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Published online before print February 28, 2006, 10.1148/radiol.2391050610
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Causes of Errors in Polyp Detection at Air-Contrast Barium Enema Examination1

William M. Thompson, MD, William L. Foster, MD, Erik K. Paulson, MD, Donna Niedzwiecki, PhD, Vincent H. S. Low, MD, Lori B. Fulford, PhD, Bob W. Broomer, BS, Linda Sanders, BS and Don C. Rockey, MD

1 From the Departments of Radiology (W.M.T., E.K.P.), Medicine (L.B.F., B.W.B., L.S., D.C.R.), and Biostatistics and Bioinformatics (D.N.), Duke University Medical Center, Box 3808, Durham, NC 27710; Department of Radiology, Durham Veterans Administration Hospital, Durham, NC (W.L.F.); and Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (V.H.S.L.). From the 2004 RSNA Annual Meeting. Received April 12, 2005; revision requested June 16; revision received July 19; final version accepted August 2. Address correspondence to W.M.T. (e-mail: thomp132{at}mc.duke.edu).


Figure 1
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  		Figure 1: Perceptual error: polyp in the barium pool. Anteroposterior spot radiograph of cecum from ACBE examination shows 9–10-mm polyp (arrow) in the barium pool not recognized during initial assessment. At optical colonoscopy, this lesion measured 15 mm.

 

Figure 2
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  		Figure 2: Perceptual error: polyp visualized en face. Left posterior oblique radiograph from ACBE examination shows 15-mm pedunculated polyp (arrow) en face, which was not detected initially.

 

Figure 3
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  		Figure 3a: Perceptual error: cancer visualized en face and contour defect. (a) Anteroposterior radiograph of cecum shows contour defect (arrows) due to 3.0-cm cecal adenocarcinoma, which was not recognized at initial examination. (b) Slight left posterior oblique radiograph of cecum shows 3.0-cm adenocarcinoma (arrows), which is difficult to recognize en face.

 

Figure 3
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  		Figure 3b: Perceptual error: cancer visualized en face and contour defect. (a) Anteroposterior radiograph of cecum shows contour defect (arrows) due to 3.0-cm cecal adenocarcinoma, which was not recognized at initial examination. (b) Slight left posterior oblique radiograph of cecum shows 3.0-cm adenocarcinoma (arrows), which is difficult to recognize en face.

 

Figure 4
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  		Figure 4: Perceptual and technical errors: poor coating. Left posterior oblique radiograph of cecum that contained three 15–20-mm polyps; one perceptual error due to poor coating (arrow). The other two polyps were not identified on any radiographs.

 

Figure 5
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  		Figure 5: Perceptual error: distraction due to diverticulosis. Coned-down anteroposterior view from radiograph of descending colon shows 10-mm polyp (arrow) adjacent to colonic diverticuli.

 

Figure 6
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  		Figure 6a: Technical error: poor distention. (a) Anteroposterior radiograph and (b) anteroposterior left lateral decubitus view from ACBE examination with poor distention. A 15-mm polyp was removed from the descending colon, which could not be seen on any radiographs.

 

Figure 6
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  		Figure 6b: Technical error: poor distention. (a) Anteroposterior radiograph and (b) anteroposterior left lateral decubitus view from ACBE examination with poor distention. A 15-mm polyp was removed from the descending colon, which could not be seen on any radiographs.

 

Figure 7
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  		Figure 7a: Technical error: marked diverticulosis. (a) Overhead anteroposterior radiograph from ACBE examination demonstrates diffuse diverticulosis obscuring 15-mm descending colon polyp. (b) Coned-down anteroposterior views of descending colon in same subject show marked diverticulosis.

 

Figure 7
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  		Figure 7b: Technical error: marked diverticulosis. (a) Overhead anteroposterior radiograph from ACBE examination demonstrates diffuse diverticulosis obscuring 15-mm descending colon polyp. (b) Coned-down anteroposterior views of descending colon in same subject show marked diverticulosis.

 

Figure 8
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  		Figure 8a: Technical error: stool and a possible polyp on ileocecal value. (a) Anteroposterior radiograph from ACBE examination of cecum shows stool (arrows) obscuring 15-mm polyp. (b) Anteroposterior radiograph shows asymmetry of ileocecal valve (arrow) but no obvious other polyps. A 15-mm polyp was removed from the cecum behind a large fold, presumably the ileocecal valve, but was not proved with follow-up ACBE examination.

 

Figure 8
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  		Figure 8b: Technical error: stool and a possible polyp on ileocecal value. (a) Anteroposterior radiograph from ACBE examination of cecum shows stool (arrows) obscuring 15-mm polyp. (b) Anteroposterior radiograph shows asymmetry of ileocecal valve (arrow) but no obvious other polyps. A 15-mm polyp was removed from the cecum behind a large fold, presumably the ileocecal valve, but was not proved with follow-up ACBE examination.

 




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