Virtual colonoscopy

Definition

Virtual colonoscopy (VC) is an imaging or x-ray test that looks for cancer, polyps, or other disease in the large intestine (colon). The medical name of this test is CT colonography.

Alternative Names

Colonoscopy - virtual; CT colonography; Computed tomographic colonography; Colography - virtual

How the Test is Performed

VC is different from regular colonoscopy. Regular colonoscopy uses a long, lighted tool called a colonoscope that is inserted into the rectum and large intestine.

VC is done in the radiology department of a hospital or medical center. No sedatives are needed and no colonoscope is used.

The exam is done as follows:

• You lie on your left side on a narrow table that is connected to a CT machine.
• Your knees are drawn up toward your chest.
• A small, flexible tube is inserted into the rectum. Air is pumped through the tube to make the colon bigger and easier to see.
• You then lie on your back.
• The table slides into a large tunnel in the CT machine. X-rays of your colon are taken.
• X-rays are also taken while you lie on your stomach.
• You must stay very still during this procedure, because movement can blur the x-rays. You may be asked to hold your breath briefly while each x-ray is taken.

A computer combines all the images to form three-dimensional pictures of the colon. The radiologist can view the images on a video monitor.

How to Prepare for the Test

Your bowels need to be completely empty and clean for the exam. A problem in your large intestine that needs to be treated may be missed if your intestines are not cleaned out.

Your health care provider will give you the steps for cleansing your bowel. This is called bowel preparation. Steps may include:

• Using enemas
• Not eating solid foods for 1 to 3 days before the test
• Taking laxatives

You need to drink plenty of clear liquids for 1 to 3 days before the test. Examples of clear liquids are:

• Clear coffee or tea
• Fat-free bouillon or broth
• Gelatin
• Sports drinks
• Strained fruit juices
• Water

Keep taking your medicines unless your health care provider tells you otherwise.

You will need to ask your provider if you need to stop taking iron pills or liquids a few days before the test, unless your provider tells you it is OK to continue. Iron can make your stool dark black. This makes it harder for the radiologist to view inside your bowel.

CT and MRI scanners are very sensitive to metals. Do not wear jewelry the day of your exam. You will be asked to change out of your street clothes and wear a hospital gown for the procedure.

How the Test will Feel

The x-rays are painless. Pumping air into the colon may cause cramping or gas pains.

After the exam:

• You may feel bloated and have mild abdominal cramping and pass a lot of gas.
• You should be able to return to your regular activities.

Why the Test is Performed

VC may be done for the following reasons:

• Follow-up on colon cancer or polyps
• Abdominal pain, changes in bowel movements, or weight loss
• Anemia due to low iron
• Blood in the stool or black, tarry stools
• Screen for cancer of the colon or rectum (should be done every 5 years)

Your provider may recommend a regular colonoscopy instead of a VC. The reason is that VC does not allow removing tissue samples or polyps.

Other times, a VC is done if a regular colonoscopy could not be completed.

Normal Results

Normal findings are images of a healthy intestinal tract.

What Abnormal Results Mean

Abnormal test results may mean any of the following:

• Colorectal cancer
• Abnormal pouches on the lining of the intestines, called diverticulosis
• Colitis (a swollen and inflamed intestine) due to Crohn disease, ulcerative colitis, infection, or lack of blood flow
• Lower gastrointestinal (GI) bleeding
• Polyps
• Tumor

Regular colonoscopy may be done (on a different day) after a VC if:

• No cause for bleeding or other symptoms were found. VC can miss some smaller problems in the colon.
• Problems that need a biopsy were seen on a VC.

Risks

Risks of VC include:

• Exposure to radiation from the CT scan
• Nausea, vomiting, bloating, or rectal irritation from medicines used to prepare for the test
• Perforation of the intestine when the tube to pump air is inserted (extremely unlikely).

Considerations

Differences between virtual and conventional colonoscopy include:

• VC can view the colon from many different angles. This is not as easy with regular colonoscopy.
• VC does not require sedation. You can usually go back to your normal activities right away after the test. Regular colonoscopy uses sedation and often the loss of a work day.
• VC using CT scanners expose you to radiation.
• Regular colonoscopy has a small risk for bowel perforation (creating a small tear). There is almost no such risk from VC.
• VC is often not able to detect polyps smaller than 10 millimeters. Regular colonoscopy can detect polyps of all sizes.

References

Garber JJ, Chung DC. Colonic polyps and polyposis syndromes. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology Diagnosis Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 126.

Kim DH, Pickhardt PJ. Computed tomography colonography and evaluation of the colon. In: Gore RM, Levine MS, eds. Textbook of Gastrointestinal Radiology. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 38.

National Cancer Institute website. Colorectal cancer prevention (PDQ) - health professional version. www.cancer.gov/types/colorectal/hp/colorectal-prevention-pdq. Updated August 18, 2023. Accessed February 11, 2024.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): colorectal cancer screening. Version 1.2024 - February 27, 2024. www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. Updated February 27, 2024. Accessed April 17, 2024.

Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479. PMID: 33657038 pubmed.ncbi.nlm.nih.gov/33657038/.

US Preventive Services Task Force website. Final recommendation statement. Colorectal cancer: screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Published May 18, 2021. Accessed February 11, 2024.