CT Colonography: Where Have We Been and Where Are We Going?
Radiology 2005; 237:819-833.
Macari M, Bini EJ.
Over the past decade, computed tomographic (CT) colonography (also known as virtual colonoscopy) has been used to investigate the colon for colorectal neoplasia. Numerous clinical and technical advances have allowed CT colonography to advance slowly from a research tool to a viable option for colorectal cancer screening. However, substantial controversy remains among radiologists, gastroenterologists, and other clinicians regarding what the current role of CT colonography should be in clinical practice.
On the one hand, all agree there is tremendous excitement about a noninvasive imaging examination that can help reliably detect clinically important colorectal lesions. However, this is tempered by several recent studies that have shown that the sensitivity of CT colonography may not be as great when performed and the results interpreted by radiologists without expertise and training. The potential to miss important lesions exists even among experts; moreover, if polyps cannot be differentiated from folds and residual fecal matter, unnecessary colonoscopy will be performed. This article will review current issues regarding colon cancer; the established and reimbursed strategies to screen for it; and the past, current, and future role of CT colonography.