Clinical Gastroenterology and Hepatology
Volume 4, Issue 8 , Pages 1039-1047, August 2006

Diagnostic Performance of Primary 3-Dimensional Computed Tomography Colonography in the Setting of Colonic Diverticular Disease

  • Matthew F. Sanford

      Affiliations

    • Department of Radiology, University of Wisconsin Medical School, Madison, Wisconsin
    • ,
  • Perry J. Pickhardt

      Affiliations

    • Department of Radiology, University of Wisconsin Medical School, Madison, Wisconsin
    • Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
    • Dr Pickhardt is a medical consultant for Viatronix.
    • Corresponding Author InformationAddress requests for reprints to: Perry J. Pickhardt, MD, Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, Wisconsin 53792-3252; fax: (608) 263-0140.

published online 22 June 2006.

Background & Aims: Colonic diverticular disease (CDD) is a leading cause of nondiagnostic segmental evaluation at computed tomography colonography (CTC). The primary goal of this study was to evaluate the impact of CDD on polyp detection at primary 3-dimensional (3D) CTC. Methods: The study group consisted of 280 asymptomatic average-risk adults (mean age, 58.1 y; 167 men, 113 women). All patients underwent CTC followed by same-day optical colonoscopy with segmental unblinding (reference standard). Primary 3D endoluminal evaluation with 2-dimensional correlation was used for initial polyp detection at CTC. Without knowledge of polyp findings, all colonic segments were reviewed for the presence of CDD and graded as absent, minimal, moderate, or extensive disease. Results: Moderate or extensive CDD was present in 271 (12.1%) of 2240 colonic segments and 142 (50.7%) of 280 patients. CTC performance for polyps 6 mm or larger in the presence and absence of moderate-extensive CDD was as follows: by-segment sensitivity of 90.3% (28/31) and 79.4% (123/155); by-patient sensitivity of 86.5% (64/74) and 83.1% (54/65); by-segment specificity of 97.1% (233/240) and 97.7% (1772/1814); by-patient specificity of 83.8% (57/68) and 83.6% (61/73); by-segment positive predictive value of 80.0% (28/35) and 74.5% (123/165); by-patient positive predictive value of 85.3% (64/75) and 81.8% (64/66); by-segment negative predictive value of 98.7% (233/236) and 98.2% (1172/1804); and by-patient negative predictive value of 85.1% (57/67) and 84.7% (61/72), respectively (not significant, P ≥ .15). Conclusions: CDD was common in this asymptomatic screening population, but its presence did not degrade the diagnostic performance of primary 3D CTC for polyp detection.

Abbreviations used in this paper:  CDD, colonic diverticular disease , CT, computed tomography , CTC, computed tomography colonography , OC, optical colonoscopy , 3D, 3-dimensional , 2D, 2-dimensional

 

 The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Navy or Defense.

PII: S1542-3565(06)00422-8

doi:10.1016/j.cgh.2006.04.005

Clinical Gastroenterology and Hepatology
Volume 4, Issue 8 , Pages 1039-1047, August 2006