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Lesion Conspicuity and Efficiency of CT Colonography with Electronic Cleansing Based on a Three-Material Transition Model

¹ Present address: Clinical Science and Advanced Development, Healthcare Informatics, Philips Medical Systems Nederland, Veenpluis 4-6, 5684 PC, Best, The Netherlands.
² Department of Biomedical Imaging, Technical University Eindhoven, Eindhoven, The Netherlands.
³ Quantitative Imaging Group, Department of Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands.
⁴ Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.

OBJECTIVE. The purpose of this article is to report the effect on lesion conspicuity and the practical efficiency of electronic cleansing for CT colonography (CTC).

MATERIALS AND METHODS. Patients were included from the Walter Reed Army Medical Center public database. All patients had undergone extensive bowel preparation with fecal tagging. A primary 3D display method was used. For study I, the data consisted of all patients with polyps 6 mm. Two experienced CTC observers (observer 1 and observer 2) scored the lesion conspicuity considering supine and prone positions separately. For study II, data consisted of 19 randomly chosen patients from the database. The same observers evaluated the data before and after electronic cleansing. Evaluation time, assessment effort, and observer confidence were recorded.

RESULTS. In study I, there were 59 lesions partly or completely covered by tagged material (to be uncovered by electronic cleansing) and 70 lesions surrounded by air (no electronic cleansing required). The conspicuity did not differ significantly between lesions that were uncovered by electronic cleansing and lesions surrounded by air (observer 1, p < 0.5; observer 2, p < 0.6). In study II, the median evaluation time per patient after electronic cleansing was significantly shorter than for original data (observer 1, 20 reduced to 12 minutes; observer 2, 17 reduced to 12 minutes). Assessment effort was significantly smaller for both observers (p < 0.0000001), and observer confidence was significantly larger (observer 1, p < 0.007; observer 2, p < 0.0002) after electronic cleansing.

CONCLUSION. Lesions uncovered by electronic cleansing have comparable conspicuity with lesions surrounded by air. CTC with electronic cleansing sustains a shorter evaluation time, lower assessment effort, and larger observer confidence than without electronic cleansing.

Keywords: CT colonography • electronic cleansing • lesion conspicuity • material fractions • partial volume effect

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