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Teniae Coli–based Circumferential Localization System for CT Colonography: Feasibility Study¹

¹ From the Diagnostic Radiology Department, Clinical Center, National Institutes of Health, 10 Center Dr, MSC 1182, Bldg 10, Room 1C351, Bethesda, MD 20892-1182 (A.H., D.A.R., R.M.S., M.F.); NIBIB/CDRH, Joint Laboratory for the Assessment of Medical Imaging Systems, U.S. Food and Drug Administration, Rockville, Md (N.P.); Uniformed Services University of the Health Sciences, Bethesda, Md (J.R.C., P.J.P.); Walter Reed Army Medical Center, Washington, DC (J.R.C.); and National Naval Medical Center, Bethesda, Md (P.J.P.). Received February 24, 2006; revision requested April 25; revision received May 19; accepted June 8; final version accepted September 1. Supported by intramural programs of the Diagnostic Radiology Department of the Clinical Center, National Institutes of Health. D.A.R. supported by a fellowship through the Clinical Research Training Program, a public-private partnership supported jointly by the National Institutes of Health and a grant to the Foundation for the National Institutes of Health from Pfizer Pharmaceuticals Group. Address correspondence to R.M.S. (e-mail: rms{at}nih.gov).

View larger version (47K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: (a) Anterior, (b) posterior, and (c) posterior oblique views of a 3D CT colonographic surface show the teniae coli in a 61-year-old woman in the supine position. The tenia omentalis (TO, solid arrows) is located on the anterior surface of the transverse colon. (a, b) The tenia libera (TL, dashed arrow) appears on the inferior aspect of the transverse colon, whereas the tenia mesocolica (TM, arrowheads) is located on the posterior surface. In c, the TO is clockwise from the ileocecal valve (arrowhead).

View larger version (44K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: (a) Anterior, (b) posterior, and (c) posterior oblique views of a 3D CT colonographic surface show the teniae coli in a 61-year-old woman in the supine position. The tenia omentalis (TO, solid arrows) is located on the anterior surface of the transverse colon. (a, b) The tenia libera (TL, dashed arrow) appears on the inferior aspect of the transverse colon, whereas the tenia mesocolica (TM, arrowheads) is located on the posterior surface. In c, the TO is clockwise from the ileocecal valve (arrowhead).

View larger version (71K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: (a) Anterior, (b) posterior, and (c) posterior oblique views of a 3D CT colonographic surface show the teniae coli in a 61-year-old woman in the supine position. The tenia omentalis (TO, solid arrows) is located on the anterior surface of the transverse colon. (a, b) The tenia libera (TL, dashed arrow) appears on the inferior aspect of the transverse colon, whereas the tenia mesocolica (TM, arrowheads) is located on the posterior surface. In c, the TO is clockwise from the ileocecal valve (arrowhead).

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 2: Segment of the two-dimensional flattened sheet derived from the 3D CT colonographic surface shown in Figure 1. The top and bottom edges of the sheet are formed by the TO (solid blue arrows). The TL (yellow stripe) and TM (green stripe) are inferred, respectively, at one-third and two-thirds the height of the sheet and approximate the longitudinal flat bands (arrowheads and dashed arrows) between the haustral folds (white arrows). A 0.9-cm adenomatous polyp (circle) can be seen touching the TM.

View larger version (52K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Teniae coli and minor grid lines on (a) anterior and (b) posterior views of the 3D CT colonographic surface shown in Figure 1. The TO (solid arrows), TL (dashed arrow), and TM (arrowheads) were mapped from the two-dimensional sheet (Fig 2) back to the 3D surface.

View larger version (49K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Teniae coli and minor grid lines on (a) anterior and (b) posterior views of the 3D CT colonographic surface shown in Figure 1. The TO (solid arrows), TL (dashed arrow), and TM (arrowheads) were mapped from the two-dimensional sheet (Fig 2) back to the 3D surface.

View larger version (9K): [in this window] [in a new window] [Download PPT slide]   Figure 4: Local coordinate systems along the centerline (dotted line). The z direction is the tangent of the centerline, the y direction is the vector pointing to the TO (dashed line), and the x direction is the cross product of the y and z directions.

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 5: Synchronized supine (left image) and prone (right image) navigation. A 0.6-cm adenomatous polyp in the transverse colon of a 65-year-old man, partially colored orange (arrows) on images created by using a computer-aided detection system, has circumference positions of 5.0 and 5.0 grid lines in the supine (arrowhead) and prone (dashed arrow) positions. The camera-controlling text boxes under the images orient the camera (from top to bottom) 49 cm away from the cecum, at a 0° rotation angle, at a 3° pitch up angle, and at a 15-unit (one unit = 0.1 radians) field of view (zoom factor); and orient the right camera 3 cm ahead in the centerline position. Analogous to clock positions, the TO (red-yellow-green stripe), TL (yellow stripe), and TM (green stripe) are labeled grid lines 12, 4, and 8, respectively.

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 6a: A 1.6-cm sessile adenoma in the transverse colon of a 52-year-old woman with a –0.5 grid line difference. (a) On supine CT scan, the polyp (thick arrow) is in the dependent location. (b) On prone CT scan, the polyp (thick arrow) has moved to the lateral location. In a and b, a small amount of dependent contrast material–enhanced residual fluid (thin arrows) is present. Corresponding (c) supine and (d) prone measurements on 3D endoluminal images obtained by using our circumferential localization method show polyp (arrow) positions at 8.6 and 8.1 grid lines, respectively.

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 6b: A 1.6-cm sessile adenoma in the transverse colon of a 52-year-old woman with a –0.5 grid line difference. (a) On supine CT scan, the polyp (thick arrow) is in the dependent location. (b) On prone CT scan, the polyp (thick arrow) has moved to the lateral location. In a and b, a small amount of dependent contrast material–enhanced residual fluid (thin arrows) is present. Corresponding (c) supine and (d) prone measurements on 3D endoluminal images obtained by using our circumferential localization method show polyp (arrow) positions at 8.6 and 8.1 grid lines, respectively.

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 6c: A 1.6-cm sessile adenoma in the transverse colon of a 52-year-old woman with a –0.5 grid line difference. (a) On supine CT scan, the polyp (thick arrow) is in the dependent location. (b) On prone CT scan, the polyp (thick arrow) has moved to the lateral location. In a and b, a small amount of dependent contrast material–enhanced residual fluid (thin arrows) is present. Corresponding (c) supine and (d) prone measurements on 3D endoluminal images obtained by using our circumferential localization method show polyp (arrow) positions at 8.6 and 8.1 grid lines, respectively.

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 6d: A 1.6-cm sessile adenoma in the transverse colon of a 52-year-old woman with a –0.5 grid line difference. (a) On supine CT scan, the polyp (thick arrow) is in the dependent location. (b) On prone CT scan, the polyp (thick arrow) has moved to the lateral location. In a and b, a small amount of dependent contrast material–enhanced residual fluid (thin arrows) is present. Corresponding (c) supine and (d) prone measurements on 3D endoluminal images obtained by using our circumferential localization method show polyp (arrow) positions at 8.6 and 8.1 grid lines, respectively.

View larger version (94K): [in this window] [in a new window] [Download PPT slide]   Figure 7a: A 1.6-cm pedunculated villous adenoma in the descending colon of a 63-year-old man with a –3.1 grid line difference. (a) On 3D endoluminal supine image, the polyp head (arrow) rests within a haustrum at 10.1 grid lines. (b) On 3D endoluminal prone image, the polyp head (arrow) touches a haustral fold at 7.0 grid lines. (c) On supine CT scan, the stalk of the polyp is visible. The polyp head (large arrow) and part of the stalk (small white arrow) are submerged in a pool of contrast-enhanced residual fluid. (d) On prone CT scan, the polyp head (large arrow) has moved owing to gravity and is touching the haustral fold. Small blue arrows in c and d indicate the approximate viewing directions for corresponding 3D endoluminal images in a and b and were generated by the colon navigation software.

View larger version (94K): [in this window] [in a new window] [Download PPT slide]   Figure 7b: A 1.6-cm pedunculated villous adenoma in the descending colon of a 63-year-old man with a –3.1 grid line difference. (a) On 3D endoluminal supine image, the polyp head (arrow) rests within a haustrum at 10.1 grid lines. (b) On 3D endoluminal prone image, the polyp head (arrow) touches a haustral fold at 7.0 grid lines. (c) On supine CT scan, the stalk of the polyp is visible. The polyp head (large arrow) and part of the stalk (small white arrow) are submerged in a pool of contrast-enhanced residual fluid. (d) On prone CT scan, the polyp head (large arrow) has moved owing to gravity and is touching the haustral fold. Small blue arrows in c and d indicate the approximate viewing directions for corresponding 3D endoluminal images in a and b and were generated by the colon navigation software.

View larger version (28K): [in this window] [in a new window] [Download PPT slide]   Figure 7c: A 1.6-cm pedunculated villous adenoma in the descending colon of a 63-year-old man with a –3.1 grid line difference. (a) On 3D endoluminal supine image, the polyp head (arrow) rests within a haustrum at 10.1 grid lines. (b) On 3D endoluminal prone image, the polyp head (arrow) touches a haustral fold at 7.0 grid lines. (c) On supine CT scan, the stalk of the polyp is visible. The polyp head (large arrow) and part of the stalk (small white arrow) are submerged in a pool of contrast-enhanced residual fluid. (d) On prone CT scan, the polyp head (large arrow) has moved owing to gravity and is touching the haustral fold. Small blue arrows in c and d indicate the approximate viewing directions for corresponding 3D endoluminal images in a and b and were generated by the colon navigation software.

View larger version (30K): [in this window] [in a new window] [Download PPT slide]   Figure 7d: A 1.6-cm pedunculated villous adenoma in the descending colon of a 63-year-old man with a –3.1 grid line difference. (a) On 3D endoluminal supine image, the polyp head (arrow) rests within a haustrum at 10.1 grid lines. (b) On 3D endoluminal prone image, the polyp head (arrow) touches a haustral fold at 7.0 grid lines. (c) On supine CT scan, the stalk of the polyp is visible. The polyp head (large arrow) and part of the stalk (small white arrow) are submerged in a pool of contrast-enhanced residual fluid. (d) On prone CT scan, the polyp head (large arrow) has moved owing to gravity and is touching the haustral fold. Small blue arrows in c and d indicate the approximate viewing directions for corresponding 3D endoluminal images in a and b and were generated by the colon navigation software.

View larger version (109K): [in this window] [in a new window] [Download PPT slide]   Figure 8a: Initial polyp mislocalizations corrected by using proposed teniae coli–based navigation system. Synchronized 3D endoluminal (a) supine and (b) prone views of a 0.8-cm sessile adenoma (arrow) in the ascending colon of 65-year-old man. Synchronized 3D endoluminal (c) supine and (d) prone views of a polyp-like bump (arrow) 7 cm away from the polyp depicted in a and b. The polyp-like bump in d was initially mislabeled as a match to the polyp in a.

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 8b: Initial polyp mislocalizations corrected by using proposed teniae coli–based navigation system. Synchronized 3D endoluminal (a) supine and (b) prone views of a 0.8-cm sessile adenoma (arrow) in the ascending colon of 65-year-old man. Synchronized 3D endoluminal (c) supine and (d) prone views of a polyp-like bump (arrow) 7 cm away from the polyp depicted in a and b. The polyp-like bump in d was initially mislabeled as a match to the polyp in a.

View larger version (113K): [in this window] [in a new window] [Download PPT slide]   Figure 8c: Initial polyp mislocalizations corrected by using proposed teniae coli–based navigation system. Synchronized 3D endoluminal (a) supine and (b) prone views of a 0.8-cm sessile adenoma (arrow) in the ascending colon of 65-year-old man. Synchronized 3D endoluminal (c) supine and (d) prone views of a polyp-like bump (arrow) 7 cm away from the polyp depicted in a and b. The polyp-like bump in d was initially mislabeled as a match to the polyp in a.

View larger version (109K): [in this window] [in a new window] [Download PPT slide]   Figure 8d: Initial polyp mislocalizations corrected by using proposed teniae coli–based navigation system. Synchronized 3D endoluminal (a) supine and (b) prone views of a 0.8-cm sessile adenoma (arrow) in the ascending colon of 65-year-old man. Synchronized 3D endoluminal (c) supine and (d) prone views of a polyp-like bump (arrow) 7 cm away from the polyp depicted in a and b. The polyp-like bump in d was initially mislabeled as a match to the polyp in a.