CT colonography predictably overestimates colonic length and distance to polyps compared with optical colonoscopy

The purpose of this study was to determine the discrepancy between CT colonography (CTC) and optical colonoscopy (OC) measurements for both anus-to-cecum length and anus-to-polyps distance and then determine whether a conversion factor could be generated to equate these CTC and OC distances.

We retrospectively reviewed CTC and OC reports from patients who had undergone both procedures as part of an established protocol. The anus-to-cecum measurement recorded on a single proprietary CTC workstation was compared with the OC cecal length for each patient. Likewise, anus-to-polyp distances were compared as measured by the radiologist and endoscopist.

Three hundred thirty-eight patients and 437 polyps were identified with complete data from both CTC and same-day OC. The average anus-to-cecum distance measured at CTC was 189 cm (range, 75-257 cm) and at OC, 108 cm (range, 65-150 cm). For polyps proximal to the splenic flexure (n = 145), the CTC anus-to-polyp measurement was on average 1.7 times that measured at OC. For left-sided polyps (n = 292), the CTC measurement was, on average, within 12 cm or 1.3 times that of the OC anus-to-polyp measurement. All the differences between CTC and OC measurements of cecal length and polyp distances were found to be statistically significant using a paired Student's t test of means (p < 0.001).

Anus-to-cecum and anus-to-polyp distances are disparate but comparable using a conversion factor of 0.57 for the CTC anus-to-cecum measurement and 0.59 for right-sided CTC anus-to-polyp or 0.78 for left-sided CTC anus-to-polyp measurements. These anus-to-polyp conversion factors could potentially augment current CTC guidelines for accurate and precise polyp localization and removal at endoscopy.