Front cover

CT Colonography PRINCIPLES AND PRACTICE OF VIRTUAL COLONOSCOPY

Copyright page

Preface

Acknowledgments

Table of contents

SECTION 1. Colorectal Polyps and Cancer

Chapter 1. Colorectal Polyps: Overview and Classification

INTRODUCTION

HISTOLOGIC CLASSIFICATION OF POLYPS

THE TARGET POLYP(S) OF COLORECTAL CANCER SCREENING

THE EFFICIENT TARGET LESION FOR CTC

SUMMARY

Chapter 2. Colorectal Polyps: Prevalence, Histology, Morphology, and Natural History

INTRODUCTION

POLYP PREVALENCE AND HISTOLOGY ACCORDING TO SIZE

POLYP MORPHOLOGY AND FLAT (NONPOLYPOID) LESIONS

POLYP NATURAL HISTORY DATA FROM THE PRE-CTC ERA

CTC SURVEILLANCE OF SMALL POLYPS: INITIAL RESULTS

SUMMARY

Chapter 3. Colorectal Cancer: Pathogenesis and Risk Factors

INTRODUCTION

GENERAL PRINCIPLES

ADENOMA–CARCINOMA SEQUENCE

SERRATED POLYP–CARCINOMA SEQUENCE

HEREDITARY COLORECTAL CANCER SYNDROMES

RISK FACTORS AND ENVIRONMENT

SUMMARY

Chapter 4. Colorectal Cancer: Staging, Treatment, and Prognosis

INTRODUCTION

TNM STAGING

IMAGING MODALITIES USED IN STAGING

OVERVIEW OF TREATMENT OPTIONS

PROGNOSIS

SUMMARY

Chapter 5. Colorectal Cancer Screening: Rationale and Available Options

GENERAL PRINCIPLES

SCREENING TESTS THAT PREVENT AND DETECT CANCER

SCREENING TESTS THAT PRIMARILY DETECT CANCER

SUMMARY

SECTION 2. General Aspects of CT Colonography

Chapter 6. CT Colonography: An Introduction and Historical Overview

INTRODUCTION

ORIGINS OF CTC

CLINICAL EVOLUTION OF CTC

FUTURE OF CTC

Chapter 7. Clinical Validation of CTC Performance

INTRODUCTION

CTC TRIALS EVALUATING POLYP-RICH COHORTS

CTC TRIALS EVALUATING LOW-PREVALENCE COHORTS

CTC AS A RECOGNIZED SCREENING OPTION

SUMMARY

Chapter 8. Building a Clinical CT Colonography Program

INTRODUCTION

CTC PROGRAM COMPONENTS

PROGRAMMATIC ISSUES CENTRAL TO CTC

PROGRAM WORKFLOW

BILLING AND REIMBURSEMENT

SUMMARY

Chapter 9. Indications for Performing CT Colonography

GENERAL PRINCIPLES

CTC FOR ASYMPTOMATIC SCREENING

DIAGNOSTIC CTC FOLLOWING INCOMPLETE COLONOSCOPY

OTHER DIAGNOSTIC INDICATIONS FOR CTC

CONTRAINDICATIONS FOR CTC EVALUATION

Chapter 10. Economic Aspects of CT Colonography

GENERAL PRINCIPLES

COST-EFFECTIVENESS ANALYSES

THIRD-PARTY REIMBURSEMENT

NONRADIOLOGIST INVOLVEMENT

Chapter 11. Future Directions for Virtual Colonoscopy

INTRODUCTION

FUTURE APPLICATIONS AND ROLES OF CTC

WHO WILL INTERPRET CTC?

FUTURE TECHNOLOGIC CAPABILITIES

CONCLUDING STATEMENTS

SECTION 3. CT Colonography Technique

Chapter 12. Bowel Preparation for CT Colonography

INTRODUCTION

PREPARATION STRATEGIES

UW PROTOCOL

BOWEL PREPARATION AFTER INCOMPLETE COLONOSCOPY

MINIMAL/”PREPLESS” BOWEL PREPARATION

TROUBLESHOOTING

SUMMARY

Chapter 13. Colonic Distention for CT Colonography

INTRODUCTION

GENERAL PRINCIPLES

ROOM AIR VERSUS CARBON DIOXIDE

USE OF SPASMOLYTICS

USE OF ADDITIONAL SERIES

HARDWARE AND DISTENTION PROTOCOL

COMPLICATIONS

TROUBLESHOOTING

SUMMARY

Chapter 14. MDCT Protocol for CT Colonography

INTRODUCTION

CT SCANNING PARAMETERS

SEQUENCES

SCANNER TYPE

RADIATION DOSE AT CTC

UNIVERSITY OF WISCONSIN MDCT PROTOCOL

CTC Protocol: Screening and Most Diagnostic Indications (no IV contrast)

CTC Protocol: Evaluation of Known Colorectal Cancer (with IV contrast)

SUMMARY

Chapter 15. Potential Complications of CT Colonography

INTRODUCTION

COMPLICATIONS RELATED TO BOWEL PREPARATION

COMPLICATIONS RELATED TO BOWEL DISTENTION

THEORETIC RADIATION RISKS

OC-RELATED COMPLICATIONS

SUMMARY

SECTION 4. CT Colonography Interpretation

Chapter 16. CTC Interpretation: An Overview

INTRODUCTION

CTC INTERPRETATION APPROACH

REPORTING AT CTC

DEDICATED CTC SOFTWARE SYSTEMS

READER TRAINING REQUIREMENTS

SUMMARY

Chapter 17. Polyp Detection at CTC: 2D versus 3D Evaluation

INTRODUCTION

GENERAL PRINCIPLES

RESULTS WITH 2D VERSUS 3D INTERPRETATION

COMBINED STRATEGIES FOR INTEGRATED POLYP DETECTION

SUMMARY

Chapter 18. Polypoid Lesions at CTC: Differential Diagnosis

INTRODUCTION

GENERAL PRINCIPLES

NEOPLASTIC MUCOSAL LESIONS

NON-NEOPLASTIC MUCOSAL LESIONS

SUBMUCOSAL AND EXTRINSIC LESIONS

ANORECTAL LESIONS

POTENTIAL PITFALLS

''DON’T TOUCH” LESIONS AT CTC

CONCLUSION

Chapter 19. Diagnostic Tools for CTC Interpretation

INTRODUCTION

DIAGNOSTIC TOOLS FOR POLYP DETECTION

DIAGNOSTIC TOOLS FOR POLYP CONFIRMATION

DIAGNOSTIC TOOLS FOR POLYP MEASUREMENT

ADVANCED APPLICATIONS AND DIAGNOSTIC TOOLS

SUMMARY

Chapter 20. Potential Pitfalls at CTC Interpretation

INTRODUCTION

GENERAL PRINCIPLES

RETAINED FECAL MATERIAL

THICKENED OR COMPLEX FOLDS

INADEQUATE LUMINAL DISTENTION

DIVERTICULAR DISEASE

FLAT AND CARPET LESIONS

POLYP MEASUREMENT

CONTRAST COATING OF POLYPS

POSITIONAL CHANGE IN POLYPS

IMAGING ARTIFACTS AND DISTORTION

ANORECTAL FINDINGS

ILEOCECAL VALVE

APPENDICEAL FINDINGS

RETAINED FLUID AND SUBMERGED POLYPS

SUBMUCOSAL LESIONS

SUMMARY

Chapter 21. Evaluation for Invasive Cancer at CTC

GENERAL PRINCIPLES

CRC EVALUATION IN SYMPTOMATIC PATIENTS

EVALUATION FOLLOWING INCOMPLETE OC

CRC DETECTION AT ASYMPTOMATIC SCREENING

IMAGING MIMICS OF CRC

CONCLUSION

Chapter 22. Submucosal Lesions at CTC

INTRODUCTION

GENERAL PRINCIPLES OF EVALUATION

NEOPLASTIC CAUSES OF INTRAMURAL ORIGIN

NEOPLASTIC CAUSES OF EXTRAMURAL ORIGIN

NONNEOPLASTIC CAUSES OF INTRAMURAL ORIGIN

NONNEOPLASTIC CAUSES OF EXTRAMURAL ORIGIN

SUMMARY

Chapter 23. 3D Imaging Displays at CTC

GENERAL PRINCIPLES

3D ENDOLUMINAL DISPLAY

VIRTUAL DISSECTION (FILET) VIEWS

OTHER ALTERNATIVE 3D DISPLAYS

COMPARISON OF 3D DISPLAYS FOR POLYP DETECTION

INTERACTIVE 3D COLON MAP

SUMMARY

Chapter 24. Computer-Aided Detection/Diagnosis (CAD) in CT Colonography

INTRODUCTION

GENERAL PRINCIPLES

CADe AND CADx

CAD READER PARADIGMS AND INTERPRETATION STRATEGY

CAD PERFORMANCE RESULTS

FACTORS OPTIMIZING CAD PERFORMANCE

SUMMARY

Chapter 25. Endoscopic and Surgical Referral from CTC

GENERAL PRINCIPLES

REFERRAL TO ENDOSCOPY

PREOPERATIVE ASSESSMENT WITH CTC

Chapter 26. Discordant Findings at CTC—Endoscopic Evaluation

INTRODUCTION

CTC FALSE-POSITIVE OR OC FALSE-NEGATIVE?

SEGMENTAL LOCALIZATION AT CTC VERSUS COLONOSCOPY

ADDITIONAL POLYPS IDENTIFIED AT COLONOSCOPY

SUMMARY

Chapter 27. Extracolonic Findings at CTC

GENERAL PRINCIPLES

TECHNIQUE, CLASSIFICATION, AND REPORTING

EXTRACOLONIC FINDINGS OF POTENTIAL SIGNIFICANCE

COST IMPLICATIONS

SUMMARY

Chapter 28. Reporting of Results and Quality Metrics in CTC

INTRODUCTION

C-RADS AND STRUCTURED REPORTING

THE DICTATION TEMPLATE

QUALITY METRICS

SUMMARY

SECTION 5. CT Colonography at the University of Wisconsin

Chapter 29. CT Colonography at the University of Wisconsin: How We Do It

INTRODUCTION

CTC PERSONNEL

PATIENT SCHEDULING AND DATABASE

CTC TECHNIQUE

CTC INTERPRETATION

REPORTING OF RESULTS

Chapter 30. CTC Program Results at the University of Wisconsin

INTRODUCTION

DESCRIPTION OF THE UW CTC PROGRAM

SCREENING POPULATION DEMOGRAPHICS

PROGRAM OPERATIONAL STATISTICS

PROGRAM YIELD

C-RADS BREAKDOWN

QUALITY ASSURANCE

SUMMARY

Index