Combined strategy of upfront CTCA and optimal treatment for stable chest pain: rationale and design of the CLEAR-CAD trial.

Background: Patients with stable chest pain suspected of coronary artery disease (CAD) usually undergo multiple diagnostic tests to confirm or rule out obstructive CAD. Some tests may not effectively assess the presence of CAD, precluding optimal treatment. A diagnostic strategy of upfront computed tomography coronary angiography (CTCA) combined with optimal medical therapy (OMT) tailored to the extent of CAD may be superior to standard care in preventing major adverse cardiac events.

The pivotal role of cardiac computed tomography angiogram and F-fluorodeoxyglucose positron emission tomography-computed tomography in the diagnosis of right sided endocarditis: a case report.

Background: Infective endocarditis (IE) poses many clinical and diagnostic challenges. Echocardiography is regarded as the imaging modality of choice for the diagnosis of IE, and plays a key role in both the diagnosis and management of endocarditis. We report on a case in which one could have overlooked an endocarditis of a pulmonary homograft if one had relied on echocardiography alone.

Percutaneous treatment of common bile duct stones: results and complications in 110 consecutive patients.

Background/aims: Choledocholithiasis is a common complication of cholecystolithiasis, occurring in 15-20% of patients who have gallbladder stones. Endoscopic retrograde cholangio-pancreatography is the standard treatment. When this is not possible or not feasible, percutaneous transhepatic stone removal is an alternative treatment.

Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis.

Objectives: Previous meta-analyses on CT-colonography included both average and high risk individuals, which may overestimate the diagnostic value in screening. A meta-analysis was performed to obtain the value of CT-colonography for screening.

Methods: A search was performed using PubMed, Embase and Cochrane.

Image quality and patient acceptance of four regimens with different amounts of mild laxatives for CT colonography.

Objective: The purpose of our study was to prospectively evaluate image quality and patient acceptance of CT colonography (CTC) with fecal tagging using different levels of catharsis.

Subjects And Methods: Forty consecutive increased-risk patients were randomized. Group 1 received orally 20 mg of bisacodyl, group 2 received 30 mg of bisacodyl, group 3 received 20 mg of bisacodyl and 8.

MR colonography with limited bowel preparation: patient acceptance compared with that of full-preparation colonoscopy.

Purpose: To prospectively evaluate participants' experience and preference of magnetic resonance (MR) colonography with limited bowel preparation compared with full-preparation colonoscopy in participants at increased risk for colorectal cancer.

Materials And Methods: This study had institutional review board approval; all participants gave written informed consent. In this multicenter study, consecutive participants undergoing conventional colonoscopy because of a personal or family history of colorectal cancer or adenomatous polyps underwent MR colonography 2 weeks prior to colonoscopy.

Feasibility study of computed tomography colonography using limited bowel preparation at normal and low-dose levels study.

The purpose was to evaluate low-dose CT colonography without cathartic cleansing in terms of image quality, polyp visualization and patient acceptance. Sixty-one patients scheduled for colonoscopy started a low-fiber diet, lactulose and amidotrizoic-acid for fecal tagging 2 days prior to the CT scan (standard dose, 5.8-8.

Magnetic resonance colonography with limited bowel preparation: a comparison of three strategies.

Purpose: To prospectively compare three strategies of magnetic resonance colonography (MRC) with fecal tagging.

Materials And Methods: Three strategies were compared: (S1) gadolinium as oral tagging agent and a gadolinium-water mixture for rectal filling (bright lumen), (S2) oral barium and water rectally, and (S3) oral barium and air rectally. In S2 and S3 (both dark lumen) gadolinium was injected intravenously.

MR colonography with limited bowel preparation compared with optical colonoscopy in patients at increased risk for colorectal cancer.

Purpose: To prospectively evaluate the diagnostic performance of magnetic resonance (MR) colonography by using limited bowel preparation in patients with polyps of 10 mm or larger in diameter in a population at increased risk for colorectal cancer, with optical colonoscopy as the reference standard.

Materials And Methods: The institutional review boards of all three hospitals approved the study. All patients provided written informed consent.

Performance of radiographers in the evaluation of CT colonographic images.

Objective: The purpose of this study was to compare the accuracy of radiographers with that of radiologists in the interpretation of CT colonographic images.

Materials And Methods: Four observers (a radiologist, a radiologist in training, and two radiographers) evaluated 145 data sets using a primary 3D approach. The radiographers were part of our CT colonography work group and underwent training that consisted of 20 cases.

A comparison of primary two- and three-dimensional methods to review CT colonography.

The aim of our study was to compare primary three-dimensional (3D) and primary two-dimensional (2D) review methods for CT colonography with regard to polyp detection and perceptive errors. CT colonography studies of 77 patients were read twice by three reviewers, first with a primary 3D method and then with a primary 2D method. Mean numbers of true and false positives, patient sensitivity and specificity and perceptive errors were calculated with colonoscopy as a reference standard.

Computed tomography colonography: current issues.

Objective: Direct and indirect evidence supports the concept of screening for adenomas and early stage colorectal cancer in reducing the incidence and disease-specific mortality. Controversy remains as to the appropriateness of and preferred methods for screening an asymptomatic population.

Methods: Review of computed tomography (CT) colonography based on the literature and personal experience.

Effective radiation doses in CT colonography: results of an inventory among research institutions.

The purpose of this study was to estimate the effective dose that is currently used in CT colonography using scan parameters that were collected for this purpose, and to investigate trends in time. PubMed was systematically searched from 1996 until January 2004 for studies investigating CT colonography. Research institutions were contacted and asked for their current scan protocol.

Colonography by computed tomography.

Computed tomographic colonography ('virtual colonoscopy') has shown promising results in the detection of large (> or = 10 mm) polyps in populations with a high prevalence of polyps. Recent studies in low prevalence populations, however, show variable results in sensitivity, ranging from 55% to 94% for the detection of patients with polyps measuring 10 mm or longer. Therefore questions have been raised about computed tomographic colonography as a screening method, probably the most valuable use of this technique.

CT colonography and colonoscopy: assessment of patient preference in a 5-week follow-up study.

Purpose: To prospectively evaluate short- and midterm patient preference of computed tomographic (CT) colonography relative to colonoscopy in patients at increased risk for colorectal cancer and to elucidate determinants of preference.

Materials And Methods: Consecutive patients at increased risk for colorectal cancer underwent CT colonography prior to scheduled colonoscopy. Patient experience and preference were assessed both directly after the examinations and 5 weeks after the examinations.

Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer.

Background & Aims: To date, computed tomographic (CT) colonography has been compared with an imperfect test, colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Therefore, the available data may not apply to screening of patients with a personal or family history of colorectal polyps or cancer (increased risk). We prospectively investigated the ability of CT colonography to identify individuals with large (>or=10 mm) colorectal polyps in consecutive patients at increased risk for colorectal cancer.

CT colonography: feasibility of substantial dose reduction--comparison of medium to very low doses in identical patients.

In a feasibility study, the authors compared polyp detection and interobserver variability at computed tomographic (CT) colonography in 15 patients with doses ranging from medium to very low (12.00-0.05 mSv).

Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus.

Background: High admission blood glucose levels after acute myocardial infarction (AMI) are common and associated with an increased risk of death in subjects with and without known diabetes. Recent data indicate a high prevalence of abnormal glucose metabolism in patients with unknown diabetes at the time of AMI. We investigated the predictive value of admission blood glucose levels after AMI for long-term prognosis in patients with and without previously diagnosed diabetes mellitus, particularly in those with unknown diabetes but with blood glucose levels in the diabetic range.

Three-dimensional display modes for CT colonography: conventional 3D virtual colonoscopy versus unfolded cube projection.

The authors compared a conventional two-directional three-dimensional (3D) display for computed tomography (CT) colonography with an alternative method they developed on the basis of time efficiency and surface visibility. With the conventional technique, 3D ante- and retrograde cine loops were obtained (hereafter, conventional 3D). With the alternative method, six projections were obtained at 90 degrees viewing angles (unfolded cube display).

CT colonography at different radiation dose levels: feasibility of dose reduction.

Purpose: To investigate the sensitivity and specificity of polyp detection and the image quality of computed tomographic (CT) colonography at different radiation dose levels and to study effective doses reported in literature on CT colonography.

Materials And Methods: CT colonography and colonoscopy were performed with 100 mAs in 50 consecutive patients at high risk for colorectal cancer; 50- and 30-mAs CT colonographic examinations were simulated with controlled addition of noise to raw transmission measurements. One radiologist randomly evaluated all original and simulated images for the presence of polyps and scored image quality.