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Filling Defects at CT Colonography: Pseudo- and Diminutive Lesions (The Good), Polyps (The Bad), Flat Lesions, Masses, and Carcinomas (The Ugly)¹

¹ From the Departments of Radiology (M.M., S.L.J., N.L., Y.W.L.) and Medicine (E.J.B.), New York University Medical Center, 560 First Ave, Suite HW 207, New York, NY 10016; and the Department of Medicine, Veterans Administration Medical Center, New York, NY (E.J.B.). Received January 7, 2003; revision requested March 6 and received April 1; accepted April 4. Address correspondence to M.M. (e-mail: michael.macari@med.nyu.edu).

Numerous filling defects may be detected in the colon during interpretation of data sets obtained with computed tomographic (CT) colonography. A series of 230 patients were evaluated with thin-section multidetector row CT colonography immediately before conventional colonoscopy. In all cases, the interpreting radiologist and gastroenterologist reviewed the imaging findings as well as the results of histologic analysis of biopsy specimens to determine the causes of filling defects. In many cases, the cause of a filling defect can be confidently determined at CT colonography by using combinations of two- and three-dimensional images. However, lesions will occasionally be indeterminate because of overlapping features and will require further evaluation with endoscopy. With knowledge of the morphologic and attenuation characteristics of the various filling defects in the colon, one should be able to differentiate those filling defects detected at CT colonography that require no further evaluation from those that require endoscopic interrogation.

© RSNA, 2003

Index Terms: Colon, CT, 75.1211 • Colon neoplasms, CT, 75.1211, 75.30 • Colon neoplasms, diagnosis, 75.30 • Computed tomography (CT), three-dimensional, 75.12117

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