2010/06/01 by Bora Özel, Bora Ozel, Perry J. Pickhardt +4 · 11 citations
Medicine · Dentistry · #Colorectal Cancer Screening and Detection #Dental Radiography and Imaging #MRI in cancer diagnosis
paper · doi:10.1007/dcr.0b013e3181d5de13
BACKGROUND: To assess the accuracy of routine contrast-enhanced computed tomography for the detection of large colorectal polyps and cancer. METHODS: The study group consisted of 100 patients who underwent abdominal computed tomography and optical colonoscopy evaluation before any treatment or intervention. Invasive colorectal carcinoma and large polyps (>or=10mm) were found at colonoscopy in 29 and 16 patients, respectively. Computed tomography studies with oral and IV contrast were retrospectively reviewed as 5-mm thick sections in standard soft tissue windows by 3 readers. The readers scored each segment for polyp or cancer utilizing a 5-point scale for receiver operating characteristic analysis. RESULTS: By-patient sensitivity/specificity for cancer detection for each reader was 69.0%/88.7%, 65.5%/84.5%, and 82.8%/77.5%, respectively. Pooled sensitivity, specificity, and accuracy for cancer was 72.4%, 83.6%, and 80.3%, respectively. The empiric area under the receiver operating characteristic curves for the readers ranged from 0.775 to 0.857. By-patient sensitivity for large polyps was poor with a pooled sensitivity of 14.5%. CONCLUSIONS: Standard computed tomography not tailored to colorectal investigation was moderately effective for detecting invasive cancers, but insensitive for large polyps. Unsuspected cancer should be a part of the standard search pattern for routine computed tomography interpretation, but more advanced colonography techniques are necessary for detecting large polyps.