Diagnostic performance of primary 3-dimensional computed tomography colonography in the setting of colonic diverticular disease
Diagnostic performance of primary 3-dimensional computed tomography colonography in the setting of colonic diverticular disease
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DOI：
10.1016/j.cgh.2006.04.005
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发表时间：
2006-08-01
影响因子：
12.6
通讯作者：
Pickhardt, Perry J.
中科院分区：
文献类型：
--
作者：
Sanford, Matthew F.;Pickhardt, Perry J.
背景与目的：结肠憩室病（CDD）是计算机断层扫描结肠成像（CTC）中非诊断性节段评估的主要原因。本研究的主要目标是评估 CDD 对原发 3 维 (3D) CTC 息肉检测的影响。方法：研究组由 280 名无症状平均风险成年人组成（平均年龄 58.1 岁；167 名男性，113 名女性）。所有患者均接受了 CTC，随后在当天进行了分段揭盲的光学结肠镜检查（参考标准）。具有二维相关性的主要 3D 腔内评估用于 CTC 的初始息肉检测。在不了解息肉发现的情况下，检查所有结肠段是否存在 CDD，并将其分级为不存在、轻微、中度或广泛疾病。结果：2240 例结肠段中有 271 例（12.1%）存在中度或广泛 CDD，280 例患者中有 142 例（50.7%）存在中度或广泛 CDD。在存在和不存在中度广泛 CDD 的情况下，6 mm 或更大息肉的 CTC 表现如下：按节段敏感性分别为 90.3% (28/31) 和 79.4% (123/155)；患者敏感性分别为 86.5% (64/74) 和 83.1% (54/65)；按细分市场的特异性分别为 97.1% (233/ 240) 和 97.7% (1772/1814)；患者特异性分别为 83.8% (57/68) 和 83.6% (61/73)；各区段阳性预测值为 80.0% (28/35) 和 74.5% (123/ 165)；患者阳性预测值为 85.3% (64/ 75) 和 81.8% (64/66)；分时段阴性预测值为 98.7% (233/236) 和 98.2% (1172/1804)；患者阴性预测值分别为 85.1% (57/ 67) 和 84.7% (61/72)（不显着，P >=.15）。结论：CDD 在该无症状筛查人群中很常见，但其存在不会降低原发 3D CTC 用于息肉检测的诊断性能。
Background & Aims: Colonic diverticular disease (CDD) is a leading cause of nondiagnostic segmental evaluation at computed tomography colonography (CTC). The primary goal of this study was to evaluate the impact of CDD on polyp detection at primary 3-dimensional (3D) CTC. Methods: The study group consisted of 280 asymptomatic average-risk adults (mean age, 58.1 y; 167 men, 113 women). All patients underwent CTC followed by same-day optical colonoscopy with segmental unblinding (reference standard). Primary 3D endoluminal evaluation with 2-dimensional correlation was used for initial polyp detection at CTC. Without knowledge of polyp findings, all colonic segments were reviewed for the presence of CDD and graded as absent, minimal, moderate, or extensive disease. Results: Moderate or extensive CDD was present in 271 (12.1%) of 2240 colonic segments and 142 (50.7%) of 280 patients. CTC performance for polyps 6 mm or larger in the presence and absence of moderate-extensive CDD was as follows: by-segment sensitivity of 90.3% (28/31) and 79.4% (123/155); by-patient sensitivity of 86.5% (64/74) and 83.1% (54/65); by-segment specificity of 97.1% (233/ 240) and 97.7% (1772/1814); by-patient specificity of 83.8% (57/68) and 83.6% (61/73); by-segment positive predictive value of 80.0% (28/35) and 74.5% (123/ 165); by-patient positive predictive value of 85.3% (64/ 75) and 81.8% (64/66); by-segment negative predictive value of 98.7% (233/236) and 98.2% (1172/1804); and by-patient negative predictive value of 85.1% (57/ 67) and 84.7% (61/72), respectively (not significant, P >=.15). Conclusions: CDD was common in this asymptomatic screening population, but its presence did not degrade the diagnostic performance of primary 3D CTC for polyp detection.