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computed tomographic colonography:Hope or hype?

World Journal of Gastroenterology 2010年第8期16卷 915-920页

作者： Otto Schiueh-Tzang Lin Digestive Diseases Institute Virginia Mason Medical Center Department of Medicine University of Washington School of Medicine

computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique,test characteristics,acceptance,safety,cost-effectiveness,follow-up strategy,and extracolonic findings. In summary,CTC technique is still evolving,and further research is needed to clarify the role of automated colonic insufflation,smooth-muscle relaxants,intravenous and oral contrast,soft-ware rendering,and patient positioning. Currently,full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%,with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy,especially in patients who have never undergone either procedure. CTC is generally safe,although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness,most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present,the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today,in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue,with multi-detector row CT scanners allowing thinner collimation and higher reso-lution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armame

关键词： computed tomographic colonography Colonoscopy Colonic neoplasms Cancer screening Colonic polyps

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Evaluation of contrast-enhanced computed tomographic colonography in detection of local recurrent colorectal cancer

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World Journal of Gastroenterology 2006年第1期12卷 123-126页

作者： Yau-Tong You Chung-Rong Chang Chien Jeng-Yi Wang Koon-Kwan Ng Jinn-Shiun Chen Reiping Tang Jy-Ming Chiang Chien-Yuh Yeh Pao-Shiu Hsieh Division of Colon and Rectal Surgery Chang Gung Memorial HospitalLin-KouTaiwanChina Division of Colon and Rectal Surgery Chang Gung Memorial HospitalJia-YiTaiwanChina Department of Radiology Chang Gung Memorial HospitalKee-LungTaiwanChina

AIM： TO evaluate the diagnostic accuracy, sensitivity, specificity of contrast-enhanced computed tomographic colonography in detecting local recurrence of colorectal cancer. METHODS： From January 2000 to December 2004, 434 patients after potentially curative resection for invasive colorectal cancer were followed up for a period ranging from 20 to 55 mo. Eighty of the four hundred and thirty-four patients showing strong clinical evidence for recurring colorectal cancer during the last followup were enrolled in this study. Each patient underwent contrast-enhanced computed tomographic colonography and colonoscopy on the same day. Any lesions, biopsies, identified during the colonoscopic examination, immediate complications and the duration of the procedure were recorded. The results of contrast-enhanced computed tomographic colonography were evaluated by comparing to those of colonoscopy, surgical finding, and clinical follow-up. RESULTS： Contrast-enhanced computed tomographic colonography had a sensitivity of 100%, a specificity of 83% and an overall accuracy of 94% in detecting local recurrent colorectal cancer. CONCLUSION： Conventional colonoscopy and contrastenhanced tomographic colonography can complement each other in detecting local recurrence of colorectal cancer.

关键词： computed tomographic colonography Recurrent colorectal cancer

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Extracolonic findings of computed tomographic colonography in Koreans

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World Journal of Gastroenterology 2009年第12期15卷 1487-1492页

作者： Sung Keun Park Dong Il Park Sun-Young Lee Sang Kil Lee Young-Ho Kim Soon Jin Lee Jeong-Sik Byeon Kyu Chan Huh Ki-Nam Shim Department of Medicine Sungkyunkwan University School of MedicineKangbuk Samsung Hospital 108Pyung-dongJongro-guSeoul 110-746South Korea Department of Internal Medicine Konkuk University School of MedicineSeoul 110-746South Korea Department of Internal Medicine Yonsei University College of MedicineSeoul 110-746South Korea Departments of Medicine Samsung Medical CenterSungkyunkwan University School of MedicineSeoul110-746South Korea Departments of Radiology Samsung Medical CenterSungkyunkwan University School of MedicineSeoul110-746South Korea Department of Internal Medicine Ulsan University College of MedicineAsan Medical CenterSeoul110-746South Korea Department of Internal Medicine Konyang University School of MedicineDaejon 302-718South Korea Department of Internal Medicine Ewha Womans University School of MedicineSeoul 110-746South Korea

AIM:To determine the frequency and characteristics of extracolonic lesions detected using computed tomographic(CT)***:The significance of extracolonic lesions was classified as high,intermediate,or *** records were reviewed to establish whether further investigations were carried out pertaining to the extracolonic lesions that were detected by CT ***:A total of 920 cases from 7 university hospitals were included,and 692 extracolonic findings were found in 532(57.8%)*** 692 extracolonic findings,60 lesions(8.7%)were highly significant,250(36.1%)were of intermediate significance,and 382(55.2%)were of low *** colonography revealed fewer extracolonic findings in subjects who were without symptoms(Pcolonography with no contrast enhancement(P=0.005).CT colonography with contrast enhancement showed higher cost-effectiveness in detecting highly significant extracolonic lesions in older subjects and in subjects with ***:Most of the extracolonic findings detected using CT colonography were of less significant *** role of CT colonography would be optimized if this procedure was performed with contrast enhancement in symptomatic older subjects.

关键词： computed tomographic colonography Extracolonic lesion Cost Contrast enhancement Clinical availability

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Multi-scale characterizations of colon polyps via computed tomographic colonography

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Visual Computing for Industry,Biomedicine,and Art 2019年第1期2卷 245-256页

作者： Weiguo Cao Marc J.Pomeroy Yongfeng Gao Matthew A.Barish Almas F.Abbasi Perry J.Pickhardt Zhengrong Liang The Department of Radiology Stony Brook UniversityStony BrookNY 11794USA The Departments of Radiology and Biomedical Engineering Stony Brook UniversityStony BrookNY 11794USA The Department of Radiology School of MedicineUniversity of WisconsinMadisonWI 53792USA

Texture features have played an essential role in the field of medical imaging for computer-aided *** gray-level co-occurrence matrix(GLCM)-based texture descriptor has emerged to become one of the most successful feature sets for these *** study aims to increase the potential of these features by introducing multi-scale analysis into the construction of GLCM texture *** this study,we first introduce a new parameter-stride,to explore the definition of *** we propose three multi-scaling GLCM models according to its three parameters,(1)learning model by multiple displacements,(2)learning model by multiple strides(LMS),and(3)learning model by multiple *** models increase the texture information by introducing more texture patterns and mitigate direction sparsity and dense sampling problems presented in the traditional Haralick *** further analyze the three parameters,we test the three models by performing classification on a dataset of 63 large polyp masses obtained from computed tomography colonoscopy consisting of 32 adenocarcinomas and 31 benign ***,the proposed methods are compared to several typical GLCM-texture descriptors and one deep learning *** obtains the highest performance and enhances the prediction power to 0.9450 with standard deviation 0.0285 by area under the curve of receiver operating characteristics score which is a significant improvement.

关键词： Colon cancer computed tomographic colonography Polyp characterization Texture feature

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computed tomography colonography in 2014:An update on technique and indications

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World Journal of Gastroenterology 2014年第45期20卷 16858-16867页

作者： Andrea Laghi Department of Radiological Sciences Oncology and Pathology Sapienza - Università di Roma I.C.O.T.Hospital

Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and polyps. This examination technique is less invasive than colonoscopy (CS), easy to perform, and standardized. Reduced bowel preparation and colonic distention using carbon dioxide favor patient compliance. Widespread implementation of a new image reconstruction algorithm has minimized radiation exposure, and the use of dedicated software with enhanced views has enabled easier image interpretation. Integration in the routine workflow of a computer-aided detection algorithm reduces perceptual errors, particularly for small polyps. Consolidated evidence from the literature shows that the diagnostic performances for the detection of CRC and large polyps in symptomatic and asymptomatic individuals are similar to CS and are largely superior to barium enema, the latter of which should be strongly discouraged. Favorable data regarding CTC performance open the possibility for many different indications, some of which are already supported by evidence-based data: incomplete, failed, or unfeasible CS; symptomatic, elderly, and frail patients; and investigation of diverticular disease. Other indications are still being debated and, thus, are recommended only if CS is unfeasible: the use of CTC in CRC screening and in surveillance after surgery for CRC or polypectomy. In order for CTC to be used appropriately, contraindications such as acute abdominal conditions (diverticulitis or the acute phase of inflammatory bowel diseases) and surveillance in patients with a long-standing history of ulcerative colitis or Crohn’s disease and in those with hereditary colonic syndromes should not be overlooked. This will maximize the benefits of the technique and minimize potential sources of frustration or disappointment for both referring clinicians and patients.

关键词： computed tomographic colonography Virtual colonoscopy computed tomographic colonography technique computed tomographic colonography neoplasm computed tomographic colonography polyp computed tomographic colonography indications computed tomographic colonography colorectal cancer screening computed tomographic colonography diverticular disease computed tomographic colonography surveillance

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CT colonography in the diagnosis and management of colorectal cancer:Emphasis on pre-and post-surgical evaluation

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World Journal of Gastroenterology 2014年第8期20卷 2014-2022页

作者： Nurhee Hong Seong Ho Park Department of Radiology and Research Institute of Radiology University of Ulsan College of MedicineAsan Medical CenterSeoul 138-736South Korea

This article addresses the use of computed tomographic colonography (CTC) for the diagnosis and management of colorectal cancer, focusing on presurgical evaluation of the colon proximal to an occlusive cancer and surveillance after cancer resection surgery. The key evidences accumulated in the literature and future work needed are summarized. CTC is a technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer, which prevents colonoscopic examination past the occlusion, either before or after metallic stent placement. The high sensitivity of CTC for detecting cancers and advanced adenomas in the proximal colon can help prevent additional surgical procedures in patients showing negative results. However, the accuracy of CTC for distinguishing intramural cancers from adenomas is low, and the technique is limited in guiding management when a medium-sized lesion that do not show invasive features such as pericolic extension or nodal metastasis is found in the proximal colon. A maximal diameter ≥ 15 mm has been proposed as a criterion for surgical removal of proximal lesions. However, this needs to be verified in a larger cohort. In addition, the influence of presurgical CTC results on the current post-cancer resection colonic surveillance timeline remains to be determined. CTC can be readily added to the routine abdominopelvic CT in the form of contrast-enhanced CTC, which can serve as an effective stand-alone tool for post-cancer resection surveillance of both the colorectum and extracolonic organs. Although the accuracy of CTC has been demonstrated, its role in the current colonoscopy-based postoperative colonic surveillance protocols remains to be determined. Readers of CTC also need to be knowledgeable on the colonic lesions that are unique to the postoperative colon.

关键词： computed tomographic colonography Colonic cancer Rectal cancer Surgery Colonoscopy

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