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Anatomic Factors Predictive of Incomplete Colonoscopy Based on Findings at CT Colonography

Meghan E. Hanson1, Perry J. Pickhardt1, David H. Kim1 and Patrick R. Pfau2

1 Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252.
2 Section of Gastroenterology and Hepatology, University of Wisconsin Medical School, Madison, WI.


Figure 1
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  		Fig. 1 —Representative collage of 3D maps from patients undergoing CT colonography after incomplete optical colonoscopy (study group). Note marked colonic tortuosity and elongation in these cases. Green line represents automated centerline for endoluminal navigation that allows length measurement.

 

Figure 2
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  		Fig. 2 —Representative collage of 3D maps from patients undergoing CT colonography before complete optical colonoscopy (control group). Degree of tortuosity and colonic lengths are notably less compared with study group with incomplete optical colonoscopy. Green line represents automated centerline for endoluminal navigation that allows length measurement.

 

Figure 3
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  		Fig. 3A —CT colonography (CTC) in 65-year-old man after incomplete optical colonoscopy. By report, optical colonoscopy examination was incomplete to hepatic flexure. Three-dimensional colon map from CTC (A) shows unusual colonic course due to paraesophageal herniation of transverse colon. Note constriction at level of esophageal hiatus (arrows).

 

Figure 4
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  		Fig. 3B —CT colonography (CTC) in 65-year-old man after incomplete optical colonoscopy. By report, optical colonoscopy examination was incomplete to hepatic flexure. CT scout (B) and 2D transverse (C) images from CTC show transverse colon (arrows) above diaphragm. Stomach is also seen to be intrathoracic in C.

 

Figure 5
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  		Fig. 3C —CT colonography (CTC) in 65-year-old man after incomplete optical colonoscopy. By report, optical colonoscopy examination was incomplete to hepatic flexure. CT scout (B) and 2D transverse (C) images from CTC show transverse colon (arrows) above diaphragm. Stomach is also seen to be intrathoracic in C.

 

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