Feasibility of using the marginal blood vessels as reference landmarks for CT colonography

The purpose of this study was to show the spatial relationship of the colonic marginal blood vessels and the teniae coli on CT colonography (CTC) and the use of the marginal blood vessels for supine-prone registration of polyps and for determination of proper connectivity of collapsed colonic segments.

We manually labeled the marginal blood vessels on 15 CTC examinations. Colon segmentation, centerline extraction, teniae detection, and teniae identification were automatically performed. For assessment of their spatial relationships, the distances from the marginal blood vessels to the three teniae coli and to the colon were measured. Student t tests (paired, two-tailed) were performed to evaluate the differences among these distances. To evaluate the reliability of the marginal vessels as reference points for polyp correlation, we analyzed 20 polyps from 20 additional patients who underwent supine and prone CTC. The average difference of the circumferential polyp position on the supine and prone scans was computed. Student t tests (paired, two-tailed) were performed to evaluate the supine-prone differences of the distance. We performed a study on 10 CTC studies from 10 patients with collapsed colonic segments by manually tracing the marginal blood vessels near the collapsed regions to resolve the ambiguity of the colon path.

The average distances (± SD) from the marginal blood vessels to the tenia mesocolica, tenia omentalis, and tenia libera were 20.1 ± 3.1 mm (95% CI, 18.5-21.6 mm), 39.5 ± 4.8 mm (37.1-42.0 mm), and 36.9 ± 4.2 mm (34.8-39.1 mm), respectively. Pairwise comparison showed that these distances to the tenia libera and tenia omentalis were significantly different from the distance to the tenia mesocolica (p < 0.001). The average distance from the marginal blood vessels to the colon wall was 15.3 ± 2.0 mm (14.2-16.3 mm). For polyp localization, the average difference of the circumferential polyp position on the supine and prone scans was 9.6 ± 9.4 mm (5.5-13.7 mm) (p = 0.15) and expressed as a percentage of the colon circumference was 3.1% ± 2.0% (2.3-4.0%) (p = 0.83). We were able to trace the marginal blood vessels for 10 collapsed colonic segments and determine the paths of the colon in these regions.

The marginal blood vessels run parallel to the colon in proximity to the tenia mesocolica and enable accurate supine-prone registration of polyps and localization of the colon path in areas of collapse. Thus, the marginal blood vessels may be used as reference landmarks complementary to the colon centerline and teniae coli.