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Clin Colon Rectal Surg 2008; 21(3): 220-231
DOI: 10.1055/s-2008-1081001
© Thieme Medical Publishers

Computed Tomography Colonography (Virtual Colonoscopy): Climax of a New Era of Validation and Transition into Community Practice

Jacob Thomas1 , Jeffrey Carenza2 , Elizabeth McFarland2 , 3
  • 1Washington University School of Medicine, St. Louis Missouri
  • 2Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
  • 3St. Luke's Hospital/Center for Diagnostic Imaging, Chesterfield, Missouri
Further Information

Publication History

Publication Date:
24 July 2008 (online)

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ABSTRACT

Colorectal cancer, which kills more than 50,000 patients every year in the United States and costs more than $6 billion in direct health costs, is a prime target for cancer prevention. Computed tomography colonography (CTC) has emerged as a minimally invasive, structural examination of the entire colon that can complement the current tools of cancer prevention and may improve patient compliance. Large trials have suggested a sensitivity of roughly 90% and specificity greater than 97% for CTC for patients with polyps ≥ 10 mm. Bowel preparation by diet restriction, catharsis, and stool and fluid tagging are typically used. A prepless CTC protocol is an active area of research with a focus on improving patient compliance. Insurance coverage of CTC is a key factor affecting current dissemination and local and national coverage decisions are ongoing. CT examination of the abdomen allows visualization of extracolonic organs, where detection of additional disease must balance any unnecessary anxiety and testing. Estimates of CTC cost-effectiveness are generally favorable, but vary due to the high sensitivity of these models to costs, polyp sensitivity, compliance rates, and other parameters, which are difficult to accurately assess. Quality initiatives are being developed that will be key for implementation into community practice.

KEYWORDS

Colorectal cancer - virtual colonoscopy - computed tomography colonography - prevention - screening

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Elizabeth McFarlandM.D. 

Department of Radiology, St. Luke's Hospital

232 South Woods Mill Rd., Chesterfield, MO 63017

Email: mcfarlandb@mir.wustl.edu

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