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Diagnosis
Virtual colonoscopy detected colorectal polyps in asymptomatic patients with average risk of colorectal neoplasia

https://doi.org/10.1136/ebm.9.4.123

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    Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003;349:2191–200.
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 Q In asymptomatic patients with average risk for colorectal neoplasia, what is the accuracy of virtual colonoscopy for detecting colorectal polyps?

    Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★★ Gastroenterology ★★★★★★★

    METHODS

    Embedded ImageDesign:

    blinded comparison of virtual colonoscopy (VC) with optical colonoscopy (OC).

    Embedded ImageSetting:

    3 medical centres in the US.

    Embedded ImagePatients:

    1233 patients (mean age 58 y, 59% men) with average risk of colorectal cancer. Exclusion criteria included positive result on guaiac based test of stool ⩽6 months before referral; iron deficiency anaemia in the previous 6 months; rectal bleeding or haematochezia or unintentional weight loss >4.5 kg in the previous 12 months; OC in the previous 10 years; barium enema in the previous 5 years; history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease; and pregnancy.

    Embedded ImageDescription of tests:

    VC was done before OC using a computed tomography (CT) protocol wherein pneumocolon was produced by insufflating room air through a rectal catheter immediately before scanning. A 4 or 8 channel CT scanner (GE LightSpeed or LightSpeed Ultra, General Electric Medical Systems) generated 2 and 3 dimensional (3 D) endoluminal displays of the colon and rectum while the patient held his or her breath in the supine …

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    Footnotes

    • For correspondence: Dr P J Pickhardt, University of Wisconsin Medical School, Madison, WI, USA. ppickhardtmail.radiology.wisc.edu

    • Source of funding: Department of Defense.

    • Abstract and commentary also appear in ACP Journal Club.