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CT Colonography with Intravenous Contrast Material: Varied Appearances of Colorectal Carcinoma¹

¹ From the Department of Diagnostic Radiology (A.C.S., A.K.H.), Division of Gastroenterology and Hepatology (J.A.L.), and Division of Colon and Rectal Surgery (J.P.H.), Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. Recipient of a Cum Laude award for an education exhibit at the 2003 RSNA Annual Meeting. Received September 30, 2004; revision requested November 8 and received May 11, 2005; accepted May 12. A.K.H. receives royalties from GE Medical Systems, Waukesha, Wis, for a CT colonoscopy software license; all other authors have no financial relationships to disclose. Address correspondence to A.C.S. (e-mail: silva.alvin{at}mayo.edu).

Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. Because colorectal cancer has a widely varying appearance at both endoscopy and CT colonography, familiarity with the gamut of morphologic appearances can help improve interpretation of the results. The addition of intravenous contrast material to CT colonography can aid differentiation of true colonic masses from pseudolesions such as residual stool and improves the depiction of enhancing masses that might otherwise be obscured by residual colonic fluid. In contrast to staging of most other tumors, staging of colorectal carcinoma depends more on the depth of tumor invasion than on the size of the primary mass. The diverse appearances of colorectal cancers at two- and three-dimensional CT colonography include sessile, annular, ulcerated, necrotic, mucinous, invasive, and noninvasive lesions. Imaging pitfalls that can simulate or obscure neoplasms are retained fecal material or fluid, incomplete distention, and advanced diverticulosis.

© RSNA, 2005

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