Positional change in colon polyps at CT colonography

To determine the frequency with which polyps change positions with respect to the bowel surface and the cause of this movement.

From December 2001 to March 2003, 113 patients underwent computed tomographic (CT) colonography prior to colonoscopy. For all confirmed polyps that were 5 mm and larger, images obtained with CT colonography were retrospectively analyzed by one author to determine if the polyp was present on both data sets or on only one data set. Retrospective evaluation of these polyps for ventral or dorsal location within the colonic lumen was performed for data sets obtained with patients in the prone and the supine position. The data sets were further reviewed by another author to determine the cause of positional change, when present.

Twenty-six patients had a total of 49 histologically proved colorectal polyps that were 5 mm and larger. Eight of 49 colorectal polyps were depicted only on images obtained with the patient in the supine or prone position. Of the remaining 41 polyps that were depicted on images obtained with the patient in the supine and the prone position, 11 moved from a dorsal to a ventral location or vice versa relative to the colonic surface when the patient changed position. Five of these polyps were pedunculated on a stalk. Six were sessile; two were located in the sigmoid colon, two in the transverse colon, one in the ascending colon, and one in the cecum. In these cases, polyp mobility was related to positional changes of the colon in the mesentery, as opposed to true mobility of the polyp.

In this series, 27% of polyps moved from a ventral location to a dorsal location relative to the colonic surface when the patient was turned from the supine to the prone position; thus, polyps appeared to be mobile. Thus, a mobile filling defect cannot be assumed to be residual fecal material at CT colonography.