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Colorectal Neoplasms: Prospective Comparison of Thin-Section Low-Dose Multi–Detector Row CT Colonography and Conventional Colonoscopy for Detection¹

¹ From the Departments of Radiology (M.M., S.S.K., D.R., H.C., G.K., A.J.M.), Medicine (E.J.B., A.M.), Environmental Medicine (X.X.), and Radiation Safety (C.H.M.), New York University Medical Center, Tisch Hospital, 560 First Ave, Suite HW 207, New York, NY 10016; and Siemens Medical Systems, Forcheim, Germany (K.K.). Received August 14, 2001; revision requested September 11; revision received November 8; accepted December 12. Supported in part by a Young Investigator Grant from the Society of Computed Body Tomography/Magnetic Resonance. Supported by the Phillip and Janice Levin Foundation and the Irwin and Marjorie Guttag Foundation. Address correspondence to M.M. (e-mail: michael.macari@med.nyu.edu).

View larger version (123K): [in a new window]   Figure 1a. Internal area of hyperlucency in stool of 58-year-old man. (a) Three-dimensional volume-rendered endoluminal CT image shows a lobulated mass (arrow) suspected of being a polyp in the transverse colon. (b) Transverse CT colonographic image shows a tiny gas bubble in the center of the mass (arrow); this finding confirmed the presence of residual fecal material. No polyp was seen at colonoscopy.

View larger version (133K): [in a new window]   Figure 1b. Internal area of hyperlucency in stool of 58-year-old man. (a) Three-dimensional volume-rendered endoluminal CT image shows a lobulated mass (arrow) suspected of being a polyp in the transverse colon. (b) Transverse CT colonographic image shows a tiny gas bubble in the center of the mass (arrow); this finding confirmed the presence of residual fecal material. No polyp was seen at colonoscopy.

View larger version (136K): [in a new window]   Figure 2a. Differentiation of bulbous folds from polyps in 63-year-old man. (a) Transverse CT colonographic image shows a 7-mm pedunculated mass (arrow) suspected of being a polyp in the descending colon. (b) Coronal CT colonographic image shows that the lesion seen in a actually represents an interhaustral fold (arrow) with a linear morphologic structure. (c) Three-dimensional endoluminal CT image findings confirm the linear morphologic structure (arrow) of the fold.

View larger version (140K): [in a new window]   Figure 2b. Differentiation of bulbous folds from polyps in 63-year-old man. (a) Transverse CT colonographic image shows a 7-mm pedunculated mass (arrow) suspected of being a polyp in the descending colon. (b) Coronal CT colonographic image shows that the lesion seen in a actually represents an interhaustral fold (arrow) with a linear morphologic structure. (c) Three-dimensional endoluminal CT image findings confirm the linear morphologic structure (arrow) of the fold.

View larger version (140K): [in a new window]   Figure 2c. Differentiation of bulbous folds from polyps in 63-year-old man. (a) Transverse CT colonographic image shows a 7-mm pedunculated mass (arrow) suspected of being a polyp in the descending colon. (b) Coronal CT colonographic image shows that the lesion seen in a actually represents an interhaustral fold (arrow) with a linear morphologic structure. (c) Three-dimensional endoluminal CT image findings confirm the linear morphologic structure (arrow) of the fold.

View larger version (117K): [in a new window]   Figure 3a. Pedunculated polyp (14 mm) in 74-year-old man. (a) Transverse CT colonographic image shows a lobulated mass (arrow) in the descending colon. (b) Coronal CT colonographic image shows excellent z-axis resolution; the findings confirm the smooth pedunculated morphologic structure of the lesion (arrow). (c) Three-dimensional volume-rendered endoluminal CT image shows the morphologic structure and the stalk (black arrow) and head (white arrow) of the pedunculated polyp. (d) Corresponding colonoscopic image shows the stalk (black arrow) and head (white arrow) of the pedunculated polyp.

View larger version (126K): [in a new window]   Figure 3b. Pedunculated polyp (14 mm) in 74-year-old man. (a) Transverse CT colonographic image shows a lobulated mass (arrow) in the descending colon. (b) Coronal CT colonographic image shows excellent z-axis resolution; the findings confirm the smooth pedunculated morphologic structure of the lesion (arrow). (c) Three-dimensional volume-rendered endoluminal CT image shows the morphologic structure and the stalk (black arrow) and head (white arrow) of the pedunculated polyp. (d) Corresponding colonoscopic image shows the stalk (black arrow) and head (white arrow) of the pedunculated polyp.

View larger version (122K): [in a new window]   Figure 3c. Pedunculated polyp (14 mm) in 74-year-old man. (a) Transverse CT colonographic image shows a lobulated mass (arrow) in the descending colon. (b) Coronal CT colonographic image shows excellent z-axis resolution; the findings confirm the smooth pedunculated morphologic structure of the lesion (arrow). (c) Three-dimensional volume-rendered endoluminal CT image shows the morphologic structure and the stalk (black arrow) and head (white arrow) of the pedunculated polyp. (d) Corresponding colonoscopic image shows the stalk (black arrow) and head (white arrow) of the pedunculated polyp.

View larger version (204K): [in a new window]   Figure 3d. Pedunculated polyp (14 mm) in 74-year-old man. (a) Transverse CT colonographic image shows a lobulated mass (arrow) in the descending colon. (b) Coronal CT colonographic image shows excellent z-axis resolution; the findings confirm the smooth pedunculated morphologic structure of the lesion (arrow). (c) Three-dimensional volume-rendered endoluminal CT image shows the morphologic structure and the stalk (black arrow) and head (white arrow) of the pedunculated polyp. (d) Corresponding colonoscopic image shows the stalk (black arrow) and head (white arrow) of the pedunculated polyp.

View larger version (115K): [in a new window]   Figure 4a. Round polyp (6 mm) in 71-year-old man. (a) Transverse CT colonographic image shows a 6-mm mass (arrow) with smooth round borders on a haustral fold in the ascending colon. (b) Coronal CT colonographic image findings confirm that the mass (arrow) seen in a has a smooth round polypoid morphologic structure. (c) Three-dimensional volume-rendered endoluminal CT image shows the polyp (arrow) to have a round morphologic structure and smooth borders. (d) Corresponding colonoscopic image shows the same round polyp (arrow) with smooth borders.

View larger version (131K): [in a new window]   Figure 4b. Round polyp (6 mm) in 71-year-old man. (a) Transverse CT colonographic image shows a 6-mm mass (arrow) with smooth round borders on a haustral fold in the ascending colon. (b) Coronal CT colonographic image findings confirm that the mass (arrow) seen in a has a smooth round polypoid morphologic structure. (c) Three-dimensional volume-rendered endoluminal CT image shows the polyp (arrow) to have a round morphologic structure and smooth borders. (d) Corresponding colonoscopic image shows the same round polyp (arrow) with smooth borders.

View larger version (149K): [in a new window]   Figure 4c. Round polyp (6 mm) in 71-year-old man. (a) Transverse CT colonographic image shows a 6-mm mass (arrow) with smooth round borders on a haustral fold in the ascending colon. (b) Coronal CT colonographic image findings confirm that the mass (arrow) seen in a has a smooth round polypoid morphologic structure. (c) Three-dimensional volume-rendered endoluminal CT image shows the polyp (arrow) to have a round morphologic structure and smooth borders. (d) Corresponding colonoscopic image shows the same round polyp (arrow) with smooth borders.

View larger version (164K): [in a new window]   Figure 4d. Round polyp (6 mm) in 71-year-old man. (a) Transverse CT colonographic image shows a 6-mm mass (arrow) with smooth round borders on a haustral fold in the ascending colon. (b) Coronal CT colonographic image findings confirm that the mass (arrow) seen in a has a smooth round polypoid morphologic structure. (c) Three-dimensional volume-rendered endoluminal CT image shows the polyp (arrow) to have a round morphologic structure and smooth borders. (d) Corresponding colonoscopic image shows the same round polyp (arrow) with smooth borders.

View larger version (113K): [in a new window]   Figure 5a. Round polyp (9 mm) in 62-year-old man who weighed 300 pounds. (a) Transverse CT colonographic image shows a 9-mm mass (arrow) with smooth round borders on a haustral fold in the sigmoid colon. (b) Sagittal CT colonographic image findings confirm the smooth round polypoid morphologic structure of the mass (arrow) seen in a. (c) Three-dimensional volume-rendered endoluminal CT image shows the polyp (arrow) to have a round morphologic structure and smooth borders.

View larger version (130K): [in a new window]   Figure 5b. Round polyp (9 mm) in 62-year-old man who weighed 300 pounds. (a) Transverse CT colonographic image shows a 9-mm mass (arrow) with smooth round borders on a haustral fold in the sigmoid colon. (b) Sagittal CT colonographic image findings confirm the smooth round polypoid morphologic structure of the mass (arrow) seen in a. (c) Three-dimensional volume-rendered endoluminal CT image shows the polyp (arrow) to have a round morphologic structure and smooth borders.

View larger version (135K): [in a new window]   Figure 5c. Round polyp (9 mm) in 62-year-old man who weighed 300 pounds. (a) Transverse CT colonographic image shows a 9-mm mass (arrow) with smooth round borders on a haustral fold in the sigmoid colon. (b) Sagittal CT colonographic image findings confirm the smooth round polypoid morphologic structure of the mass (arrow) seen in a. (c) Three-dimensional volume-rendered endoluminal CT image shows the polyp (arrow) to have a round morphologic structure and smooth borders.

View larger version (130K): [in a new window]   Figure 6a. False-positive CT colonographic findings in 55-year-old man. (a) Coronal CT colonographic image shows a smooth round 6-mm mass (arrow) without an internal area of hyperlucency on the fold in the ascending colon. (b) Three-dimensional volume-rendered CT image of the mass seen in a shows a polypoid morphologic structure consistent with a polyp (arrow). At colonoscopy, no lesion was seen. Although we considered this lesion to be a false-positive finding, it is possible that it was a true polyp that was missed at colonoscopy.

View larger version (129K): [in a new window]   Figure 6b. False-positive CT colonographic findings in 55-year-old man. (a) Coronal CT colonographic image shows a smooth round 6-mm mass (arrow) without an internal area of hyperlucency on the fold in the ascending colon. (b) Three-dimensional volume-rendered CT image of the mass seen in a shows a polypoid morphologic structure consistent with a polyp (arrow). At colonoscopy, no lesion was seen. Although we considered this lesion to be a false-positive finding, it is possible that it was a true polyp that was missed at colonoscopy.