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European Radiology
Published in: European Radiology 11/2018

Open Access 01-11-2018 | Gastrointestinal

CT colonography: size reduction of submerged colorectal polyps due to electronic cleansing and CT-window settings

Authors: Christian Bräuer, Philippe Lefere, Stefaan Gryspeerdt, Helmut Ringl, Ali Al-Mukhtar, Paul Apfaltrer, Dominik Berzaczy, Barbara Füger, Julia Furtner, Christina Müller-Mang, Matthias Pones, Martina Scharitzer, Ramona Woitek, Anno Graser, Michael Weber, Thomas Mang

Published in: European Radiology | Issue 11/2018

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Abstract

Objectives

To assess whether electronic cleansing (EC) of tagged residue and different computed tomography (CT) windows influence the size of colorectal polyps in CT colonography (CTC).

Methods

A database of 894 colonoscopy-validated CTC datasets of a low-prevalence cohort was retrospectively reviewed to identify patients with polyps ≥6 mm that were entirely submerged in tagged residue. Ten radiologists independently measured the largest diameter of each polyp, two-dimensionally, before and after EC in colon, bone, and soft-tissue-windows, in randomised order. Differences in size and polyp count before and after EC were calculated for size categories ≥6 mm and ≥10 mm. Statistical testing involved 95% confidence interval, intraclass correlation and mixed-model ANOVA.

Results

Thirty-seven patients with 48 polyps were included. Mean polyp size before EC was 9.8 mm in colon, 9.9 mm in bone and 8.2 mm in soft-tissue windows. After EC, the mean polyp size decreased significantly to 9.4 mm in colon, 9.1 mm in bone and 7.1 mm in soft-tissue windows. Compared to unsubtracted colon windows, EC, performed in colon, bone and soft-tissue windows, led to a shift of 6 (12,5%), 10 (20.8%) and 25 (52.1%) polyps ≥6 mm into the next smaller size category, thus affecting patient risk stratification.

Conclusions

EC and narrow CT windows significantly reduce the size of polyps submerged in tagged residue. Polyp measurements should be performed in unsubtracted colon windows.

Key Points

• EC significantly reduces the size of polyps submerged in tagged residue.
• Abdominal CT-window settings significantly underestimate 2D sizes of submerged polyps.
• Size reduction in EC is significantly greater in narrow than wide windows.
• Underestimation of polyp size due to EC may lead to inadequate treatment.
• Polyp measurements should be performed in unsubtracted images using a colon window.
Appendix
Available only for authorised users
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Metadata
Title
CT colonography: size reduction of submerged colorectal polyps due to electronic cleansing and CT-window settings
Authors
Christian Bräuer
Philippe Lefere
Stefaan Gryspeerdt
Helmut Ringl
Ali Al-Mukhtar
Paul Apfaltrer
Dominik Berzaczy
Barbara Füger
Julia Furtner
Christina Müller-Mang
Matthias Pones
Martina Scharitzer
Ramona Woitek
Anno Graser
Michael Weber
Thomas Mang
Publication date
01-11-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5416-0

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