of CTC acquisition, analysis and reporting, we wrote this article to update the new, potential and emerging CTC indications. CTC is increasingly used after incomplete OC, for undetermined colonic anomalies, in elderly and/or fragile patients or when OC is refused. Recent routine clinical use has broadened CTC's applications, proving its usefulness in local colon-cancer staging, preoperative laparoscopic surgery planning, and selecting patients with severe diverticular disease for elective sigmoidectomy. CRITICAL RELEVANCE STATEMENT: Beyond its excellent performance in detecting advanced adenomas and cancers, CTC provides precise staging of locally advanced tumors, guiding decisions on neoadjuvant therapy, and coupled with contrast-enhanced thoracic-abdominal-pelvic acquisition, enables comprehensive, preoperative evaluation for laparoscopic colectomy. KEY POINTS: CT colonography (CTC) and optical colonoscopy (OC) are similarly able to detect advanced adenomas (≥ 10 mm) and early-stage colorectal cancer. CTC enables a "one-stop shop" examination for laparoscopic surgery planning, with precise localization and detailed vascular mesenteric mapping. With the rise of neoadjuvant treatments for advanced colorectal cancer, CTC may become pivotal in radiological staging.
计算机断层结肠成像（CTC），也称为虚拟结肠镜检查，是一种耐受性良好、微创且有效的检查方法。CTC已应用二十多年，有大量研究和荟萃分析作为支撑，其表现已证明与光学结肠镜检查（OC）相当。然而，包括美国在内的许多国家，CTC的使用普遍不足；相比之下，在一些国家，如英国，它被广泛应用。CTC需要用泻药进行肠道准备并使用粪便造影剂标记，随后通过低压、自动二氧化碳充气使结肠扩张。它能够通过后处理软件进行详细的图像分析，对于在潜在恶性转化前数年检测出癌症以及直径≥10毫米的重要良性前驱病变（腺瘤性息肉和无蒂锯齿状息肉）具有高度敏感性和特异性。在回顾了CTC采集、分析和报告的技术现状后，我们撰写本文以更新新的、潜在的和新兴的CTC适应症。在OC检查不完全、结肠异常情况不明、老年和/或体弱患者或患者拒绝OC检查时，越来越多地使用CTC。近期的常规临床应用拓宽了CTC的用途，证明其在局部结肠癌分期、术前腹腔镜手术规划以及选择严重憩室病患者进行择期乙状结肠切除术方面的有用性。关键相关性声明：除了在检测高级别腺瘤和癌症方面表现出色外，CTC还能对局部晚期肿瘤进行精确分期，指导新辅助治疗决策，并且结合增强型胸腹部盆腔采集，能够为腹腔镜结肠切除术进行全面的术前评估。要点：CT结肠成像（CTC）和光学结肠镜检查（OC）在检测高级别腺瘤（≥10毫米）和早期结直肠癌方面同样有效。CTC能够为腹腔镜手术规划提供“一站式”检查，具有精确的定位和详细的血管肠系膜映射。随着晚期结直肠癌新辅助治疗的兴起，CTC在放射学分期中可能变得至关重要。
