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Quality of Virtual Colonoscopy in Patients Who Have Undergone Radiation Therapy or Surgery

How Successful Are We?

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
² Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

View larger version (131K): [in a new window]   Fig. 1A. —Colonic distention rating system. Axial two-dimensional CT scans from virtual colonoscopy show air-insufflated sigmoid colon with patient in supine position. Scans reveal the following segments of varying distention from different patients: optimal distention (rating, 4; A), good distention (rating, 3; B), poor distention (rating, 2; C), and nondistended (rating, 1; D). Arrow in D indicates collapsed sigmoid colon (rating, 1).

View larger version (126K): [in a new window]   Fig. 1B. —Colonic distention rating system. Axial two-dimensional CT scans from virtual colonoscopy show air-insufflated sigmoid colon with patient in supine position. Scans reveal the following segments of varying distention from different patients: optimal distention (rating, 4; A), good distention (rating, 3; B), poor distention (rating, 2; C), and nondistended (rating, 1; D). Arrow in D indicates collapsed sigmoid colon (rating, 1).

View larger version (109K): [in a new window]   Fig. 1C. —Colonic distention rating system. Axial two-dimensional CT scans from virtual colonoscopy show air-insufflated sigmoid colon with patient in supine position. Scans reveal the following segments of varying distention from different patients: optimal distention (rating, 4; A), good distention (rating, 3; B), poor distention (rating, 2; C), and nondistended (rating, 1; D). Arrow in D indicates collapsed sigmoid colon (rating, 1).

View larger version (130K): [in a new window]   Fig. 1D. —Colonic distention rating system. Axial two-dimensional CT scans from virtual colonoscopy show air-insufflated sigmoid colon with patient in supine position. Scans reveal the following segments of varying distention from different patients: optimal distention (rating, 4; A), good distention (rating, 3; B), poor distention (rating, 2; C), and nondistended (rating, 1; D). Arrow in D indicates collapsed sigmoid colon (rating, 1).

View larger version (101K): [in a new window]   Fig. 2A. —Colonic fluid and stool retention rating system. Axial two-dimensional CT scans from virtual colonscopy show air-insufflated right colon (arrows) with patient in prone position. Scans reveal the following varying degrees of fluid retention from different patients: none (rating, 3; A), less than one-half filled lumen (rating, 2; B), and more than one-half filled lumen (rating, 1; C).

View larger version (108K): [in a new window]   Fig. 2B. —Colonic fluid and stool retention rating system. Axial two-dimensional CT scans from virtual colonscopy show air-insufflated right colon (arrows) with patient in prone position. Scans reveal the following varying degrees of fluid retention from different patients: none (rating, 3; A), less than one-half filled lumen (rating, 2; B), and more than one-half filled lumen (rating, 1; C).

View larger version (115K): [in a new window]   Fig. 2C. —Colonic fluid and stool retention rating system. Axial two-dimensional CT scans from virtual colonscopy show air-insufflated right colon (arrows) with patient in prone position. Scans reveal the following varying degrees of fluid retention from different patients: none (rating, 3; A), less than one-half filled lumen (rating, 2; B), and more than one-half filled lumen (rating, 1; C).

View larger version (119K): [in a new window]   Fig. 3A. —Segmental adequacy qualifier. Axial two-dimensional CT scans from virtual colonoscopy show no distention (rating, 1) of sigmoid colon with patient in supine position qualified with plus (+) rating (A) because same segment with patient in prone position (B) shows optimal distention (rating, 4).

View larger version (123K): [in a new window]   Fig. 3B. —Segmental adequacy qualifier. Axial two-dimensional CT scans from virtual colonoscopy show no distention (rating, 1) of sigmoid colon with patient in supine position qualified with plus (+) rating (A) because same segment with patient in prone position (B) shows optimal distention (rating, 4).

View larger version (137K): [in a new window]   Fig. 4A. —Segmental adequacy qualifier. Axial two-dimensional CT scans from virtual colonoscopy show no distention (rating, 1) of sigmoid colon (arrow, A) with patient in supine position qualified with negative (-) rating because same segment is still nondistended with patient in prone position (arrow, B).

View larger version (143K): [in a new window]   Fig. 4B. —Segmental adequacy qualifier. Axial two-dimensional CT scans from virtual colonoscopy show no distention (rating, 1) of sigmoid colon (arrow, A) with patient in supine position qualified with negative (-) rating because same segment is still nondistended with patient in prone position (arrow, B).

View larger version (12K): [in a new window]   Fig. 5. —Line graph of mean colonic distention rating for all patients in prone position, observer 1.

View larger version (12K): [in a new window]   Fig. 6. —Line graph of mean colonic distention rating for all patients in prone position, observer 2.

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