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Pitfalls of Using Three-Dimensional CT Colonography with Two-Dimensional Imaging Correlation

¹ Both authors: Department of Radiology, Abdominal Imaging, NYU Medical Center, Tisch Hospital, 560 First Ave., Ste. HW 206, New York, NY 10016.

View larger version (113K): [in a new window]   Fig. 1. —50-year-old man with normal colon. Three-dimensional thresholdrendered endoluminal CT colonograph of descending colon shows good distention (arrow) without interhaustral fold delineation.

View larger version (132K): [in a new window]   Fig. 2A. —60-year-old man with normal colon. Three-dimensional threshold-rendered endoluminal CT colonograph of splenic flexure shows multiple thin linear filling defects (arrow) haphazardly arranged, consistent with interhaustral folds.

View larger version (124K): [in a new window]   Fig. 2B. —60-year-old man with normal colon. Three-dimensional threshold-rendered endoluminal CT colonograph of transverse colon reveals multiple thin linear filling defects (arrow) arranged in continuous pattern, consistent with interhaustral folds.

View larger version (127K): [in a new window]   Fig. 3A. —64-year-old man with incompletely distended colon. Three-dimensional threshold-rendered endoluminal CT colonograph of sigmoid colon shows poor distention limiting endoluminal perspectives. An 8-mm polyp (arrow) is difficult to perceive because of incomplete distention (same arrow).

View larger version (123K): [in a new window]   Fig. 3B. —64-year-old man with incompletely distended colon. Two-dimensional axial CT scan of same region again reveals poor distention. Polyp (arrow) is easier to appreciate on 2D imaging in this case.

View larger version (96K): [in a new window]   Fig. 4A. —51-year-old man with residual fecal material. Three-dimensional threshold-rendered endoluminal CT colonograph of cecum shows large filling defect (arrows). Differential diagnosis includes polyp, neoplasm, stool, and extrinsic compression.

View larger version (122K): [in a new window]   Fig. 4B. —51-year-old man with residual fecal material. Coronal reformatted CT scan at same level as A reveals filling defect that contains bubbles of gas (arrow), consistent with residual fecal material.

View larger version (137K): [in a new window]   Fig. 5A. —75-year-old woman with known rectal neoplasm who has two filling defects seen on CT colonography. IV contrast material was administered in this case for staging purposes. Three-dimensional threshold-rendered endoluminal CT colonograph of rectum shows two indistinguishable filling defects (arrows). Differential diagnosis for each lesion includes neoplasm and stool.

View larger version (113K): [in a new window]   Fig. 5B. —75-year-old woman with known rectal neoplasm who has two filling defects seen on CT colonography. IV contrast material was administered in this case for staging purposes. Axial CT scan of rectum at level of upper vagina reveals homogeneously enhancing mass (arrow) consistent with neoplasm. Mass corresponds with small arrow in A.

View larger version (122K): [in a new window]   Fig. 5C. —75-year-old woman with known rectal neoplasm who has two filling defects seen on CT colonography. IV contrast material was administered in this case for staging purposes. Axial CT scan 1 cm cephalad to B reveals residual fecal material (arrow). Note small bubbles of gas in filling defect, confirming stool. This finding corresponds with large arrow in A.

View larger version (107K): [in a new window]   Fig. 6A. —70-year-old woman with impacted diverticulum. Three-dimensional threshold-rendered endoluminal CT colonograph of sigmoid colon shows raised filling defect (arrow), suggesting polyp.

View larger version (101K): [in a new window]   Fig. 6B. —70-year-old woman with impacted diverticulum. Coronal reformatted CT scan at same level as filling defect in A reveals impacted diverticulum (arrow) filled with high-density stool and residual barium from previous examination.

View larger version (102K): [in a new window]   Fig. 7A. —66-year-old man with diverticulum. Three-dimensional threshold-rendered endoluminal CT colonograph of transverse colon shows 1-cm defect surrounded by complete ring shadow (arrow), suggesting diverticulum.

View larger version (92K): [in a new window]   Fig. 7B. —66-year-old man with diverticulum. Coronal reformatted CT scan at level of defect seen in A reveals defect represents a diverticulum (arrow).

View larger version (105K): [in a new window]   Fig. 8A. —56-year-old woman with small polyp. Three-dimensional threshold-rendered endoluminal CT colonograph of cecum shows 5-mm filling defect with incomplete ring (arrow). Differential diagnosis includes polyp, residual fecal material, and atypical diverticulum.

View larger version (95K): [in a new window]   Fig. 8B. —56-year-old woman with small polyp. Axial CT scan at same level as defect in A reveals pedunculated polyp (arrow).

View larger version (146K): [in a new window]   Fig. 9A. —70-year-old man with papillary type ileocecal valve. Three-dimensional threshold-rendered endoluminal CT colonograph of ascending colon shows 1.5-cm raised filling defect (arrow). Note depression in center (arrowhead) of defect. Differential diagnosis includes ulcerated neoplasm and ileocecal valve.

View larger version (124K): [in a new window]   Fig. 9B. —70-year-old man with papillary type ileocecal valve. Coronal reformatted CT scan at same level as A reveals filling defect is actually prominent ileocecal valve (arrow). Note cephalad and caudal leaflets of valve and terminal ileum.

View larger version (131K): [in a new window]   Fig. 10A. —76-year-old man with labial type ileocecal valve. Three-dimensional threshold-rendered endoluminal CT colonograph of ascending colon shows small opening in expected region of ileocecal valve (arrow). Differential diagnosis includes incompetent valve or diverticulum.

View larger version (96K): [in a new window]   Fig. 10B. —76-year-old man with labial type ileocecal valve. Axial CT scan at same level as A reveals ileocecal valve. Note opening of leaflets of valve (arrow).

View larger version (145K): [in a new window]   Fig. 11A. —50-year-old man with external compression from posteroinferior segment (segment VI) of liver. Three-dimensional threshold-rendered endoluminal CT colonograph of ascending colon viewing toward hepatic flexure shows large filling defect (arrows). Differential diagnosis includes neoplasm, stool, and extrinsic compression.

View larger version (119K): [in a new window]   Fig. 11B. —50-year-old man with external compression from posteroinferior segment (segment VI) of liver. Coronal reformatted CT scan at same level as A reveals impression on hepatic flexure (arrow) by inferior surface of liver segment VI (6).

View larger version (132K): [in a new window]   Fig. 12A. —52-year-old woman with external compression from adjacent loop of distended bowel. Three-dimensional threshold-rendered endoluminal CT colonograph of ascending colon shows large filling defect (arrow). Differential diagnosis includes neoplasm, stool, and extrinsic compression.

View larger version (103K): [in a new window]   Fig. 12B. —52-year-old woman with external compression from adjacent loop of distended bowel. Axial CT scan reveals impression on ascending colon from adjacent loop of distended bowel (arrow).

View larger version (117K): [in a new window]   Fig. 13A. —82-year-old man with external compression from psoas muscle. Three-dimensional threshold-rendered endoluminal CT colonograph of ascending colon shows long filling defect (arrows). Appearance is atypical for polyp or neoplasm.

View larger version (96K): [in a new window]   Fig. 13B. —82-year-old man with external compression from psoas muscle. Axial CT scan reveals impression on ascending colon from psoas muscle (arrow) in this thin patient.

View larger version (119K): [in a new window]   Fig. 14A. —74-year-old man with external compression from aorta. Three-dimensional threshold-rendered endoluminal CT colonograph of sigmoid colon shows filling defect (arrow). Differential diagnosis includes neoplasm, stool, and extrinsic compression.

View larger version (137K): [in a new window]   Fig. 14B. —74-year-old man with external compression from aorta. Axial CT scan reveals impression on sigmoid colon is from aorta (arrow).

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