CT colonography interpretation requires radiologists to create interactively two- and three-dimensional images of the colonic lumen, use a variety of window and level settings, and compare supine and prone three-dimensional datasets. Colonic datasets are interrogated systematically to screen for potential colorectal lesions, employing well-established problem-solving techniques at the computer workstation to distinguish true neoplasms from benign and normal structures. A visual understanding of the normal appearance of colorectal structures, benign lesions, disease mimics and colorectal neo-plasia is necessary in utilizing the capabilities of modern CT colonography computer workstations to accurately diagnose disease.

Fig. 14.26a-c. Annular cancer: a,b 2D axial images demonstrate focal circumferential wall thickening of soft tissue attenuation with proximal and distal shouldering (arrows); c note the shouldering of the distal edge of the lesion is visible on 3-D endo-luminal view (arrow)
Fig. 14.27a-c. Scirrhous cancer demonstrates luminal constriction, irregularity and wall thickening in the mid-rectum: a,b 2D MPR images; c the luminal constriction best highlighted on the virtual barium enema rendering

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