Contraindications

10.1055/b-0034-91845

Contraindications

Contraindications include all conditions under which CT colonography could be harmful to the patient as well as situations in which it offers no diagnostic benefit. Among the contraindications for CT colonography are acute abdominal pain, nausea, vomiting, and diarrhea. CT colonography is also contraindicated in patients who have recently undergone laparotomy until the surgical wound has healed. It is also contraindicated after colon resection (recommended interval of approximately 3 months) and immediately after conventional colonoscopy with deep biopsy or polypectomy (recommended interval approximately 10 days). Other contraindications are hernias of the abdominal wall involving the colon; acute inflammatory bowel disease, such as acute diverticulitis or an acute episode of chronic inflammatory bowel disease; and previous total or subtotal colectomy. In such cases, distending the colon with gas could cause perforation and potentially subsequent peritonitis.

In certain situations, CT colonography is methodologically inappropriate. Examples include routine surveillance of chronic inflammatory bowel disease and evaluation of hereditary polyposis and nonpolyposis carcinoma syndromes, since follow-up of these patients requires biopsies.

Contraindications for CT colonography
Specific contraindications for CT colonography
Acute abdominal symptoms: acute pain, vomiting, diarrhea, acute abdomen Less than 3 month (at least) after laparotomy or colon resection After total or subtotal colectomy Less than 10 days after polypectomy or deep biopsy Abdominal hernias with complex colonic involvement Acute inflammatory bowel disease: Acute episode of inflammatory bowel disease Toxic megacolon Acute diverticulitis Acute infectious colitis
General CT contraindications
Pregnancy Morbid obesity
CT colonography is unsuitable for:
Surveillance of patients with chronic inflammatory bowel disease Hereditary polyposis and nonpolyposis carcinoma syndromes Diseases of the anal canal

In addition, the same contraindications apply as for CT examinations in general: the weight and size restrictions of the examination table, metal implants that cause artifacts in the scan field, pregnancy, and claustrophobia (Table 1.2).

Bibliography

American College of Radiology. ACR practice guideline for the performance of computed tomography (CT) colonography in adults. ACR practice guideline 2009; [cited 2010 September 30]; Available from: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/ct.aspx Barish MA, Rocha TC. Multislice CT colonography: current status and limitations. Radiol Clin North Am 2005;43:1049–1062, viii Biancone L, Fiori R, Tosti C, et al. Virtual colonoscopy compared with conventional colonoscopy for stricturing postoperative recurrence in Crohn′s disease. Inflamm Bowel Dis 2003; 9(6):343–350 Burling D, Halligan S, Slater A, Noakes MJ, Taylor SA. Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology 2006;239(2):464–471 Cash BD, Rockey DC, Brill JV. AGA standards for gastroenterologists for performing and interpreting diagnostic computed tomography colonography: 2011 update. Gastroenterology 2011; 141(6):2240–2266 Chung DJ, Huh KC, Choi WJ, Kim JK. CT colonography using 16-MDCT in the evaluation of colorectal cancer. AJR Am J Roentgenol 2005;184(1):98–103 Copel L, Sosna J, Kruskal JB, Raptopoulos V, Farrell RJ, Morrin MM. CT colonography in 546 patients with incomplete colonoscopy. Radiology 2007;244(2):471–478 Cotton PB, Durkalski VL, Pineau BC, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 2004;291:1713–1719 Dachman AH. Advice for optimizing colonic distention and minimizing risk of perforation during CT colonography. Radiology 2006;239(2):317–321 Fenlon HM, McAneny DB, Nunes DP, Clarke PD, Ferrucci JT. Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon. Radiology 1999; 210(2):423–428 Ferrucci JT. Double-contrast barium enema: use in practice and implications for CT colonography. AJR Am J Roentgenol 2006; 187(1):170–173 Filippone A, Ambrosini R, Fuschi M, Marinelli T, Genovesi D, Bonomo L. Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography—initial experience. Radiology 2004;231(1):83–90 Hanson ME, Pickhardt PJ, Kim DH, Pfau PR. Anatomic factors predictive of incomplete colonoscopy based on findings at CT colonography. AJR Am J Roentgenol 2007;189(4):774–779 Harned RK, Consigny PM, Cooper NB, Williams SM, Woltjen AJ. Barium enema examination following biopsy of the rectum or colon. Radiology 1982;145(1):11–16 Iannaccone R, Laghi A, Passariello R. Colorectal carcinoma: detection and staging with multislice CT (MSCT) colonography. Abdom Imaging 2005;30(1):13–19 Kim HJ, Park SH, Pickhardt PJ, et al. CT colonography for combined colonic and extracolonic surveillance after curative resection of colorectal cancer. Radiology 2010;257(3):697–704 Laghi A. Virtual colonoscopy: clinical application. Eur Radiol 2005;15(Suppl 4):D138–D141 Laghi A, Rango M, Graser A, Iafrate F. Current status on performance of CT colonography and clinical indications. Eur J Radiol 2012; Jun 27 [Epub ahead of print] Lefere P, Dachman AH, Gryspeerdt S. Computed tomographic colonography: clinical value. Abdom Imaging 2007;32(5):541–551 Lefere P, Gryspeerdt S, Baekelandt M, Dewyspelaere J, van Holsbeeck B. Diverticular disease in CT colonography. Eur Radiol 2003;13(Suppl 4):L62–L74 Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58(3):130–160 Macari M, Berman P, Dicker M, Milano A, Megibow AJ. Usefulness of CT colonography in patients with incomplete colonoscopy. AJR Am J Roentgenol 1999;173(3):561–564 Macari M, Bini EJ. CT colonography: where have we been and where are we going? Radiology 2005;237(3):819–833 Mang T, Graser A, Schima W, Maier A. CT colonography: techniques, indications, findings. Eur J Radiol 2007;61(3):388–399 Mang T, Schima W, Brownstone E, et al. Consensus statement of the Austrian Society of Radiology, the Austrian Society of Gastroenterology and Hepatology and the Austrian Society of Surgery on CT colonography (Virtual Colonoscopy). [Article in German] Rofo 2011;183(2):177–184 McArthur DR, Mehrzad H, Patel R, et al. CT colonography for synchronous colorectal lesions in patients with colorectal cancer: initial experience. Eur Radiol 2010;20(3):621–629 Moawad FJ, Maydonovitch CL, Cullen PA, Barlow DS, Jenson DW, Cash BD. CT colonography may improve colorectal cancer screening compliance. AJR Am J Roentgenol 2010;195:1118–1123 Neri E, Turini F, Cerri F, et al. Comparison of CT colonography vs. conventional colonoscopy in mapping the segmental location of colon cancer before surgery. Abdom Imaging 2010;35(5):589–595 Ota Y, Matsui T, Ono H, et al. Value of virtual computed tomographic colonography for Crohn′s colitis: comparison with endoscopy and barium enema. Abdom Imaging 2003;28(6):778–783 Park SH, Lee JH, Lee SS, et al. CT colonography for detection and characterisation of synchronous proximal colonic lesions in patients with stenosing colorectal cancer. Gut 2011; Nov 23 [Epub ahead of print] Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003;349(23):2191–2200 Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection—systematic review and meta-analysis. Radiology 2011;259(2):393–405 Rockey DC, Barish M, Brill JV, et al. Standards for gastroenterologists for performing and interpreting diagnostic computed tomographic colonography. Gastroenterology 2007;133(3):1005–1024 Rockey DC, Paulson E, Niedzwiecki D, et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 2005;365(9456): 305–311 Rogalla P, Janka R, Baum U, et al. CT colography: guideline of the Gastrointestinal Diagnostics Team of the German Radiological Society regarding the indication and technical implementation of endoluminal colon diagnostics using computed tomography (known as virtual colonoscopy). [Article in German] Rofo 2008;180(5):466–469 Tarján Z, Zágoni T, Györke T, Mester A, Karlinger K, Makó EK. Spiral CT colonography in inflammatory bowel disease. Eur J Radiol 2000;35(3):193–198 Taylor SA, Halligan S, Saunders BP, et al. Use of multidetector-row CT colonography for detection of colorectal neoplasia in patients referred via the Department of Health “2-Week-wait” initiative. Clin Radiol 2003;58(11):855–861 Yucel C, Lev-Toaff AS, Moussa N, Durrani H. CT colonography for incomplete or contraindicated optical colonoscopy in older patients. AJR Am J Roentgenol 2008;190(1):145–150

Only gold members can continue reading. Log In or Register to continue