CT colonography: Patient's tolerance of faecal tagging regimen vs cathartic cleansing
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1 CT colonography: Patient's tolerance of faecal tagging regimen vs cathartic cleansing Poster No.: B-502 Congress: ECR 2010 Type: Scientific Paper Topic: GI Tract Authors: D. Buccicardi, M. Grosso, I. Caviglia, A. Gastaldo, E. Neri, P Quadri ; Savona/IT, Genoa/IT, Pisa/IT Keywords: CT colonography, faecal tagging, severe abdominal pain DOI: /ecr2010/B-502 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11
2 Purpose Aim of our prospective study: to compare patient's tolerance of faecal tagging regimen (FT) to traditional cathartic cleansing (CC) Fig.: virtual colonoscopy navigation clip References: D. Buccicardi; radiology, San Paolo Hospital, Savona, ITALY Page 2 of 11
3 Methods and Materials During the period March September 2009, 264 consecutive patients (105 # and 159 #; mean age 62y ± 5sd) at average risk for development of colorectal cancer, were submitted to 32 rows CT colonography in supine and prone position (120 kvp; mas; 0.5s scanning; 1.25 mm collimation; 1.25 mm rec. interval). Patients were alternatively placed into 2 study groups: # Group 1 (132 patients) followed traditional cathartic cleansing(cc) # Group 2 (132 patients) followed faecal tagging regimen(ft). CC protocol: no fiber diet and administration of sodium phosphate acid monohydrated and disodium phosphate eptahydrate (Phospho-lax ), 80 ml in 2 litres of water the day before imaging. FT protocol: no fiber diet and ingestion with meals (3 times a day) of 30 ml of water-soluble iodinated contrast agent (diatrizoate meglumine and diatrizoate sodium - Gastrografin ) for 2 days before imaging. - All patients were administered i.v. hyoscine buthylbromide (20 mg) immediately before scanning [1]. - Colonic distension was achieved via a small flexible rectal catheter, using an automated carbon dioxide insufflation system, insufflating up to 6L maximum [2]. Page 3 of 11
4 Fig.: automated carbon dioxide insufflator for CTC References: - All CTC data sets were evaluated by experienced reviewers who had a prior experience of at least 150 CTC examinations with colonoscopic verification. - All studies were reviewed in a combined way: primary 2D images evaluation followed by 3D endoluminal views and dissected views for problem solving (without electronic cleansing) [3-4]. Page 4 of 11
5 - All detected lesions were localized according to their segmental location in the colon (cecum; ascending colon; right flexure; transverse colon; left flexure; descending colon; sigmoid colon; rectum). - After the examination all patients were asked to provide a feedback about tolerance to their bowel preparation: they were asked if experienced severe abdominal pain while following their regimen (answer yes/no - dichotomical variable). - The first 30 patients of each group (Group1* and Group2*) were further investigated with optical colonoscopy in order to confirm our CTC diagnosis. Results 1) Study subjects who received FT did not report severe abdominal pain when compared to those of CC: in FT group (group 2) only 24 cases of severe abdominal pain were detected while CC group (group 1) revealed 107 cases and this difference was 2 statistically significant (# test: p<0.001). 2) A total of 90 colorectal lesions (Group1+Group2) were identified: 18 stenosis 2 flat lesions 70 polyps # 62 sessile and 8 pedunculated Page 5 of 11
6 # 28<6 mm; 6mm#22#10 mm; 20>10mm Fig.: descending colon pedunculated polyp (FT) dissected view References: D. Buccicardi; radiology, San Paolo Hospital, Savona, ITALY Page 6 of 11
7 Fig.: descending colon pedunculated polyp (FT) 3D References: D. Buccicardi; radiology, San Paolo Hospital, Savona, ITALY Page 7 of 11
8 Fig.: descending colon pedunculated polyp (TF) 2D References: D. Buccicardi; radiology, San Paolo Hospital, Savona, ITALY 3) Segmental location of all lesions (Group1+Group2): cecum (n=10) ascending colon (n=4) right flexure (n=2) transverse colon (n=16) left flexure (n=4) descending colon (n=13) sigmoid colon (n=34) rectum (n=7) Page 8 of 11
9 4) After optical colonoscopy verification: Group 1*(CC) revealed 10 polyps diam. # 6 mm. 7TP; 1FN; 2FP CTC sensibility 88%, specificity 91% PPV=0.78, NPV=0.95, PLR=9.63, NLR=0.14 diagnostic OR 70(IC95% ) Group 2*(FT) revealed 10 polyps diam. # 6 mm. 8TP; 1FN; 1FP CTC sensibility 89%, specificity 95% PPV=0.89, NPV=0.95, PLR=18.67, NLR=0.12 diagnostic OR 160 (IC95% ) Conclusion CT Colonography with FT is a reliable, safe and well-accepted diagnostic tool for colorectal carcinoma detection [5]. FT regimen, compared to CC, reduces patient's discomfort and seems to improve diagnostic accuracy of CT Colonography. Page 9 of 11
10 References Taylor SA, Halligan S, Goh V, et al. Optimizing colonic distention for multidetector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. Radiology 2003;229 : Shinners TJ, Pickhardt PJ, Taylor AJ et al. Patient-Controlled Room Air Insufflation Versus Automated Carbon Dioxide Delivery for CT Colonography. Am. J. Roentgenol., Jun 2006; 186: Barish MA, Soto JA, Ferrucci JT. Consensus on current clinical practice of virtual colonoscopy. AJR2005; 184: Silva AC, Wellnitz CV, Hara AK. Three-dimensional virtual dissection at CT colonography: unraveling the colon to search for lesions. RadioGraphics 2006;26 : Mahgerefteh S, Fraifeld S, Blachar A, et al. CT Colonography With Decreased Purgation: Balancing Preparation, Performance, and Patient Acceptance. Am. J. Roentgenol., Dec 2009; 193: Personal Information Page 10 of 11
11 Fig.: Duccio Buccicardi References: D. Buccicardi; radiology, San Paolo Hospital, Savona, ITALY 37 years old, fascinated by all imaging post-processing techniques, loves red wines, contemporary art and vintage watches. Page 11 of 11
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