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DOI: 10.1148/rg.272065081
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RadioGraphics 2007;27:431-454
© RSNA, 2007


EDUCATION EXHIBIT

Pitfalls in Multi–Detector Row CT Colonography: A Systematic Approach1

Thomas Mang, MD, Andrea Maier, MD, Christina Plank, MD, Christina Mueller-Mang, MD, Christian Herold, MD and Wolfgang Schima, MD, MSc

1 From the Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received April 25, 2006; revision requested June 12 and received August 9; accepted August 23. All authors have no financial relationships to disclose. Address correspondence to T.M. (e-mail: thomas.mang{at}meduniwien.ac.at).

Thin-section multi–detector row computed tomographic (CT) colonography is a powerful tool for the detection and classification of colonic lesions. However, each step in the process of a CT colonographic examination carries the potential for misdiagnosis. Suboptimal patient preparation, CT scanning protocol deficiencies, and perception and interpretation errors can lead to false-positive and false-negative findings, adversely affecting the diagnostic performance of CT colonography. These problems and pitfalls can be overcome with a variety of useful techniques and observations. A relatively clean, dry, and well-distended colon can be achieved with careful patient preparation, thereby avoiding the problem of residual stool and fluid. Knowledge of the morphologic and attenuation characteristics of common colonic lesions and artifacts can help identify bulbous haustral folds, impacted diverticula, an inverted appendiceal stump, or mobile polyps, any of which may pose problems for the radiologist. A combined two-dimensional and three-dimensional imaging approach is recommended for each colonic finding. A thorough knowledge of the various pitfalls and pseudolesions that may be encountered at CT colonography, along with use of dedicated problem-solving techniques, will help the radiologist differentiate between definite colonic lesions and pseudolesions.

© RSNA, 2007







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