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- Title
CT colonography: size reduction of submerged colorectal polyps due to electronic cleansing and CT-window settings.
- Authors
Bräuer, Christian; Lefere, Philippe; Gryspeerdt, Stefaan; Ringl, Helmut; Al-Mukhtar, Ali; Apfaltrer, Paul; Berzaczy, Dominik; Füger, Barbara; Furtner, Julia; Müller-Mang, Christina; Pones, Matthias; Scharitzer, Martina; Woitek, Ramona; Graser, Anno; Weber, Michael; Mang, Thomas
- Abstract
<bold>Objectives: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>EC and narrow CT windows significantly reduce the size of polyps submerged in tagged residue. Polyp measurements should be performed in unsubtracted colon windows.<bold>Key Points: </bold>• 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.
- Subjects
VIRTUAL colonoscopy; COLON polyps; TUMOR diagnosis; EARLY detection of cancer; BOWEL preparation (Procedure); THERAPEUTICS
- Publication
European Radiology, 2018, Vol 28, Issue 11, p4766
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-018-5416-0