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CT COLONOSCOPY

CT COLONOSCOPY

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CT COLONOSCOPY. Turki Alhazmi ,MB.CHB, FRCPC , dABR Interventional Radiology-Body MRI Ass. Prof.  Faculty of Medicine Umm Al Qura University Makkah-Saudi Arabia. Colorectal Cancers. 3rd most common cancer in men and women The age range is late 40s to 70s in average-risk patients - PowerPoint PPT Presentation

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Page 1: CT COLONOSCOPY

CT COLONOSCOPY

Page 2: CT COLONOSCOPY

Turki Alhazmi ,MB.CHB, FRCPC , dABR Interventional Radiology-Body MRI

Ass. Prof.  Faculty of MedicineUmm Al Qura University

Makkah-Saudi Arabia

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Colorectal Cancers

• 3rd most common cancer in men and women

• The age range is late 40s to 70s in average-risk patients

• 20% occur in high risk genetically predisposed patients

• 80% occur sporadically in otherwise low risk individuals

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“The adenoma carcinoma sequence”

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“The adenoma carcinoma sequence”

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“The adenoma carcinoma sequence”

risk factors for transformation into colorectal cancer through the “adenoma-

carcinomasequence

• Polyps greater than 10 mm in diameter

• >3 in number, regardless of their size

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“The adenoma carcinoma sequence”

Interruption of this progression by:

detection and removal of threatening pre-cursor adenomas by endoscopic polypectomy results in a decrease of cancer related mortality by 30%

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Colorectal Cancers

• Arise from pre-existing adenomatous polyp

• Requiring10–15 years

• The majority of adenomas that will develop into cancer are polypoid or villous in shape

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Colorectal Cancers

The risk of an adenoma (5 mm or less )to develop into cancer is significantly low, approximating 0.9%

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Screening

• Asymptomatic

• At age of 50 years

• Fecal occult blood + Colonoscopy or CTC

• Every five years, the combination of fecal occult blood and colonoscopy or CTC

• Every five years, double contrast barium enema

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Screening

• Conventional colonoscopy is still the gold standard for colon cancer screening

• Cancers have also been missed by conventional colonoscopy

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Screening

Why cancers are missed on conventional colonoscopy:

1.poor bowel prep

2.Slippage of the endoscope around flexures

3. redundant colon

4.misinterpretation of findings

5.failure to biopsy

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Conventional ColonoscopyAdverse Outcome

• Hemorrhage & Perforation : most common

• Perforation rate 0.2 - 0.4% after diagnostic colonoscopy

• 5% increases in perforation with polypectomy

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SENSETIVITY

CTC CC

10 mm polyp 93.9 % 87.5 %

8 mm polyp 93.8 % 92.3 %

6 mm polyp 88.7 % 91.5 %

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SPECIFICITY

CTC CC

10 mm polyp 96 % 96.1 %

8 mm polyp 92.2 % 91.6 %

6 mm polyp 79.6 % 77.1 %

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Screening

• The sensitivity and specificity per patient and per polyp were similar

• There is no statistically difference between CT COLONOSCOPY (CTC) and Conventional Colonoscopy for adenomas detection greater than 10 mm

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CTC VS DCBE

sensitivity and specificity of polyp detection is higher for CTC compared to DCBE

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Indications

The indications for CTC closely follow the indications for conventional optical colonoscopy with few exceptions

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CTC VS CC

If you have a patient who is Elderly

With cardiovascular disease

With bleeding diathesis

With history of failed colonoscopies

CTC > CC> DCBE

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CTC VS CC

• CTC is relatively fast without the need for sedation

• Less post procedure discomfort CTC than CC

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Virtual disection

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• Proper cleansing of the colon is essential

• Bowel cleansing for CTC is similar to barium enema and standard colonoscopy

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