Diverticular disease in CT colonography.

The aim of this study was to evaluate findings on CT colonography (CTC) in patients with diverticular disease. In a retrospective analysis of 160 consecutive patients, who underwent CTC and conventional colonoscopy (CC), patients with diverticular disease were retrieved. The CTC images were compared with CC and, if possible, with pathology. Findings on both 2D and 3D images are illustrated with emphasis on diagnostic problems and the possible solutions to overcome these problems. Several aspects of diverticulosis were detected: prediverticulosis (3%); global (55.6%); and focal wall thickening (4%) caused by thickened haustral folds, fibrosis, inflammation and adenocarcinoma; diverticula (52%); pseudopolypoid lesions caused by diverticular fecaliths (39%); inverted diverticula (1.2%); and mucosal prolapse (0.6%). Solutions to overcome pitfalls are described as abdominal windowing, content of the pseudopolypoid lesion, comparison of 2D and 3D images, prone-supine imaging and the aspect of the pericolic fat. In this series there were equivocal findings in case of mucosal prolapse (0.6%) and focal wall thickening (4%). Diverticulosis is a challenge for CTC to avoid false-positive diagnosis of polypoid and tumoral disease. Knowledge of possible false causes of polypoid disease and comparison of 2D and 3D images are necessary to avoid false-positive diagnosis. In case of equivocal findings additional conventional colonoscopy should be advised whenever a clinically significant lesion (> or = 1 cm) is suspected.

Dietary fecal tagging as a cleansing method before CT colonography: initial results polyp detection and patient acceptance.

PURPOSE: To compare reduced colonic cleansing based on dietary fecal tagging (FT) with standard (non-FT) colonic cleansing with regard to patient acceptance, sensitivity, and specificity. MATERIALS AND METHODS: In 50 patients (FT group), FT was performed by means of diet, magnesium citrate, and a barium suspension. In another 50 patients (non-FT group), preparation was based on polyethylene glycol administration. All patients underwent conventional colonoscopy after computed tomographic (CT) colonography. Sensitivity and specificity for polyp detection were calculated by using conventional colonography as the reference standard. At CT colonography, fecal residue was evaluated. Patients were interviewed to determine discomfort, side effects, sleep quality, final opinion on examination comfort, and whether they would be reluctant to undergo the same examination again. RESULTS: FT left more fecal residue but improved differentiation from polyps (FT specificity, 88% [30 of 34 patients]; non-FT, 77% [23 of 30 patients]). Sensitivities were comparable: FT, 88% (14 of 16 patients); non-FT, 85% (17 of 20 patients). FT significantly reduced discomfort, side effects, and sleep disturbance, and resulted in an improved final opinion of how comfortable the examination was (P <.05). Although FT improved patient willingness to repeat the examination, this improvement was not statistically significant (P >.05). CONCLUSION: FT offers the patient a well-tolerated preparation and improves specificity, with improved differentiation of polyps from residual stool.