Skip to main content
SpringerLink
Log in

CT-Kolonographie: Pathologische Befunde und Pitfalls

CT colonography: pathologic findings and pitfalls

  • Leitthema: Kolondiagnostik
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Die Kolonographie mittels Multidetektorcomputertomographie (MDCT; CT-Kolonographie) ist eine leistungsfähige Methode zur Detektion und Klassifikation kolorektaler Läsionen. Sie beruht auf der Anfertigung eines CT-Datensatzes mit einer rekonstruierten Schichtdicke von 0,75–2 mm. Die akquirierten Daten werden dann zu zwei- und dreidimensionalen Bildern verarbeitet. Die Auswertung eines CT-Kolonographie-Datensatzes basiert auf der Detektion und korrekten Interpretation von Läsionen und Füllungsdefekten des Kolons. Zur richtigen Interpretation von Füllungsdefekten und zur Differenzierung von echten Läsionen und Pseudoläsionen bedarf es verschiedener Kriterien. Dazu zählen v. a. die äußere Form, die innere Struktur, das Kontrastmittelaufnahmeverhalten und die Lagestabilität von Läsionen. Die Kenntnis morphologischer und struktureller Charakteristika echter Läsionen und Pseudoläsionen des Kolons ist eine Vorrausetzung zur richtigen Interpretation eines Füllungsdefekts. In diesem Übersichtsartikel werden die MDCT-Charakteristika von Polypen, Divertikeln, Lipomen und Karzinomen sowie von häufigen Pseudoläsionen des Kolons zusammengefasst.

Abstract

Thin-section multidetector-row computed tomographic (MDCT) colonography is a powerful tool for detection and classification of colonic lesions. It is based on a helical thin-section (0.75–2 mm) CT dataset of the cleansed and air-distended colon. 2D and 3D projections are prepared and used for image interpretation. Evaluation of CT colonography datasets requires correct perception and interpretation of colonic lesions and filling defects. Various criteria are needed for correct interpretation of filling defects and differentiaton between genuine lesions and artifacts. Such defects are characterized by their morphology, their structure, the absorption of contrast medium and their mobility. Knowledge of the morphologic and attenuation characteristics of common colonic lesions and of artifacts is essential for the correct interpretation of a filling defect. This review article summarizes the main imaging features of polyps, diverticula, lipomas, and carcinomas and also of common pseudolesions of the colon.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12

Literatur

  1. Burling D, Halligan S, Slater A et al. (2006) Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology 239: 464–471

    Article  PubMed  Google Scholar 

  2. Chung DJ, Huh KC, Choi WJ, Kim JK (2005) CT colonography using 16-MDCT in the evaluation of colorectal cancer. AJR Am J Roentgenol 184: 98–103

    PubMed  Google Scholar 

  3. Fenlon HM (2002) CT colonography: pitfalls and interpretation. Abdom Imaging 27: 284–291

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Filippone A, Ambrosini R, Fuschi M et al. (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography – initial experience. Radiology 231: 83–90

    Article  PubMed  Google Scholar 

  6. Fletcher JG, Johnson CD, MacCarty RL et al. (1999) CT colonography: potential pitfalls and problem-solving techniques. AJR Am J Roentgenol 172: 1271–1278

    PubMed  CAS  Google Scholar 

  7. 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: 893–904

    Article  PubMed  Google Scholar 

  8. Hara AK, Johnson CD, Reed JE (1997) Colorectal lesions: evaluation with CT colography. Radiographics 17: 1157–1167; discussion 1167–1168

    PubMed  CAS  Google Scholar 

  9. Laks S, Macari M, Bini EJ (2004) Positional change in colon polyps at CT colonography. Radiology 231: 761–766

    Article  PubMed  Google Scholar 

  10. Lefere P, Gryspeerdt S, Baekelandt M et al. (2003) Diverticular disease in CT colonography. Eur Radiol 13 [suppl 4]: L62–L74

  11. Lefere PA, Gryspeerdt SS, Dewyspelaere J et al. (2002) Dietary fecal tagging as a cleansing method before CT colonography: initial results polyp detection and patient acceptance. Radiology 224: 393–403

    Article  PubMed  Google Scholar 

  12. Macari M, Bini EJ, Jacobs SL et al. (2003) Filling defects at CT colonography: pseudo- and diminutive lesions (the good), polyps (the bad), flat lesions, masses, and carcinomas (the ugly). Radiographics 23: 1073–1091

    Article  PubMed  Google Scholar 

  13. Macari M, Megibow AJ (2001) Pitfalls of using three-dimensional CT colonography with two-dimensional imaging correlation. AJR Am J Roentgenol 176: 137–143

    PubMed  CAS  Google Scholar 

  14. Mang T, Graser A, Schima W, Maier A (2007) CT colonography: techniques, indications, findings. Eur J Radiol 61: 388–399

    Article  PubMed  Google Scholar 

  15. Mang T, Maier A, Plank C et al. (2007) Pitfalls in multi-detector row CT colonography: a systematic approach. Radiographics 27: 431–454

    Article  PubMed  Google Scholar 

  16. Morrin MM, Farrell RJ, Raptopoulos V et al. (2000) Role of virtual computed tomographic colonography in patients with colorectal cancers and obstructing colorectal lesions. Dis Colon Rectum 43: 303–311

    Article  PubMed  CAS  Google Scholar 

  17. Neri E, Giusti P, Battolla L et al. (2002) Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology 223: 615–619

    Article  PubMed  Google Scholar 

  18. Neri E, Vagli P, Picchietti S et al. (2005) CT colonography: contrast enhancement of benign and malignant colorectal lesions versus fecal residuals. Abdom Imaging 30: 694–697

    Article  PubMed  CAS  Google Scholar 

  19. Oto A, Gelebek V, Oguz BS et al. (2003) CT attenuation of colorectal polypoid lesions: evaluation of contrast enhancement in CT colonography. Eur Radiol 13: 1657–1663

    Article  PubMed  Google Scholar 

  20. Park SH, Ha HK, Kim AY et al. (2006) Flat polyps of the colon: detection with 16-MDCT colonography – preliminary results. AJR Am J Roentgenol 186: 1611–1617

    Article  PubMed  Google Scholar 

  21. Park SH, Lee SS, Choi EK et al. (2007) Flat colorectal neoplasms: definition, importance, and visualization on CT colonography. AJR Am J Roentgenol 188: 953–959

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. 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  PubMed  CAS  Google Scholar 

  24. 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: 1343–1347

    PubMed  Google Scholar 

  25. Prout TM, Taylor AJ, Pickhardt PJ (2006) Inverted appendiceal stumps simulating large pedunculated polyps on screening CT colonography. AJR Am J Roentgenol 186: 535–538

    Article  PubMed  Google Scholar 

  26. 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: 1211–1214

    Article  PubMed  CAS  Google Scholar 

  27. Rogalla P, Lembcke A, Ruckert JC et al. (2005) Spasmolysis at CT colonography: butyl scopolamine versus glucagon. Radiology 236: 184–188

    Article  PubMed  Google Scholar 

  28. Silva AC, Hara AK, Leighton JA, Heppell JP (2005) CT colonography with intravenous contrast material: varied appearances of colorectal carcinoma. Radiographics 25: 1321–1334

    Article  PubMed  Google Scholar 

  29. Taylor SA, Halligan S, Goh V et al. (2003) Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. Radiology 229: 99–108

    Article  PubMed  Google Scholar 

  30. Winawer SJ, Zauber AG, Ho MN et al. (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329: 1977–1981

    Article  PubMed  CAS  Google Scholar 

  31. Yasumoto T, Murakami T, Yamamoto H et al. (2006) Assessment of two 3D MDCT colonography protocols for observation of colorectal polyps. AJR Am J Roentgenol 186: 85–89

    Article  PubMed  Google Scholar 

  32. Yee J, Kumar NN, Hung RK et al. (2003) Comparison of supine and prone scanning separately and in combination at CT colonography. Radiology 226: 653–661

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Univ.-Klinik für Radiodiagnostik, Medizinische Universität Wien, Währinger Gürtel 18–20, A-1090, Wien, Österreich

    T. Mang, A. Maier, C. Mueller-Mang & W. Schima

  2. Institut für Klinische Radiologie, Klinikum Großhadern der LMU München, München, Deutschland

    A. Graser

  3. Abteilung für diagnostische und interventionellen Radiologie, A.ö. Krankenhaus der Elisabethinen Linz, Linz, Österreich

    G. Böhm

Authors
  1. T. Mang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Graser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Mueller-Mang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Böhm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Schima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Mang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mang, T., Graser, A., Maier, A. et al. CT-Kolonographie: Pathologische Befunde und Pitfalls. Radiologe 48, 146–155 (2008). https://doi.org/10.1007/s00117-007-1614-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-007-1614-5

Schlüsselwörter

Keywords

Search

Navigation