Aktuelle Standards der MR-Kolonographie

Zusammenfassung

Voraussetzung für die Prävention des kolorektalen Karzinoms ist eine zuverlässige Früherkennung, die neben hoher diagnostischer Genauigkeit auch durch eine hohe Patientenakzeptanz gekennzeichnet sein sollte. Die MR-Kolonographie erfüllt diese Voraussetzungen: Mit einer Sensitivität und Spezifität von über 90 % für die Detektion kolorektaler Polypen > 10 mm ist die Untersuchung genau. Nicht-Invasivität, fehlende Strahlenexposition und eine schmerzfreie Untersuchung bedingen eine hohe Patientenakzeptanz. Letztere kann durch den Einsatz neu entwickelter Untersuchungsstrategien, die eine bislang notwendige Darmsäuberung überflüssig machen, z. B. durch Stuhlverfärbung (fecal tagging), weiter gesteigert werden. Diese Übersichtsarbeit beschreibt die der MR-Kolonographie zugrunde liegenden Techniken sowie erste Ergebnisse der „fecal tagging” Konzepte.

Abstract

MR colonoscopy is suitable for colorectal cancer screening. This imaging modality is non-invasive, has no harmful side effects and provides a high diagnostic accuracy. MR colonoscopy has been found to be highly sensitive and specific in detecting colorectal lesions > 10 mm in size. Since colonic polyps are difficult to differentiate from residual stool, colonic cleansing has been unavoidable but reduces patient acceptance. Cleansing of the bowel can be avoided if the signal of stool is rendered different from its surrounding. This can be achieved by adding an agent to the food that tags the feces (fecal tagging). This article describes current techniques of MR colonoscopy as well as first results with fecal tagging.

Key words

MR colonoscopy - colorectal carcinoma - screening examination - fecal tagging

Literatur

• 1 Silverberg E, Boring C C, Squires T S. Cancer statistics, 1990.  CA Cancer J Clin. 1990;  40 9-26
• 2 Landis S H, Murray T, Bodden S, Wingo P A. Cancer statistics, 1988.  CA Cancer J Clin. 1998;  48 6-29
• 3 O'Brien M J, Winawer S J, Zauber A G, Gottlieb L S, Sternberg S S, Diaz B. et al . The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas.  Gastroenterology. 1990;  98 371-379
• 4 Winawer S J, Zauber A G, Ho M N, O'Brien M J, Gottlieb L S, Sternberg S S. et al . Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.  N Engl J Med. 1993;  329 1977-1981
• 5 Vernon S W. Participation in colorectal cancer screening.  J Natl Cancer Inst. 1997;  98 1406-1422
• 6 Centers for Disease Control . Screening for colorectal cancer - United States.  MMWR. 1999;  48 116-121
• 7 Frommer D J. What's new in colorectal cancer screening?.  J Gastroenterol and Hepatol. 1998;  13 528-533
• 8 Rex D K, Rahmani E Y, Haseman J H, Lemmel G T, Kaster S, Buckley J S. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.  Gastroenterology. 1997;  112 17-23
• 9 Lieberman D. Colon cancer screening: beyond efficacy.  Gastroenterology. 1994;  106 803-807
• 10 Lee P Y, Fletcher W S, Sullivan E S, Vetto J T. Colorectal cancer in young patients: characteristics and outcome.  Am Surg. 1994;  60 607-612
• 11 Lieberman D A, Smith F W. Screening for colon malignancy with colonoscopy.  Am J Gastroenterol. 1991;  86 946-951
• 12 Angtuaco T L, Banaad-Omiotek G D, Howden C W. Differing attitudes toward virtual and conventional colonoscopy for colorectal cancer screening: surveys among primary care physicians and potential patients.  Am J Gastroenterol. 2001;  96 887-893
• 13 Fenlon H M, Nunes D P, Schroy P C, Barish M A, Clarke P D, Ferrucci J T. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps.  N Engl J Med. 1999;  341 1496-1503
• 14 Fletcher J G, Johnson C D, Welch T J, MacCarty R L, Ahlquist D A, Reed J E. et al . Optimization of CT colonography technique: prospective trial in 180 patients.  Radiology. 2000;  216 704-711
• 15 Becker C R, Schatzl M, Feist H, Bauml A, Bruning R, Schopf U J. et al . Radiation exposure during CT examination of thorax and abdomen. Comparison of sequential, spiral and electron beam computed tomography.  Radiologe. 1998;  38 726-729
• 16 Hara A K, Johnson C D, Reed J E, Ehman R L, Ilstrup D M. Colorectal polyp detection with CT colonography: two-versus three-dimensional techniques.  Radiology. 1996;  200 49-54
• 17 Fenlon H M, Clarke P D, Ferrucci J T. Virtual colonoscopy: imaging features with colonoscopic correlation.  Am J Roentgenol. 1998;  170 1303-1309
• 18 Rogalla P, Meiri N. CT colonography: data acquisition and patient preparation techniques.  Semin Ultrasound CT MR. 2001;  22 405-412
• 19 Murphy K J, Brunberg J A, Cohan R H. Adverse reactions to gadolinium contrast media: a review of 36 cases.  Am J Roentgenol. 1996;  167 847-849
• 20 Prince M R, Arnoldus C, Frisoli J K. Nephrotoxicity of high-dose gadolinium compared with iodinated contrast.  J Magn Reson Imaging. 1996;  6 162-166
• 21 Luboldt W, Bauerfeind P, Steiner P, Fried M, Krestin G P, Debatin J F. Preliminary assessment of three-dimensional magnetic resonance imaging for various colonic disorders.  Lancet. 1997;  349 1288-1291
• 22 Luboldt W, Steiner P, Bauerfeind P, Pelkonen P, Debatin J F. Detection of mass lesions with MR colonography.  Radiology. 1998;  207 59-65
• 23 Luboldt W, Bauerfeind P, Wildermuth S, Marincek B, Fried M, Debatin J F. Colonic masses: detection with MR colonography.  Radiology. 2000;  216 383-388
• 24 Saar B, Heverhagen J T, Obst T, Berthold L D, Kopp I, Klose K J. et al . Magnetic resonance colonography and virtual magnetic resonance colonoscopy with the 1.0-T system: a feasibility study.  Invest Radiol. 2000;  35 521-526
• 25 Pappalardo G, Polettini E, Frattaroli F M, Casciani E, D'Orta C, D'Amato M. et al . Magnetic resonance colonography versus conventional colonoscopy for the detection of colonic endoluminal lesions.  Gastroenterology. 2000;  119 300-304
• 26 Luboldt W, Bauerfeind P, Pelkonen P, Steiner P, Krestin G P, Debatin J F. 3D-MRI Of the colon: methods and initial results.  Fortschr Röntgenstr. 1997;  167 252-256
• 27 Lauenstein T C, Herborn C U, Vogt F M, Gohde S C, Debatin J F, Ruehm S G. Dark lumen MR-colonograph: initial experience.  Fortschr Röntgenstr. 2001;  173 785-789
• 28 Morrin M M, Farrell R J, Kruskal J B, Reynolds K, McGee J B, Raptopoulos V. Utility of intravenously administered contrast material at CT colonography.  Radiology. 2000;  217 765-771
• 29 Marcos H B, Semelka R C. Evaluation of Crohn's disease using half-fourier RARE and gadolinium-enhanced SGE sequences: initial results.  Magn Reson Imaging. 2000;  18 263-268
• 30 Lomas D J, Sood R R, Graves M J, Miller R, Hall N R, Dixon A K. Colon Carcinoma: MR imaging with CO₂ enema.  Radiology. 2001;  219 558-562
• 31 Morrin M M, Hochman M G, Farrell R J, Marquesuzaa H, Rosenberg S, Edelman R R. Colonography using colonic distention with air as the contrast material.  Am J Roentgenol. 2001;  176 144-146
• 32 Villavicencio R T, Rex D X. Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy.  Semin Gastrointest Dis. 2000;  11 185-193
• 33 Hofstad B, Vatn M H, Andersen S N, Huitfeldt H S, Rognum T, Larsen S. et al . Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years.  Gut. 1996;  39 449-456
• 34 Elwood M J, Ali G, Schlup M T, McNoe B, Barbezat G O, North F. et al . Flexible sigmoidoscopy or colonoscopy for colorectal screening: a randomized trial of performance and acceptability.  Cancer Detection and Prevention. 1995;  19 337-347
• 35 Weishaupt D, Patak M A, Fröhlich J, Rühm S G, Debatin J F. Faecal tagging to avoid colonic cleaning before MRI colonography.  Lancet. 1999;  354 835-836
• 36 Lauenstein T, Holtmann G, Schoenfelder D, Bosk S, Ruehm S G, Debatin J F. MR colonography without colonic cleansing: a new strategy to improve patient acceptance.  Am J Roentgenol. 2001;  177 823-827
• 37 Lauenstein T C, Goehde S C, Ruehm S G, Holtmann G, Debatin J F. MR Colonography with Barium-based Fecal Tagging: Initial Clinical Experience.  Radiology. 2002;  223 248-254
• 38 Javors B R, Applbaum Y, Gerard P. Severe allergic reaction: an unusual complication of barium enema.  Gastrointest Radiol. 1984;  9 357-358
• 39 Sodickson D K, McKenzie C A, Ohliger M A, Yeh E N, Price M D. Recent advances in image reconstruction, coil sensitivity calibration, and coil array design for SMASH and generalized parallel MRI.  MAGMA. 2002;  13 158-163
• 40 Weiger M, Pruessmann K P, Boesiger P. 2D-SENSE for faster 3D-MRI.  MAGMA. 2002;  14 10-19