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http://dx.doi.org/10.3348/kjr.2012.13.3.290

Comparison between CT Colonography and Double-Contrast Barium Enema for Colonic Evaluation in Patients with Renal Insufficiency  

Chung, Sun-Young (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Park, Seong-Ho (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Lee, Seung-Soo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Lee, Ju-Hee (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Kim, Ah-Young (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Park, Su-Kil (Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center)
Han, Duck-Jong (Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center)
Ha, Hyun-Kwon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Publication Information
Korean Journal of Radiology / v.13, no.3, 2012 , pp. 290-299 More about this Journal
Abstract
Objective: To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. Materials and Methods: Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean ${\pm}$ SD in age, 51 ${\pm}$ 6.4 years) and CTC (n = 176; 50 ${\pm}$ 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of ${\geq}$ 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups. Results: Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups. Conclusion: In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.
Keywords
CT colonography; Double-contrast barium enema; Diagnostic yield; Colonic neoplasia; Renal insufficiency;
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1 Lee S, Wasserberg N, Petrone P, Rosca J, Selby R, Ortega A, et al. The prevalence of colorectal neoplasia in patients with end-stage renal disease: a case-control study. Int J Colorectal Dis 2008;23:47-51
2 Iseki K, Osawa A, Fukiyama K. Evidence for increased cancer deaths in chronic dialysis patients. Am J Kidney Dis 1993;22:308-3   DOI
3 Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, et al. Cancer in patients on dialysis for endstage renal disease: an international collaborative study. Lancet 1999;354:93-99   DOI   ScienceOn
4 Marple JT, MacDougall M. Development of malignancy in the end-stage renal disease patient. Semin Nephrol 1993;13:306- 314
5 Parikshak M, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Margolin DA. The role of endoscopic colon surveillance in the transplant population. Dis Colon Rectum 2002;45:1655-1660   DOI   ScienceOn
6 Penn I. The effect of immunosuppression on pre-existing cancers. Transplantation 1993;55:742-747   DOI   ScienceOn
7 Saidi RF, Dudrick PS, Goldman MH. Colorectal cancer after renal transplantation. Transplant Proc 2003;35:1410-1412   DOI   ScienceOn
8 Vamvakas S, Bahner U, Heidland A. Cancer in end-stage renal disease: potential factors involved -editorial-. Am J Nephrol 1998;18:89-95   DOI   ScienceOn
9 Penn I. Tumors after renal and cardiac transplantation. Hematol Oncol Clin North Am 1993;7:431-445
10 EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: long-term management of the transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid organ cancers: prevention and treatment. Nephrol Dial Transplant 2002;17 Suppl 4:32, 34-36
11 Coccolini F, Catena F, Di Saverio S, Ansaloni L, Faenza A, Pinna AD. Colonic perforation after renal transplantation: risk factor analysis. Transplant Proc 2009;41:1189-1190   DOI   ScienceOn
12 Dalla Valle R, Capocasale E, Mazzoni MP, Busi N, Benozzi L, Sivelli R, et al. Acute diverticulitis with colon perforation in renal transplantation. Transplant Proc 2005;37:2507-2510   DOI   ScienceOn
13 Ponticelli C, Passerini P. Gastrointestinal complications in renal transplant recipients. Transpl Int 2005;18:643-650   DOI   ScienceOn
14 Yun JY, Ro HJ, Park JB, Choi JB, Chung JE, Kim YJ, et al. Diagnostic performance of CT colonography for the detection of colorectal polyps. Korean J Radiol 2007;8:484-491   DOI   ScienceOn
15 Park SH, Yee J, Kim SH, Kim YH. Fundamental elements for successful performance of CT colonography (virtual colonoscopy). Korean J Radiol 2007;8:264-275
16 Rubesin SE, Levine MS, Laufer I, Herlinger H. Doublecontrast barium enema examination technique. Radiology 2000;215:642-650   DOI
17 Rockey DC, Paulson E, Niedzwiecki D, Davis W, Bosworth HB, Sanders L, et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 2005;365:305-311   DOI
18 Lee SS, Park SH, Kim JK, Kim N, Lee J, Park BJ, et al. Panoramic endoluminal display with minimal image distortion using circumferential radial ray-casting for primary threedimensional interpretation of CT colonography. Eur Radiol 2009;19:1951-1959   DOI   ScienceOn
19 Johnson CD, MacCarty RL, Welch TJ, Wilson LA, Harmsen WS, Ilstrup DM, et al. Comparison of the relative sensitivity of CT colonography and double-contrast barium enema for screen detection of colorectal polyps. Clin Gastroenterol Hepatol 2004;2:314-321   DOI   ScienceOn
20 Kim MJ, Park SH, Lee SS, Byeon JS, Choi EK, Kim JH, et al. Efficacy of barium-based fecal tagging for CT colonography: a comparison between the use of high and low density barium suspensions in a Korean population-a preliminary study. Korean J Radiol 2009;10:25-33   DOI   ScienceOn
21 Zalis ME, Barish MA, Choi JR, Dachman AH, Fenlon HM, Ferrucci JT, et al. CT colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9   DOI   ScienceOn
22 The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007;37:1-33
23 Johnson CD, Chen MH, Toledano AY, Heiken JP, Dachman A, Kuo MD, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008;359:1207- 1217   DOI   ScienceOn
24 Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML,Hildebrandt HA, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003;349:2191-2200   DOI   ScienceOn
25 Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 2007;357:1403-1412   DOI   ScienceOn
26 Hollingworth W, Jarvik JG. Technology assessment in radiology: putting the evidence in evidence-based radiology. Radiology 2007;244:31-38   DOI   ScienceOn
27 Sosna J, Sella T, Sy O, Lavin PT, Eliahou R, Fraifeld S, et al. Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol 2008;190:374-385   DOI   ScienceOn
28 Tawn DJ, Squire CJ, Mohammed MA, Adam EJ. National audit of the sensitivity of double-contrast barium enema for colorectal carcinoma, using control charts For the Royal College of Radiologists Clinical Radiology Audit Sub- Committee. Clin Radiol 2005;60:558-564   DOI   ScienceOn
29 Kung JW, Levine MS, Glick SN, Lakhani P, Rubesin SE, Laufer I. Colorectal cancer: screening double-contrast barium enema examination in average-risk adults older than 50 years. Radiology 2006;240:725-735   DOI   ScienceOn
30 Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 1997;112:17-23   DOI   ScienceOn
31 Ferrucci JT. Double-contrast barium enema: use in practice and implications for CT colonography. AJR Am J Roentgenol 2006;187:170-173   DOI   ScienceOn
32 Stevenson G. Colon imaging in radiology departments in 2008: goodbye to the routine double contrast barium enema. Can Assoc Radiol J 2008;59:174-182
33 Fletcher RH. The end of barium enemas? N Engl J Med 2000;342:1823-1824   DOI   ScienceOn
34 Klabunde CN, Jones E, Brown ML, Davis WW. Colorectal cancer screening with double-contrast barium enema: a national survey of diagnostic radiologists. AJR Am J Roentgenol 2002;179:1419-1427   DOI   ScienceOn
35 Borden ZS, Pickhardt PJ, Kim DH, Lubner MG, Agriantonis DJ, Hinshaw JL. Bowel preparation for CT colonography: blinded comparison of magnesium citrate and sodium phosphate for catharsis. Radiology 2010;254:138-144   DOI   ScienceOn
36 Barkun A, Chiba N, Enns R, Marcon M, Natsheh S, Pham C, et al. Commonly used preparations for colonoscopy: efficacy, tolerability, and safety--a Canadian Association of Gastroenterology position paper. Can J Gastroenterol 2006;20:699-710   DOI
37 Fine A, Patterson J. Severe hyperphosphatemia following phosphate administration for bowel preparation in patients with renal failure: two cases and a review of the literature. Am J Kidney Dis 1997;29:103-1   DOI   ScienceOn
38 Tan JJ, Tjandra JJ. Which is the optimal bowel preparation for colonoscopy-a meta-analysis. Colorectal Dis 2006;8:247-258   DOI   ScienceOn
39 Smith C. Colorectal cancer. Radiologic diagnosis. Radiol Clin North Am 1997;35:439-456
40 Wiberg JJ, Turner GG, Nuttall FQ. Effect of phosphate or magnesium cathartics on serum calcium: observations in normocalcemic patients. Arch Intern Med 1978;138:1114-1116   DOI   ScienceOn
41 Drugs.com Website. Available at: http://www.drugs.com/pro/gastrografin.html. Accessed October 5, 2011
42 Kemerink GJ, Borstlap AC, Frantzen MJ, Schultz FW, Zoetelief J, van Engelshoven JM. Patient and occupational dosimetry in double contrast barium enema examinations. Br J Radiol 2001;74:420-428   DOI