Anatomic Factors Predictive of Incomplete Colonoscopy Based on Findings at CT Colonography
University of Wisconsin–Madison, Madison, Wisconsin, United States American Journal of Roentgenology
(Impact Factor: 2.73).
11/2007; 189(4):774-9. DOI: 10.2214/AJR.07.2048
Reasons for failure to reach the cecum at optical colonoscopy are multifactorial. The purpose of this study was to compare CT colonography (CTC) findings in patients with complete versus those with incomplete optical colonoscopy.
The clinical data and CTC examinations were reviewed in 100 patients who underwent CTC after incomplete optical colonoscopy. The findings were compared with a control group of 100 patients who underwent complete optical colonoscopy after CTC. The interactive 3D colon map and 2D multiplanar reconstruction images from CTC were reviewed independently by two experienced gastrointestinal radiologists for colorectal length (total, sigmoid colon, and transverse colon), number of acute angle flexures (reflecting tortuosity), and advanced diverticular disease. Discrepancies were resolved by secondary consensus review.
Significant differences existed between the complete and incomplete optical colonoscopy groups, respectively, for age (mean, 58.2 vs 63.4 years; p < 0.001), sex (60 men and 40 women vs 41 men and 59 women; p < 0.01), and prior abdominal surgery (26.0% vs 48.0%; p < 0.01). Significant differences were seen between the complete and incomplete optical colonoscopy groups, respectively, for all the CTC factors that were evaluated: total colorectal length (mean, 167.0 vs 210.8 cm; p < 0.0001), sigmoid colon length (mean, 48.7 vs 66.8 cm; p < 0.0001), transverse colon length (mean, 49.2 vs 66.3 cm; p < 0.0001), number of flexures (mean, 9.6 vs 11.9; p < 0.0001), and advanced diverticular disease (22.0% vs 34.0%; p <0.05).
Anatomic features associated with failure to reach the cecum at optical colonoscopy included colonic elongation, tortuosity, and advanced diverticular disease. These predictive factors may have implications for optical colonoscopy training and performance and for patients sent to optical colonoscopy for polyps prospectively detected at CTC.
Available from: PubMed Central
- "Therefore, for assessment of colorectal cancer staging, other diagnostic tools are necessary. The most common tool is multidetector contrast-enhanced computed tomography (CT) of the abdomen and pelvis [5–9]. Computed tomographic colonography (CTC) has the potential to become an accepted technique for both detecting and staging colorectal cancer as well as for evaluating the entire colon in these patients. "
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ABSTRACT: This study aimed to assess the usefulness of computed tomographic colonography (CTC) in preoperative evaluation of colorectal tumors and the entire bowel including endoscopically inaccessible regions.
Colonoscopy and CTC were performed for 49 patients. The tumor and the entire colon were assessed, and the results were compared with colonoscopy. The extraluminal findings of CTC were compared with contrast-enhanced computed tomography (CT) of the abdomen and the pelvis in 33 patients. All these patients had undergone surgery. A comparison of results for tumor node metastasis classification between CTC, CT, and histopathology was performed.
Exploration of the entire colon was possible for 89.8% of the patients using CTC and 49.0% of the patients using colonoscopy. Bowel cleansing was assessed as worse with CTC. In the evaluation of tumor location and morphologic type, CTC was congruent with colonoscopy. Colonoscopy enabled approximate tumor size and volume to be evaluated for only 59.2% (29/49) and 30.6% (15/49) of patients, respectively, whereas CTC enabled evaluation of all 48 (100.0%) visualized tumors. Wall thickening, outer contour, and suspected infiltration of surrounding tissues and organs are impossible to determine with colonoscopy but can be determined with CTC. Using CTC, two additional tumors were found proximate to occlusive masses in endoscopically inaccessible regions.
Computed tomographic colonography is a useful method for diagnosing colorectal tumors. It allows the clinician to diagnose tumor, determine local tumor progression, and detect synchronous lesions in the large bowel including endoscopically inaccessible regions.
Surgical Endoscopy 03/2011; 25(7):2344-9. DOI:10.1007/s00464-010-1566-0 · 3.26 Impact Factor
Available from: Andrea Laghi
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ABSTRACT: Introduzione La colonscopia virtuale è una tecnica di stu-dio non invasiva del colon, proposta inizialmente dal radiologo statunitense Vining nel 1994 1 , che si effettua mediante un moderno apparecchio TC multistrato, previa preparazione intestinale e di-stensione gassosa del colon. L'esame, della durata di pochi secondi, non ri-chiede l'introduzione di alcuna sonda endoscopi-ca né sedazione o somministrazione endovenosa di mezzo di contrasto. I dati acquisiti sono suc-cessivamente elaborati e analizzati su stazioni di lavoro dedicate, in grado di effettuare una rico-struzione tridimensionale delle immagini (figura 1 alla pagina 63). Riassunto. La colonscopia virtuale è una tecnica di studio non invasiva che consente di studiare il colon dal suo interno, in modo simile alla colonscopia convenzionale, ma sen-za l'introduzione di alcuna sonda endoscopica. La colonscopia virtuale è in grado di stu-diare tutto il colon e le sue patologie, individuandone precocemente le cause (colite, poli-pi, diverticoli, neoplasie), senza rischi né controindicazioni. È una metodica accurata, si-cura e ben tollerata, oggi ufficialmente accettata quale opzione di screening per la pre-venzione del cancro del colon-retto. Le indicazioni principali all'utilizzo di questa meto-dica sono a scopo preventivo: tutti i soggetti a rischio medio, maschi e femmine, di età su-periore a 50 anni, come stabilito dalle Linee Guida sullo screening del cancro del colon-retto, pubblicate nel marzo 2008 dall'American Cancer Society. A scopo diagnostico, la metodica è indicata in tutti i pazienti che presentino disturbi intestinali che, a discrezio-ne del medico, potrebbero richiedere uno studio radiologico o endoscopico del colon come completamento di un esame di colonscopia convenzionale risultato incompleto; ed anche in pazienti anziani e in coloro i quali abbiano una controindicazione alla colonscopia con-venzionale (es. cardiopatici, bronchitici cronici).
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ABSTRACT: This paper presents a technique for describing the behavior of transmission gates (TGs) in VHDL. The concept of virtual signal is introduced into the TG's data structure to represent the nature of the connection. The model's semantics are coded in three parts: the state transition, the steady states, and the connecting protocol. Simulation results indicate that the model is correct and robust.
Design Automation, 1989. 26th Conference on; 07/1989
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