Skip to main content
SpringerLink
Log in

Polyps

  • Chapter
  • First Online:
CT Colonography for Radiographers

  • 791 Accesses

Abstract

Being able to readily identify the different types of polyps on a CTC study is important in terms of patient management. Sessile, pedunculated, flat and carpet lesions are described with examples of 2D and 3D CTC images. Although a reader can describe the size and shape of polyps on a CTC study, their histological type has to be confirmed by biopsy. Colon polyps are described with accompanying CTC images. It is important to have a working knowledge of polyp morphology and how to accurately measure polyps. Examples of volume measurements and positioning of polyps in a head-on position are used to highlight the importance of accurate polyp measurement. There is a critical threshold between a diminutive polyp at 5 mm and a small polyp at 6 mm, as well as between a small polyp at 9 mm, and an advanced adenoma at 10 mm. Non-neoplastic mucosal lesions, and submucosal lesions are covered with some examples.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Pickhardt PJ, Kim DH. Colorectal cancer screening with CT colonography: key concepts regarding polyp prevalence, size, histology, morphology, and natural history. AJR Am J Roentgenol. 2009;193(1):40–6. http://dx.doi.org/10.2214/ajr.08.1709.

    Article  PubMed  Google Scholar 

  2. Bortz JH. An approach for performing a successful CT colonography examination. S Afr J Rad. 2014;18(1); http://dx.doi/org/10.4102/sajr. v18i1.607 [www.sajr.org.za].

  3. Pickhardt PJ. Differential diagnosis of polypoid lesions seen at CT colonography (virtual colonoscopy). Radiographics. 2004;24(6):1535–56.

    Article  PubMed  Google Scholar 

  4. Johnson CD, Chen M, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359(12):1207–17. http://dx.doi.org/NEJMoa0800996.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, 7th Ed. 2003. [cited 2015 August 7]. Available from: http://medical-dictionary.thefreedictionary.com/prevalence.

  6. Farlex Partner Medical Dictionary. 2012. [cited 2015 August]. Available from: http://medical-dictionary.thefreedictionary.com/incidence.

  7. Pickhardt PJ, Choi JR, Hwong I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349(23):2199–200.

    Article  Google Scholar 

  8. WHO. Cancer key facts. [cited 2015 June 25]. Available from: http://www.who.int/mediacentre/factsheets/fs297/en/.

  9. Levin B, Lieberman DA, McFarland B, et al. Screening surveillance for the early detection of colorectal cancer and adenomatous polyps 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on colorectal cancer, and the American College of Radiology. CA: Cancer J Clin. 2008;58(3):130–60. https://dx.doi.org/10.3322/CA.2007.0018.

    Google Scholar 

  10. Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for detection of advanced neoplasia. N Engl J Med. 2007;357(14):1403–12.

    Article  CAS  PubMed  Google Scholar 

  11. Pickhardt PJ, Hassan C, Laghi A, et al. Small and diminutive polyps detected at screening CT colonography: a decision analysis for referral to colonoscopy. AJR Am J Roentgenol. 2008;190(1):136–44.

    Article  PubMed  Google Scholar 

  12. Pickhardt PJ, Hassan C, Laghi A, et al. Clinical management of small (6 – to 9–mm) polyps detected at screening CT colonography: a cost-effectiveness analysis. AJR Am J Roentgenol. 2008;191(5):1509–16.

    Article  PubMed  Google Scholar 

  13. Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112(1):24–8.

    Article  CAS  PubMed  Google Scholar 

  14. Leufkens AM, van Oijen MG, Vleggaar FP, Siersema PD. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscopy. 2012;44(5):470–5 (abstract). doi:10.1055/s-0031-1291666.

    Article  CAS  PubMed  Google Scholar 

  15. Pooler DB, Kim DH, Weiss JM et al. Colorectal polyps missed with optical colonoscopy despite previous detection and location with CT colonography. Radiology. 2015; 150294 (EPUB ahead of print).

    Google Scholar 

  16. Zalis ME, Barish MA, Choi JR, et al. CT colonography reporting and data system: a consensus proposal. Radiology. 2005;236:3–9.

    Article  PubMed  Google Scholar 

  17. Dorland’s Pocket Medical Dictionary 29th ed. Philadelphia: WB Saunders; 2012.

    Google Scholar 

  18. Kim DH, Hinshaw L, Lubner MG, Munoz de Rio A, Pooler BD, Pickhardt PJ. Contrast coating for the surface of flat polyps at CT colonography: a marker for detection. Eur Radiol. 2014;24(4):940–46. http://dx.doi.org/10.1007/s00330-014-3095-z.

    Google Scholar 

  19. Tanaka S, Haruma K, Oka S, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc. 2001;54(1):62–6.

    Article  CAS  PubMed  Google Scholar 

  20. O’Brien MJ, Winawer SJ, Zauber AG, et al. Flat adenomas in the National Polyp Study: is there increased risk for high-grade dysplasia initially or during surveillance. Clin Gastroenterol Hepatol. 2004;2(10):905–11.

    Article  PubMed  Google Scholar 

  21. Dachman AH, Zalis ME. Quality and consistency in CT colonography and research reporting. Radiology. 2004;230(2):319–23.

    Article  PubMed  Google Scholar 

  22. Pickhardt PJ, Taylor AJ, Jonson GL, et al. Building a CT colonography program: necessary ingredients for reimbursement and clinical success. Radiology. 2005;235(1):17–20.

    Article  PubMed  Google Scholar 

  23. Pickhardt PJ, Lehman VT, Winter TC, Taylor AJ. Polyp volume versus linear size measurements at CT colonography: implications for noninvasive surveillance of unresected colorectal lesions. AJR Am J Roentgenol. 2006;186(6):1605–10.

    Article  PubMed  Google Scholar 

  24. Pickhardt PJ, Kim DH. Performance of CTC for detecting diminutive, small and flat polyps. Gastrointest Endoscopy Clin N Am. 2010;20(2):209–26.

    Article  Google Scholar 

  25. Van Dam J, Cotton P, Johnson CD, et al. AGA future trends report: CT colonography. Gastroenterology. 2004;127:970–84.

    Article  PubMed  Google Scholar 

  26. Ransohoff DF. CON. Immediate colonoscopy is not necessary in patients who have polyps smaller than 1 cm on computed tomographic colonography. Am J Gastroenterol. 2005;100:1905–7.

    Article  PubMed  Google Scholar 

  27. Bond JH. Clinical relevance of the small colorectal polyp. Endoscopy. 2001;33(5):454–7.

    Article  CAS  PubMed  Google Scholar 

  28. Schoenfeld P. Small and diminutive polyps: implications for colorectal cancer screening with computed tomography colonography. Clin Gastroenterol Hepatol. 2006;4:293–5.

    Article  PubMed  Google Scholar 

  29. Lieberman D, Moravec M, Holub J, et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. 2008;135(4):1100–5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pickhardt PJ, Wise SM, Kim DH. Positive predictive value for polyps detected at screening CT colonography. Eur Radiol. 2010;20(7):1651–6.

    Article  PubMed  Google Scholar 

  31. Hofstad B, Vatn MH, Andersen SN, et al. Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of 3 years. Gut. 1996;39(3):449–56. doi:10.1136/gut.39.3.449.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Pickhardt PJ, Choi JR, Hwang I, et al. Nonadenomatous polyps at CT colonography: prevalence, size, distribution, and detection rates. Radiology. 2004;232(3):784–90.

    Article  PubMed  Google Scholar 

  33. Van Stolk RU, Beck GJ, Baron JA, et al. Adenoma characteristics at first colonoscopy as predictors of adenoma recurrence and characteristics at follow-up. Gastroenterology. 1998;115(1):13–8.

    Article  PubMed  Google Scholar 

  34. Bond JH. Clinical evidence for the adenoma-carcinoma sequence, and the management of patients with colorectal adenomas. Semin Gastrointest Dis. 2000;11:176–84.

    CAS  PubMed  Google Scholar 

  35. Winawer SJ, Zauber AG. The advanced adenoma as the primary target of screening. Gastrointest Endosc Clin N Am. 2002;12(1):1–9.

    Article  PubMed  Google Scholar 

  36. O’Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyp Study – patient and polyp characteristics associated with high-grade dysplasia in colorectal adenoma. Gastroenterology. 1990;98(2):371–9.

    Article  PubMed  Google Scholar 

  37. Macari M, Bini EJ. CT colonography: where have we been and where are we going? Radiology. 2005;237(3):819–33. http://dx.doi.org/10.1148/radiol.22373041717.

    Article  PubMed  Google Scholar 

  38. Waye JD, Bilotta JJ. Rectal hyperplastic polyps – now you seen them, now you don’t – a different point. Am J Gastroenterol. 1990;85(12):1557–9.

    CAS  PubMed  Google Scholar 

  39. Church JM. Clinical significance of small colorectal polyps. Dis Colon Rectum. 2004;47(4):481–5.

    Article  PubMed  Google Scholar 

  40. Pickhardt PJ, Kim DH, Meiners RJ, et al. Colorectal and extracolonic cancers detected at screening CT colonography in 10,286 asymptomatic adults. Radiology. 2010;255(1):83–8.

    Article  PubMed  Google Scholar 

  41. Pickhardt PJ, Lam VP, Weiss JM, et al. Carpet lesions detected at CT colonography: clinical, imaging, and pathologic features. Radiology. 2014;270:435–43.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rubesin SE, Saul SH, Laufer I, et al. Carpet lesions of the colon. Radiographics. 1985;5(4):537–52.

    Article  Google Scholar 

  43. Pickhardt PJ, Kim DH, Robbins JB. Flat (nonpolypoid) colorectal lesions identified at CT colonography in a US screening population. Acad Radiol. 2010;17(6):784–90. http://dx.doi.org/10.1016/j.acra.2010.01.010.

    Article  PubMed  Google Scholar 

  44. Rosty C, Hewett DG, Brown IS, et al. Serrated polyps of the large intestine: current understanding of diagnosis, pathogenesis, and clinical management. J Gastroenterol. 2013;48(3):287–302.

    Article  PubMed  Google Scholar 

  45. Torlakovic E, Skovlund E, Snover DC, et al. Morphological reappraisal of serrated colorectal polyps. Am J Surg Pathol. 2003;27:65–8.

    Article  PubMed  Google Scholar 

  46. Rex DK, Ahren DJ, Baron JA, et al. Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol. 2012;107:1315–29.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP. Serrated polyps of the large intestine. Am J Clin Pathol. 2005;124:380–91.

    Article  PubMed  Google Scholar 

  48. East JE, Vieth M, Rex DK. Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance. Gut. 2015;64(6):991–1000.

    Article  PubMed  Google Scholar 

  49. Hazewinkel Y, López-Cerón M, East JE, et al. Endoscopic features of sessile serrated adenomas: validation by international experts using hi-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc. 2013;77:916–24.

    Article  PubMed  Google Scholar 

  50. Calva D, Howe JR. Hamartomatous polyposis syndromes. Surg Clin North Am. 2008;88(4):779-vii.

    Article  PubMed Central  Google Scholar 

  51. Pickhardt PJ, Kim DH. CT colonography: principles and practice of virtual colonoscopy. Philadelphia: Saunders; 2009. p. 359.

    Google Scholar 

  52. Hancock BJ, Vajcner A. Lipomas of the colon – a clinicopathologic review. Can J Surg. 1988;31(3):178–81.

    CAS  PubMed  Google Scholar 

  53. Levy AD, Sobin LH. From the archives of the AFIP. Gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics. 2007;27(1):237-U19.

    Article  Google Scholar 

  54. Wong MJC, Eu KW. Primary colorectal lymphomas. Colorectal Dis. 2006;8(7):586–91.

    Article  CAS  PubMed  Google Scholar 

  55. Stanojevic GZ, Nestorovic MD, Brankovic BR, et al. Primary colorectal lymphoma: an overview. World J Gastrointest Oncol. 2011;3(1):14–8.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Liegl-Atzwanger B, Fletcher JA, Fletcher CD. Gastrointestinal stromal tumours. Virchows Arch. 2010;456:111–27. https://dx.doi.org/10.1007/s00428-010-0891-y.

    Article  PubMed  Google Scholar 

  57. Zwas FR, Lyon DJ. Endometriosis – an important condition in clinical gastroenterology. Dig Dis Sci. 1991;36(3):353–64.

    Article  CAS  PubMed  Google Scholar 

  58. Pickhardt PJ, Levy AD, Rohrmaan CA, et al. Primary neoplasms of the appendix: radiologic spectrum of disease with pathological correlation. Radiographics. 2003;23(3):645–22.

    Article  PubMed  Google Scholar 

  59. Lee AD, Pickhardt PJ, Gopol DN, et al. Venous malformations mimicking multiple mucosal polyps on screening CT colonography. AJR Am J Roentgenol. 2006;186(4):1113–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Professor D Kim from Wisconsin University is thanked for the carpet lesion examples. Clinton Bopp is thanked for drawing the target line diagram.

Author information

Authors and Affiliations

  1. LSG Imaging, Los Angeles, CA, USA

    Joel H. Bortz MBChB, DMRD, FRCR, FFRRCS

Authors
  1. Joel H. Bortz MBChB, DMRD, FRCR, FFRRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel H. Bortz MBChB, DMRD, FRCR, FFRRCS .

Editor information

Editors and Affiliations

  1. LSG Imaging, Los Angeles, California, USA

    Joel H. Bortz

  2. Diagnostic Radiography and Imaging, University of Hertfordshire, Hertfordshire, United Kingdom

    Aarthi Ramlaul

  3. Formerly School of Radiography, King Edward VIII Hospital, Durban, KZN, South Africa

    Leonie Munro

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Bortz, J.H. (2016). Polyps. In: Bortz, J., Ramlaul, A., Munro, L. (eds) CT Colonography for Radiographers. Springer, Cham. https://doi.org/10.1007/978-3-319-29379-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29379-0_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29377-6

  • Online ISBN: 978-3-319-29379-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation