CT colonography of the unprepared colon: An evaluation of electronic stool subtraction

Michael J. Carston, Robert J. Wentz, Armando Manduca, C. Daniel Johnson

Research output: Contribution to journalConference articlepeer-review

7 Scopus citations


CT colonography (CTC) is being extensively studied for its potential value in colon examinations, since it offers many advantages such as lower risk and less patient discomfort. However, CTC, like all other types of full structural colorectal examinations to date, requires complete bowel preparation. The inconvenience and discomfort associated with this preparation is an important obstacle to compliance with currently recommended colorectal screening guidelines. To maximize compliance, CTC would ideally be performed on an unprepared colon. However, in an unprepared colon residual stool and fluid can mimic soft tissue density and thus confound the identification of polyps. An alternative is to tag the stool with an opacifying agent so that it is brighter than soft tissue and thus easily recognized automatically and then reset to air values. However, such electronic stool subtraction in a totally unprepared colon is difficult to perform accurately for several reasons, including poorly labeled areas of stool, the need to accurately quantify partial volume effects, and noise. In this study the performance of a novel stool subtraction algorithm was assessed in unprepared CT colonography exams of 25 consecutive volunteers who had undergone colonoscopy with positive findings. Results showed 81% sensitivity to clinically relevant lesions > 1 cm with 0.52 false positives per patient compared to colonoscopy findings. Although further study and refinement of the stool subtraction process is required, CT colonography of the unprepared colon with electronic stool subtraction is feasible at detection levels comparable to the prepared colon.

Original languageEnglish (US)
Article number46
Pages (from-to)424-431
Number of pages8
JournalProgress in Biomedical Optics and Imaging - Proceedings of SPIE
Issue numberII
StatePublished - 2005
EventMedical Imaging 2005 - Physiology, Function, and Structure from Medical Images - San Diego, CA, United States
Duration: Feb 13 2005Feb 15 2005


  • CT
  • Cancer
  • Colon
  • Colon cleansing
  • Colonography
  • Colonoscopy
  • Electronic stool subtraction
  • Stool tagging

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging
  • Biomaterials


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