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Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography

Perry J. Pickhardt1,2, Andrew D. Lee1, Andrew J. Taylor1, Steven J. Michel1, Thomas C. Winter1, Anthony Shadid1, Ryan J. Meiners1, Peter J. Chase1, J. Louis Hinshaw1, John G. Williams1, Tyler M. Prout1, S. Hamid Husain1 and David H. Kim1

1 Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252.
2 Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD.


Figure 1
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  		Fig. 1A —Screening CT colonography (CTC) in asymptomatic average-risk 54-year-old man. Oblique orientation of 3D map shows location of 10-mm rectosigmoid polyp (red dot) that was identified at prospective primary 3D evaluation but was missed at retrospective primary 2D evaluation. Blue arrow indicates 3D endoluminal vantage point shown in B. Green line indicates automated centerline for endoluminal navigation. This large polyp was confirmed at same-day optical colonoscopy.

 

Figure 2
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  		Fig. 1B —Screening CT colonography (CTC) in asymptomatic average-risk 54-year-old man. Endoluminal 3D CTC image shows 10-mm ovoid, sessile polyp (asterisk), which extends off edge of fold. Lesion was obvious at real-time 3D fly-through evaluation, confirmed on secondary 2D correlation, and given highest diagnostic confidence score by interpreting radiologist.

 

Figure 3
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  		Fig. 1C —Screening CT colonography (CTC) in asymptomatic average-risk 54-year-old man. Magnified 2D transverse CTC image with polyp window settings (width, 2,000 H; level, 0 H) shows polyp (arrowhead), which is difficult to distinguish from fold it arises from and was missed at primary 2D evaluation.

 

Figure 4
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  		Fig. 1D —Screening CT colonography (CTC) in asymptomatic average-risk 54-year-old man. Lesion (arrowheads) is somewhat more conspicuous on coronal (D) and sagittal (E) 2D displays compared with transverse projection.

 

Figure 5
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  		Fig. 1E —Screening CT colonography (CTC) in asymptomatic average-risk 54-year-old man. Lesion (arrowheads) is somewhat more conspicuous on coronal (D) and sagittal (E) 2D displays compared with transverse projection.

 

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