title: Colonoscopy detects significantly more flat adenomas than 3-tesla magnetic resonance colonography: a pilot trial.
abstract: OBJECTIVE
  Colorectal cancer (CRC) is one of the most common cancers worldwide, and several efforts have been made to reduce its occurrence or severity. Although colonoscopy is considered the gold standard in CRC prevention, it has its disadvantages: missed lesions, bleeding, and perforation. Furthermore, a high number of patients undergo this procedure even though no polyps are detected. Therefore, an initial screening examination may be warranted. Our aim was to compare the adenoma detection rate of magnetic resonance colonography (MRC) with that of optical colonoscopy.
  
  
  METHODS
  A total of 25 patients with an intermediate risk for CRC (17 men, 8 women; mean age 57.6, standard deviation 11) underwent MRC with a 3.0-tesla magnet, followed by colonoscopy. The endoscopist was initially blinded to the results of MRC and unblinded immediately after examining the distal rectum. Following endoscopic excision, the size, anatomical localization, and appearance of all polyps were described according to the Paris classification.
  
  
  RESULTS
  A total of 93 lesions were detected during colonoscopy. These included a malignant infiltration of the transverse colon due to gastric cancer in 1 patient, 28 adenomas in 10 patients, 19 hyperplastic polyps in 9 patients, and 45 non-neoplastic lesions. In 5 patients, no lesion was detected. MRC detected significantly fewer lesions: 1 adenoma (P = 0.001) and 1 hyperplastic polyp (P = 0.004). The malignant infiltration was seen with both modalities. Of the 28 adenomas, 23 (82 %) were 5 mm or smaller; only 4 adenomas 10 mm or larger (14 %) were detected.
  
  
  CONCLUSIONS
  MRC does not detect adenomas sufficiently independently of the location of the lesion. Even advanced lesions were missed. Therefore, colonoscopy should still be considered the current gold standard, even for diagnostic purposes.
authors.affiliation: Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hüneburg
authors.affiliation: Department of Radiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Kukuk
authors.affiliation: Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.
authors.forename: Jacob
authors.initials: J
authors.lastname: Nattermann
authors.affiliation: Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Endler
authors.affiliation: Department of Radiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Arndt-Hendrik
authors.initials: AH
authors.lastname: Penner
authors.affiliation: Department of Radiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Wolter
authors.affiliation: Department of Radiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Schild
authors.affiliation: Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Strassburg
authors.affiliation: Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Sauerbruch
authors.affiliation: Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.affiliation: Department of Radiology, University Hospital of Bonn, Bonn, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Willinek