Potentially Important Extracolonic Findings at Screening CT Colonography: Incidence and Outcomes Data From a Clinical Screening Program

Abstract

Objective The impact of detection of extracolonic findings at screening CT colonography (CTC) remains controversial. Our objective is to analyze the incidence and outcomes of unsuspected potentially significant (C-RADS extracolonic category E4) findings in a clinical CTC screening population. Methods Over 98 months (April 2004 – June 2012), 7,952 consecutive asymptomatic adults (mean age 56.7 ± 7.3 years, 3,675 men, 4,277 women) underwent first-time screening CTC. Examinations were prospectively interpreted by radiologists within our abdominal imaging section and extracolonic findings recorded and categorized. Potentially significant (ie, C-RADS extracolonic category E4) findings were retrospectively reviewed with additional analysis of follow-up and ultimate clinical outcome. Results Overall, 2.5% (202/7952) of patients had a potentially significant (E4) extracolonic finding for which further imaging (55.9%, 113/202) or clinical follow-up (44.1%, 89/202) was recommended. No patients had multiple E4 findings. 22 patients were lost to follow-up. Of the remaining 180 patients, 68% (123/180) proved to have clinically significant disease, including 23% (42/180) with malignant or potentially malignant neoplasms and 32% (57/180) with abdominal aortic or other visceral artery aneurysms requiring treatment or surveillance. The most commonly involved organ systems included vascular (26.2%, 53/202), liver (14.9%, 30/202), genitourinary (13.9%, 28/202), gastrointestinal (9.9%, 20/202), lung (9.4%, 19/202), and gynecologic (6.9%, 14/202). Conclusions Potentially significant extracolonic findings in asymptomatic adults at screening CTC are uncommon, seen in 2–3% of cases. However, the majority of these findings will prove to be clinically significant, including a number of malignancies and aneurysms requiring treatment or surveillance.

Indeterminate but Likely Unimportant Extracolonic Findings at Screening CT Colonography (C-RADS Category E3): Incidence and Outcomes Data From a Clinical Screening Program

“…As noted, a separate sub-cohort of this screening population was previously reported on by Pooler, et al (C-RADS category E4 extracolonic findings). [11] Exclusion criteria again included a history of colorectal cancer, known inflammatory bowel disease, known polyposis syndromes, and a history of colorectal surgery. All examinations were prospectively interpreted by a board-certified radiologist practicing within our abdominal imaging section.…”

“…[9] Nonetheless, the perceived lack of understanding of the ramifications of these extracolonic findings has been cited as a reason for exclusion of CTC from some U.S. national colorectal cancer screening guidelines. [10] In an effort to address this perceived deficiency in the literature, our research group recently published findings from a large, single-center clinical screening program detailing the incidence and outcomes of concerning or potentially important extracolonic findings,[11] which are classified as C-RADS category E4 according to the definitions established by the Working Group for Virtual Colonoscopy in 2005. [12] We found that C-RADS category E4 extracolonic findings were uncommon at screening CTC (2.5% of patients), but that nearly 70% of these findings represented clinically significant diagnoses, including a large number of frank or potential malignancies, with very few patients undergoing unnecessary further workup.…”

Analysis of morphological changes after facial massage by a novel approach using three‐dimensional computed tomography

“…Current CT technology affords high-resolution images with extremely low X-ray doses, and is therefore considered safe for routine screening and clinical practice (4)(5)(6)(7)(14)(15)(16). Helical scanning, as employed in MDCT, provides data from which detailed 3-D CT images can be reconstructed.…”

“…Due to advances in diagnostic imaging equipment, computed tomography (CT) is widely used for diagnosis and screening examinations (4)(5)(6)(7). In particular, multi-detector-row CT (MDCT) can provide three-dimensional (3D) CT images (8) of face and body shape, as well as subcutaneous structures (4,5,9,10).…”

“…In particular, multi-detector-row CT (MDCT) can provide three-dimensional (3D) CT images (8) of face and body shape, as well as subcutaneous structures (4,5,9,10).…”