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Significance of Missed Polyps at CT Colonography

Michael Macari1, Edmund J. Bini2, Stacy L. Jacobs1, Yvonne W. Lui1, Shaked Laks1, Andrew Milano2 and James Babb1

1 Department of Radiology, Abdominal Imaging, NYU Medical Center, Tisch Hospital, 560 First Ave., Ste. HW 207, New York, NY 10016.
2 Department of Medicine, Division of Gastroenterology, NYU Medical Center, New York, NY 10016.



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  		Fig. 1. —Diminutive filling defect at colonoscopy in 63-year old man. Conventional colonoscopic image shows 3-mm raised lesion (arrow) that could not be visualized in retrospect with either 2D or 3D CT colonography. Histologic analysis showed this to be normal colonic mucosa.

 


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  		Fig. 2. —Diminutive filling defect at colonoscopy in 57-year old man. Conventional colonoscopic image shows 3-mm raised lesion (arrow) that could not be visualized in retrospect with either 2D or 3D CT colonography. Histologic analysis showed this to be hyperplastic polyp.

 


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  		Fig. 3. —Diminutive filling defect at colonoscopy in 65-year old man. Conventional colonoscopic image shows 3-mm raised lesion (arrow) that could not be visualized in retrospect with either 2D or 3D CT colonography. Histologic analysis showed this to be tubular adenoma.

 


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  		Fig. 4A. —Polyp behind fold in 67-year-old man with initially negative findings on colonscopy. Axial CT scans with patient in supine (A) and prone (B) positions show 12-mm filling defect (arrow) adjacent to fold.

 


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  		Fig. 4B. —Polyp behind fold in 67-year-old man with initially negative findings on colonscopy. Axial CT scans with patient in supine (A) and prone (B) positions show 12-mm filling defect (arrow) adjacent to fold.

 


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  		Fig. 4C. —Polyp behind fold in 67-year-old man with initially negative findings on colonscopy. CT colonographic image confirms polypoid morphology (arrow). Note large interhaustral fold (arrowhead). This lesion was not seen at initial endoscopy. Follow-up colonoscopy was recommended.

 


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  		Fig. 4D. —Polyp behind fold in 67-year-old man with initially negative findings on colonscopy. Follow-up colonoscopic image confirms 12-mm polyp (arrow) in sigmoid colon. Histologic analysis revealed villous adenoma. Even large polyps like this can be missed at endoscopy if obscured by large haustral fold.

 


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  		Fig. 5A. —Polyp in region of extensive diverticulosis in 58-year-old man with initially negative findings on colonscopy. Axial CT scan with patient in supine position shows 10-mm lesion (arrow) in sigmoid colon. Note adjacent diverticula (arrowheads).

 


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  		Fig. 5B. —Polyp in region of extensive diverticulosis in 58-year-old man with initially negative findings on colonscopy. CT colonographic image confirms polypoid morphology (arrow). Note adjacent diverticulum (arrowhead). This lesion was not seen at initial colonoscopy. Follow-up colonoscopy was recommended.

 


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  		Fig. 5C. —Polyp in region of extensive diverticulosis in 58-year-old man with initially negative findings on colonscopy. Follow-up colonoscopic image confirms 10-mm polyp (arrow) in sigmoid colon. Note adjacent diverticulum (arrowhead). Histologic analysis revealed tubulovillous adenoma.

 


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  		Fig. 6A. —Polyp in colon proximal to incomplete colonoscopy in 55-year-old man. Axial CT scan with patient supine shows 17-mm lesion (arrow) in ascending colon.

 


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  		Fig. 6B. —Polyp in colon proximal to incomplete colonoscopy in 55-year-old man. CT colonographic image confirms polypoid morphology (arrow). This lesion was not seen at initial colonoscopy, which was incomplete because of patient discomfort. Follow-up colonoscopy was recommended.

 


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  		Fig. 6C. —Polyp in colon proximal to incomplete colonoscopy in 55-year-old man. Follow-up colonoscopic image confirms 17-mm polyp (arrow) in ascending colon. Histologic analysis revealed tubular adenoma.

 

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