0:01

So for this case, I'm gonna show you something

0:02

that's a little more typical of most, uh, CT colonies.

0:06

Not everything is a mass, you know, or a large, large polyp.

0:10

I wanted to show you what some sub centimeter polyps look

0:12

like and how subtle they can sort of be.

0:14

Sometimes here you can see there's something

0:16

that looks different from the adjacent halal fold.

0:18

It looks like it's a, uh, something

0:21

that looks more Cecile in appearance as in lacking a stock.

0:25

So undulated is where the stock is narrower than the head

0:28

of the polyp, whereas uh, Cecile is something

0:31

that's has a broad base that doesn't, uh, have a stock.

0:34

And on the two D images you can confirm

0:36

that there's soft tissue attenuation there.

0:38

Maybe there's a little bit of contrast adjacent to it,

0:41

but this sal polyp measures less than a centimeter in size.

0:46

You measure on your calipers about seven millimeters

0:51

and uh, there may be one other one I can show you.

0:54

So there are two of them next to each other

0:57

and they send in the ascending colon.

0:59

Again, this one is measuring less than one centimeter in

1:02

size and I wanted to differentiate

1:04

that from other findings here in the colon.

1:07

Um, I'm show you the supine images

1:11

what tag stool looks like again,

1:13

and it's usually very easy

1:15

to see when there's tagging material on boards.

1:17

So here on the three D views, it's hard

1:20

to tell if you're dealing with a mass multiple masses

1:23

or stool without looking at the two D images.

1:26

So you really cannot do

1:28

CT colonography without using both the two D

1:30

and the three D images in conjunction.

1:32

You can't do it with two D images alone without uh,

1:35

three D correlation from measurement and from morphology.

1:38

But you also can't do it

1:40

with three D imaging alone without the two D images,

1:43

which is, uh, probably the reason why many endoscopists have

1:46

not gotten into virtual colonoscopy for themselves.

1:49

'cause you still have to learn how to read a CT image

1:52

and it's pretty easy to tell

1:54

that this is not soft tissue attenuation.

1:55

It's all tagged fecal material

1:58

and it looks relatively solid here

2:00

because there's no, uh,

2:01

gas fluid level in this particular case.

2:04

But it, uh, looks to be appropriately, um, repositioning

2:08

with changes in position and it looks

2:09

like it's adequately tagged.

2:11

So you can see through it to the colonic wall beyond.

2:15

And those polyps were confirmed endoscopically

2:17

as adenomas polyps.