Intravenous, contrast-enhanced MR colonography using air as endoluminal contrast agent: Impact on colorectal polyp detection

Purpose: To compare diagnostic accuracy and patient tolerance of MR colonography with intravenous contrast and luminal air (MRC) to conventional colonoscopy (CC). Materials and methods: IRB approval and written informed consent were obtained. Forty-six patients, both screening and symptomatic, underwent MRC followed by CC. The MRC technique employed 3D T1W spoiled gradient echo sequences performed after the administration of gadopenetate dimeglumine, with parallel imaging. The diagnostic accuracy and tolerance of patients for MRC was compared to CC. Results: Twenty-four polyps were detected in eighteen patients with CC (5 polyps ≥10 mm, 4 polyps 6-9 mm, 15 polyps ≤5 mm). MRC was 66.7% (12/18) sensitive and 96.4% (27/28) specific for polyp detection on a per-patient basis. When analyzed by polyp size, sensitivity and specificity of MRC was 100% (5/5) and 100% (19/19), respectively, for lesions greater than 10 mm, 100% (4/4) and 100% (20/20) for lesions 6-9 mm, and sensitivity of 20% (3/15) lesions less than 5 mm. The sensitivity and specificity of MRC for detecting significant lesions (>6 mm) was 100% (9/9) and 100% (15/15), respectively. Regarding tolerance of the exams, there were no significant differences between MRC and CC. Thirty-five percent (n = 16) of patients preferred MRC as a future screening test compared to 33% (n = 15) for CC. Conclusion: MRC using air as an intraluminal contrast agent is a feasible and well-tolerated technique for detecting colonic polyps ≥6 mm in size. Further studies are warranted.