Virtual colonoscopy

Answer 1

DefinitionVirtual colonoscopy (VC) combinesMRIorCTscans with sophisticated computer software to produce three-dimensional images of the colon and rectum. The test is less invasive than conventionalcolonoscopy. Alternative Names

Colonoscopy - virtual; CT colonography

How the test is performed

Patients must follow a strict bowel-emptying procedure the day before, just as they would for a standard colonoscopy. The test is performed in the radiology department of a hospital or medical center. Unlike conventional colonoscopy, no sedatives are needed and no scope is used.

You will lie down on your left side on a narrow table that is connected to an MRI or CT machine. Your knees will be up toward your chest. A small, flexible tube will be inserted into your rectum. Air is pumped through the tube to make the colon bigger and easier to see. After this is done, you'll be asked to lie on your back.

Next, the table slides into a large tunnel through the machine, where x-rays create images of your colon. You must stay very still during this procedure, since movement can blur the pictures. You may be asked to hold your breath briefly while each picture is taken.

A computer combines all the images to form three-dimensional pictures of the colon, which are viewed on a video monitor.

Pictures are also taken while you lie on your stomach.

The exam takes about 20 minutes.

How to prepare for the test

Preparations can vary, depending on your health care provider. Everyone undergoing any type of colonoscopy must completely empty their bowels before the exam. This may be done using an enema or laxatives combined with a liquid diet the day before the test. The bowel must be completely emptied until no solid matter remains.

Unfortunately, diarrhea is common during preparation. Drink plenty of clear liquids, such as apple juice and chicken broth, to avoid dehydration.

Make sure you tell your health care provider about any medications you are taking. You'll be told which you can take, and which you should temporarily stop. CT and MRI scanners are very sensitive to metals. Don't wear jewelry the day of your exam. You'll be asked to wear a hospital gown for the procedure.

How the test will feel

The x-rays are painless. Pumping air into the colon can create temporary cramping or gas pains.

Why the test is performed

Virtual colonoscopy may be performed to:

• Diagnose colorectal cancer
• Examine those with a family history of colon cancer
• Follow up after an incomplete or failed colonoscopy
• Follow up after a previous finding of colon cancer or polyps
• Look for polyps

Normal Values

Normal findings are images of a healthy intestinal tract.

What abnormal results mean

• Polyps
• Colorectal cancer
• Diverticulosis
• Lower gastrointestinal (GI) bleeding
• Tumor
• Inflammatory bowel disease

What the risks are

• Radiation exposure
• The medications to prepare for the test can cause nausea, vomiting, bloating, or rectal irritation.

Special considerations

Differences between virtual and conventional colonoscopy include:

• Both procedures can spot polyps that have reached a large, worrisome size. However, virtual colonoscopy is not as detailed as a conventional colonoscopy, and may miss polyps smaller than 10 millimeters in diameter or flat lesions.
• If a polyp is found with virtual colonoscopy, the patient must have a conventional colonoscopy to remove the abnormality. Conventional colonoscopy allows for the immediate removal of polyps.
• Virtual colonoscopy can view the colon from many different angles. This is not easy with conventional colonoscopy.
• Virtual colonoscopy uses no sedation, and patients are usually able to resume normal activities immediately after the test. Conventional colonoscopy involves sedation, and usually the loss of a work day.

Virtual colonoscopy is now one of the American Cancer Society's recommended screening tools for colon cancer.

References

Lieberman, D. Colonoscopy: as good as gold? Ann Intern Med. 2004;141:401-403.

Pickhardt P, et al. Location of adenomas missed by optical colonoscopy. Ann Intern Med. 2004;141:352-359.

Rosman AS, Korsten MA. Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy. Am J Med.2007;120(3):203-210.e.4.

Van Dam J, et al. AGA future trends report: CT colonography. Gastroenterology. 2004;127:970-984.

Virtual colonoscopy. Med Lett Drugs Ther. 2005;47(1202):15-16.

Answer 2

Definition

Virtual colonoscopy (VC) is an imaging or x-ray test that looks for cancer, polyps, or other disease in the large intestine (colon).

Alternative Names

Colonoscopy - virtual; CT colonography

How the test is performed

A virtual colonoscopy is different from a regular colonoscopy, in which a long, lighted tool called a colonoscope is inserted into the rectum and large intestine.

The test is performed in the radiology department of a hospital or medical center. No sedatives are needed and no scope is used.

You will lie on your left side on a narrow table that is connected to an MRIor CT scanmachine.

• Your knees will be up toward your chest. A small, flexible tube will be inserted into your rectum. Air is pumped through the tube to make the colon bigger and easier to see.
• After this is done, youa€™ll be asked to lie on your back.
• Next, the table slides into a large tunnel through the machine, where x-rays create images of your colon.
• You must stay very still during this procedure, since movement can blur the pictures. You may be asked to hold your breath briefly while each picture is taken.

A computer combines all the images to form three-dimensional pictures of the colon, which are viewed on a video monitor.

Pictures are also taken while you lie on your stomach.

The exam takes about 20 minutes.

How to prepare for the test

Everyone undergoing any type of colonoscopy must completely empty their bowels before the exam. This may be done using an enema or laxatives combined with a liquid diet the day before the test. The bowel must be completely emptied until no solid matter remains.

Unfortunately, diarrhea is common during preparation. Drink plenty of clear liquids, such as apple juice and chicken broth, to avoid dehydration.

Make sure you tell your health care provider about any medications you are taking. Youa€™ll be told which you can take, and which you should temporarily stop. CT and MRI scanners are very sensitive to metals. Dona€™t wear jewelry the day of your exam. Youa€™ll be asked to wear a hospital gown for the procedure.

How the test will feel

The x-rays are painless. Pumping air into the colon can create cramping or gas pains.

Why the test is performed

Virtual colonoscopy may be performed to:

• Follow-up on colon cancer or polyps
• Look for the cause of:
  • Abdominal pain, changes in bowel movements, or weight loss
  • Anemia due to low iron
  • Blood in the stool or black, tarry stools
• Screen for cancer of the colon or rectum (should be done every 5 years)

Your doctor may want to do a conventional colonoscopy instead of a virtual colonoscopy. The reason is that virtual colonoscopy does not allow the doctor to remove tissue samples or polyps.

A regular colonoscopy may be done (on a different day) after a virtual colonoscopy if:

• No cause for bleeding or other symptoms were found. Virtual colonoscopy can miss some smaller problems in the colon.
• Problems that need a biopsy were seen on a virtual colonoscopy

Other times, a virtual colonoscopy is done if your doctor was not able to move the flexible tube all the way through the colon during a conventional colonoscopy.

Normal Values

Normal findings are images of a healthy intestinal tract.

What abnormal results mean

• Colorectal cancer
• Diverticulosis
• Inflammatory bowel disease
• Lower gastrointestinal (GI) bleeding
• Polyps
• Tumor

What the risks are

• Radiation exposure
• The medications to prepare for the test can cause nausea, vomiting, bloating, or rectal irritation.

Special considerations

Differences between virtual and conventional colonoscopy include:

• Virtual colonoscopy can view the colon from many different angles. This is not as easy with conventional colonoscopy.
• Virtual colonoscopy uses no sedation, and patients are usually able to go back to their normal activities right away after the test. Conventional colonoscopy involves sedation, and usually the loss of a work day.

Virtual colonoscopy is now one of the American Cancer Society's recommended screening tools for colon cancer.

References

Burt RW, Barthel JS, Dunn KB, David Ds, Drelichman E, Ford JM, et al. NCCN clinical practice guidelines in oncology. Colorectal cancer screening. J Natl Compr Canc Netw. 2010;8:8-61.

Bresalier RS. Colorectal cancer. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 123.

Reviewed By

Review Date: 11/12/2010

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by Todd Eisner, MD, Private practice specializing in Gastroenterology, Boca Raton, FL. Clinical Instructor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.