diagnostic accuracy

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Dark Lumen MR Colonography Based on Fecal Tagging For Detection of Colorectal Masses: Accuracy And Patient Acceptance

Journal Title, Volume, Page: 
Abdom Imaging. 2005 Sep-Oct;30(5):576-83. Epub 2005 Mar 4
Year of Publication: 
2005
Authors: 
S. C. Goehde
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
E. Descher
Private practice for gastroenterology, I Hagen 26, Essen, 45127, Germany
A. Boekstegers
Private practice for gastroenterology, I Hagen 26, Essen, 45127, Germany
T. Lauenstein
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
C. Kühle
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
S. G. Ruehm
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
W. Ajaj
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

BACKGROUND: Magnetic resonance colonography (MRC) with fecal tagging has recently been investigated in clinical studies for the detection of polyps. We assessed fecal tagging MRC in a field trial.
METHODS: Forty-two patients in a private gastroenterologic practice underwent MRC with barium-based fecal tagging (150 mL of 100% barium at each of 6 main meals before MRC) and conventional colonoscopy. Diagnostic accuracy of MRC and patient acceptance were assessed and compared with the respective results of conventional colonoscopy.
RESULTS: Eighteen percent of all MRC examinations showed a remaining high stool signal in the colon that impeded a reliable inclusion or exclusion of polyps. On a lesion-by-lesion basis, sensitivities for polyp detection were 100% for polyps larger than 2 cm (n = 1), 40% for polyps between 10 and 19 mm, 16.7% for polyps between 6 and 9 mm, and 9.1% for polyps smaller than 6 mm. The main reason for the low acceptance of MRC was the barium preparation, which was rated worse than the bowel cleaning procedure with conventional colonoscopy. CONCLUSION: MRC with fecal tagging must be further optimized. The large amount of barium resulted in poor patient acceptance, and barium according to this protocol did not provide sufficient stool darkening. Other strategies, such as increasing the hydration of stool, must be developed. 

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MR Colonography Without Bowel Purgation For The Assessment of Inflammatory Bowel Diseases: Diagnostic Accuracy And Patient Acceptance

Journal Title, Volume, Page: 
Inflamm Bowel Dis Volume 13, Number 8, August 2007
Year of Publication: 
2007
Authors: 
Jost Langhorst
Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Germany
Christiane A. Kuhle
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
Waleed Ajaj
Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Michael Nufer
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
Jorg Barkhausen
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
Andreas Michalsen
Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Germany
Gustav J. Dobos
Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Germany
Thomas C. Lauenstein
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
Preferred Abstract (Original): 

Background: The purpose of this pilot study was to assess the diagnostic accuracy of MR colonography (MRC) without bowel cleansing regarding its ability to quantify inflammatory bowel disease (IBD). In addition, patient acceptance was compared with conventional colonoscopy (CC).
Methods: In all, 29 patients with IBD (17 ulcerative colitis; 12 Crohn’s disease) were included. While CC was performed after bowel cleansing as the gold standard, MRC was based on a fecal tagging technique and performed 48–72 hours prior to CC. The presence of inflammation in each of 7 ileocolonic segments was rated for every procedure. Patients evaluated both modalities and dedicated aspects of the examination according to a 10-point-scale (1  good, 10  poor acceptance). Furthermore, preferences for future examinations were investigated.
Results: Inflammatory segments were found by means of CC in 23 and by MRC in 14 patients. Overall sensitivity and specificity of MRC in a segment-based detection were 32% and 88%, respectively. Concerning severely inflamed segments, sensitivity increased to 53% for MRC. Overall acceptance of CC was significantly higher compared to MRC (mean value (mv) for MRT  6.0; CC  4.1; P  0.003). For MRC, the placement of the rectal tube (mv  7.3), and for CC bowel purgation (mv  6.5), were rated as the most unpleasant. A total of 67% of patients voted for CC as the favorable tool for future examinations.
Conclusions: The presented data indicate that ‘fecal tagging MRC’ is not suitable for an adequate quantification of inflammatory diseases of the large bowel. Furthermore, overall acceptance of endoscopic colonoscopy was superior to MRC.

w.ajaj's picture

Dark Lumen MR Colonography Based on Fecal Tagging For Detection of Colorectal Masses: Accuracy And Patient Acceptance

Journal Title, Volume, Page: 
Abdom Imaging (2005) 30:576–583
Year of Publication: 
2005
Authors: 
S. C. Goehde
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
E. Descher
Private practice for gastroenterology, I Hagen 26, Essen, 45127, Germany
A. Boekstegers
Private practice for gastroenterology, I Hagen 26, Essen, 45127, Germany
T. Lauenstein
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
C. Kuhle
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
S. G. Ruehm
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
W. Ajaj
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Background: Magnetic resonance colonography (MRC) with fecal tagging has recently been investigated in clinical studies for the detection of polyps. We assessed fecal tagging MRC in a field trial.
Methods: Forty-two patients in a private gastroenterologic practice underwent MRC with barium-based fecal tagging (150 mL of 100% barium at each of 6main meals before MRC) and conventional colonoscopy. Diagnostic accuracy of MRC and patient acceptance were assessed and compared with the respective results of conventional colonoscopy.
Results: Eighteen percent of all MRC examinations showed a remaining high stool signal in the colon that impeded a reliable inclusion or exclusion of polyps. On a lesion-by-lesion basis, sensitivities for polyp detection were 100% for polyps larger than 2 cm (n = 1), 40% for polyps between 10 and 19 mm, 16.7% for polyps between 6and 9 mm, and 9.1% for polyps smaller than 6mm. The main reason for the low acceptance of MRC was the barium preparation, which was rated worse than the bowel cleaning procedure with conventional colonoscopy.
Conclusion: MRC with fecal tagging must be further optimized. The large amount of barium resulted in poor patient acceptance, and barium according to this protocol did not provide sufficient stool darkening. Other strategies, such as increasing the hydration of stool, must be developed.

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