RESUMEN
To establish the optimum barium-based reduced-laxative tagging regimen prior to CT colonography (CTC). Ninety-five subjects underwent reduced-laxative (13 g senna/18 g magnesium citrate) CTC prior to same-day colonoscopy and were randomised to one of four tagging regimens using 20 ml 40%w/v barium sulphate: regimen A: four doses, B: three doses, C: three doses plus 220 ml 2.1% barium sulphate, or D: three doses plus 15 ml diatriazoate megluamine. Patient experience was assessed immediately after CTC and 1 week later. Two radiologists graded residual stool (1: none/scattered to 4: >50% circumference) and tagging efficacy for stool (1: untagged to 5: 100% tagged) and fluid (1: untagged, 2: layered, 3: tagged), noting the HU of tagged fluid. Preparation was good (76-94% segments graded 1), although best for regimen D (P = 0.02). Across all regimens, stool tagging quality was high (mean 3.7-4.5) and not significantly different among regimens. The HU of layered tagged fluid was higher for regimens C/D than A/B (P = 0.002). Detection of cancer (n = 2), polyps > or =6 mm (n = 21), and < or =5 mm (n = 72) was 100, 81 and 32% respectively, with only four false positives > or =6 mm. Reduced preparation was tolerated better than full endoscopic preparation by 61%. Reduced-laxative CTC with three doses of 20 ml 40% barium sulphate is as effective as more complex regimens, retaining adequate diagnostic accuracy.
Asunto(s)
Sulfato de Bario , Catárticos/administración & dosificación , Colonografía Tomográfica Computarizada/normas , Heces , Laxativos/administración & dosificación , Satisfacción del Paciente , Anciano , Anciano de 80 o más Años , Ácido Cítrico/administración & dosificación , Medios de Contraste , Diatrizoato de Meglumina , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Extracto de Senna/administración & dosificación , Encuestas y CuestionariosRESUMEN
PURPOSE: To investigate effect of attenuation of tagged fluid and viewing window on polyp conspicuity and measurement with porcine colonic specimen. MATERIALS AND METHODS: Eleven (3-10-mm-diameter) polyps were created in porcine colon and the specimen submerged in saline. Four-detector row CT was performed after gas distension and after filling with six barium sulfate suspensions (attenuation, 100-1000 HU). Two readers independently measured maximal two-dimensional polyp diameter on each data set with the following four viewing windows and window levels and window widths, respectively: colon (-150 HU, 1500 HU), lung (-500 HU, 1500 HU), bone (500 HU, 2500 HU), and abdomen (40 HU, 400 HU). In consensus, polyp conspicuity (compared with air data set) was assigned a grade of 1-4 for each viewing window (grade 1, not seen or barely visible; grade 4, optimally seen). For statistical analysis, conspicuity grades were collapsed to a two-point scale. Data were analyzed with Mann-Whitney, Kruskal-Wallis, and chi2 tests. RESULTS: Accuracy of polyp measurement was independent of viewing window for attenuation of tagged fluid of 100-300 HU but differed significantly for 500-1000 HU (P < .001); that for colonic and bone viewing windows was superior (median size difference, 1.0 mm; interquartile range, 0.5-1.5). Conspicuity differed significantly according to viewing window at all attenuation values (P < .001). For 100-300 HU with abdominal viewing window, 83% (24 of 29) of observations were assigned grade 3 or 4 (best). For 500-1000 HU with bone viewing window, 94% (30 of 32) of observations were assigned grade 3 or 4 (superior). Overall conspicuity was best with bone viewing windows at 700 HU. CONCLUSION: Polyp conspicuity and measurement in tagged data sets were optimized at 700 HU with bone viewing windows. At less than 300 HU, conspicuity improved with abdominal viewing windows.
Asunto(s)
Pólipos del Colon/diagnóstico por imagen , Colonografía Tomográfica Computarizada , Imagenología Tridimensional , Animales , Pólipos del Colon/patología , Técnicas In Vitro , Variaciones Dependientes del Observador , Intensificación de Imagen Radiográfica , PorcinosRESUMEN
This study investigated the variability in baseline computed tomography colonography (CTC) performance using untrained readers by documenting sources of error to guide future training requirements. Twenty CTC endoscopically validated data sets containing 32 polyps were consensus read by three unblinded radiologists experienced in CTC, creating a reference standard. Six readers without prior CTC training [four residents and two board-certified subspecialty gastrointestinal (GI) radiologists] read the 20 cases. Readers drew a region of interest (ROI) around every area they considered a potential colonic lesion, even if subsequently dismissed, before creating a final report. Using this final report, reader ROIs were classified as true positive detections, true negatives correctly dismissed, true detections incorrectly dismissed (i.e., classification error), or perceptual errors. Detection of polyps 1-5 mm, 6-9 mm, and > or =10 mm ranged from 7.1% to 28.6%, 16.7% to 41.7%, and 16.7% to 83.3%, respectively. There was no significant difference between polyp detection or false positives for the GI radiologists compared with residents (p=0.67, p=0.4 respectively). Most missed polyps were due to failure of detection rather than characterization (range 82-95%). Untrained reader performance is variable but generally poor. Most missed polyps are due perceptual error rather than characterization, suggesting basic training should focus heavily on lesion detection.
Asunto(s)
Pólipos del Colon/diagnóstico por imagen , Colonografía Tomográfica Computarizada , Errores Diagnósticos , Competencia Clínica , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Interpretación de Imagen Radiográfica Asistida por Computador , Sensibilidad y EspecificidadRESUMEN
The involvement of 5-HT(3) receptor mediated modulation of formalin and carrageenan induced inflammatory transmission was investigated. The effects of the selective 5-HT(3) receptor antagonist ondansetron on the electrically evoked responses of dorsal horn neurones in normal animals were compared to those following carrageenan. The effect of pre-treatment on the formalin response was also studied. Ondansetron had no significant effect on the electrically evoked responses of dorsal horn neurones in normal animals or following carrageenan induced inflammation, but significantly inhibited both phases of the formalin response. Our results suggest that 5-HT(3) receptors in the spinal cord have no significant role under normal conditions. However, during formalin (but not carrageenan) induced inflammation this system is activated, maintaining the response of nociceptive spinal neurones to peripheral formalin.