Tomographic Colonography Research Articles

Colorectal cancer screening issues: a role for CT colonography?

Colorectal cancer is the third most common cancer in the United States and will cause 56,700 deaths in 2001, despite the availability of screening tests capable of detecting the disease at earlier stages and reducing mortality. This article reviews the natural history of colorectal cancer, common risk factors and prevention strategies, and the strengths, limitations, and cost effectiveness of available screening tests. Although reminders to undergo colorectal cancer screening have become commonplace in the popular media, compliance with screening guidelines remains poor. Although still an unproven technology for widespread screening, computed tomographic (CT) colonography has several attractive characteristics for a screening test. For example, CT scanners are widely available, in contrast to limited numbers of gastroenterologists and radiologists' declining skill and interest in barium enema examinations. Also, patients may be less reluctant to undergo CT colonography than screening colonoscopy. Development of virtual bowel cleansing could further increase compliance and thereby reduce mortality from colorectal cancer. Other articles in this Feature Section discuss technical details of CT colonography and its methodologic challenges.

Spiral CT colonography in inflammatory bowel disease

Objective: Most of the studies on virtual colonoscopy are dealing with the role of detecting colorectal polyps or neoplasms. We have undertaken this study to evaluate the value of CT colonography in patients with colonic Crohn’s disease. Methods and material: Five patients (three males, two females, 23–51 years, mean age 42 years) with known (4) or suspected (1) Crohn’s disease of the colon underwent fiberoptic colonoscopy and CT colonography in the same day or during a 1-week period. The images were evaluated with the so called zoomed axial slice movie technique and in some regions intra- and extraluminal surface shaded and volume rendered images were generated on a separate workstation. The results were compared to those of a colonoscopy. Results: The final diagnosis was Crohn’s disease in four patients and colitis ulcerosa in one. Total examination was possible by colonoscopy in two cases, and with CT colonography in all five cases. The wall of those segments severely affected by the disease were depicted by the axial CT scans to be thickened. The thick walled, segments with narrow lumen seen on CT colonography corresponded to the regions where colonoscopy was failed to pass. Air filled sinus tracts, thickening of the wall of the terminal ileum, loss of haustration pseudopolyps and deep ulcers were seen in CT colonography. Three dimensional (3D) endoluminal views demonstrated pseudopolyps similar to endoscopic images None of the colonoscopically reported shallow ulcerations or aphtoid ulcerations or granular mucosal surface were observed on 2- or 3D CT colonographic images. Conclusion: CT colonography by depicting colonic wall thickening seems to be a useful tool in the diagnosis of Crohn’s colitis, which could be a single examination depicting the intraluminal, and transmural extent of the disease.

Best Results Yet for Virtual Colonoscopy

Computed tomography (CT) and magnetic resonance (MR) colonography (virtual colonoscopy) are new methods for imaging the colon for neoplasia.

Computed tomography and magnetic resonance colonography (Virtual colonoscopy)

Computed tomography and magnetic resonance colonography are new tools that apply advanced computer graphics software to volumetric computed tomography or magnetic resonance data in order to create both 2-dimensional and 3-dimensional images of the colon. With 3-dimensional images, an endoluminal perspective of the colon can be created that simulates an endoscopic view. Virtual colonoscopy refers to the virtual reality imaging that allows physicians to navigate through the simulated colonic views in the same way one looks at a luminal colonoscopic view with a fiberoptic device. These new techniques seem to offer advantages over current imaging technology and may prove to be of clinical use in the near future in the diagnosis of colorectal diseases.