MEDICAL RADIOLOGY Diagnostic Imaging

Transcription

1 MEDICAL RADIOLOGY Diagnostic Imaging Editors: A. L. Baert, Leuven M. F. Reiser, München H. Hricak, New York M. Knauth, Göttingen

2 P. Lefere S. Gryspeerdt (Eds.) Virtual Colonoscopy A Practical Guide 2nd Edition With Contributions by Y. Arai D. Bielen F. Booya D. Burling F. Cerri A. H. Dachman A. H. de Vries H. Fenlon J. G. Fletcher S. Gryspeerdt L. S. Guimaraes S. Halligan G. Iinuma A. Laghi P. Lefere A. Maier T. Mang B. G. McFarland R. Mendelson M. Miyake N. Moriyama K. J. Mortelé Y. Muramatsu D. Murphy E. Neri P. R. Obara A. S. Odulate M. Raquel Oliva P. Pokieser W. Schima J. Stoker S. A. Taylor F. Turini K. Uchida J. Yee H. Yoshida M. E. Zalis Foreword by A. L. Baert With 198 Figures in 355 Separate Illustrations, 146 in Color and 16 Tables

3 Philippe Lefere, MD Stedelijk Ziekenhuis Roeselare Department of Radiology Bruggesteenweg Roeselare Belgium Stefaan Gryspeerdt, MD Stedelijk Ziekenhuis Roeselare Department of Radiology Bruggesteenweg Roeselare Belgium Medical Radiology Diagnostic Imaging and Radiation Oncology Series Editors: A. L. Baert L. W. Brady H.-P. Heilmann M. Knauth M. Molls C. Nieder Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology ISBN: e-isbn: DOI: / Springer Heidelberg Dordrecht London New York Medical Radiology Diagnostic Imaging and Radiation Oncology ISSN Library of Congress Control Number: Springer-Verlag Berlin Heidelberg 2010 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Publishing Services Teichmann, Mauer, Germany Printed on acid-free paper Springer is part of Springer Science+Business Media (

4 Foreword Rapid progress in the technique and practice of virtual colonoscopy as well as the continuing clinical high interest for this radiodiagnostic procedure made this second edition, only 3 years after the publication of the first edition of this successful volume, necessary. This new edition includes the latest study results and technical developments of this exciting noninvasive diagnostic modality for the evaluation of the colon. The technical presentation and lay out of the text and of the many new illustrations are impeccable. The editors were again able to ensure the collaboration of many international leaders in the field and the book offers a very comprehensive overview of all aspects and issues of CT colonography with a focus on how to perform practically this examination, which requires meticulous technique starting from rigorous preparation, then the conduct of the study itself, and finally the interpretation of the results. I am very much indebted to the editors and the collaborating authors for preparing this outstanding volume in a record short time period, which enabled them to include the latest technical advances in this rapidly evolving important radiological method. It is highly recommended to general and gastrointestinal radiologists as well as gastroeneterologists as a most welcome update of their knowledge and as a practical guide in their daily practice. I am convinced that this second edition will meet the same success with our readership as the first one. Leuven, Belgium Albert L. Baert Series Editor

5 Preface to the Second Edition The publication of this second revised edition of the practical guide on virtual colonoscopy less than 4 years after the publication of the first edition underscores the big interest for CT colonography. In the past 4 years, the promising expectations of the technique were confirmed by several large multicenter studies obtaining very good results for colorectal neoplasia detection. This was possible by establishing a state-of-the-art technique of CT colonography (CTC) in combination with image interpretation performed by experienced teams. This updated edition confirms the efforts of the international CTC community to promote this technique as a widely accepted imaging technique for exploring the colon for colorectal neoplasia. In the past 4 years, these efforts have been focused on the development and fine tuning of the state-of-the-art application of CTC in order to allow widespread implementation of a high-quality total colonic examination. All different aspects of the CTC technique are widely covered in this edition. In the past years, it also became obvious that a structured education is mandatory in obtaining sufficient expertise in CTC before starting the technique in a clinical practice. This expertise will prove invaluable for CTC to become a robust technique performed on a high scientific level by a large community of radiologists. Once this goal is achieved, it will be possible considering reimbursement of CTC and its use as tool for populationbased screening for colorectal cancer. We are very grateful to all authors of the first and second edition, who made both issues a very rich resource of information on CT colonography and to the series editor of this book, Professor Dr. A.L. Baert, who enabled this second revised edition. Roeselare, Belgium Philippe Lefere Stefaan Gryspeerdt

6 Preface to the First Edition Virtual colonoscopy or computed tomographic (CT) colonography is a recent radiological technique enabling detection of tumoral lesions in the colon. As in the past two decades its radiological predecessor, double-contrast barium enema (DCBE), has lost most of its adherents, CT colonography constitutes a real opportunity for gastrointestinal radiologists to play a preponderant role in the diagnosis and treatment of colorectal cancer and the adenoma. Since its introduction by David Vining in 1994, CT colonography has very rapidly shown its virtues as a possible substitute for DCBE. The first important study on CT colonography by Helen Fenlon from the Boston Medical Center, published in 1999 in the New England Journal of Medicine, reporting very good lesion detection, underscored this aspiration. Since then, CT colonography has markedly evolved by the refinement of existing techniques and the introduction of new ones: fecal tagging with the option of reducing the cathartic or laxative part of the preparation, the use of carbon dioxide to inflate the colon, the introduction of multidetector CT scanners producing spectacular images with isotropic resolution and reducing the examination time for the patient, the use of ultra-low-dose scan protocols reducing the radiation burden, improvement of the image postprocessing with fast three-dimensional functions, and computer-aided diagnosis (CAD). These technical improvements help both the radiologist and the patient. For the former, there is an improvement of the reading conditions, possibly improving diagnostic accuracy; for the latter, the preparation and examination are more comfortable. Despite these improvements in technique, however, CT colonography has not yet been able to break through as an acceptable tool for colorectal cancer screening. This is because of the disappointing results in some recent large multicenter trials. Most probably suboptimal technique in preparation, colonic distension, scanning parameters, and image postprocessing was the main cause of this failure. In fact, each of these stages needs rigorous attention if one is to achieve optimal results like those obtained in another momentous study, performed by Perry Pickhardt and published in the New England Journal of Medicine in Based upon a meticulous technique of preparation with fecal tagging, colonic inflation, scanning parameters, and reading conditions, CT colonography obtained better scores than optical colonoscopy in this study. Furthermore, the examinations were interpreted by a team of radiologists experienced in CT colonography. This brings us to another important aspect of CT colonography. As was the case with DCBE, the degree of experience needed to adequately read and interpret CT colonography should not be underestimated.

7 X Preface to the First Edition In experienced hands, CT colonography seems to be ripe for prime-time colorectal cancer screening. However, it is not yet ready for widespread application of screening for the aforementioned reasons. CT colonography is now at an important crossroad, and serious efforts should be undertaken to take it to the level of being a widely accepted screening method for colorectal cancer. To fulfill this goal, tremendous efforts are being undertaken in both Europe and the United States to educate radiologists with workshops, data banks, and numerous scientific publications. With contributions from several leaders in the field, this book, entirely dedicated to this exciting technique, sets out to be a guide for both the beginner and the experienced CT colonographer. It provides the reader with a wealth of information on all the prerequisites to perform state-of-the-art CT colonography. We want to express our sincere gratitude and appreciation to all the renowned radiologists experienced in CT colonography who have contributed to this volume. We also thank Professor Albert L. Baert, who gave us the unique opportunity to edit this book and to bring it to a successful conclusion. We hope that the reader will enjoy this work and will find it a help when performing CT colonography. Roeselare, Belgium Philippe Lefere Stefaan Gryspeerdt

8 Contents 1 Why We Do CTC: Screening for Colorectal Cancer Richard M. Mendelson 2 The Performance of CTC Didier Bielen 3 Starting CT Colonography in Your Department Darra Murphy, Alan O Hare, and Helen Fenlon 4 The Eligible Patient: Indications and Contraindications M. Raquel Oliva, Ayodale S. Odulate, and Koenraad J. Mortele 5 Patient Preparation for CT Colonography J. Yee 6 The Prerequisite: Faecal Tagging Philippe Lefere and Stefaan Gryspeerdt 7 How to Get the Colon Distended? David Burling, Stuart Taylor, and Steve Halligan 8 Right Parameters Andrea Laghi 9 How to Interpret CTC Data: Evaluation of the Different Lesion Morphologies Beth G. McFarland 10 How to Avoid Pitfalls in Imaging: Causes and Solutions to Overcome False-Negatives and False-Positives Stefaan Gryspeerdt and Philippe Lefere 11 3D Imaging: Invaluable for the Correct Diagnosis? Ayso H. de Vries and Jaap Stoker 12 The Challenge: Detection of Early-Stage Superficial Colorectal Lesions Gen Iinuma, Mototaka Miyake, Kaori Uchida, Yasuaki Arai, Yukio Muramatsu, and Noriyuki Moriyama

9 XII Contents 13 Extracolonic Findings Francesca Turini, Francesca Cerri, and Emanuele Neri 14 The Future: Computer-Aided Detection H. Yoshida 15 Quality and Consistency in Reporting CT Colonography Abraham H. Dachman, Piotr R. Obara, and Michael E. Zalis 16 Virtual Colonoscopy: Beyond Polyp Detection? T. Mang, W. Schima, A. Maier, and P. Pokieser 17 Pictorial Overview of Normal Anatomy, Mimics of Disease, and Neoplasia Using CT Colonography J. G. Fletcher, Fargol Booya, and Luis S. Guimaraes Subject Index List of Contributors