Full-laxative Versus Minimum-laxative Fecal-tagging CT Colonography Using 64-detector Row CT: Prospective Blinded Comparison of Diagnostic Performance, Tagging Quality, and Patient Acceptance
Full-laxative Versus Minimum-laxative Fecal-tagging CT Colonography Using 64-detector Row CT: Prospective Blinded Comparison of Diagnostic Performance, Tagging Quality, and Patient Acceptance
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DOI：
10.1016/j.acra.2008.12.027
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发表时间：
2009-07-01
影响因子：
4.8
通讯作者：
Yoshida, Hiroyuki
中科院分区：
文献类型：
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作者：
Nagata, Koichi;Okawa, Tomohiko;Yoshida, Hiroyuki
理由和目标。前瞻性比较64排探测器计算机断层结肠成像（CTC）后，充分泻药标记为基础的准备（充分准备）与最小泻药标记为基础的准备（最小准备）在息肉的检测，标记质量和患者接受的诊断性能。将101例结直肠癌高危患者分为粪标记CTC的完全准备组（n = 51）和最小准备组（n = 50）。完整制备包括给予2 L聚乙二醇溶液和20 mL泛影酸钠用于粪便标记。最低准备包括在CT前3天内摄入总计45 mL泛影酸钠，并在CT前一天晚上摄入10 mL匹可硫酸钠溶液。结肠镜检查用作参考标准。我们评估了息肉检测的准确性和每种制剂的标记质量。对所有患者进行问卷调查。对于息肉>= 6 mm，每个患者的敏感性、特异性以及阳性和阴性预测值如下：充分准备组，分别为97%、92%、88%和98%;最小准备组，分别为88%、68%、56%和92%。完全准备组和最小准备组的平均视觉主观标记得分分别为94.6%和76.1%（P < .0001）。最小准备比完全准备耐受性更好。尽管全泻药和最小泻药粪便标记CTC在检测>= 6 min的息肉时产生了同样高的灵敏度，但全泻药粪便标记CTC产生了比最小泻药粪便标记CTC更好的特异性。因此，希望为患者提供全泻药粪便标记CTC的选择，以获得最高的诊断准确性和在不进行额外肠道准备的情况下进行当天治疗性结肠镜检查的能力，或者为那些不愿意进行充分准备但愿意接受特异性适度降低的患者提供最小泻药粪便标记CTC。
Rationale and Objectives. To compare prospectively 64-detector-row computed tomographic colonography (CTC) after a full-laxative tagging-based preparation (full preparation) with a minimum-laxative tagging-based preparation (minimum preparation) with respect to diagnostic performance in the detection of polyps, tagging quality, and patient acceptance.Materials and Methods. Consecutive 10 1 patients at high risk for developing colorectal cancer were alternately assigned to either a full preparation group (n = 51) or a minimum preparation group (n = 50) for fecal-tagging CTC. The full preparation consisted of administration of 2-L polyethylene glycol solution with 20 mL of sodium diatrizoate for fecal tagging. The minimum preparation consisted of ingestion of a total of 45 mL of sodium diatrizoate during the 3 days before and 1 0 mL of sodium picosulfate solution the night before CT. Colonoscopy was used as the reference standard. We assessed the accuracy of polyp detection and the tagging quality for each preparation. All patients were given questionnaires related to their acceptance.Results. Per-patient sensitivity, specificity, and positive and negative predictive values for polyps >= 6 mm were as follows: full preparation group, 97%, 92%, 88%, and 98%, respectively; minimum preparation group, 88%, 68%, 56%, and 92%, respectively. Average visual subjective tagging scores for the full and minimum preparation groups were 94.6% and 76.1%, respectively (P < .0001). Minimum preparation was better tolerated than full preparation.Conclusion. Although full-laxative and minimum-laxative fecal-tagging CTC yielded an equally high sensitivity in the detection of polyps >= 6 min, the full-laxative fecal-tagging CTC yielded a better specificity than did the minimum-laxative fecal-tagging CTC. Thus, it is desirable to offer patients an option of either full-laxative fecal-tagging CTC for highest diagnostic accuracy and ability to perforin a same-day therapeutic colonoscopy without additional bowel preparation, or minimum-laxative fecal-tagging CTC for those unwilling to undergo full preparation but willing to accept moderate decrease in specificity.