Indications for CTC

The indications for CTC continue to grow [17]. Indications with scientific validation include incomplete colonoscopy and evaluating the proximal colon in patients with colonic obstruction. Other indications that have received acceptance from the medical community include patients who require a colon examination and cannot have colonoscopy safely. These patient groups include patients on anticoagulants and with a prior adverse event related to sedation. Data from the Pickhardt study [6] supports a screening indication for CTC, but this remains controversial. The use of CTC in symptomatic patients is also controversial, as many experts would recommend colonoscopy in these patients. As most colon neoplasms are not associated with symptoms, it seems reasonable to select symptoms as indications for a CTC examination (anemia, change in bowel habits, abdominal pain).

CTC is not appropriate in certain situations. There is no clear data that CTC can successfully image patients with inflammatory bowel disease. Further, patients with acute gastrointestinal blood loss (most commonly due to angiodysplasia and diverticular bleeding) are better imaged by colonoscopy. Patients with suspected diverticuli-tis are well-served with a CT examination, but do not require the laxative preparation or colonic insufflation required with CTC.

Table 1. Summary, CTC sensitivity

Author

# of Pts

Sens < 6

6-9 mm

> 9 mm

Rockey (2005)

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