Flat Colorectal Neoplasms: Definition, Importance, and Visualization on CT Colonography
Seong Ho Park1,
Seung Soo Lee1,
Eugene K. Choi2,
So Yeon Kim1,
Suk-Kyun Yang3,
Jin Ho Kim3 and
Hyun Kwon Ha1
1 Department of Radiology and Research Institute of Radiology, University of
Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong,
Songpa-gu, 138-736, Seoul, Korea.
2 Weill Medical College of Cornell University, New York, NY 10021.
3 Department of Internal Medicine, University of Ulsan College of Medicine, Asan
Medical Center, Seoul, Korea.
View larger version (136K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1A —54-year-old man with approximately 4-cm flat villotubular adenoma
with intramucosal adenocarcinoma with irregular lesion margin in cecum.
Three-dimensional endoluminal CT colonography image shows irregular mucosal
nodularity (arrows) in cecal tip.
|
|
View larger version (145K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1B —54-year-old man with approximately 4-cm flat villotubular adenoma
with intramucosal adenocarcinoma with irregular lesion margin in cecum.
Two-dimensional transverse image obtained using wide window settings (width,
1,500 H; level, -400 H) shows flat elevation with nodular surfaces
(arrowheads).
|
|
View larger version (135K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1C —54-year-old man with approximately 4-cm flat villotubular adenoma
with intramucosal adenocarcinoma with irregular lesion margin in cecum.
Colonoscopy shows irregular mucosal nodularity in area of cecum corresponding
to that shown in A and B.
|
|
View larger version (149K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2A —53-year-old woman with approximately 5-cm flat tubular adenoma with
intramucosal adenocarcinoma with smooth, well-circumscribed, peripheral rim in
sigmoid colon. Three-dimensional endoluminal CT colonography image shows round
flat lesion (arrowheads) in sigmoid colon. Lesion shows nodular
surfaces and is well circumscribed by polypoid rim in periphery.
|
|
View larger version (148K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2B —53-year-old woman with approximately 5-cm flat tubular adenoma with
intramucosal adenocarcinoma with smooth, well-circumscribed, peripheral rim in
sigmoid colon. Two-dimensional multiplanar reformatted image obtained using
wide window settings (width, 1,500 H; level, -400 H) shows flat elevation with
nodular surfaces (arrowheads).
|
|
View larger version (154K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 2C —53-year-old woman with approximately 5-cm flat tubular adenoma with
intramucosal adenocarcinoma with smooth, well-circumscribed, peripheral rim in
sigmoid colon. Colonoscopy shows corresponding round flat lesion with nodular
surfaces and well-circumscribed margin.
|
|
View larger version (113K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3A —67-year-old man with 10-mm flat adenocarcinoma with submucosal
extension in sigmoid colon. Three-dimensional endoluminal CT colonography
image shows slightly elevated lesion with central depression (arrows)
in sigmoid colon.
|
|
View larger version (116K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3B —67-year-old man with 10-mm flat adenocarcinoma with submucosal
extension in sigmoid colon. Two-dimensional transverse image obtained using
wide window settings (width, 1,500 H; level, -400 H) shows slightly elevated
lesion (arrowheads). Central depression, albeit subtle, is noted.
|
|
View larger version (141K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 3D —67-year-old man with 10-mm flat adenocarcinoma with submucosal
extension in sigmoid colon. Colonoscopy with chromoscopic examination (i.e.,
mucosal spraying of methylene blue dye) shows surface topography of lesion
more clearly as dye pools in mucosal grooves, crevices, and depressions.
|
|
View larger version (153K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 4A —76-year-old woman with 18-mm flat adenocarcinoma that extends to
submucosa in rectum. Three-dimensional endoluminal CT colonography image
depicts slightly elevated lesion with centrally depressed area
(arrows) on haustral fold in rectum. Rectal tube
(arrowheads) is seen adjacent to lesion.
|
|
View larger version (138K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 4B —76-year-old woman with 18-mm flat adenocarcinoma that extends to
submucosa in rectum. Two-dimensional multiplanar reformatted image obtained
using wide window settings (width, 1,500 H; level, -400 H) shows thickening of
haustral fold (arrow). However, overall morphology of lesion is not
apparent on this image.
|
|
View larger version (145K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 4C —76-year-old woman with 18-mm flat adenocarcinoma that extends to
submucosa in rectum. Colonoscopy shows slightly elevated lesion that is
plaque-shaped and has centrally depressed area (arrowheads) on
haustral fold.
|
|
View larger version (130K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 5A —51-year-old woman with 13-mm flat adenocarcinoma with submucosal
extension in rectosigmoid junction. Three-dimensional endoluminal CT
colonography (CTC) image shows plaquelike, flat lesion with lobulated margin
(arrows) in rectosigmoid junction.
|
|
View larger version (127K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 5B —51-year-old woman with 13-mm flat adenocarcinoma with submucosal
extension in rectosigmoid junction. Two-dimensional transverse
contrast-enhanced CTC images obtained with wide window (B: width, 1,500
H; level, -400 H) and soft-tissue window (C: width, 400 H; level, 20 H)
settings show slightly elevated lesion (arrowheads). On soft-tissue
window image (C), lesion presents as enhancing focal thickening of
colonic wall that can be distinguished from adjacent colonic wall that is
barely perceptible after distention.
|
|
View larger version (133K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 5C —51-year-old woman with 13-mm flat adenocarcinoma with submucosal
extension in rectosigmoid junction. Two-dimensional transverse
contrast-enhanced CTC images obtained with wide window (B: width, 1,500
H; level, -400 H) and soft-tissue window (C: width, 400 H; level, 20 H)
settings show slightly elevated lesion (arrowheads). On soft-tissue
window image (C), lesion presents as enhancing focal thickening of
colonic wall that can be distinguished from adjacent colonic wall that is
barely perceptible after distention.
|
|
View larger version (133K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6B —52-year-old man with 8-mm flat tubular adenoma in sigmoid colon.
Two-dimensional transverse CTC images obtained with wide window (B:
width, 1,500 H; level, -400 H) and soft-tissue window (C: width, 400 H;
level, 20 H) settings show slightly elevated lesion (arrowheads). On
soft-tissue window image (C), lesion presents as focal thickening of
colonic wall that can be is distinguished from adjacent colonic wall that is
barely perceptible after distention.
|
|
View larger version (133K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 6C —52-year-old man with 8-mm flat tubular adenoma in sigmoid colon.
Two-dimensional transverse CTC images obtained with wide window (B:
width, 1,500 H; level, -400 H) and soft-tissue window (C: width, 400 H;
level, 20 H) settings show slightly elevated lesion (arrowheads). On
soft-tissue window image (C), lesion presents as focal thickening of
colonic wall that can be is distinguished from adjacent colonic wall that is
barely perceptible after distention.
|
|
View larger version (144K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 7A —69-year-old man with 2.5-cm flat adenocarcinoma with focal extension
to proper muscle in ascending colon. Three-dimensional endoluminal CT
colonography images show lesion that presents as smooth thickening of haustral
fold (arrows) in ascending colon.
|
|
View larger version (149K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 7B —69-year-old man with 2.5-cm flat adenocarcinoma with focal extension
to proper muscle in ascending colon. Three-dimensional endoluminal CT
colonography images show lesion that presents as smooth thickening of haustral
fold (arrows) in ascending colon.
|
|
View larger version (135K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 7C —69-year-old man with 2.5-cm flat adenocarcinoma with focal extension
to proper muscle in ascending colon. Two-dimensional transverse image obtained
using wide window settings (width, 1,500 H; level, -400 H) also shows smooth
thickening of haustral fold (arrows).
|
|
View larger version (114K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 7D —69-year-old man with 2.5-cm flat adenocarcinoma with focal extension
to proper muscle in ascending colon. Colonoscopy shows thickened haustral fold
(arrowheads) that corresponds to findings in A-C.
|
|
View larger version (141K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 8A —76-year-old man with 15-mm flat tubular adenoma with high-grade
dysplasia in descending colon. Three-dimensional endoluminal CT colonography
image shows lesion that presents as nodular thickening of haustral fold
(arrows) in descending colon.
|
|
View larger version (129K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 8B —76-year-old man with 15-mm flat tubular adenoma with high-grade
dysplasia in descending colon. Two-dimensional transverse image obtained using
wide window settings (width, 1,500 H; level, -400 H) shows thickened haustral
fold (arrowheads).
|
|
View larger version (112K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 8C —76-year-old man with 15-mm flat tubular adenoma with high-grade
dysplasia in descending colon. Colonoscopy with mucosal spraying of methylene
blue dye shows thickened fold with surface lobulations (arrowheads,
C) in descending colon, which is in contrast to sharp and smooth
appearance of normal haustral folds (arrowheads, D) in
adjacent area of descending colon.
|
|
View larger version (121K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 8D —76-year-old man with 15-mm flat tubular adenoma with high-grade
dysplasia in descending colon. Colonoscopy with mucosal spraying of methylene
blue dye shows thickened fold with surface lobulations (arrowheads,
C) in descending colon, which is in contrast to sharp and smooth
appearance of normal haustral folds (arrowheads, D) in
adjacent area of descending colon.
|
|
View larger version (139K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 9A —59-year-old woman with 9-mm residual fecal material that mimics flat
lesion in transverse colon. Three-dimensional endoluminal CT colonography
image shows nodular elevation with central depression (arrowheads) in
transverse colon that was proven to be residual fecal material at colonoscopy
with chromoscopic examination and segmental unblinding. Colon was cleansed
vigorously with 4 L of polyethylene glycol as shown by clean colonic wall
except for pseudolesion.
|
|
View larger version (119K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 9B —59-year-old woman with 9-mm residual fecal material that mimics flat
lesion in transverse colon. Targeted 2D transverse image obtained using wide
window settings (width, 1,500 H; level, -400 H) shows subtle nodularity
(arrowhead) in nondependent wall of transverse colon that corresponds
to pseudolesion shown in A.
|
|
View larger version (160K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 10A —64-year-old woman with residual fecal material that mimics flat
lesion in cecum. Irregular mucosal nodular structure (arrows) that
mimics morphology of carpet lesion (e.g., Fig.
1A,
1B,
1C) is noted in cecum on 3D
endoluminal view.
|
|
View larger version (161K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 10B —64-year-old woman with residual fecal material that mimics flat
lesion in cecum. Pseudolesion (arrowheads)—that is, residual
feces—can be clearly distinguished from true lesion on 2D transverse
image obtained using wide window settings (width, 1,500 H; level, -400 H) due
to bariumbased tagging.
|
|
View larger version (111K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 11A —57-year-old man with air bubble that mimics flat lesion in sigmoid
colon. Three-dimensional endoluminal CT colonography image from supine scan
shows pseudolesion with thin, ringlike peripheral elevation and central
depression (arrow).
|
|
View larger version (106K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 11B —57-year-old man with air bubble that mimics flat lesion in sigmoid
colon. Three-dimensional endoluminal image from prone scan of same location as
A shows pseudolesion is no longer present.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2007 by the American Roentgen Ray Society.
