Extracolonic and incidental findings on CT colonography (virtual colonoscopy).

OBJECTIVE: The objective of our study was to prospectively determine the frequency and clinical importance of extracolonic findings on CT colonography in symptomatic patients. SUBJECTS AND METHODS. One hundred eleven symptomatic patients referred for colonoscopy underwent CT colonography before colonoscopy. Helical CT from the diaphragm to the symphysis was performed with the patient in the supine and prone positions after rectal air insufflation. Image interpretation was done on a digital workstation. Extracolonic findings were classified as minor, moderate, or major according to potential clinical importance. Patient records, with a follow-up time of about 3 years, were reviewed to determine final diagnoses. RESULTS: Twenty-six (23%) of the patients had CT findings of major importance such as lymphadenopathy (n = 7), aortic aneurysm (n = 6), suspected solid hepatic masses (n = 5), and suspected solid renal masses (n = 4). Fifty-eight patients (52%) had findings of moderate importance such as gallstones (n = 16), indeterminate renal masses (n = 9), adrenal masses with benign appearance (n = 8), and hiatal hernia (n = 7). Forty-six patients (41%) had no or only minor findings, such as renal cysts (n = 34), renal calcifications (n = 19), and hepatic cysts (n = 14). Review of patient records showed that CT colonography contributed to the detection of major, previously unknown extracolonic disorders in 14 (13%) of the 111 patients. CONCLUSION: Potentially important extracolonic findings were revealed in 23% of the patients, leading to additional diagnostic or therapeutic considerations. Some of these findings were clinically important, whereas others were previously known or led to unnecessary workup. This finding must be taken into account when CT colonography is considered for routine diagnostic workup or screening.

Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease.

PURPOSE: To prospectively evaluate, by means of self-assessed questionnaires, patient acceptance of computed tomographic (CT) colonography compared with that of conventional colonoscopy, when performed in patients with or suspected of having colorectal disease. MATERIALS AND METHODS: One hundred eleven patients underwent CT colonography followed immediately by conventional colonoscopy. Patient acceptance was evaluated with questionnaires, and the proportions of patients who favored one examination were compared. The main variables were overall impression, discomfort during air filling or instrumentation, and perceived pain, evaluated by using ordered verbal descriptor scales after each examination. The preference for either examination was evaluated after completion of both examinations. RESULTS: Of the 68 patients who favored one examination, 56 (82%) preferred CT colonography (P <.00001). Concerning overall impression of problems or discomfort in connection with the examination, 49 (69%) of 71 with a preference considered colonoscopy to be more difficult (P =.002). CT colonography was regarded as "not painful" by 62 (57%) of 108 patients compared with 28 (26%) for colonoscopy, and a larger proportion of patients rated pain as higher during colonoscopy than during CT colonography (95% CI: 30%, 56%). Discomfort from air filling of the colon was the major complaint about CT colonography. CONCLUSION: CT colonography was considered less painful and less difficult overall than colonoscopy and was the preferred examination.

Clinical and radiological renal characteristics of patients with terminal uraemia.

OBJECTIVE: To investigate, by means of ultrasonography and plain film radiography, the radiological appearance of the kidneys in patients with uraemia, and to study renal development during the time course preceding dialysis. Aetiology, clinical characteristics and long-term clinical outcome were also studied. MATERIAL AND METHODS: Ultrasonography and plain film radiography of the kidneys, physical examination, laboratory tests, review of hospital files and interviews regarding risk factors were performed in 67 patients (median age 65.0 years) entering a dialysis programme. They were followed prospectively for 54-77 months. In a retrospective part of the study, old radiographs of the kidneys were compared with radiographs obtained at the start of dialysis. RESULTS: Chronic glomerulonephritis (CGN) and diabetic nephropathy (DN) were the leading causes of uraemia. Forty-two patients (63%) died during follow-up, mostly due to cardiovascular disease. Normal kidney size and echogenicity were common among DN patients, while the kidneys of CGN patients were generally small and hyperechoic. Mean renal length reduction was 23.6 mm in CGN patients and 18.9 mm in DN patients, during median times of 7.7 years and 5.0 years preceding dialysis, respectively. The most rapid renal length reduction was 27 mm in 1.5 years. CONCLUSIONS: The study illustrates the changing aetiological spectrum and high mortality rate in patients with dialysis-treated uraemia. The ultrasonographic appearance of the kidneys in uraemia varies considerably, depending on the underlying disorder, but analysis of size and echogenicity are helpful in the evaluation of these patients. A rapid reduction in kidney size in renal failure patients is important to consider during radiological evaluation.