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Cecal Mobility: A Potential Pitfall of CT Colonography

Jarvis C. Chen1 and Abraham H. Dachman1

1 Both authors: Department of Radiology, The University of Chicago, 5841 S Maryland Ave., Chicago, IL 60637.


Figure 1
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  		Fig. 1A —Diagrams of method of calculating change in ileocecal-appendiceal angle. In these sagittal views, ventral abdominal wall is to left and spine is to right. Baseline prone image shows location of ileocecal valve, appendix, polyp in cecum, and vertical line drawn to ileocecal valve.

 

Figure 2
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  		Fig. 1B —Diagrams of method of calculating change in ileocecal-appendiceal angle. In these sagittal views, ventral abdominal wall is to left and spine is to right. Comparison supine view shows change in ileocecal angle of 60° relative to prone baseline view. Anteroposterior rotation leaves ileocecal valve in same location but causes appendix to be located more caudally and posteriorly when patient is in supine position.

 

Figure 3
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  		Fig. 1C —Diagrams of method of calculating change in ileocecal-appendiceal angle. In these sagittal views, ventral abdominal wall is to left and spine is to right. Second comparison view shows relative change in ileocecal-appendiceal angle of 120°. Note that in this case, complex rotation resulted in ileocecal valve moving to position anterior to appendix. In both examples (B and C), polyp remains constant in location relative to origin of appendix but appears to move with gravity to dependent surface.

 

Figure 4
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  		Fig. 2A —Ileocecal-appendiceal angle change of 101°. Prone view with lines drawn shows ileocecal-appendiceal angel is 41° in axial plane.

 

Figure 5
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  		Fig. 2B —Ileocecal-appendiceal angle change of 101°. In supine view, ileocecal-appendiceal angle is 61°, measured clockwise from vertical, in axial plane.

 

Figure 6
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  		Fig. 3 —Bar graph shows change in ileocecal-appendiceal angle, grouped by subjective assessment, for potential for diagnostic dilemma caused by cecal mobility. Average and ranges (isobars) are shown for axial, sagittal, and coronal planes. There is statistically significant difference between average angles in diagnostic-dilemma and no-diagnostic-dilemma groups. Gray bars = axial change in axis, black bars = sagittal change in axis, white bars = coronal change in axis.

 

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