Korean J Radiol.  2012 Jun;13(3):290-299. 10.3348/kjr.2012.13.3.290.

Comparison between CT Colonography and Double-Contrast Barium Enema for Colonic Evaluation in Patients with Renal Insufficiency

• Chung SY
• Park SH
• Lee SS
• Lee JH
• Kim AY
• Park SK
• Han DJ
• Ha HK

• KMID: 1372848
• DOI: http://doi.org/10.3348/kjr.2012.13.3.290

Abstract

OBJECTIVE
To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency.
MATERIALS AND METHODS
Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean +/- SD in age, 51 +/- 6.4 years) and CTC (n = 176; 50 +/- 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of > or = 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups.
RESULTS
Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups.
CONCLUSION
In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.

Keyword

CT colonography; Double-contrast barium enema; Diagnostic yield; Colonic neoplasia; Renal insufficiency

MeSH Terms

Analysis of Variance
Barium Sulfate/diagnostic use
Colonic Polyps/diagnosis/radiography
*Colonography, Computed Tomographic
Colorectal Neoplasms/*diagnosis/radiography
Contrast Media/diagnostic use
*Enema
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Renal Insufficiency/*complications
Risk Factors
Sensitivity and Specificity

Figure

• 

  Fig. 1 Enrollment and outcomes of patients undergoing CTC and DCBE. A. Patients undergoing a CTC. *Positive for colonic masses/polyps ≥ 6 mm in size, †Seven patients were lost to follow-up without subsequent colonoscopy as they finally declined or were denied renal transplantation, and four patients did not undergo colonoscopy, most likely due to small lesion size. B. Patients undergoing DCBE. *Positive for colonic masses/polyps ≥ 6 mm in size, †Patients were lost to follow-up without subsequent colonoscopy as they finally declined or were denied to undergo renal transplantation. CTC = CT colonography, DCBE = double-contrast barium enema

• 

  Fig. 2 15-mm adenocarcinoma in sigmoid colon of 55-year-old man detected by CTC. CTC also detected another 9-mm cancerous polyp (not shown). A. 3D endoluminal image of CTC showing rounded polyp in sigmoid colon (arrow). White curvilinear area (arrowheads) represents tagged fluid around polyp. B. Sagittal 2D CTC image showing polyp (arrow) and tagged fluid (arrowheads) adjacent to lesion. C. Colonoscopy performed next day showing corresponding 15-mm polyp. CTC = CT colonography

• 

  Fig. 3 Two 25-mm and 20-mm adenocarcinomas in sigmoid colon of 65-year-old man detected by DCBE. A. DCBE image of sigmoid colon showing two polypoid masses (arrows). B, C. Colonoscopy performed three weeks after DCBE showing 25-mm polypoid mass with ulceration in sigmoid colon (B) and another 20-mm polypoid mass located more proximally (C). DCBE = double-contrast barium enema

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