Abstract
Objectives
To determine the proportion of diagnostic computed tomography colonography (CTC) Reporting and Data System (C-RADS) categories in a non-screening population, and which patient factors are associated with a positive CTC (C2–4), a non-diagnostic CTC (C0), and potentially relevant extracolonic findings (ECF, E3–4).
Methods
Diagnostic CTCs performed at a single academic center from 2017 to 2018 were retrospectively reviewed. For each examination, the indications, age, sex, admission status, and C-RADS categories were recorded. Multivariate logistic regression was performed of patient demographic factors and clinical indications, with adjusted odds ratios (OR) and 95% confidence intervals.
Results
1373 CTCs were included. The mean age was 66.4 ± 13 years (range 24–97). There were 782 women and 75 inpatients. The number of CTCs reported as C0–C4 were 194/1373 (14.1%), 970/1373 (70.6%), 77/1373 (5.6%), 86/1373 (6.3%), and 46/1373 (3.4%), respectively, and 134/1373 (9.8%), 960/1373 (69.9%), 173/1373 (12.6%), and 106/1373 (7.7%) CTCs were reported as E1–4, respectively. Factors that demonstrated the strongest associations were as follows: with C2–4, age groups 50–79 (OR 2.8, 95% confidence interval 1.4–6.1), 80–89 (6.2, 2.9–14.5) and ≥ 90 (7.6, 2.0–29.1), and inpatients (3.4, 1.8–6.4); with C0, age groups 50–79 (5.9, 2.2–24.4), 80–89 (9.8, 3.4–41.8), and ≥ 90 (22.5, 5.8–113.0), incomplete colonoscopy (3.2, 2.0–5.1) and melena or gastrointestinal bleeding (4.1, 1.8–9.4); and with E3–4, age groups 50–79 (1.6, 1.0–2.9), 80–89 (2.0, 1.1–3.9), and ≥ 90 (3.2, 1.2–8.8), and inpatients (2.3, 1.3–3.9).
Conclusion
Older age is increasingly associated with a positive test, a non-diagnostic test and potentially relevant ECF. Inpatients are also associated with positive tests and E3–4 findings. Symptoms are not strongly associated with a positive CTC.
Similar content being viewed by others
References
Hassan C, Pickhardt PJ (2013) Cost-effectiveness of CT colonography. Radiologic clinics of North America 51 (1):89-97. https://doi.org/10.1016/j.rcl.2012.09.006
van der Meulen MP, Lansdorp-Vogelaar I, Goede SL, Kuipers EJ, Dekker E, Stoker J, van Ballegooijen M (2018) Colorectal Cancer: Cost-effectiveness of Colonoscopy versus CT Colonography Screening with Participation Rates and Costs. Radiology 287 (3):901-911. https://doi.org/10.1148/radiol.2017162359
Pickhardt PJ (2017) Imaging and Screening for Colorectal Cancer with CT Colonography. Radiologic clinics of North America 55 (6):1183-1196. https://doi.org/10.1016/j.rcl.2017.06.009
ACR-SAR-SCBT-MR Practice Parameter for the performance of computed tomography (CT) colonography in adults. (2014). https://www.acr.org/-/media/ACR/Files/Practice-Parameters/ct-colonog.pdf. Accessed 23 May 2019
Badiani S, Hernandez ST, Karandikar S, Roy-Choudhury S (2011) CT Colonography to exclude colorectal cancer in symptomatic patients. European radiology 21 (10):2029-2038. https://doi.org/10.1007/s00330-011-2151-1
White TJ, Avery GR, Kennan N, Syed AM, Hartley JE, Monson JR (2009) Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer--a prospective trial of 150 patients. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 11 (2):138-145. https://doi.org/10.1111/j.1463-1318.2008.01554.x
Atkin W, Dadswell E, Wooldrage K, Kralj-Hans I, von Wagner C, Edwards R, Yao G, Kay C, Burling D, Faiz O, Teare J, Lilford RJ, Morton D, Wardle J, Halligan S, investigators S (2013) Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet 381 (9873):1194-1202. https://doi.org/10.1016/S0140-6736(12)62186-2
Sabanli M, Balasingam A, Bailey W, Eglinton T, Hider P, Frizelle FA (2010) Computed tomographic colonography in the diagnosis of colorectal cancer. The British journal of surgery 97 (8):1291-1294. https://doi.org/10.1002/bjs.7098
Zalis ME, Barish MA, Choi JR, Dachman AH, Fenlon HM, Ferrucci JT, Glick SN, Laghi A, Macari M, McFarland EG, Morrin MM, Pickhardt PJ, Soto J, Yee J, Working Group on Virtual C (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236 (1):3-9. https://doi.org/10.1148/radiol.2361041926
Kim DH, Pickhardt PJ, Hanson ME, Hinshaw JL (2010) CT colonography: performance and program outcome measures in an older screening population. Radiology 254 (2):493-500. https://doi.org/10.1148/radiol.09091478
Pooler BD, Kim DH, Pickhardt PJ (2016) Indeterminate but Likely Unimportant Extracolonic Findings at Screening CT Colonography (C-RADS Category E3): Incidence and Outcomes Data From a Clinical Screening Program. AJR American journal of roentgenology 207 (5):996-1001. https://doi.org/10.2214/AJR.16.16275
Pooler BD, Kim DH, Pickhardt PJ (2016) Potentially Important Extracolonic Findings at Screening CT Colonography: Incidence and Outcomes Data From a Clinical Screening Program. AJR American journal of roentgenology 206 (2):313-318. https://doi.org/10.2214/AJR.15.15193
Pooler BD, Kim DH, Lam VP, Burnside ES, Pickhardt PJ (2014) CT Colonography Reporting and Data System (C-RADS): benchmark values from a clinical screening program. AJR American journal of roentgenology 202 (6):1232-1237. https://doi.org/10.2214/AJR.13.11272
Badiani S, Tomas-Hernandez S, Karandikar S, Roy-Choudhury S (2013) Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms. Acta radiologica 54 (8):851-862. https://doi.org/10.1177/0284185113486371
Hock D, Materne R, Ouhadi R, Mancini I, Aouachria SA, Nchimi A (2015) Test-positive rate at CT colonography is increased by rectal bleeding and/or unexplained weight loss, unlike other common gastrointestinal symptoms. European journal of radiology open 2:32-38. https://doi.org/10.1016/j.ejro.2014.12.002
Macari M, Nevsky G, Bonavita J, Kim DC, Megibow AJ, Babb JS (2011) CT colonography in senior versus nonsenior patients: extracolonic findings, recommendations for additional imaging, and polyp prevalence. Radiology 259 (3):767-774. https://doi.org/10.1148/radiol.11102144
Netz FRS, Pickhardt PJ, Janssen Heijnen MLG, Simons PCG (2017) Detection of potentially relevant extracolonic and colorectal findings at CT colonography in a low-risk symptomatic patient population. Abdominal radiology 42 (12):2799-2806. https://doi.org/10.1007/s00261-017-1221-5
Pickhardt PJ, Correale L, Delsanto S, Regge D, Hassan C (2018) CT Colonography Performance for the Detection of Polyps and Cancer in Adults >/= 65 Years Old: Systematic Review and Meta-Analysis. AJR American journal of roentgenology 211 (1):40-51. https://doi.org/10.2214/AJR.18.19515
Pickhardt PJ, Correale L, Morra L, Regge D, Hassan C (2018) JOURNAL CLUB: Extracolonic Findings at CT Colonography: Systematic Review and Meta-Analysis. AJR American journal of roentgenology 211 (1):25-39. https://doi.org/10.2214/AJR.17.19495
Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. Journal of the American College of Radiology : JACR 7 (10):754-773. https://doi.org/10.1016/j.jacr.2010.06.013
Buchach CM, Kim DH, Pickhardt PJ (2011) Performing an additional decubitus series at CT colonography. Abdominal imaging 36 (5):538-544. https://doi.org/10.1007/s00261-010-9666-9
Adelstein BA, Macaskill P, Chan SF, Katelaris PH, Irwig L (2011) Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review. BMC gastroenterology 11:65. https://doi.org/10.1186/1471-230X-11-65
Adelstein BA, Irwig L, Macaskill P, Turner RM, Chan SF, Katelaris PH (2010) Who needs colonoscopy to identify colorectal cancer? Bowel symptoms do not add substantially to age and other medical history. Alimentary pharmacology & therapeutics 32 (2):270-281. https://doi.org/10.1111/j.1365-2036.2010.04344.x
JJellema P, van der Windt DA, Bruinvels DJ, Mallen CD, van Weyenberg SJ, Mulder CJ, de Vet HC (2010) Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis. Bmj 340:c1269. https://doi.org/10.1136/bmj.c1269
Halligan S, Wooldrage K, Dadswell E, Shah U, Kralj-Hans I, von Wagner C, Faiz O, Teare J, Edwards R, Kay C, Yao G, Lilford RJ, Morton D, Wardle J, Atkin W, Investigators S (2015) Identification of Extracolonic Pathologies by Computed Tomographic Colonography in Colorectal Cancer Symptomatic Patients. Gastroenterology 149 (1):89-101 e105. https://doi.org/10.1053/j.gastro.2015.03.011
Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M (2011) Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 74 (4):885-896. https://doi.org/10.1016/j.gie.2011.06.023
Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, Ransohoff DF (2009) Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med 150 (12):849-857, W152
Cha JM, Kozarek RA, La Selva D, Gluck M, Ross A, Chiorean M, Koch J, Lin OS (2016) Risks and Benefits of Colonoscopy in Patients 90 Years or Older, Compared With Younger Patients. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 14 (1):80-86 e81. https://doi.org/10.1016/j.cgh.2015.06.036
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
IRB approval was obtained for this work.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kamali, M., Brake, A., Pothier, M. et al. The yield and patient factors associated with CT colonography C-RADS results in a non-screening patient population. Abdom Radiol 44, 2971–2977 (2019). https://doi.org/10.1007/s00261-019-02099-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-019-02099-9