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New CT Colonography Technique Is Easiest Yet

May 15, 2012
Written by: , Filed in: Abdominal Imaging, Gastrointestinal Imaging
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The easier and more comfortable a colonoscopy procedure is, the more people will use it. The development of “virtual colonoscopy,” using CT instead of a fiber-optic tube to look for potentially cancerous colon polyps, increased the comfort level greatly. But most patients still disliked the required laxative preparation.

Now a research team based at Massachusetts General Hospital in Boston has found a promising new technique that doesn’t require a laxative. Maybe that will finally make virtual colonoscopy a mainstream screening tool.

Michael Zalis, MD, director of CT colonography at Massachusetts General, led the study. He said:

While we know that colon screening can save lives, not enough people participate, in part because of the discomfort of the required laxative preparation. In our study, the laxative-free form of CT colonography performed well enough that it might someday become an option for screening, which we hope would increase participation.

Dr. Zalis was quoted in a Massachusetts General news release.

Note that he said “someday.” The new technique uses a computer both to virtually cleanse fecal material from the images and to analyze those images. It did well at detecting larger adenomas, the type of polyps most likely to become cancerous. It was not as good at detecting smaller lesions.

The new procedure involves two days of a low-fiber diet and oral ingestion of small doses of a contrast agent to label fecal material. The computer program subtracts the feces from the image and looks for lesions.

In the study, published Tuesday in Annals of Internal Medicine, laxative-free CT colonographies were done on 604 patients within five weeks before scheduled traditional optical colonoscopies. Patients completed written surveys about the two procedures and were asked which they preferred. Not surprisingly, 62 percent preferred the CT procedure.

Three cases of colon cancer were found among the group, all of which were detected by both screening methods.

Dr. Zalis noted that radiation levels for virtual colonoscopies are much lower than for diagnostic CT scanning and would be considered safe for widespread screening of adults 50 or older—the target colonoscopy screening demographic. He was hopeful about the study’s implications:

If these results hold up in larger trials, we would expect this procedure would first be offered to moderate-risk patients who are otherwise unable or unwilling to be screened. If we can validate that this form of CT colonography performs reasonably well for screening and is easier for patients, it could have a significant impact on reducing the incidence of colon cancer and related cancer deaths.

Related seminar: Abdominal and Pelvic Imaging: CT/MR/US (all-new release)

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