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Evaluation of Submucosal Lesions of the Large Intestine

Part 2. Nonneoplastic Causes¹

¹ From the Department of Radiology (P.J.P., D.H.K.), Section of Gastroenterology and Hepatology (D.V.G.), and Department of Surgery (C.P.H.), University of Wisconsin Medical School, 600 Highland Ave, E3/311 Clinical Science Center, Madison, WI 53792-3252; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.O.M.); and the Department of Gastroenterology, Portsmouth Naval Hospital, Portsmouth, Va (G.M.A.). Recipient of a Certificate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received February 20, 2007; revision requested March 23 and received May 7; accepted May 10. P.J.P. is a consultant with Viatronix, Medicsight, and C.B. Fleet; D.H.K. is a speaker with Viatronix and Medicsight; all remaining authors have no financial relationships to disclose. Address correspondence to P.J.P. (e-mail: pj.pickhardt{at}hosp.wisc.edu).

Various nonneoplastic entities may manifest as submucosal abnormalities at colorectal evaluation, and it may be difficult to distinguish between those with an intramural origin and those with an extramural origin on the basis of optical colonoscopy alone. Cross-sectional radiologic imaging, which allows evaluation of the entire bowel wall and the surrounding tissues, plays an important role in the localization and characterization of these abnormalities. However, some superficial submucosal lesions that are initially detected at computed tomographic colonography or barium enema studies may be better characterized with colonoscopy; thus, it is important to recognize the complementary uses of these diagnostic tests. In addition, modalities such as transrectal ultrasonography and magnetic resonance imaging may be useful for the identification and characterization of some abnormalities. For timely and effective management, it is especially important that submucosal neoplasms of the large intestine be accurately distinguished from nonneoplastic entities such as lymphoid polyps, vascular lesions, and cystic lesions, as well as from extracolonic abnormalities (eg, endometriosis, uterine fibroids) and normal extracolonic structures (eg, uterus, vasculature).

© RSNA, 2007

Related Article

Evaluation of Submucosal Lesions of the Large Intestine: Part 1. Neoplasms

Perry J. Pickhardt, David H. Kim, Christine O. Menias, Deepak V. Gopal, Glen M. Arluk, and Charles P. Heise
RadioGraphics 2007 27: 1681-1692. [Abstract] [Full Text] [PDF]