Accuracy of CT colonography with mannitol preparation for detecting synchronous lesions in obstructive colorectal cancer

IF 3.2 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-05-05 DOI:10.1016/j.ejrad.2025.112151

Angela H.M. Caiado , Sergio C. Nahas , Ilka R.S. Oliveira , Serli K.N. Ueda , Caio S.R. Nahas , Manoel S. Rocha , Ulysses S. Torres , Carlos A. Buchpiguel

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引用次数: 0

Abstract

Objective

Preoperative detection of advanced neoplasms is essential for surgical planning in colorectal cancer (CRC). CT colonography (CTC) has emerged as a reliable alternative when obstructive CRC prevents complete optical colonoscopy (OC). Mannitol, commonly used for OC preparation in some countries, offers potential advantages over polyethylene glycol (PEG), including low cost, reduced ingestion volume, fast action, and a more palatable sweet taste. We evaluated the diagnostic accuracy of mannitol-based CTC for detecting synchronous lesions in CRC, hypothesizing that this low-volume preparation could maintain high accuracy while improving patient tolerability.

Methods

Of 150 CRC patients with incomplete OC who underwent preoperative CTC following cathartic preparation with mannitol, 62 were retrospectively analyzed. Their CTC findings were compared with postoperative surgical and pathological results and follow-up OC. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for lesions ≥6 mm. In addition, the quality of bowel preparation with mannitol (amount of liquid and solid residue) was compared with historical data from published studies.

Results

In 62 patients (372 segments), 26 synchronous lesions were identified (9 ≥ 10 mm, 17 sized 6–9 mm). For lesions ≥6 mm, CTC achieved a sensitivity of 92.3 % (95 % CI: 74.9–99.1 %), specificity of 99.1 % (95 % CI: 97.5–99.8 %), PPV of 88.9 % (95 % CI: 70.8–97.6 %), and NPV of 99.4 % (95 % CI: 97.9–99.9 %). Bowel cleansing was adequate, with 82.8 % of segments showing no or minimal residual fluid and 96.3 % with no or minimal solid residue.

Conclusion

CTC with a mannitol-based preparation demonstrated high accuracy in detecting synchronous neoplasms among patients with obstructive CRC and incomplete OC. These findings suggest that mannitol is a feasible alternative to PEG, maintaining excellent diagnostic performance while possibly improving tolerability. Additionally, it could streamline surgical planning and improve overall outcomes in modern CRC management.

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甘露醇制剂CT结肠镜检查梗阻性结直肠癌同步病变的准确性

目的探讨结直肠癌（CRC）晚期肿瘤的术前检测对手术规划的重要性。CT结肠镜检查（CTC）已成为一种可靠的替代方案，当梗阻性结直肠癌阻止完全光学结肠镜检查（OC）。甘露醇在一些国家通常用于OC制剂，与聚乙二醇（PEG）相比，它具有潜在的优势，包括成本低、摄入量少、作用快和更可口的甜味。我们评估了基于甘露醇的CTC检测CRC同步病变的诊断准确性，假设这种小体积的制备可以在提高患者耐受性的同时保持较高的准确性。方法回顾性分析150例不完全结直肠癌患者术前经甘露醇泻剂预备行CTC的62例。比较术后手术病理结果和随访OC。对≥6 mm的病变进行敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）评估。此外，用甘露醇进行肠道准备的质量（液体和固体残留物的量）与已发表研究的历史数据进行了比较。结果62例患者（372节段）共发现26个同步病灶（≥10 mm 9个，6-9 mm 17个）。对于≥6 mm的病变，CTC的敏感性为92.3% (95% CI: 74.9 - 99.1%)，特异性为99.1% (95% CI: 97.5 - 99.8%)， PPV为88.9% (95% CI: 70.8 - 97.6%)， NPV为99.4% （95% CI: 97.9 - 99.9%）。肠道清洁是足够的，82.8%的肠段没有或只有很少的液体残留，96.3%的肠段没有或只有很少的固体残留。结论以甘露醇为基础的ctc对梗阻性结直肠癌和不完全性结直肠癌的同步肿瘤检测具有较高的准确性。这些发现表明甘露醇是PEG的可行替代品，在保持良好诊断性能的同时可能提高耐受性。此外，它可以简化手术计划，提高现代CRC管理的总体结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.