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Colon Cancer Screening with Virtual Colonoscopy

Promise, Polyps, Politics

¹ Department of Radiology, Boston Medical Center, Boston University School of Medicine, 88 E. Newton St., Boston, MA 02118.

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View larger version (96K): [in a new window]   Fig. 1. —Axial two-dimensional CT colonography image in 62-year-old man shows 1.0-cm polyp on anterior wall of transverse colon. Lung windows are used to optimize gas—soft-tissue interfaces.

View larger version (177K): [in a new window]   Fig. 2A. —Three-dimensional volume-rendered CT colonography endoluminal images of normal colon. Colonic folds have well-defined opaque free edges. Illusion of depth is given by variably darkened edges of fold surfaces and blurring of near-field structures. Descending colon is characterized by its straight course and circular folds.

View larger version (155K): [in a new window]   Fig. 2B. —Three-dimensional volume-rendered CT colonography endoluminal images of normal colon. Colonic folds have well-defined opaque free edges. Illusion of depth is given by variably darkened edges of fold surfaces and blurring of near-field structures. Transverse colon is characterized by typical triangular haustral folds.

View larger version (138K): [in a new window]   Fig. 3A. —Colonic polyps seen on endoluminal three-dimensional images. Images of 72-year-old man (A) and 67-year-old man (B) show polyps as well-defined rounded intraluminal projections with sharp edge enhancement of free margins.

View larger version (141K): [in a new window]   Fig. 3B. —Colonic polyps seen on endoluminal three-dimensional images. Images of 72-year-old man (A) and 67-year-old man (B) show polyps as well-defined rounded intraluminal projections with sharp edge enhancement of free margins.

View larger version (165K): [in a new window]   Fig. 4A. —Colon cancer on endoluminal three-dimensional views. Fine mucosal surface irregularity such as that which might be expected at barium enema or conventional colonoscopy is not apparent on volume-rendered endoluminal display. Polypoid fungating lesion in descending colon of 54-year-old man.

View larger version (153K): [in a new window]   Fig. 4B. —Colon cancer on endoluminal three-dimensional views. Fine mucosal surface irregularity such as that which might be expected at barium enema or conventional colonoscopy is not apparent on volume-rendered endoluminal display. Infiltrating annular constricting lesion in sigmoid colon of 75-year-old woman.

View larger version (82K): [in a new window]   Fig. 5. —Display of computer-calculated center line for automatic flythrough navigation during workstation interpretation of volume-rendered data sets.

View larger version (59K): [in a new window]   Fig. 6. —Computer-aided diagnosis for automatic polyp detection. Photograph shows synthetic polyps on computer-simulated model of colon mucosal surface. Elevated shape-based algorithm shows large haustral fold (right), large polyp (middle), and small polyp (left) on thin haustral fold. (Reprinted with permission from [56])

View larger version (148K): [in a new window]   Fig. 7A. —Fecal tagging with orally administered barium supplement in two patients. Two-dimensional CT image shows high-attenuation of barium-impregnated stool in descending colon (arrowhead). Note soft-tissue attenuation of adjacent adenocarcinoma (arrow).

View larger version (175K): [in a new window]   Fig. 7B. —Fecal tagging with orally administered barium supplement in two patients. Computer-generated electronic accented image shows high-attenuation barium-impregnated stool as blue pixels before electronic subtraction (thin arrow). Soft-tissue-attenuation adjacent polyp (thick arrow) is visible more ventrally. (Courtesy of Johnson CD, Fletcher J, Callstrom R; Rochester, MN)

View larger version (115K): [in a new window]   Fig. 8. —What would you do? 66-year-old man with single 7-mm polyp (arrow) in descending colon. Given reliable data about status of their colon, certain patients may judge significance of their polyp unimportant and elect to forego conventional colonoscopy. This patient deferred colonoscopy.

View larger version (111K): [in a new window]   Fig. 9. —Incidental finding at virtual colonoscopy in 59-year-old man. Axial two-dimensional CT section, viewed at lung window setting, shows 5-cm solid mass, proven to be renal cell carcinoma, on lateral aspect of right kidney.

View larger version (72K): [in a new window]   Fig. 10. —A polyp map for the colonoscopist. Two-dimensional transparency rendering of colon, with arrows marking locations of polyps identified at virtual colonoscopy. This image could be provided as hard-copy report to aid colonoscopist in rapid and accurate identification of polypoid lesions at time of conventional colonoscopy.

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