Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy.

INTRODUCTION: Published studies have reported a wide range of sensitivities and specificities for computed tomographic (CT) colonography for polyp detection, generating controversy regarding its diagnostic accuracy. METHODS: A meta-analysis of published studies comparing the accuracies of CT colonography and colonoscopy for polyp detection was performed. The pooled per-patient sensitivities and specificities were calculated at various thresholds for polyp size. Summary receiver operating characteristic (sROC) curves were also constructed. RESULTS: Thirty studies were included in the meta-analysis of CT colonography. The pooled per-patient sensitivity of CT colonography was higher for polyps greater than 10 mm (0.82, 95% confidence interval [CI], 0.76-0.88) compared with polyps 6 to 10 mm (0.63, 95% CI, 0.52-0.75) and polyps 0 to 5 mm (0.56, 95% CI, 0.42-0.70). Similarly, the exact area under the sROC curve (area +/- standard error) was higher using a threshold greater than 10 mm (0.898 +/- 0.063) compared with thresholds of greater than 5 mm and any size (0.884 +/- 0.033 and 0.822 +/- 0.059, respectively). There were no significant differences in the diagnostic characteristics of 2-dimensional versus 3-dimensional CT colonography. At a threshold greater than 5 mm, the exact area under the sROC curve was significantly higher for endoscopic colonoscopy compared with CT colonography (0.998 +/- 0.006 vs 0.884 +/- 0.033, P < .005). CONCLUSIONS: CT colonography has a reasonable sensitivity and specificity for detecting large polyps but was less accurate than endoscopic colonoscopy for smaller polyps. Thus, CT colonography may not be a reasonable alternative in situations in which a small polyp may be clinically relevant.

Chiropractic sympathectomy: carotid artery dissection with oculosympathetic palsy after chiropractic manipulation of the neck.

The clinical association between carotid artery dissection and oculosympathetic palsy is well-known. However, the occurrence of this combination with chiropractic manipulation of the cervical neck is rare. We describe the case of a 54-year-old Caucasian American male who underwent cervical manipulation for neck pain. The following day he noticed drooping of his left eyelid, with an unequal pupil size. Imaging later confirmed carotid artery dissection. Only three previous cases (one from the United States ), of an association between carotid artery dissection and chiropractic sympathectomy (oculosympathetic palsy after chiropractic manipulation of the neck) have been reported. Pictures of the oculosympathetic palsy, computed tomography of the head and magnetic resonance imaging of the dissection are presented.