Contrast coating for the surface of flat polyps at CT colonography: a marker for detection
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To assess the frequency of oral contrast coating of flat polyps, which may promote detection, and influencing factors within a screening CT colonography (CTC) population.
This was a retrospective, observational study performed at one institution. From 7,426 individuals, 123 patients with 160 flat polyps were extracted. Flat polyps were defined as plaque-like, raised at most 3 mm in height and reviewed for contrast coating. Factors including demographic variables such as age and sex, and polyp variables such as polyp size, location and histology were analysed for effect on coating.
Of 160 flat polyps (mean size 9.4 mm ± 3.6), 78.8 % demonstrated coating. Mean coat thickness was 1.5 mm ± 0.6; 23.8 % (n = 30) demonstrated a thin film of contrast. Large size (≥10 mm) and proximal colonic location (relative to splenic flexure) were predictive variables by univariate logistic regression [OR (odds ratio) 3.4 (CI 1.3–8.9; p = 0.011), 2.0 (CI 1.2–3.5; p = 0.011), respectively]. Adenomas (OR 0.37, CI 0.14–1.02; p = 0.054) and mucosal polyps or venous blebs (OR 0.07, CI 0.02–0.25; p < 0.001) were less likely to coat than serrated/hyperplastic lesions. Age and sex were not predictive for coating (p = 0.417, p = 0.499, respectively).
Surface contrast coating is common for flat polyps at CTC, promoted by large size, proximal location and serrated/hyperplastic histology. Given the difficulty in detection, recognition may aid in flat polyp identification.
• Oral contrast coats the surface of most flat colorectal polyps at CT colonography.
• Large size, proximal colonic location and serrated/hyperplastic histology increase polyp coating.
• Contrast coating increases diagnostic confidence for flat polyps.
• Contrast coating may help in flat polyp detection at CTC.
- Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200 CrossRef
- Lefere PA, Gryspeerdt SS, Dewyspelaere J, Baekelandt M, Van Holsbeeck BG (2002) Dietary fecal tagging as a cleansing method before CT colonography: initial results-polyp detection and patient acceptance. Radiology 224:393–403 CrossRef
- O'Connor SD, Summers RM, Choi JR, Pickhardt PJ (2006) Oral contrast adherence to polyps on CT colonography. J Comput Assist Tomogr 30:51–57 CrossRef
- Pickhardt PJ, Kim DH, Robbins JB (2010) Flat (nonpolypoid) colorectal lesions identified at CT colonography in a US screening population. Acad Radiol 17:784–790 CrossRef
- Pickhardt PJ, Nugent PA, Choi JR, Schindler WR (2004) Flat colorectal lesions in asymptomatic adults: implications for screening with CT virtual colonoscopy. Am J Roentgenol 183:1343–1347 CrossRef
- Sakamoto T, Mitsuzaki K, Utsunomiya D et al (2012) Detection of flat colorectal polyps at screening CT colonography in comparison with conventional polypoid lesions. Acta Radiol 53:714–719 CrossRef
- Soetikno RM, Kaltenbach T, Rouse RV et al (2008) Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 299:1027–1035 CrossRef
- Pickhardt PJ, Kim DH, Pooler BD et al (2013) Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history. Lancet Oncol 14:711–720 CrossRef
- Pickhardt PJ, Lam VP, Weiss JM, Kennedy GD, Kim DH. Carpet lesions detected at CT colonography: clinical, imaging, and pathologic features. Radiology. 2013 Sep 13. [Epub ahead of print] PMID: 24029647
- Pickhardt PJ, Lee AD, McFarland EG, Taylor AJ (2005) Linear polyp measurement at CT colonography: in vitro and in vivo comparison of two-dimensional and three-dimensional displays. Radiology 236:872–878 CrossRef
- Pickhardt PJ, Choi JR, Nugent PA, Schindler WR (2004) The effect of diagnostic confidence on the probability of optical colonoscopic confirmation of potential polyps detected on CT colonography: prospective assessment in 1,339 asymptomatic adults. Am J Roentgenol 183:1661–1665 CrossRef
- Kim DH, Pooler BD, Weiss JM, Pickhardt PJ (2012) Five year colorectal cancer outcomes in a large negative CT colonography screening cohort. Eur Radiol 22:1488–1494 CrossRef
- Kim DH, Pickhardt PJ, Hanson ME, Hinshaw JL (2010) CT colonography: performance and program outcome measures in an older screening population. Radiology 254:493–500 CrossRef
- Pickhardt PJ (2007) Screening CT colonography: how I do it. Am J Roentgenol 189:290–298 CrossRef
- Buchach CM, Kim DH, Pickhardt PJ (2011) Performing an additional decubitus series at CT colonography. Abdom Imaging 36:538–544 CrossRef
- R Development Core Team (2009) R: a language and environment for statistical computing. R Foundation of Statistical Computing, Vienna, http://www.R-project.org. ISBN 3-900051-07-0
- Park SH, Ha HK, Kim AY et al (2006) Flat polyps of the colon: detection with 16-MDCT colonography - preliminary results. Am J Roentgenol 186:1611–1617 CrossRef
- Rosty C, Hewett DG, Brown IS, Leggett BA, Whitehall VLJ (2013) Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management. J Gastroenterol 48:287–302 CrossRef
- Jass JR (2007) Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 50:113–130 CrossRef
- O'Brien MJ (2007) Hyperplastic and serrated polyps of the colorectum. Gastroenterol Clin N Am 36:947–968 CrossRef
- Torlakovic E, Skovlund E, Snover DC, Torlakovic G, Nesland JM (2003) Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 27:65–81 CrossRef
- Baxter NN, Goldwasser MA, Paszat l, Saskin R, Urbach DR, Rabeneck l (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150:1–8 CrossRef
- Ishigooka S, Nomoto M, Obinata N et al (2012) Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps. World J Gastroenterol 18:4308–4316 CrossRef
- Gibson JA, Hahn HP, Shahsafaei A, Odze RD (2011) MUC expression in hyperplastic and serrated colonic polyps: lack of specificity of MUC6. Am J Surg Pathol 35:742–749 CrossRef
- Macari M, Lavelle M, Pedrosa I et al (2001) Effect of different bowel preparations on residual fluid at CT colonography. Radiology 218:274–277 CrossRef
- Conry BG, Jones S, Bartram CI (1987) The effect of oral magnesium-containing bowel preparation agents on mucosal coating by barium-sulfate suspensions. Br J Radiol 60:1215–1219 CrossRef
- Contrast coating for the surface of flat polyps at CT colonography: a marker for detection
Volume 24, Issue 4 , pp 940-946
- Cover Date
- Print ISSN
- Online ISSN
- Springer Berlin Heidelberg
- Additional Links
- CT colonography
- Flat polyps
- Industry Sectors
- Author Affiliations
- 1. Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center 600 Highland Ave., Madison, WI, 53792-3252, USA