Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps.
OBJECTIVE
We prospectively compared the performance of low-dose multidetector computed tomographic colonography (CTC) without cathartic preparation with that of colonoscopy for the detection of colorectal polyps.


METHODS
A total of 203 patients underwent low-dose CTC without cathartic preparation followed by colonoscopy. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. No subtraction of tagged feces was performed. Colonoscopy was performed 3-7 days after CTC. Three readers interpreted the CTC examinations separately and independently using a primary 2-dimensional approach using multiplanar reconstructions and 3-dimensional images for further characterization. Colonoscopy with segmental unblinding was used as reference standard. The sensitivity of CTC was calculated both on a per-polyp and a per-patient basis. For the latter, specificity, positive predictive values, and negative predictive values were also calculated.


RESULTS
CTC had an average sensitivity of 95.5% (95% confidence interval [CI], 92.1%-99%) for the identification of colorectal polyps > or =8 mm. With regard to per-patient analysis, CTC yielded an average sensitivity of 89.9% (95% CI, 86%-93.7%), an average specificity of 92.2% (95% CI, 89.5%-94.9%), an average positive predictive value of 88% (95% CI, 83.3%-91.5%), and an average negative predictive value of 93.5% (95% CI, 90.9%-96%). Interobserver agreement was high on a per-polyp basis (kappa statistic range, .61-.74) and high to excellent on a per-patient basis (kappa statistic range, .79-.91).


CONCLUSIONS
Low-dose multidetector CTC without cathartic preparation compares favorably with colonoscopy for the detection of colorectal polyps.
Iannaccone
Riccardo
R
Department of Radiological Sciences, University of Rome, Rome, Italy. r_iannaccone@yahoo.it
Laghi
Andrea
A
Catalano
Carlo
C
Mangiapane
Filippo
F
Lamazza
Antonietta
A
Schillaci
Alberto
A
Sinibaldi
Giovanni
G
Murakami
Takamichi
T
Sammartino
Paolo
P
Hori
Masatoshi
M
Piacentini
Francesca
F
Nofroni
Italo
I
Stipa
Vincenzo
V
Passariello
Roberto
R
D000328:Adult; D000368:Aged; D002400:Cathartics; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D003111:Colonic Polyps / Q000000981:diagnostic imaging*; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
D002400:Cathartics