Skip to main content
Top
Published in: European Radiology 8/2008

01-08-2008 | Computer Tomography

CT colonography: computer-aided detection of morphologically flat T1 colonic carcinoma

Authors: Stuart A. Taylor, Gen Iinuma, Yutaka Saito, Jie Zhang, Steve Halligan

Published in: European Radiology | Issue 8/2008

Login to get access

Abstract

The purpose was to evaluate the ability of computer-aided detection (CAD) software to detect morphologically flat early colonic carcinoma using CT colonography (CTC). Twenty-four stage T1 colonic carcinomas endoscopically classified as flat (width over twice height) were accrued from patients undergoing staging CTC. Tumor location was annotated by three experienced radiologists in consensus aided by the endosocpic report. CAD software was then applied at three settings of sphericity (0, 0.75, and 1). Computer prompts were categorized as either true positive (overlapping tumour boundary) or false positive. True positives were subclassified as focal or non focal. The 24 cancers were endoscopically classified as type IIa (n=11) and type IIa+IIc (n=13). Mean size (range) was 27 mm (7–70 mm). CAD detected 20 (83.3%), 17 (70.8%), and 13 (54.1%) of the 24 cancers at filter settings of 0, 0.75, and 1, respectively with 3, 4, and 8 missed cancers of type IIa, respectively. The mean total number of false-positive CAD marks per patient at each filter setting was 36.5, 21.1, and 9.5, respectively, excluding polyps. At all settings, >96.1% of CAD true positives were classified as focal. CAD may be effective for the detection of morphologically flat cancer, although minimally raised laterally spreading tumors remain problematic.
Literature
1.
go back to reference Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL, Gopal DV, Reichelderfer M, Hsu RH, Pfau PR (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 4(357):1403–1412CrossRef Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL, Gopal DV, Reichelderfer M, Hsu RH, Pfau PR (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 4(357):1403–1412CrossRef
2.
go back to reference Halligan S, Altman DG, Taylor SA et al (2005) CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 237:893–904PubMedCrossRef Halligan S, Altman DG, Taylor SA et al (2005) CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 237:893–904PubMedCrossRef
3.
go back to reference Sosna J, Morrin MM, Kruskal JB, Lavin PT, Rosen MP, Raptopoulos V (2003) CT colonography of colorectal polyps: a metaanalysis. AJR Am J Roentgenol 181:1593–1598PubMed Sosna J, Morrin MM, Kruskal JB, Lavin PT, Rosen MP, Raptopoulos V (2003) CT colonography of colorectal polyps: a metaanalysis. AJR Am J Roentgenol 181:1593–1598PubMed
4.
go back to reference Macari M, Bini EJ (2005) CT colonography: where have we been and where are we going. Radiology 237:819–833PubMedCrossRef Macari M, Bini EJ (2005) CT colonography: where have we been and where are we going. Radiology 237:819–833PubMedCrossRef
5.
go back to reference The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 2003;58:S3–S43 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 2003;58:S3–S43
6.
go back to reference Fidler JL, Johnson CD, MacCarty RL, Welch TJ, Hara AK, Harmsen WS (2002) Detection of flat lesions in the colon with CT colonography. Abdom Imaging 27:292–300PubMed Fidler JL, Johnson CD, MacCarty RL, Welch TJ, Hara AK, Harmsen WS (2002) Detection of flat lesions in the colon with CT colonography. Abdom Imaging 27:292–300PubMed
7.
go back to reference Taylor SA, Halligan S, Bartram CI (2003) CT colonography: methods, pathology and pitfalls. Clin Radiol 58:179–190PubMedCrossRef Taylor SA, Halligan S, Bartram CI (2003) CT colonography: methods, pathology and pitfalls. Clin Radiol 58:179–190PubMedCrossRef
8.
go back to reference Macari M, Bini EJ, Jacobs SL, Lange N, Lui YW (2003) Filling defects at CT colonography: pseudo- and diminutive lesions (the good), polyps (the bad), flat lesions, masses, and carcinomas (the ugly). Radiographics 23:1073–1091PubMedCrossRef Macari M, Bini EJ, Jacobs SL, Lange N, Lui YW (2003) Filling defects at CT colonography: pseudo- and diminutive lesions (the good), polyps (the bad), flat lesions, masses, and carcinomas (the ugly). Radiographics 23:1073–1091PubMedCrossRef
9.
go back to reference Park SH, Lee SS, Choi EK et al (2007) Flat colorectal neoplasms: definition, importance, and visualization on CT colonography. AJR Am J Roentgenol 188:953–959PubMedCrossRef Park SH, Lee SS, Choi EK et al (2007) Flat colorectal neoplasms: definition, importance, and visualization on CT colonography. AJR Am J Roentgenol 188:953–959PubMedCrossRef
10.
go back to reference Pickhardt PJ, Nugent PA, Choi JR, Schindler WR (2004) Flat colorectal lesions in asymptomatic adults: implications for screening with CT virtual colonoscopy. AJR Am J Roentgenol 183:1343–1347PubMed Pickhardt PJ, Nugent PA, Choi JR, Schindler WR (2004) Flat colorectal lesions in asymptomatic adults: implications for screening with CT virtual colonoscopy. AJR Am J Roentgenol 183:1343–1347PubMed
11.
go back to reference Jensch S, van Gelder RE, Florie J et al (2007) Performance of radiographers in the evaluation of CT colonographic images. AJR Am J Roentgenol 188:W249–W255PubMedCrossRef Jensch S, van Gelder RE, Florie J et al (2007) Performance of radiographers in the evaluation of CT colonographic images. AJR Am J Roentgenol 188:W249–W255PubMedCrossRef
12.
go back to reference Effect of directed training on reader performance for CT colonography: multicenter study. Radiology 242:152–161 Effect of directed training on reader performance for CT colonography: multicenter study. Radiology 242:152–161
13.
go back to reference O’Brien MJ, Winawer SJ, Zauber AG et al (2004) Flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance. Clin Gastroenterol Hepatol 2:905–911PubMedCrossRef O’Brien MJ, Winawer SJ, Zauber AG et al (2004) Flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance. Clin Gastroenterol Hepatol 2:905–911PubMedCrossRef
14.
go back to reference Soetikno R, Friedland S, Kaltenbach T, Chayama K, Tanaka S (2006) Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology 130:566–576PubMedCrossRef Soetikno R, Friedland S, Kaltenbach T, Chayama K, Tanaka S (2006) Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology 130:566–576PubMedCrossRef
15.
go back to reference Summers RM, Yao J, Pickhardt PJ et al (2005) Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population. Gastroenterology 129:1832–1844PubMedCrossRef Summers RM, Yao J, Pickhardt PJ et al (2005) Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population. Gastroenterology 129:1832–1844PubMedCrossRef
16.
go back to reference Mang T, Peloschek P, Plank C et al (2007) Effect of computer-aided detection as a second reader in multidetector-row CT colonography. Eur Radiol 17:2598–2607PubMedCrossRef Mang T, Peloschek P, Plank C et al (2007) Effect of computer-aided detection as a second reader in multidetector-row CT colonography. Eur Radiol 17:2598–2607PubMedCrossRef
17.
go back to reference Nappi J, Yoshida H (2002) Automated detection of polyps with CT colonography: evaluation of volumetric features for reduction of false-positive findings. Acad Radiol 9:386–397PubMedCrossRef Nappi J, Yoshida H (2002) Automated detection of polyps with CT colonography: evaluation of volumetric features for reduction of false-positive findings. Acad Radiol 9:386–397PubMedCrossRef
18.
go back to reference Dachman AH, Lefere P, Gryspeerdt S, Morin M (2007) CT colonography: visualization methods, interpretation, and pitfalls. Radiol Clin North Am 45:347–359PubMedCrossRef Dachman AH, Lefere P, Gryspeerdt S, Morin M (2007) CT colonography: visualization methods, interpretation, and pitfalls. Radiol Clin North Am 45:347–359PubMedCrossRef
19.
go back to reference Fidler JL, Fletcher JG, Johnson CD et al (2004) Understanding interpretive errors in radiologists learning computed tomography colonography. Acad Radiol 11:750–756PubMedCrossRef Fidler JL, Fletcher JG, Johnson CD et al (2004) Understanding interpretive errors in radiologists learning computed tomography colonography. Acad Radiol 11:750–756PubMedCrossRef
20.
go back to reference Slater A, Taylor SA, Tam E et al (2006) Reader error during CT colonography: causes and implications for training. Eur Radiol 16:2275–2283PubMedCrossRef Slater A, Taylor SA, Tam E et al (2006) Reader error during CT colonography: causes and implications for training. Eur Radiol 16:2275–2283PubMedCrossRef
21.
go back to reference Hart AR, Kudo S, Mackay EH, Mayberry JF, Atkin WS (1998) Flat adenomas exist in asymptomatic people: important implications for colorectal cancer screening programmes. Gut 43:229–231PubMedCrossRef Hart AR, Kudo S, Mackay EH, Mayberry JF, Atkin WS (1998) Flat adenomas exist in asymptomatic people: important implications for colorectal cancer screening programmes. Gut 43:229–231PubMedCrossRef
22.
go back to reference Saito Y, Fujii T, Kondo H et al (2001) Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 33:682–686PubMedCrossRef Saito Y, Fujii T, Kondo H et al (2001) Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 33:682–686PubMedCrossRef
23.
go back to reference Uraoka T, Saito Y, Matsuda T et al (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597PubMedCrossRef Uraoka T, Saito Y, Matsuda T et al (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597PubMedCrossRef
24.
go back to reference Taylor SA, Halligan S, Burling D et al (2006) Computer-assisted reader software versus expert reviewers for polyp detection on CT colonography. AJR Am J Roentgenol 186:696–702PubMedCrossRef Taylor SA, Halligan S, Burling D et al (2006) Computer-assisted reader software versus expert reviewers for polyp detection on CT colonography. AJR Am J Roentgenol 186:696–702PubMedCrossRef
25.
go back to reference Halligan S, Altman DG, Mallett S et al (2006) Computed tomographic colonography: assessment of radiologist performance with and without computer-aided detection. Gastroenterology 131:1690–1699PubMedCrossRef Halligan S, Altman DG, Mallett S et al (2006) Computed tomographic colonography: assessment of radiologist performance with and without computer-aided detection. Gastroenterology 131:1690–1699PubMedCrossRef
26.
go back to reference Dehmeshki J, Halligan S, Taylor SA et al (2007) Computer assisted detection software for CT colonography: effect of sphericity filter on performance characteristics for patients with and without fecal tagging. Eur Radiol 17:662–668PubMedCrossRef Dehmeshki J, Halligan S, Taylor SA et al (2007) Computer assisted detection software for CT colonography: effect of sphericity filter on performance characteristics for patients with and without fecal tagging. Eur Radiol 17:662–668PubMedCrossRef
27.
go back to reference Muto T, Bussey HJ, Morson BC (1975) The evolution of cancer of the colon and rectum. Cancer 36:2251–2270PubMed Muto T, Bussey HJ, Morson BC (1975) The evolution of cancer of the colon and rectum. Cancer 36:2251–2270PubMed
28.
go back to reference Saitoh Y, Waxman I, West AB et al (2001) Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 120:1657–1665PubMedCrossRef Saitoh Y, Waxman I, West AB et al (2001) Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 120:1657–1665PubMedCrossRef
29.
go back to reference Rembacken BJ, Fujii T, Cairns A et al (2000) Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet 355:1211–1214PubMedCrossRef Rembacken BJ, Fujii T, Cairns A et al (2000) Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet 355:1211–1214PubMedCrossRef
30.
go back to reference Halligan S, Taylor SA, Dehmeshki J et al (2006) Computer-assisted detection for CT colonography: external validation. Clin Radiol 61:758–763PubMedCrossRef Halligan S, Taylor SA, Dehmeshki J et al (2006) Computer-assisted detection for CT colonography: external validation. Clin Radiol 61:758–763PubMedCrossRef
31.
go back to reference Yoshida H, Dachman AH (2005) CAD techniques, challenges, and controversies in computed tomographic colonography. Abdom Imaging 30:26–41PubMedCrossRef Yoshida H, Dachman AH (2005) CAD techniques, challenges, and controversies in computed tomographic colonography. Abdom Imaging 30:26–41PubMedCrossRef
32.
go back to reference Kiss G, Van Cleynenbreugel J, Thomeer M, Suetens P, Marchal G (2002) Computer-aided diagnosis in virtual colonography via combination of surface normal and sphere fitting methods. Eur Radiol 12:77–81PubMedCrossRef Kiss G, Van Cleynenbreugel J, Thomeer M, Suetens P, Marchal G (2002) Computer-aided diagnosis in virtual colonography via combination of surface normal and sphere fitting methods. Eur Radiol 12:77–81PubMedCrossRef
33.
go back to reference Yoshida H, Nappi J, MacEneaney P, Rubin DT, Dachman AH (2002) Computer-aided diagnosis scheme for detection of polyps at CT colonography. Radiographics 22:963–979PubMed Yoshida H, Nappi J, MacEneaney P, Rubin DT, Dachman AH (2002) Computer-aided diagnosis scheme for detection of polyps at CT colonography. Radiographics 22:963–979PubMed
34.
go back to reference Summers RM, Beaulieu CF, Pusanik LM et al (2000) Automated polyp detector for CT colonography: feasibility study. Radiology 216:284–290PubMed Summers RM, Beaulieu CF, Pusanik LM et al (2000) Automated polyp detector for CT colonography: feasibility study. Radiology 216:284–290PubMed
35.
go back to reference Paik DS, Beaulieu CF, Rubin GD et al (2004) Surface normal overlap: a computer-aided detection algorithm with application to colonic polyps and lung nodules in helical CT. IEEE Trans Med Imaging 23:661–675PubMedCrossRef Paik DS, Beaulieu CF, Rubin GD et al (2004) Surface normal overlap: a computer-aided detection algorithm with application to colonic polyps and lung nodules in helical CT. IEEE Trans Med Imaging 23:661–675PubMedCrossRef
36.
go back to reference Kim SH, Lee JM, Lee JG et al (2007) Computer-aided detection of colonic polyps at CT colonography using a Hessian matrix-based algorithm: preliminary study. AJR Am J Roentgenol 189:41–51PubMedCrossRef Kim SH, Lee JM, Lee JG et al (2007) Computer-aided detection of colonic polyps at CT colonography using a Hessian matrix-based algorithm: preliminary study. AJR Am J Roentgenol 189:41–51PubMedCrossRef
37.
go back to reference Acar B, Beaulieu CF, Gokturk SB et al (2002) Edge displacement field-based classification for improved detection of polyps in CT colonography. IEEE Trans Med Imaging 21:1461–1467PubMedCrossRef Acar B, Beaulieu CF, Gokturk SB et al (2002) Edge displacement field-based classification for improved detection of polyps in CT colonography. IEEE Trans Med Imaging 21:1461–1467PubMedCrossRef
38.
go back to reference Nappi JJ, Frimmel H, Dachman AH, Yoshida H (2004) Computerized detection of colorectal masses in CT colonography based on fuzzy merging and wall-thickening analysis. Med Phys 31:860–872PubMedCrossRef Nappi JJ, Frimmel H, Dachman AH, Yoshida H (2004) Computerized detection of colorectal masses in CT colonography based on fuzzy merging and wall-thickening analysis. Med Phys 31:860–872PubMedCrossRef
39.
go back to reference Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578 Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578
Metadata
Title
CT colonography: computer-aided detection of morphologically flat T1 colonic carcinoma
Authors
Stuart A. Taylor
Gen Iinuma
Yutaka Saito
Jie Zhang
Steve Halligan
Publication date
01-08-2008
Publisher
Springer-Verlag
Published in
European Radiology / Issue 8/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-008-0936-7

Other articles of this Issue 8/2008

European Radiology 8/2008 Go to the issue