CT Colonography: Principles and Practice of Virtual Colonoscopy

✍ Scribed by Perry J. Pickhardt MD, David H. Kim MD

• Publisher: Saunders
• Year: 2009
• Tongue: English
• Leaves: 513
• Edition: Har/DVD
• Category: Library

✦ Synopsis

In CT Colonography, Perry Pickhardt and David Kim present techniques for quicker evaluation and diagnosis of colon cancer through the pioneering, specialty-changing imaging technique of virtual colonoscopy (VC). This combination of sophisticated X-rays and CT scans of the abdomen offers patients an alternative to colonoscopy that is cost effective and reduces the need for unnecessary polyp removal. Abundantly illustrated in full color, this pioneering book describes CT colonography from pathogenesis, staging and treatment through indications, technique, and interpretation for the most common pathologies. You'll have the full spectrum of VC technique and be able to see procedures performed through video clips on the included DVD.Covers principles, techniques, and interpretations for the most common pathologies in a logical, practical organization.Presents tips from the authors on setting up a VC practice to provide a personal, instructive guide.Provides over 1000 full-color, high-resolution anatomic images throughout for the clearest, most accurate picture of colorectal cancer, its natural history, and its diagnosis by VC.Focuses on images, with the text serving as context for the proper use and understanding of VC.Features a DVD with video clips of VC procedures that clarify the text and supplement the images that are included for download.

✦ Table of Contents

CT Colonography: Principles and Practice of Virtual Colonoscopy......Page 1
Copyright......Page 2
Dedication......Page 3
Preface......Page 5
Acknowledgments......Page 7
SECTION 1: Colorectal Polyps and Cancer......Page 8
INTRODUCTION......Page 9
Adenomatous Polyps......Page 10
Hyperplastic Polyps and Other Serrated Polyps......Page 12
THE TARGET POLYP(S) OF COLORECTAL CANCER SCREENING......Page 13
THE EFFICIENT TARGET LESION FOR CTC......Page 14
SUMMARY......Page 15
POLYP PREVALENCE AND HISTOLOGY ACCORDING TO SIZE......Page 16
POLYP MORPHOLOGY AND FLAT (NONPOLYPOID) LESIONS......Page 18
POLYP NATURAL HISTORY DATA FROM THE PRE-CTC ERA......Page 20
CTC SURVEILLANCE OF SMALL POLYPS: INITIAL RESULTS......Page 23
SUMMARY......Page 24
GENERAL PRINCIPLES......Page 29
ADENOMA-CARCINOMA SEQUENCE......Page 30
SERRATED POLYP-CARCINOMA SEQUENCE......Page 31
HEREDITARY COLORECTAL CANCER SYNDROMES......Page 32
SUMMARY......Page 36
TNM STAGING......Page 39
Imaging Determination of Distant Disease......Page 41
Imaging Determination of Bowel Wall and Local Lymph Node Involvement......Page 42
OVERVIEW OF TREATMENT OPTIONS......Page 45
PROGNOSIS......Page 47
SUMMARY......Page 48
SCREENING TESTS THAT PREVENT AND DETECT CANCER......Page 50
Flexible Sigmoidoscopy......Page 51
Double Contrast Barium Enema......Page 52
Guaiac-Based Fecal Occult Blood Tests......Page 53
SUMMARY......Page 54
SECTION 2: General Aspects of CT Colonography......Page 57
ORIGINS OF CTC......Page 58
Validation Phase......Page 59
Implementation Phase......Page 62
FUTURE OF CTC......Page 63
CTC TRIALS EVALUATING POLYP-RICH COHORTS......Page 65
The Initial Four Studies......Page 66
Subsequent Validation Studies......Page 69
CTC AS A RECOGNIZED SCREENING OPTION......Page 70
SUMMARY......Page 71
CTC PROGRAM COMPONENTS......Page 73
Scheduling and the Clinical Database......Page 75
Polyp Surveillance of Patients at Low Risk......Page 78
Integrated CTC-OC Screening Paradigm......Page 79
PROGRAM WORKFLOW......Page 80
SUMMARY......Page 81
CTC FOR ASYMPTOMATIC SCREENING......Page 82
DIAGNOSTIC CTC FOLLOWING INCOMPLETE COLONOSCOPY......Page 83
OTHER DIAGNOSTIC INDICATIONS FOR CTC......Page 92
CONTRAINDICATIONS FOR CTC EVALUATION......Page 93
COST-EFFECTIVENESS ANALYSES......Page 98
THIRD-PARTY REIMBURSEMENT......Page 103
NONRADIOLOGIST INVOLVEMENT......Page 104
For Screening......Page 107
In Preoperative Planning and Staging......Page 108
In Other Diagnostic Indications......Page 110
WHO WILL INTERPRET CTC?......Page 111
FUTURE TECHNOLOGIC CAPABILITIES......Page 112
CONCLUDING STATEMENTS......Page 115
SECTION 3: CT Colonography Technique......Page 117
PREPARATION STRATEGIES......Page 118
UW PROTOCOL......Page 119
Cathartic Agents......Page 122
Tagging Agents......Page 124
Protocol Timing......Page 125
BOWEL PREPARATION AFTER INCOMPLETE COLONOSCOPY......Page 127
MINIMAL/"PREPLESS" BOWEL PREPARATION......Page 128
Diet Restriction......Page 130
Cathartic Agents......Page 131
SUMMARY......Page 132
ROOM AIR VERSUS CARBON DIOXIDE......Page 134
USE OF SPASMOLYTICS......Page 137
USE OF ADDITIONAL SERIES......Page 138
HARDWARE AND DISTENTION PROTOCOL......Page 140
COMPLICATIONS......Page 143
TROUBLESHOOTING......Page 145
SUMMARY......Page 148
Collimation......Page 151
Pitch......Page 153
Reconstruction Interval......Page 154
Tube Current/Potential......Page 155
SEQUENCES......Page 156
UNIVERSITY OF WISCONSIN MDCT PROTOCOL......Page 157
Scan Factors......Page 158
SUMMARY......Page 159
COMPLICATIONS RELATED TO BOWEL PREPARATION......Page 160
COMPLICATIONS RELATED TO BOWEL DISTENTION......Page 161
THEORETIC RADIATION RISKS......Page 163
OC-RELATED COMPLICATIONS......Page 164
SUMMARY......Page 174
SECTION 4: CT Colonography Interpretation......Page 176
Intraluminal Examination: Polyp Detection and Characterization......Page 177
Extracolonic Evaluation......Page 179
REPORTING AT CTC......Page 180
DEDICATED CTC SOFTWARE SYSTEMS......Page 181
SUMMARY......Page 183
Primary 2D Polyp Detection......Page 185
Primary 3D Polyp Detection......Page 189
RESULTS WITH 2D VERSUS 3D INTERPRETATION......Page 192
COMBINED STRATEGIES FOR INTEGRATED POLYP DETECTION......Page 193
SUMMARY......Page 195
"DON'T TOUCH" LESIONS AT CTC......Page 198
NEOPLASTIC MUCOSAL LESIONS......Page 200
NON-NEOPLASTIC MUCOSAL LESIONS......Page 208
SUBMUCOSAL AND EXTRINSIC LESIONS......Page 212
ANORECTAL LESIONS......Page 215
CONCLUSION......Page 216
Colonic Segmentation: 3D Map and Centerline......Page 218
Tracking 3D Mucosal Coverage......Page 221
Translucency Rendering......Page 226
Tools for Localizing Between Different Displays......Page 227
Manual Measurement of Linear Size......Page 233
Electronic Fluid Cleansing (Digital Subtraction)......Page 236
SUMMARY......Page 239
GENERAL PRINCIPLES......Page 241
RETAINED FECAL MATERIAL......Page 242
THICKENED OR COMPLEX FOLDS......Page 247
INADEQUATE LUMINAL DISTENTION......Page 263
DIVERTICULAR DISEASE......Page 269
FLAT AND CARPET LESIONS......Page 280
POLYP MEASUREMENT......Page 287
POSITIONAL CHANGE IN POLYPS......Page 291
IMAGING ARTIFACTS AND DISTORTION......Page 292
ANORECTAL FINDINGS......Page 306
APPENDICEAL FINDINGS......Page 318
RETAINED FLUID AND SUBMERGED POLYPS......Page 325
SUBMUCOSAL LESIONS......Page 328
SUMMARY......Page 332
GENERAL PRINCIPLES......Page 334
CRC EVALUATION IN SYMPTOMATIC PATIENTS......Page 342
CRC DETECTION AT ASYMPTOMATIC SCREENING......Page 347
IMAGING MIMICS OF CRC......Page 352
CONCLUSION......Page 356
GENERAL PRINCIPLES OF EVALUATION......Page 360
Lymphoma......Page 361
Gastrointestinal Stromal Tumor......Page 368
NEOPLASTIC CAUSES OF EXTRAMURAL ORIGIN......Page 370
Peritoneal Carcinomatosis......Page 373
Appendiceal Tumors......Page 374
Vascular Lesions......Page 378
Pneumatosis Cystoides......Page 383
Endometriosis......Page 387
Extrinsic Impression......Page 389
SUMMARY......Page 391
3D ENDOLUMINAL DISPLAY......Page 393
VIRTUAL DISSECTION (FILET) VIEWS......Page 398
OTHER ALTERNATIVE 3D DISPLAYS......Page 402
COMPARISON OF 3D DISPLAYS FOR POLYP DETECTION......Page 409
SUMMARY......Page 411
GENERAL PRINCIPLES......Page 416
CADe AND CADx......Page 417
CAD READER PARADIGMS AND INTERPRETATION STRATEGY......Page 420
CAD PERFORMANCE RESULTS......Page 421
FACTORS OPTIMIZING CAD PERFORMANCE......Page 425
SUMMARY......Page 426
REFERRAL TO ENDOSCOPY......Page 427
PREOPERATIVE ASSESSMENT WITH CTC......Page 433
CTC FALSE-POSITIVE OR OC FALSE-NEGATIVE?......Page 441
SEGMENTAL LOCALIZATION AT CTC VERSUS COLONOSCOPY......Page 448
ADDITIONAL POLYPS IDENTIFIED AT COLONOSCOPY......Page 450
SUMMARY......Page 451
Technique......Page 453
Classification......Page 457
Reporting......Page 463
EXTRACOLONIC FINDINGS OF POTENTIAL SIGNIFICANCE......Page 465
COST IMPLICATIONS......Page 470
SUMMARY......Page 474
Lexicon and Polyp Descriptors......Page 476
Colonic and Extracolonic Classification Schemas......Page 482
QUALITY METRICS......Page 486
SUMMARY......Page 490
SECTION 5: CT Colonography at the University of Wisconsin......Page 491
CTC PERSONNEL......Page 492
CTC TECHNIQUE......Page 494
Bowel Preparation......Page 497
Colonic Distention......Page 499
CTC INTERPRETATION......Page 502
REPORTING OF RESULTS......Page 506
DESCRIPTION OF THE UW CTC PROGRAM......Page 509
PROGRAM OPERATIONAL STATISTICS......Page 510
Colorectal Results......Page 511
QUALITY ASSURANCE......Page 512
SUMMARY......Page 513