Virtual Colonographies Can Detect Gastrointestinal Problems in Elderly Patients

A virtual colonography can help doctors detect problems both within and outside the colon and is an excellent diagnostic opportunity for elderly patients who might not tolerate other colorectal screening methods. The study, which was conducted at St. James's University Hospital in Leeds, United Kingdom, focused on elderly patients who had gastrointestinal problems detected by a virtual colonography.

A virtual colonography is also known as a CT colonography or a CAT scan. Although more expensive, it is far less invasive than other colonoscopies. A virtual colonography uses special x ray equipment to create images of the inside of the colon and surrounding organs. A virtual colonography can map bone, soft tissue, internal organs, and even blood vessels.

By encouraging elderly patients to consider a virtual colonography, they can get the benefit of a colon exam that could diagnose problems not only of the colon. The study followed 400 patients who all had virtual colonographies over the 14 months during which the study was conducted.

"We decided to target older patients (over age 70) with lower gastrointestinal tract symptoms, who were referred to radiology for work up, as this group generally tolerates barium enema examinations less well than those under age 70," said Damian Tolan, MD, lead author of the study.

"Our study centered on the initial analysis of CT colonography examinations in this patient group. We only looked for significant pathology, excluding common benign incidental findings; for example gallstones or adrenal adenomas," he said.

These findings are particularly important because currently virtual colonographies are only used for patients that already are displaying symptoms of colorectal cancer. By encouraging elderly patients to use this as a screening technique, problems could be detected much earlier.

"Lower gastrointestinal symptoms in older patients over 70 are less specific for colorectal cancer than in younger patients. In our study, patients had a high yield for significant colonic pathology, including colon cancer and advanced adenomas," said Dr. Tolan.

"While these would almost certainly have been detected by colonoscopy and barium enema, CT colonography detected a wide range of other abnormalities as well," Dr. Tolan said. "In all, 29% of patients had significant pathology outside the colon, and in 24% this was a newly diagnosed condition. These included gastric, lung and renal cancers (5.8%), complications of diverticular disease (2%) and a range of other conditions from abdominal aortic aneurysms to cirrhosis."

Not only will these new recommendations a virtual colonography encourage earlier diagnosis, but it will also allow physicians to make better treatment recommendations.

"CT colonography also allowed simultaneous full staging of patients, determining whether tumors were localized or advanced with evidence of metastatic spread, thereby providing important prognostic information for referring physicians when deciding treatment options," Dr. Tolan said.

Source:

American Roentgen Ray Society, "CT colonography detects wide-range of extracolonic abnormalities in elderly patients", Eurekalert