| Backgroundcolorectal cancer is one of the common neoplasms,newly increased cases yearly is close to1million. About500000people died in colorectal cancer, Most of the early colorectal cancer is benignadenomatous polyps, From the adenomatous polyp to malignant tumor transformation process takes about5-15years, If we can find and resect the adenomatous polyp, it can block the cancer ration,,even Unfortunately develop into malignant tumor, if we can diagnose and treat in early stage before the diffusion, Patient surial rates has also greatly improved.At present the clinical diagnosis of colorectal cancer early get only5%. At present the clinical common inspection methods used for colon polyps and cancer screening include:Fecal occult blood test, carcinoembryonic antigen, electronic colonoscopy,etc.But colon polyps fecal occult blood test positive rate of only30%, In the large intestine cancer is only50%-60%,Detection of colorectal adenomas in defecate occult blood test65%～75%is negative, Detection of colorectal cancer in defecate occult blood test38%～50%were negative. So stool occult blood test negative still cannot rule out the possibility of large intestinal tumors or cancer,Carcinoembryonic antigen both false positive and false negative. Early patients with low positive rate,50%the CEA of patients with lymph node metastasis are higher than normal.Most of the large intestine cancer patients serum CEA level often increases, More than50μg/ml. But the test specificity is not strong, In some non gastrointestinal cancer and benign lesions such as colon polyps, Serum level can be raised.Colonoscopy in the diagnosis of colon cancer is considered to be the most effective method.However, about10%of the patients can’t see the whole colon For some patients cannot afford the pain, which could lead to misdiagnosis, in addition to the need to the intestinal tract preparation, Colonoscopy invasive,more pain patients in Inspection process, easy to damage intestinal wall in the process of operation,can lead to bowel perforation, intestinal bleeding and even check when pull the over-consumption of vagus nerve stimulation can cause reflective arrhythmia and cardiac arrest, colonoscopy can’t pass the recent pathological changes due to Colorectal obstruction, cannot have the comprehensive evaluation on the tumor itself. Virtual colonoscopy is a kind of new method of diagnosis of colon cancer, One of CT virtual colonoscopy technology or called a virtual colonoscopy in1994first put forward by Vimnv, etc, With the continuous development of CT technology, Especially the emergence of multislice CT in recent years, virtual colonoscopy technology is more and more mature, Think CT virtual colonoscopy technology as a high risk effective tools of finding the colon tumor on asymptomatic patients, it is the common CT imaging software with a combination of a3d image, the3d image that virtual colonoscopy can see the intestinal wall inside the image, the but again not invasive. Traditional CT is depending on the human body on X-ray absorption and transmittance, application of high sensitivity of the instrument to measure to the human body, and then acquired by measuring data input computer, the data processing by computer, can be captured on the body check parts of the section or three-dimensional image, find small lesions in most parts of the body, but for poor bowel wall display. Virtual colonoscopy overcome this shortcoming, it applies a special software for data processing, establish intestinal3d reconstruction images, which can simulate colonoscopy visual bowel wall situation, found that intestinal lesions. Many literature reported about virtual colonoscopy technology at home and abroad and the development of the virtual colonoscopy in the diagnosis of colorectal neoplasm reports the clinical application value of aspect, the technology observation area wide positioning is accurate, especially security great advantages in the diagnosis of colorectal neoplasm made Vc application has become a hot spot. For those who cannot tolerate a colonoscopy, such as poor lung function in patients with heart is Especially for virtual colonoscopy examination. But the virtual colonoscopy system technology is not enough mature, for some flat polyps or polyps/tumor diameter less than5mm maybe missing; Cannot detect the distribution of blood vessels and the mucosa of the color change,takes longer X-ray image processing the damage to the body,not enough bowel preparation and inflation affect the accuracy of the virtual colonoscopy,completely using contrast material such as carbon dioxide or barium enema may cause perforation of the colon etc,they limits the clinical application of virtual colonoscopy. Thus virtual colonoscopy system still need to get some improvement, to improve its sensitivity and specific degrees, can make it widely clinical application and benefit the people. This study compare virtual colonoscopy and colonoscopy in the diagnosis of colorectal neoplasm diagnosis efficiency and consistency evaluation to them, Comparing vital signs change before and after two kinds of inspection methods, To evaluate the clinical application value of the virtual colonoscopy in the diagnosis of colorectal neoplasm.Purposeto colonoscopy for gold standard, analysis of virtual colonoscopy diagnosis efficiency and consistency between of the number of all lesions and lesions more than7mm number and total lesions diameter and focal diameter greater than7mm diameter of the of the total evaluation and safety indicators to evaluate the diagnosis of virtual colonoscopy colorectal polyps of clinical application.Materials and methodsMaterials (1) contrast agent:5%flood shadow meglumine solution, by the guangdong yue dragon medical imaging technology co.LTD. Provide unified, specification:500ml/bottle, batch number:20110318, validity:1year, for a CT scan of the intestinal auxiliary development.(2)654-2injection by research center to provide (zhujiang hospital, southern medical university). During the inspection to reduce intestinal peristalsis, virtual colonoscopy inspection must be applied, electronic colonoscopy can use discretion.(3)16/64floor multi-slice spiral CT (for the research center’s inherent equipment), margin dragon virtual colonoscopy system (by guangdong yue dragon medical imaging technology co.LTD. Provide). Methods: choose fifty patients clinically were suspected colon polyps/tumor patients, Age limited in eighteen-70years old, male or female, gender ratio, height, weight, no clinical symptoms of abdominal pain and bloody stool, defecate habit and character change, angular, abdominal masses, anemia, occult blood test and positive, always have cancer and polyps history, family history of cancer, etc. Sorbent for allergy, with severe heart, liver, kidney and hematopoietic system of primary disease serious to check the intolerance and the anus and rectum serious stenosis or the presence of painful lesions, glaucoma, prostatic hypertrophy, urinary retention and gastrointestinal spasmolytic contraindication person, pregnancy and menstrual period women and patients were excluded. To the patient or family member replacement condition and sign the informed consent form,every case was processed by colonoscopy and virtual CT. Measured data was saved. Using Spssl3.0statistical analysis software processed data, General description of measurement data were mean+sd, median、95%CI、Upper and lower quartiles; Count data by chi-square test、 Kappa test、precision, etc. Hypothesis testing was used by both sides test, Test statistic and its corresponding P values are given, as P less than or equal to0.05as significant statistical significance.analyzed the data of patients in general such as age and gender age frequency distribution and weight and height on the efficiency of virtual colonoscopy and colonoscopy in the diagnosis of colonic neoplasm Using bivariate correlation analysis. By Self controlled multicenter trial design methods, Colonoscopy in the diagnosis for gold standard, Namely CT virtual colonoscopy diagnosis efficiency (coincidence rate, sensitivity, specific degree, the missed, the misdiagnosis rate, Yin/positive predictive value and negative/positive likelihood ratio). To compare the virtual colonoscopy and colonoscopy in the diagnosis effectiveness Respectively from the diameterand number of the colon neoplasm,consistency evaluation of All the lesions and the number of lesions is greater than the number of7mm by matching counting card party test and Kappa methods, consistency evaluation of all could be used to measure the diameter of the lesion, Because the patient parameters had no obvious effect on the results, So consider the two processing methods were given50cases of patients to be a two independent samples, lesions more than7mm diameter by two independent sample t test, To evaluate the accuracy of the virtual colonoscopy in the diagnosis of colonic neoplasm, record the vital signs before and after two check (temperature, blood pressure, breathing, heart rate), compare the vital signs changes before and after the inspection by Paired sample t test method, so as to evaluate the safety of virtual colonoscopy, To evaluate the safety of virtual colonoscopy.Resultscolonoscopy for gold standard to patients as the unit statistics, such as two kinds of methods are found polyp/tumor, and as long as there is a polyp/tumor consistent with that identified as positive, such as CT found and colonoscopy was not found for false positive and vice versa; Two kinds of inspection methods not find polyp is determined for true negative. The number of cases in the fifty cases, Two cases of CT virtual colonoscopy can’t draw the image and failure,2cases of automaticly exit test,1case of colonoscopy could not describe colon tumor size, No case of adverse events.44cases had abnormal findings, in9patients that colon cancer, virtual colonoscopy found seven cases of colon cancer, the coincidence rate77.78%, Total number of162lesions found in colonoscopy, virtual colonoscopy found that134lesions,82.71%(134/162), the sensitivity of The diameter greater than the7mm of colorectal neoplasm was97.06%(33/34).1cases of colonic neoplasm by virtual colonoscopy findings and colonoscopy was not found, there are2cases of colonic neoplasm discovered by colonoscopy but were not finded by virtual colonoscopy.In the diagnosis efficiency of colon tumor, compared with colonoscopy, virtual93.18%, colonoscopy CT was93.18%The total coincidence rate,95%sensitivity,75%sensitivity specific degrees, the missed5%, the misdiagnosis rate was25%, positive predictive value of97.44%,60%negative predictive value, positive likelihood ratio3.8, negative likelihood ratio of0.07.the correlation between Patient parameters such as age, weight, height and virtual colonoscopy and colonoscopy is not big, in the consistency evaluation betweenVirtual colonoscopy and colonoscopy, Using a paired sample t test and chi-square test kappa consistency test method, The results show that their Ability of two kinds of methods between Virtual colonoscopy and colonoscopy finding lesions total number has a moderate consistency (K=0.552,P=0.000),their Ability in finding the total number of Diameter greater than7mm is medium consistency (K=0.667,p=0.000), Virtual colonoscopy and colonoscopy in discovery of colorectal neoplasm of diameter greater than7mm is consistent, and is statistically significant (t=-0.803, P=0.425), Virtual colonoscopy and colonoscopy in discovery of colorectal neoplasm of the overall average is consistent,and is statistical significance (t=-0.925,p=0.358). In the safety evaluation of between virtual colonoscopy and colonoscopy,the vital signs change were compared before and after two methods checking, such as temperature, breathing, heart rate and systolic blood pressure, diastolic blood pressure.The results shows before and after two methods checking the vital signs change has no significant differences (p>0.05), Also suggest that the two ways effect on vital signs change is not obvious.conclusionVirtual colonoscopy can simulate colonoscopy in roaming within the intestinal wall by navigation technology, and intuitive "within the walls of her intestines, find and diagnose colon polyps/tumor.Through the analysis of the diagnostic performance of compared with the colonoscopy, concluded that the diagnosis of effect is considerable. At the same time, virtualcolonoscopy used compound meglumine as a contrast agent in the process of examination, due to its safety and the extensive shadow meglumine has the intestinal contents good softening effect to eliminate feces and waste water,compared with barium enema or carbon dioxide contrast agent, so that the virtual colonoscopy in the diagnosis of colonic neoplasm guaranteed the safety and accuracy.but There are some disadvantages,such as for some flat polyps or diameter smaller polyps/tumor may be missing, Can’t test the distribution of blood vessels, the color of the mucous membrane of the change, image processing waste of time, To less than0.5cm of polyps and ray on the body of damage, lack of bowel preparation,and expansion affect the accuracy of the virtual colonoscopy,they Limit the clinical application of the virtual colonoscopy. Thus virtual colonoscopy system still need to be gotten some improvement, improve the sensitivity and specific degrees, make its can get a wide range of clinical application. |
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