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Significance of missed polyps at CT colonography

Macari, Michael; Bini, Edmund J; Jacobs, Stacy L; Lui, Yvonne W; Laks, Shaked; Milano, Andrew; Babb, James
OBJECTIVE: Our purpose was to determine the clinical significance of polyps missed on CT colonography using histologic analysis and the natural history of colorectal polyps and to propose guidelines for follow-up colon surveillance based on CT colonographic findings. SUBJECTS AND METHODS. One hundred eighty-six men (age range, 40-87 years; mean, 62.3 years) underwent CT colonography immediately before conventional colonoscopy. All polyps detected on CT colonography were measured and imaged, and their segmental location was documented. All polyps detected on colonoscopy were measured, photographed, biopsied, and histologically analyzed. Results of CT colonography and conventional colonoscopy were compared with the final pathology reports. Conventional colonoscopy was used as the gold standard unless CT colonography showed a lesion measuring 10 mm or more that was not detected on conventional colonoscopy and had characteristics of a polyp. In these cases, follow-up conventional colonoscopy was offered. RESULTS: One hundred ninety-one polyps were detected on conventional colonoscopy. CT colonography prospectively detected 53 polyps. Histologic analysis of the polyps not detected on CT colonography showed that of those 5 mm or smaller, 58.1% were not adenomas, and of those measuring 6-9 mm, 42.8% were not adenomas. Both missed polyps at CT colonography of 10 mm or more were adenomas. Of the 22 polyps measuring 10 mm or more, three were not detected on conventional colonoscopy. Of these three, CT colonography showed a lesion having characteristics of a polyp, follow-up endoscopy confirmed the presence of the lesion, and histologic analysis showed a villous adenoma, a tubulovillous adenoma, and a tubular adenoma. CONCLUSION: If CT colonography shows no abnormality, follow-up screening in 5 years is recommended. If CT colonography detects a lesion smaller than 5 mm, follow-up imaging in 3-5 years is recommended. If CT colonography detects a lesion measuring 6 mm or more, endoscopy and polypectomy should be offered unless contraindicated
PMID: 15208126
ISSN: 0361-803x
CID: 46120

Colorectal polyps and cancers in asymptomatic average-risk patients: evaluation with CT colonography

Macari, Michael; Bini, Edmund J; Jacobs, Stacy L; Naik, Sanjay; Lui, Yvonne W; Milano, Andrew; Rajapaksa, Roshini; Megibow, Alec J; Babb, James
PURPOSE: To compare thin-section multi-detector row computed tomographic (CT) colonography with conventional colonoscopy in the evaluation of colorectal polyps and cancer in asymptomatic average-risk patients. MATERIALS AND METHODS: Sixty-eight asymptomatic men (age > 50 years) scheduled to undergo screening colonoscopy were enrolled in this study. CT colonography was followed by conventional colonoscopy, performed on the same day. Supine and prone CT colonography were performed after colonic insufflation with room air. A gastroenterologist measured all polyps, which were categorized as 1-5, 6-9, or over 10 mm. Biopsy and histologic evaluation were performed of all polyps. CT colonography and colonoscopy results were compared for location, size, and morphology of detected lesions. Point estimates and 95% CIs were provided for specificity and sensitivity of CT by using results at conventional colonoscopy as the reference standard. RESULTS: At colonoscopy, 98 polyps were identified in 39 patients; 21 (21.4%) of 98 were detected at CT colonography. Sensitivity was 11.5% (nine of 78) for polyps 1-5 mm, 52.9% (nine of 17) for polyps 6-9 mm, and 100% (three of three) for polyps over 10 mm. Results at colonoscopy were normal in 29 (42.6%) of 68 patients; at CT colonography, results were correctly identified as normal in 26 of these 29 patients. In one of these patients, a lesion larger than 10 mm was detected at CT colonography. The per-patient specificity of CT was 89.7% (26 of 29; 95% CI: 72.7%, 97.8%). The mean time for CT image interpretation was 9 minutes. CONCLUSION: In patients at average risk for colorectal cancer, CT colonography is a sensitive and specific screening test for detecting polyps 10 mm or larger; the sensitivity for detecting smaller polyps is decreased. Examination findings can be interpreted in a clinically feasible amount of time
PMID: 14739311
ISSN: 0033-8419
CID: 42610

Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection

Macari, Michael; Bini, Edmund J; Xue, Xiaonan; Milano, Andrew; Katz, Seth S; Resnick, Daniel; Chandarana, Hersh; Krinsky, Glen; Klingenbeck, Klaus; Marshall, Christopher H; Megibow, Alec J
PURPOSE: To prospectively compare thin-section low-dose multi-detector row computed tomographic (CT) colonography with conventional colonoscopy for the detection of colorectal neoplasms. MATERIALS AND METHODS: One hundred five patients underwent CT colonography immediately before colonoscopy. Supine and prone CT colonographic acquisitions to image the region during a 30-second breath hold were performed. CT colonographic images were prospectively interpreted for the presence, location, size, and morphologic features of polyps. The time of image interpretation was noted. Sensitivity, specificity, and positive and negative predictive values of CT colonography were calculated, with 95% CIs, by using colonoscopic findings as the reference standard. The weighted CT dose index was calculated on the basis of measurements in a standard body phantom. Effective dose was calculated by using commercially available software. RESULTS: Median CT data interpretation time was 12 minutes. One hundred thirty-two polyps in 59 patients were identified at colonoscopy; no polyps were detected in 46 patients. Sensitivities for detection of polyps smaller than 5 mm, 6-9 mm, and larger than 10 mm in diameter were 12% (11 of 91 polyps), 70% (19 of 27 polyps), and 93% (13 of 14 polyps), respectively. Estimated overall specificity was 97.7% (515 of 527 imaging results). The total weighted CT dose index for combined supine and prone CT colonography was 11.4 mGy. The effective doses for combined CT colonography were 5.0 mSv and 7.8 mSv for men and women, respectively. CONCLUSION: Low-dose multi-detector row CT colonography has excellent sensitivity and specificity for detection of colorectal neoplasms 10 mm and larger
PMID: 12147833
ISSN: 0033-8419
CID: 32913

Prospective comparison of virtual and conventional colonoscopy for colorectal cancer screening in asymptomatic average-risk patients [Meeting Abstract]

Bini, EJ; Naik, S; Milano, A; Babb, J; Macari, M
ISSN: 0016-5085
CID: 108246

Effect of different bowel preparations on residual fluid at CT colonography

Macari M; Lavelle M; Pedrosa I; Milano A; Dicker M; Megibow AJ; Xue X
The effect of different bowel preparations on residual fluid during computed tomographic (CT) colonography was evaluated. Forty-two patients received either a polyethylene glycol electrolyte solution preparation or a phospho-soda preparation the day prior to CT colonography. The amount of residual fluid was calculated for each patient. On average, a phospho-soda preparation provided significantly less residual fluid than a polyethylene glycol electrolyte solution preparation
PMID: 11152814
ISSN: 0033-8419
CID: 21257

Comparison of time-efficient CT colonography with two- and three-dimensional colonic evaluation for detecting colorectal polyps

Macari M; Milano A; Lavelle M; Berman P; Megibow AJ
OBJECTIVE: We compared the findings of time-efficient CT colonography with complete two-dimensional (2D) and three-dimensional (3D) CT colonography and conventional colonoscopy in detecting colorectal polyps. SUBJECTS AND METHODS: Forty-two patients undergoing colonoscopy screening were examined with CT colonography before endoscopy. Data were examined following one of two methods. In method 1, axial 2D data sets were examined in a cine mode. If findings were suggestive of abnormality, focal areas were examined with 3D CT colonography. In method 2, data sets were examined exactly as in method 1, and subsequent to that review, data sets were examined with simultaneous 3D 'fly-through' CT colonography (surface-rendered images) and multiplanar reformatted images. The time required to examine CT colonography using each technique was recorded and abnormal findings were documented. Results of methods 1 and 2 were compared with findings on colonoscopy. RESULTS: Colonoscopy detected 16 polyps in 13 patients (polyp size, 2-10 mm). Ten polyps measured 5 mm or less, five measured between 6 and 9 mm, and one measured 10 mm or more. Using method 1, two of 10 polyps measuring less than 5 mm, three of five polyps measuring between 6 and 9 mm, and one polyp measuring 10 mm were detected. We noted no false-positive polyps. Average evaluation time was 16 min. With method 2, the same polyps were seen as with method 1. No additional polyps were detected, and the average evaluation time was 40 min. CONCLUSION: Axial 2D CT colonography can be performed quickly and is comparable with complete 2D and 3D CT colonography in detecting colorectal polyps
PMID: 10845478
ISSN: 0361-803x
CID: 11651

Usefulness of CT colonography in patients with incomplete colonoscopy

Macari M; Berman P; Dicker M; Milano A; Megibow AJ
OBJECTIVE: Our objective was to investigate the use of CT colonography in patients who have undergone incomplete colonoscopy. CONCLUSION: CT colonography is effective in evaluating portions of the colon not seen during colonoscopy and may have an adjunctive role
PMID: 10470879
ISSN: 0361-803x
CID: 6189

Diagnosis of familial adenomatous polyposis using two-dimensional and three-dimensional CT colonography [Case Report]

Macari M; Green JC; Berman P; Milano A
PMID: 10397149
ISSN: 0361-803x
CID: 6156

Metastatic vulvar ulceration in Crohn's disease [Case Report]

Reyman L; Milano A; Demopoulos R; Mayron J; Schuster S
PMID: 3942123
ISSN: 0002-9270
CID: 28273

Familial Mediterranean fever associated with menstruation. Efficacy of intermittent colchicine therapy

Milano, A M
The majority of patients with familial Mediterranean fever have a random pattern of attacks without a clear prodrome. Continuous prophylaxis with colchicine has been shown to reduce the frequency of attacks. It is generally considered undesirable, however, to expose young patients to the potential adverse effects of continuous colchicine prophylaxis. The alternative of intermittent short courses of colchicine during acute attacks is often ineffective in patients without a clear prodrome. Case reports of patients with a pattern of attacks occurring 12-24 hours after the onset of menstrual bleeding have appeared. Such patients should be ideal candidates for intermittent colchicine therapy. A review of the literature reveals that a consistent pattern of attacks closely following the onset of menstruation is not uncommon. Such a patient is described who has responded completely to short courses of colchicine begun at the first sign of menstrual bleeding
PMID: 7198867
ISSN: 0002-9270
CID: 141868