Automated detection of colorectal lesions with dual-energy CT colonography

Conventional single-energy computed tomography colonography (CTC) tends to miss polyps 6 - 9 mm in size and flat lesions. Dual-energy CTC (DE-CTC) provides more complete information about the chemical composition of tissue than does conventional CTC. We developed an automated computer-aided detection (CAD) scheme for detecting colorectal lesions in which dual-energy features were used to identify different bowel materials and their partial-volume artifacts. Based on these features, the dual-energy CAD (DE-CAD) scheme extracted the region of colon by use of a lumen-tracking method, detected lesions by use of volumetric shape features, and reduced false positives by use of a statistical classifier. For validation, 20 patients were prepared for DE-CTC by use of reduced bowel cleansing and orally administered fecal tagging with iodine and/or barium. The DE-CTC was performed in dual positions by use of a dual-energy CT scanner (SOMATOM Definition, Siemens) at 140 kVp and 80 kVp energy levels. The lesions identified by subsequent same-day colonoscopy were correlated with the DE-CTC data. The detection accuracies of the DE-CAD and conventional CAD schemes were compared by use of leave-one-patient-out evaluation and a bootstrap analysis. There were 25 colonoscopy-confirmed lesions: 22 were 6 - 9 mm and 3 were flat lesions ≥10 mm in size. The DE-CAD scheme detected the large flat lesions and 95% of the 6 - 9 mm lesions with 9.9 false positives per patient. The improvement in detection accuracy by the DE-CAD was statistically significant.