Assessment of polyp and mass histopathology by intravenous contrast-enhanced CT colonography.
OBJECTIVE
We sought to demonstrate that intravenous contrast-enhanced CT colonography (CTC) can distinguish colonic adenomas from carcinomas.


METHODS
Supine intravenous contrast-enhanced CTC with colonoscopic and/or surgical correlation was performed on 25 patients with colonic adenomas or carcinomas. Standard deviation of mean polyp CT attenuation was computed and assessed using ANOVA and receiver-operating characteristic analyses.


RESULTS
Colonoscopy confirmed 32 polyps or masses 1 to 8 cm in size. The standard deviations of CT attenuation were carcinomas (n = 13; 36 +/- 6 HU; range 28-48 HU) and adenomas (n = 19; 49 +/- 14 HU; range 31-100 HU) (P = 0.005). At a standard deviation threshold of 42 HU, the sensitivity and specificity for classifying a polyp or mass as a carcinoma were 92% and 79%, respectively. The area under the receiver-operating characteristic curve was 0.89 +/- 0.06 (95% confidence interval 0.73-0.96).


CONCLUSIONS
Measurement of the standard deviation of CT attenuation on intravenous contrast-enhanced CTC permits histopathologic classification of polyps 1 cm or larger as carcinomas versus adenomas. The presence of ulceration or absence of muscular invasion in carcinomas creates overlap with adenomas, reducing the specificity of carcinoma classification.
Summers
Ronald M
RM
Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, Room 1C351, 10 Center Dr. MSC 1182, Bethesda, MD 20892-1182, USA. rms@nih.gov
Huang
Adam
A
Yao
Jianhua
J
Campbell
Shannon R
SR
Dempsey
Jennifer E
JE
Dwyer
Andrew J
AJ
Franaszek
Marek
M
Brickman
Danny S
DS
Bitter
Ingmar
I
Petrick
Nicholas
N
Hara
Amy K
AK
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003111:Colonic Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D003287:Contrast Media; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
D003287:Contrast Media