Skip to main content
Log in

Errors in CT colonography

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

CT colonography (CTC) is a colorectal cancer screening modality which is becoming more widely implemented and has shown polyp detection rates comparable to those of optical colonoscopy. CTC has the potential to improve population screening rates due to its minimal invasiveness, no sedation requirement, potential for reduced cathartic examination, faster patient throughput, and cost-effectiveness. Proper implementation of a CTC screening program requires careful attention to numerous factors, including patient preparation prior to the examination, the technical aspects of image acquisition, and post-processing of the acquired data. A CTC workstation with dedicated software is required with integrated CTC-specific display features. Many workstations include computer-aided detection software which is designed to decrease errors of detection by detecting and displaying polyp-candidates to the reader for evaluation. There are several pitfalls which may result in false-negative and false-positive reader interpretation. We present an overview of the potential errors in CTC and a systematic approach to avoid them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16

Similar content being viewed by others

References

  1. U.S. Cancer Statistics Working Group. (2014) United States Cancer Statistics: 1999–2011 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Available at: www.cdc.gov/uscs

  2. Coffield AB, Maciosek MV, McGinnis JM, et al. (2001) Priorities among recommended clinical preventive services. Am J Prev Med 21:1–9

    Article  CAS  PubMed  Google Scholar 

  3. Whitlock EP, Lin J, Liles E, et al. (2008) Screening for colorectal cancer: an updated systemic review [Internet]. Rockville: Agency for Healthcare Research and Quality (US). http://www.ncbi.nlm.nih.gov/books/NBK35179/. Accessed 15 March 2013

  4. Kim DH, Pickhardt PJ, Hoff G, Kay CL (2007) Computed tomographic colonography for colorectal screening. Endoscopy 39(6):545–549

    Article  CAS  PubMed  Google Scholar 

  5. Johnson CD, Harmsen WS, Wilson LA, et al. (2003) Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps. Gastroenterology 125:311–319

    Article  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. Cotton PB, Durkalski VL, Pineau BC, et al. (2004) Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 291:1713–1719

    Article  CAS  PubMed  Google Scholar 

  8. Rockey DC, Paulson E, Niedzwiecki D, et al. (2005) Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 365:305–311

    Article  CAS  PubMed  Google Scholar 

  9. Kim DH, Pickhardt PJ, Taylor AJ, et al. (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357(14):1403–1412

    Article  CAS  PubMed  Google Scholar 

  10. Pooler BD, Baumel MJ, Cash BD, et al. (2012) Screening CT colonography: multicenter survey of patient experience, preference, and potential impact on adherence. Am J Roentgenol 198(6):1361–1366

    Article  Google Scholar 

  11. Knudsen AB, Lansdorp-Vogelaar I, Rutter CM, et al. (2010) Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the Medicare population. J Natl Cancer Inst 102(16):1238–1252

    Article  PubMed Central  PubMed  Google Scholar 

  12. Doshi T, Rusinak D, Halvorsen RA, et al. (2007) CT colonography: false-negative interpretations. Radiology 244(1):165–173

    Article  PubMed  Google Scholar 

  13. Nappi JJ, Nagata K (2011) Sources of false positives in computer-assisted CT colonography. Abdom Imaging 36(2):153–164

    Article  PubMed  Google Scholar 

  14. Fidler JL, Fletcher JG, Johnson CD, et al. (2004) Understanding interpretive errors in radiologists learning computed tomography colonography. Acad Radiol 11(7):750–756

    Article  PubMed  Google Scholar 

  15. Trilisky I, Dachman AH, Wroblewski K, Vannier MW, Horne JM (2014) CT colonography with computer-aided detection: recognizing the causes of false-positive reader results. Radiographics 34(7):1885–1905

    Article  PubMed  Google Scholar 

  16. Pollentine A, Mortimer A, McCoubrie P, Archer L (2012) Evaluation of two minimal-preparation regimes for CT colonography: optimising image quality and patient acceptability. Br J Radiol 85(1016):1085–1092. doi:10.1259/bjr/22421731

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Johnson CD, et al. (2008) Noncathartic CT colonography with stool tagging: performance with and without electronic stool subtraction. Am J Roentgenol 190(2):361–366

    Article  Google Scholar 

  18. Wi JY, Kim SH, Lee JY, et al. (2010) Electronic cleansing for CT colonography: does it help CAD software performance in a high-risk population for colorectal cancer? Eur Radiol 20(8):1905–1916

    Article  PubMed  Google Scholar 

  19. Pickhardt PJ, Choi JH (2003) Electronic cleansing and stool tagging in CT colonography: advantages and pitfalls with primary three-dimensional evaluation. Am J Roentgenol 181(3):799–805

    Article  Google Scholar 

  20. Chang KJ, Soto JA (2011) Computed tomographic colonography: image display methods. In: Dachman AH, Laghi A (eds) Atlas of virtual colonoscopy, 2nd edn. New York: Springer, pp 111–132

    Chapter  Google Scholar 

  21. Dachman AH, Obuchowski NA, Hoffmeister JW, et al. (2010) Effect of computer-aided detectionfor CT colonography in a multireader, multicase trial. Radiology 256(3):827–835

    Article  PubMed Central  PubMed  Google Scholar 

  22. Lawrence EM, Pickhardt PJ, Kim DH, Robbins JB (2010) Computer-aided detection (CAD) of colorectal polyps: standalone performance in a large asymptomatic screening population. Radiology 256:791–798

    Article  PubMed  Google Scholar 

  23. Petrick N, Haider M, Summers RM, et al. (2007) CT colonography with computer-aided detection as a second reader: observer performance study. Radiology 246(1):148–156

    Article  Google Scholar 

  24. Regge D, Della Monica P, Galatola G, et al. (2013) Efficacy of computer-aided detection as a second reader for 6-9-mm lesions at CT colonography: multicenter prospective trial. Radiology 266(1):168–176

    Article  PubMed  Google Scholar 

  25. Shinya H, Wolff WI (1979) Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg 190:679–683

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Bond JH (2001) Clinical relevance of the small colorectal polyp. Endoscopy 33:454–457

    Article  CAS  PubMed  Google Scholar 

  27. 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(3):872–878

    Article  PubMed  Google Scholar 

  28. Zalis ME, Barish MA, Choi JR, Working Group on Virtual Colonoscopy, et al. (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236(1):3–9

    Article  PubMed  Google Scholar 

  29. Pickhard PJ, Hassan C, Laghi A, et al. (2008) Small and diminutive polyps detected at screening CT colonography: a decision anaylsis for referral to colonoscopy. Am J Roentgenol 190(1):136–144

    Article  Google Scholar 

  30. Pickhardt PJ, Hassan C, Laghi A, et al. (2008) Clinical management of small (6- to 9-mm) polyps detected at screening CT colonography: a cost-effectiveness analysis. Am J Roentgenol 191(5):1509–1516

    Article  Google Scholar 

  31. Winawer SJ, Zauber AG, Fletcher RH, et al. (2006) Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin 56(3):143–159 (quiz 184–185)

    Article  PubMed  Google Scholar 

  32. Lostumbo A, Suzuki K, Dachman AH (2010) Flat lesions in CT colonography. Abdom Imaging 35(5):578–583

    Article  PubMed  Google Scholar 

  33. Lieberman D, Moravec M, Holub J, Michaels L, Eisen G (2008) Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 135(4):1100–1105

    Article  PubMed Central  PubMed  Google Scholar 

  34. Rex DK, Overhiser AJ, Chen SC, Cummings OW, Ulbright TM (2009) Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol 104(1):149–153

    Article  PubMed  Google Scholar 

  35. 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(7):714–719. doi:10.1258/ar.2012.110685

    Article  PubMed  Google Scholar 

  36. Krupinski EA (2009) What can the radiologist teach CAD: lessons from CT colonoscopy. Acad Radiol 16:1–3

    Article  PubMed  Google Scholar 

  37. Bogoni L, Cathier P, Dundar M, et al. (2005) Computer-aided detection (CAD) for CT colonography: a tool to address a growing need. Br J Radiol 78:S57–S62

    Article  PubMed  Google Scholar 

  38. Summers RM, Yao J, Pickhardt PJ, et al. (2005) Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population. Gastroenterology 129(6):1832–1844

    Article  PubMed Central  PubMed  Google Scholar 

  39. Yoshida H, Nappi J, MacEneaney P, Rubin DT, Dachman AH (2002) Computer-aided diagnosis scheme for detection of polyps at CT colonography. RadioGraphics 22:963–979

    Article  PubMed  Google Scholar 

  40. Suzuki K, Yoshida H, Nappi J, Armato SG 3rd, Dachman AH (2008) Mixture of expert 3D massive-training ANNs for reduction of multiple types of false positives in CAD for detection of polyps in CT colonography. Med Phys 35(2):694–703

    Article  PubMed  Google Scholar 

  41. Suzuki K, Rockey DC, Dachman AH (2010) CT colonography: advanced computer-aided detection scheme utilizing MTANNs for detection of “missed” polyps in a multicenter clinical trial. Med Phys 37(1):12–21

    Article  PubMed Central  PubMed  Google Scholar 

  42. Park HS, Kim SH, Kim JH, et al. (2010) Computer-aided polyp detection on CT colonography: comparison of three systems in a high-risk human population. Eur J Radiol 75(2):e147–e157

    Article  PubMed  Google Scholar 

  43. Hein PA, Krug LD, Romano VC, et al. (2010) Computer-aided detection in computed tomography colonography with full fecal tagging: comparison of standalone performance of 3 automated polyp detection systems. Can Assoc Radiol J 61(2):102–108

    Article  PubMed  Google Scholar 

  44. Yoshida H, Nappi J (2007) CAD in CT colonography without and with oral contrast agents: progress and challenges. Comput Med Imaging Graph 31(4–5):267–284

    Article  PubMed  Google Scholar 

  45. Yoshida H, Masutani Y, MacEneaney P, Rubin DT, Dachman AH (2002) Computerized detection of colonic polyps at CT colonography on the basis of volumetric features: pilot study. Radiology 222(2):327–336

    Article  PubMed  Google Scholar 

  46. Yitta S, Tatineny KC, Cipriani NA, Dachman AH (2006) Characterization of normal ileocecal valve density on CT colonography. J Comput Assist Tomogr 30(1):58–61

    Article  PubMed  Google Scholar 

  47. O’Connor SD, Summers RM, Choi JR, Pickhardt PJ (2006) Oral contrast adherence to polyps on CT colonography. J Comput Assist Tomogr 30(1):51–57

    Article  PubMed  Google Scholar 

  48. Pickhardt PJ (2004) Differential diagnosis of polypoid lesions seen at CT colonography (virtual colonoscopy). RadioGraphics 24(6):1535–1556 (discussion 1557–1559)

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Igor Trilisky.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Trilisky, I., Ward, E. & Dachman, A.H. Errors in CT colonography. Abdom Imaging 40, 2099–2111 (2015). https://doi.org/10.1007/s00261-015-0501-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-015-0501-1

Keywords

Navigation