CT Colonography: Pertinent Issues for the Colorectal Surgeon

Computed tomography colonography (CTC) has rapidly evolved into a clinically effective tool since its initial introduction in 1994. Although not in widespread use for colorectal cancer (CRC) screening in part due to reimbursement issues, there is emerging consensus that advances in hardware and software technology as well as in specific protocol techniques have allowed polyp detection performance characteristics equivalent to optical colonoscopy. CTC issues relevant to the colorectal surgeon revolve around both those concerning CRC screening and those regarding focused problem-solving for specific clinical situations. This article will outline the basic components of a CTC examination as well as the specific parameters in current use in a large-scale screening CTC program. The potential roles of CTC in the CRC screening realm, performance characteristics with state-of-the-art techniques, theorized radiation risks, and the issue regarding extracolonic findings will be addressed. The utility of standardized lexicon and reporting system will be highlighted. Problem-solving issues pertinent for the colorectal surgeon to be addressed include lesion localization for preoperative planning, synchronous lesion assessment, and submucosal lesion characterization.