CT colonography: revisited after 30 years.

Area of Science:

• Gastroenterology
• Radiology
• Oncology

Background:

• Computed tomography colonography (CTC), or virtual colonoscopy, is a minimally invasive imaging technique.
• Extensive research demonstrates CTC's performance is comparable to optical colonoscopy (OC).
• Despite proven efficacy, CTC is underutilized in some regions, while widely adopted in others.

Purpose of the Study:

• To review the current state of CTC acquisition, analysis, and reporting.
• To update and highlight new, potential, and emerging indications for CTC.
• To emphasize CTC's evolving role in colorectal cancer management.

Main Methods:

• Review of existing literature and clinical data on CTC.
• Analysis of current practices in CTC acquisition, image postprocessing, and interpretation.
• Identification and categorization of established and novel CTC applications.

Main Results:

• CTC is highly sensitive and specific for detecting colorectal cancers and significant polyps (≥10 mm).
• New indications include use after incomplete OC, for elderly/fragile patients, and when OC is refused.
• CTC is valuable for local colon cancer staging, surgical planning, and assessing diverticular disease.

Conclusions:

• CTC offers comparable detection rates to OC for advanced adenomas and early colorectal cancer.
• CTC serves as a comprehensive tool for preoperative planning, including detailed vascular mapping.
• CTC's role in radiological staging is growing, particularly with the advent of neoadjuvant therapies for advanced colorectal cancer.