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- colorectal masses
- conventional colonoscopy
- inflammatory bowel disease
- magnetic resonance imaging
- virtual colonoscopy
Virtual colonoscopy can be considered as work in progress and may be the state of the art technique for a non-invasive and perhaps even pleasant colonoscopy in the future
The term “virtual colonoscopy” was initially coined by Vinig et al in 1994 who demonstrated the feasibility of creating three dimensional pictures of the colon using spiral computed tomography (CT) technology.1 Since the term “virtual colonoscopy” is misleading and implies a colonoscopic procedure rather than generation of images, this methodology should be referred to as virtual colonography (VC). VC can be performed using CT or magnetic resonance imaging (MRI). In this issue of Gut, Ajaj and colleagues2 present an evaluation of a new MR colonography technique employing a water enema for contrasting and extending the colon [see page 1738]. The so called “dark lumen” technique, which was first published in a small feasibility study3 and further described in a recently published review by the same group,4 offers the advantage that the lumen of the colon is pictured black whereas the colonic wall as well as polyps are brightly enhanced in T1 weighted sequences following the application of intravenous paramagnetic contrast. So what is the difference between this technique and that used in other published MR colonography studies? The common procedure is still administration of enemas mixed with paramagnetic contrast such as gadolinium, resulting in a “white” lumen in the T1 sequences. The high bright intraluminal signal contrasts with the black signal of the colonic wall; however, air bubbles and residual faeces also appear black with this technique, necessitating collecting data sets from both the prone and supine patient positions to differentiate real “sessile” polyps from “wandering” air bubbles or faeces. Hence the advantages of the “black lumen” are obvious. Because of the bright appearance …