Zusammenfassung
Diese Übersicht stellt die verfügbaren Daten zur CT-Kolographie zusammen und diskutiert sowohl die technischen als auch medizinischen Aspekte der Entwicklung der letzten 10 Jahre. Obwohl prinzipiell gleichermaßen mit CT wie MRT möglich, wird vorwiegend auf die CT-Technik eingegangen. Die Entwicklung der CT-Technik zum sog. Multi-Detektor-Reihen-CT wird dargestellt und der Einfluss unterschiedlicher Untersuchungstechniken (Schichtdicke, Dosis, Patientenvorbereitung, Nachverarbeitung) erläutert.
Die Methode hat eine hohe Sensitivität, Spezifität und einen hohen negativen Vorhersagewert für Polypen ≥ 1 cm, wobei sie bisher unbefriedigend für Polypen < 5 mm abschneidet. Sie ist eine valide Ergänzung bei inkompletter konventioneller Endoskopie sowie eine Alternative zu „Hochrisiko”-Endoskopien. In der Zukunft wird sie möglicherweise eine Alternative zur konventionellen Endoskopie im Rahmen von Screening-Programmen auf kolorektale Karzinome darstellen.
Abstract
This article reviews published data regarding CT colonography and discusses both technical and medical aspects of its development over the last 10 years. Although colonography can be performed using MRI instead of CT, mainly CT aspects are dealt with. The technical development of CT to the current generation of Multi-detector-row-CT is explained, and the influence of various factors (slice thickness, dose, patient preparation, post processing) is discussed.
The method has a high sensitivity and specifity as well as a high negative predictive value for the detection of polyps ≥ 1 cm, but is currently still insufficient in the detection of polyps < 5 mm. It is a valid alternative after incomplete optical colonoscopy and an alternative in patients with “high-risk” for conventional endoscopy. In the future it may become an alternative for conventional endoscopy in screening programms for colorectal cancer.
Schlüsselwörter
CT-Kolonographie - Kolon - Polypen - Screening - Kolonkarzinom
Key words
CT colonography - colon - polyps - screening - colon carcinoma
Literatur
-
1
Fenlon H M, Nunes D P, Schroy P C 3rd. et al .
A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps.
N Engl J Med.
1999;
341 (20)
1496-1503
-
2
Bond J H.
Virtual colonoscopy - promising, but not ready for widespread use.
N Engl J Med.
1999;
341 (20)
1540-1542
-
3
Pickhardt P J, Choi J R, Hwang I. et al .
Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.
N Engl J Med.
2003;
349 (23)
2191-2200
-
4 Vining D J, Gelfand D W. Noninvasive colonoscopy using helical CT scanning, 3D reconstruction, and virtual reality. In: Annual meeting of the Society of Gastrointestinal Radiologists,. Maui; 13. - 18.2.1994
-
5
Johnson C D, Hara A K, Reed J E.
Virtual endoscopy: what’s in a name?.
AJR Am J Roentgenol.
1998;
171 (5)
1201-1202
-
6
Lauenstein T C, Goehde S C, Ruehm S G. et al .
MR colonography with barium-based fecal tagging: initial clinical experience.
Radiology.
2002;
223 (1)
248-254
-
7
Debatin J F, Luboldt W, Bauerfeind P.
Virtual colonoscopy in 1999: computed tomography or magnetic resonance imaging?.
Endoscopy.
1999;
31 (2)
174-179
-
8
Röttgen R, Schröder R J, Lorenz M. et al .
CT-Kolonographie mit dem 16-Zeilen-Detektor zur Diagnostik kolorektaler Neoplasien und entzündlicher Kolonerkrankungen.
Fortschr Röntgenstr.
2003;
175 (10)
1384-1391
-
9
Brambs H J, Juchems M S.
Virtual endoscopy using CT scan.
Min Invas Ther and Allied Technol.
2003;
12 (5)
207-216
-
10
Zalis M E, Perumpillichira J, Del F rate C. et al .
CT colonography: digital subtraction bowel cleansing with mucosal reconstruction initial observations.
Radiology.
2003;
226 (3)
911-917
-
11
Jerebko A K, Summers R M, Malley J D. et al .
Computer-assisted detection of colonic polyps with CT colonography using neural networks and binary classification trees.
Med Phys.
2003;
30 (1)
52-60
-
12
Macari M, Lavelle M, Pedrosa I. et al .
Effect of different bowel preparations on residual fluid at CT colonography.
Radiology.
2001;
218 (1)
274-277
-
13
Ginnerup P edersen B, Moller C hristiansen TE. et al .
Bowel cleansing methods prior to CT colonography.
Acta Radiol.
2002;
43 (3)
306-311
-
14
Taylor S A, Halligan S, Goh V. et al .
Optimizing bowel preparation for multidetector row CT colonography: effect of Citramag and Picolax.
Clin Radiol.
2003;
58 (9)
723-732
-
15
Fletcher J G, Johnson C D, Welch T J. et al .
Optimization of CT colonography technique: prospective trial in 180 patients.
Radiology.
2000;
216 (3)
704-711
-
16
Yee J, Kumar N N, Hung R K. et al .
Comparison of supine and prone scanning separately and in combination at CT colonography.
Radiology.
2003;
226 (3)
653-661
-
17
Bielen D, Thomeer M, Vanbeckevoort D. et al .
Dry preparation for virtual CT colonography with fecal tagging using water-soluble contrast medium: initial results.
Eur Radiol.
2003;
13 (3)
453-458
-
18
Callstrom M R, Johnson C D, Fletcher J G. et al .
CT colonography without cathartic preparation: feasibility study.
Radiology.
2001;
219 (3)
693-698
-
19
Morrin M M, Farrell R J, Kruskal J B. et al .
Utility of intravenously administered contrast material at CT colonography.
Radiology.
2000;
217 (3)
765-771
-
20
Sosna J, Morrin M M, Kruskal J B. et al .
Colorectal neoplasms: role of intravenous contrast-enhanced CT colonography.
Radiology.
2003;
228 (1)
152-156
-
21
Luboldt W, Fletcher J G, Vogl T J.
Colonography: current status, research directions and challenges. Update 2002.
Eur Radiol.
2002;
12 (3)
502-524
-
22
Cohnen M, Poll L J, Puettmann C. et al .
Effective doses in standard protocols for multi-slice CT scanning.
Eur Radiol.
2003;
13 (5)
1148-1153
-
23
Iannaccone R, Laghi A, Catalano C. et al .
Detection of colorectal lesions: lower-dose multi-detector row helical CT colonography compared with conventional colonoscopy.
Radiology.
2003;
229 (3)
775-781
-
24
Iannaccone R, Laghi A, Catalano C. et al .
Feasibility of ultra-low-dose multislice CT colonography for the detection of colorectal lesions: preliminary experience.
Eur Radiol.
2003;
13 (6)
1297-1302
-
25
Cohnen M, Vogt C, Aurich V. et al .
Multi-slice CT-colonography in low-dose technique - Preliminary results.
Fortschr Röntgenstr.
2002;
174 (7)
835-838
-
26
Forbes G M, Mendelson R M.
Patient acceptance of virtual colonoscopy.
Endoscopy.
2000;
32 (3)
274-275
-
27
Ristvedt S L, McFarland E G, Weinstock L B. et al .
Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation.
Am J Gastroenterol.
2003;
98 (3)
578-585
-
28
Svensson M H, Svensson E, Lasson A. et al .
Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease.
Radiology.
2002;
222 (2)
337-345
-
29
Thomeer M, Bielen D, Vanbeckevoort D. et al .
Patient acceptance for CT colonography: what is the real issue?.
Eur Radiol.
2002;
12 (6)
1410-1415
-
30
Taylor S A, Halligan S, Saunders B P. et al .
Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy.
AJR Am J Roentgenol.
2003;
181 (4)
913-921
-
31
Angtuaco T L, Banaad-Omiotek G D, Howden C W.
Differing attitudes toward virtual and conventional colonoscopy for colorectal cancer screening: surveys among primary care physicians and potential patients.
Am J Gastroenterol.
2001;
96 (3)
887-893
-
32
Wessling J, Fischbach R, Meier N. et al .
CT colonography: Protocol optimization with multi-detector row CT-study in an anthropomorphic colon phantom.
Radiology.
2003;
228 (3)
753-759
-
33
Taylor S A, Halligan S, Bartram C I. et al .
Multi-detector row CT colonography: effect of collimation, pitch, and orientation on polyp detection in a human colectomy specimen.
Radiology.
2003;
229 (1)
109-118
-
34
Lui Y W, Macari M, Israel G. et al .
CT Colonography Data Interpretation: Effect of Different Section Thicknesses-Preliminary Observations.
Radiology.
2003;
229 (3)
791-797
-
35
Johnson C D, Toledano A Y, Herman B A. et al .
Computerized tomographic colonography: performance evaluation in a retrospective multicenter setting.
Gastroenterology.
2003;
125 (3)
688-695
-
36
Pineau B C, Paskett E D, Chen G J. et al .
Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps.
Gastroenterology.
2003;
125 (2)
304-310
-
37
Rex D K, Cutler C S, Lemmel G T. et al .
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.
Gastroenterology.
1997;
112 (1)
24-28
-
38
Fenlon H M, McAneny D B, Nunes D P. et al .
Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon.
Radiology.
1999;
210 (2)
423-428
-
39
Edwards J T, Wood C J, Mendelson R M. et al .
Extracolonic findings at virtual colonoscopy: implications for screening programs.
Am J Gastroenterol.
2001;
96 (10)
3009-3012
PD Dr. med. Andrik J. Aschoff
Leitender Oberarzt, Abt. Röntgendiagnostik, Universitätsklinikum Ulm
Steinhövelstraße 9
89075 Ulm
Telefon: ++ 49/7 31/5 00-2 74 30
Fax: ++ 49/7 31/5 00-2 66 92
eMail: andrik.aschoff@medizin.uni-ulm.de
