CT colonography: revisited after 30 years

Sep 24, 2026

Uploaded by Aran

Computed tomography colonography (CTC), also called virtual colonoscopy, is a well-tolerated, minimally invasive, effective screening and diagnostic procedure supported by decades of studies and meta-analyses. It uses bowel preparation with laxatives and fecal tagging, followed by low-pressure CO2 insufflation and postprocessing analysis. CTC performs similarly to optical colonoscopy and is sensitive for advanced adenomas and early colorectal cancer, especially significant benign precursors.

LanguageEnglish

CategoryHealthcare

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Pages16

Reading Time40 min

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Abstract

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Introduction

Educational Review (Open Access)

Graphical Abstract

Cadi et al. Insights into Imaging (2025)16:160 [https://doi.org/10.1186/s13244-025-02038-x](https://doi.org/10.1186/s13244-025-02038-x) EDUCATIONAL REVIEW Open Access CT colonography: revisited after 30 years Mehdi Cadi 1,2* , Charles André Cuenod 1, Philippe A. Grenier3, Aurélien Saltel 1, Mohamed Abdulbaki 1, Gilles Manceau4 and Mehdi Karoui4 Abstract Computed tomography colonography (CTC), also known as virtual colonoscopy, is a well-tolerated, minimally invasive and effective procedure. Used for over two decades and supported by extensive studies and meta-analyses, CTC has demonstrated performance comparable to that of optical colonoscopy (OC) . However, CTC remains generally underutilized in many countries, including the United States of America; in contrast, in some countries, such as the United Kingdom, it is widely used. CTC requires bowel preparation with laxative and fecal contrast-agent tagging, followed by colonic distension with low-pressure, automated, CO2 insufﬂation. It enables detailed image analysis with postprocessing software and is highly sensitive and speciﬁc for detecting cancers and signiﬁcant benign precursors ≥ 10 mm (adenomatous and sessile-serrated polyps) years before potential malignant transformation. After reviewing the state of the art of CTC acquisition, analysis and reporting, we wrote this article to update the new, potential and emerging CTC indications. CTC is increasingly used after incomplete OC, for undetermined colonic anomalies, in elderly and/or fragile patients or when OC is refused. Recent routine clinical use has broadened CTC’s applications, proving its usefulness in local colon-cancer staging, preoperative laparoscopic surgery planning, and selecting patients with severe diverticular disease for elective sigmoidectomy. Critical relevance statement Beyond its excellent performance in detecting advanced adenomas and cancers, CTC provides precise staging of locally advanced tumors, guiding decisions on neoadjuvant therapy, and coupled with contrast-enhanced thoracic–abdominal–pelvic acquisition, enables comprehensive, preoperative evaluation for laparoscopic colectomy. Key Points ● CT colonography (CTC) and optical colonoscopy (OC) are similarly able to detect advanced adenomas (≥ 10 mm) and early-stage colorectal cancer. ● CTC enables a “one-stop shop” examination for laparoscopic surgery planning, with precise localization and detailed vascular mesenteric mapping. ● With the rise of neoadjuvant treatments for advanced colorectal cancer, CTC may become pivotal in radiological staging. Keywords CT colonography, Laparoscopic surgery, Cancer screening, Diverticular disease, Incomplete colonoscopy *Correspondence: Mehdi Cadi [mehdi.cadi@aphp.fr](mehdi.cadi@aphp.fr) Full list of author information is available at the end of the article © The Author(s) 2025 . Open Access This article is licensed under a Creative Commons Attribution 4 . 0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/) . Cadi et al. Insights into Imaging (2025)16:160 Page 2 of 16 Graphical Abstract CT colonography: revisited after 30 years Beyond its excellent detection performance of advanced adenomas and cancers, CTC pr

FAQs

What is CT colonography (CTC) and how does it work?

CTC, also known as virtual colonoscopy, uses CT imaging after bowel preparation and fecal contrast-agent tagging. The colon is distended with low-pressure CO2 and then evaluated with postprocessing software.

How does CTC compare with optical colonoscopy (OC)?

The document states that CTC can detect advanced adenomas (≥10 mm) and early-stage colorectal cancer similarly to OC. It also notes that CTC remains underutilized in many countries despite comparable performance.

Why is CTC considered useful in clinical decision-making beyond cancer detection?

CTC supports precise staging of locally advanced tumors, guiding decisions on neoadjuvant therapy. It can also improve preoperative evaluation for laparoscopic colectomy and help plan surgery when OC is incomplete or refused.

Sep 24, 2026

Uploaded by Aran