Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps

Iannaccone, Riccardo; Laghi, Andréa; Catalano, Carlo; Mangiapane, Filippo; Lamazza, Antonietta; Schillaci, Alberto; Sinibaldi, G; Murakami, Takamichi; Sammartino, Paolo; Hori, Masatoshi; Piacentini, Francesca; Nofroni, Italo; Stipa, Vincenzo; Passariello, Roberto

doi:10.1053/j.gastro.2004.08.025

Cited by 266 publications

(169 citation statements)

References 56 publications

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“…Research into noncathartic approaches to minimize the bowel preparation is underway, but this technique has not yet been validated in a multicenter screening trial. [159][160][161] However, under conditions where same-day or next-day referral for colonoscopy would be possible, one drawback of noncathartic CTC is that a cathartic bowel preparation would still be required prior to removal of polyps.…”

Section: Ctcmentioning

confidence: 99%

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Levin

Lieberman

McFarland

et al. 2008

CA: A Cancer Journal for Clinicians

1,567

916

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In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening. (CA Cancer J Clin 2008;58:130-160.)

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Section: Ctcmentioning

confidence: 99%

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Levin

Lieberman

McFarland

et al. 2008

CA: A Cancer Journal for Clinicians

1,567

916

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“…The first report of the use of iodinated contrast alone without laxatives was by Iannaccone et al [8]. They described use of Gastrografin taken with a low-fibre diet at a dose of 100 ml per day for 2 days before CT.…”

Section: Discussionmentioning

confidence: 99%

Laxative-free CT colonography

Slater¹,

Betts²,

DʼCosta³

2012

The British Journal of Radiology

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Objectives: The aim of this study was to determine if the introduction of faecal tagging to CT colonography (CTC) made the examination easier to tolerate or reduced the number of false-positives. Methods: Our department changed bowel preparation for CT colonography from Picolax (Ferring Pharmaceuticals Ltd, London, UK) to Gastrografin® (Bracco Diagnostics Inc, Princeton, NJ) only with a modified diet. Questionnaires were given to a subgroup of patients within these cohorts. The numbers of false-positives were compared between two cohorts before and after this change. false-positives were defined as lesions reported on CT that were not confirmed by subsequent endoscopic examination. Polyps were matched if they were in the same or adjacent segments, and were within 5 mm of the reported size. Results: 412 patients were identified from the Picolax cohort, and 116 from the Gastrografin cohort. 62 patients in each group completed questionnaires. Gastrografin produced less diarrhoea; 34% had five or more bowel motions in the previous day and night, compared with 77% for Picolax (p<0.001), although more patients found drinking it unpleasant compared with Picolax (85% reported drinking Picolax as “easy” vs 61% for Gastrografin; p=0.002). Picolax produced more non-diagnostic examinations, although this difference was not statistically significant. There was not a significant reduction in the numbers of false-positives (2 out of 112 for Gastrografin group, 14 out of 389 for the Picolax group; p=0.54). Conclusion: Switching from Picolax to Gastrografin as a CTC preparation technique produced less diarrhoea, but did not reduce the number of false-positives.

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“…Although the use of laxative ftCTC cases may provide excellent conditions for the application of automated imageprocessing methods, the requirement of laxative bowel cleansing is also considered to be one of the major barriers for patient adherence to colorectal cancer screening guidelines (Gluecker et al (2003); Beebe et al (2007)). Efforts to minimize this burden are under investigation and include, for example, structured low-fiber diets and complete elimination of the laxative dose (Lefere et al (2002); Zalis et al (2003); Iannaccone et al (2004)). It is important to note that the CTC outcome of these protocols can vary greatly, and that automated image-processing methods that have been designed to rely on the special characteristics of a specific type of bowel preparation may fail with other types of clinical cases.…”

Section: Discussionmentioning

confidence: 99%

Adaptive correction of the pseudo-enhancement of CT attenuation for fecal-tagging CT colonography

Näppi

Yoshida

2008

Medical Image Analysis

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In fecal-tagging CT colonography (ftCTC), orally administered positive-contrast tagging agents are used for opacifying residual bowel materials to facilitate reliable detection of colorectal lesions. However, tagging agents that have high radio-density tend artificially to elevate the observed CT attenuation of nearby materials to that of tagged materials on a standard Hounsfield unit (HU) scale due to the pseudo-enhancement effect. We developed an image-based adaptive density-correction (ADC) method for minimizing pseudo-enhancement in ftCTC data. After the correction, we can confidently assume that soft-tissue materials and air are represented by CT attenuations on the standard HU scale, whereas higher CT attenuations indicate tagged materials. The ADC method was optimized for ftCTC by use of an anthropomorphic phantom filled partially with 300 HU, 600 HU, and 900 HU tagging concentrations. The effect of ADC on ftCTC was assessed visually and quantitatively by comparison of the accuracy of computer-aided detection (CAD) without and with the use of the ADC method in two different types of clinical ftCTC databases: 20 laxative ftCTC cases with 24 polyps, and 23 reduced-preparation ftCTC cases with 28 polyps. Visual evaluation suggested that ADC minimizes the observed pseudo-enhancement in phantoms and clinical cases. Quantitative evaluation suggested that ADC yields a significant improvement in the CAD accuracy in clinical databases. The results indicate that ADC is a useful pre-processing method for automated image processing applications in CTC.

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Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps

Cited by 266 publications

References 56 publications

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

Laxative-free CT colonography

Adaptive correction of the pseudo-enhancement of CT attenuation for fecal-tagging CT colonography

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