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Fundamental elements for successful performance of CT colonography (virtual colonoscopy).

Park SH, Yee J, Kim SH, Kim YH - Korean J Radiol (2007 Jul-Aug)

Bottom Line: Fecal and fluid tagging may improve the diagnostic accuracy and allow for reduced bowel preparation.Polyps detected at CTC should be measured accurately and reported following the "polyp size-based" patient management system.The time-intensive nature of CTC and the limited resources for training radiologists appear to be the major barriers for implementing CTC in Korea.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2dong, Songpa-gu, 138-736 Seoul, Korea. seongho@amc.seoul.kr

ABSTRACT
There are many factors affecting the successful performance of CT colonography (CTC). Adequate colonic cleansing and distention, the optimal CT technique and interpretation with using the newest CTC software by a trained reader will help ensure high accuracy for lesion detection. Fecal and fluid tagging may improve the diagnostic accuracy and allow for reduced bowel preparation. Automated carbon dioxide insufflation is more efficient and may be safer for colonic distention as compared to manual room air insufflation. CT scanning should use thin collimation of < or =3 mm with a reconstruction interval of < or =1.5 mm and a low radiation dose. There is not any one correct method for the interpretation of CTC; therefore, readers should be well-versed with both the primary 3D and 2D reviews. Polyps detected at CTC should be measured accurately and reported following the "polyp size-based" patient management system. The time-intensive nature of CTC and the limited resources for training radiologists appear to be the major barriers for implementing CTC in Korea.

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Related in: MedlinePlus

A 68-year-old male with fecal residue that is tagged with orally-administered barium.A. 3D endoluminal view shows an 8-mm polypoid structure (arrowhead) on a haustral fold of the sigmoid colon.B. 2D transverse image using a wide-window setting (width: 1500 HU, level: -400 HU) shows very high attenuation of the olypoid structure (white arrowhead), which clearly demonstrates it is tagged stool. Another piece of tagged stool is noted in the sigmoid colon (black arrowhead).
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Figure 1: A 68-year-old male with fecal residue that is tagged with orally-administered barium.A. 3D endoluminal view shows an 8-mm polypoid structure (arrowhead) on a haustral fold of the sigmoid colon.B. 2D transverse image using a wide-window setting (width: 1500 HU, level: -400 HU) shows very high attenuation of the olypoid structure (white arrowhead), which clearly demonstrates it is tagged stool. Another piece of tagged stool is noted in the sigmoid colon (black arrowhead).

Mentions: Fecal and fluid tagging is labeling the fecal residue in the colon with using radiopaque contrast media (Figs. 1, 2). The contrast agent is orally administered at each meal, typically the day before the CTC. It then mixes with the ingested food material starting from the stomach. As the mixture passes through the bowel, the nutrients are digested and absorbed, and the tagging agent becomes more thoroughly mixed with the undigested residue. The contrast material also mixes with the residual fluid in the colon. Some of the tagged feces and fluid are evacuated after bowel preparation and the rest remains in the colon. On CT, the fecal matter that is mixed with the orally administered contrast material appears hyperdense or white, making it easily distinguishable from the homogeneous soft tissue density of colonic polyps.


Fundamental elements for successful performance of CT colonography (virtual colonoscopy).

Park SH, Yee J, Kim SH, Kim YH - Korean J Radiol (2007 Jul-Aug)

A 68-year-old male with fecal residue that is tagged with orally-administered barium.A. 3D endoluminal view shows an 8-mm polypoid structure (arrowhead) on a haustral fold of the sigmoid colon.B. 2D transverse image using a wide-window setting (width: 1500 HU, level: -400 HU) shows very high attenuation of the olypoid structure (white arrowhead), which clearly demonstrates it is tagged stool. Another piece of tagged stool is noted in the sigmoid colon (black arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627155&req=5

Figure 1: A 68-year-old male with fecal residue that is tagged with orally-administered barium.A. 3D endoluminal view shows an 8-mm polypoid structure (arrowhead) on a haustral fold of the sigmoid colon.B. 2D transverse image using a wide-window setting (width: 1500 HU, level: -400 HU) shows very high attenuation of the olypoid structure (white arrowhead), which clearly demonstrates it is tagged stool. Another piece of tagged stool is noted in the sigmoid colon (black arrowhead).
Mentions: Fecal and fluid tagging is labeling the fecal residue in the colon with using radiopaque contrast media (Figs. 1, 2). The contrast agent is orally administered at each meal, typically the day before the CTC. It then mixes with the ingested food material starting from the stomach. As the mixture passes through the bowel, the nutrients are digested and absorbed, and the tagging agent becomes more thoroughly mixed with the undigested residue. The contrast material also mixes with the residual fluid in the colon. Some of the tagged feces and fluid are evacuated after bowel preparation and the rest remains in the colon. On CT, the fecal matter that is mixed with the orally administered contrast material appears hyperdense or white, making it easily distinguishable from the homogeneous soft tissue density of colonic polyps.

Bottom Line: Fecal and fluid tagging may improve the diagnostic accuracy and allow for reduced bowel preparation.Polyps detected at CTC should be measured accurately and reported following the "polyp size-based" patient management system.The time-intensive nature of CTC and the limited resources for training radiologists appear to be the major barriers for implementing CTC in Korea.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2dong, Songpa-gu, 138-736 Seoul, Korea. seongho@amc.seoul.kr

ABSTRACT
There are many factors affecting the successful performance of CT colonography (CTC). Adequate colonic cleansing and distention, the optimal CT technique and interpretation with using the newest CTC software by a trained reader will help ensure high accuracy for lesion detection. Fecal and fluid tagging may improve the diagnostic accuracy and allow for reduced bowel preparation. Automated carbon dioxide insufflation is more efficient and may be safer for colonic distention as compared to manual room air insufflation. CT scanning should use thin collimation of < or =3 mm with a reconstruction interval of < or =1.5 mm and a low radiation dose. There is not any one correct method for the interpretation of CTC; therefore, readers should be well-versed with both the primary 3D and 2D reviews. Polyps detected at CTC should be measured accurately and reported following the "polyp size-based" patient management system. The time-intensive nature of CTC and the limited resources for training radiologists appear to be the major barriers for implementing CTC in Korea.

Show MeSH
Related in: MedlinePlus