Digital subtraction dark-lumen MR colonography: Initial experience

Purpose: To evaluate image subtraction for the detection of colonic pathologies in a dark-lumen MR colonography exam. Materials and Methods: A total of 20 patients (12 males; 8 females; mean 51.4 years of age) underwent MR colonography after standard cleansing and a rectal water enema on a 1.5-T whole-body MR system. After suppression of peristaltic motion, native and Gd-contrast-enhanced three-dimensional T1-w gradient echo images were acquired in the coronal plane. Two radiologists analyzed the MR data sets in consensus on two separate occasions, with and without the subtracted images for lesion detection, and assessed the value of the subtracted data set on a five-point Likert scale (1 = very helpful to 5 = very unhelpful). All imaging results were compared with endoscopy. Results: Without subtracted images, MR-colonography detected a total of five polyps, two inflammatory lesions, and one carcinoma in eight patients, which were all verified by endoscopy. Using subtraction, an additional polyp was found, and readout time was significantly shorter (6:41 vs. 7:39 minutes; P < 0.05). In two patients, endoscopy detected a flat adenoma and a polyp (0.4 cm) that were missed in the MR exam. Sensitivity and specificity without subtraction were 0.67/1.0, and 0.76/1.0 with the subtracted images, respectively. Subtraction was assessed as helpful in all exams (mean value 1.8 +/- 0.5 Likert scale). Conclusion: : We consider subtraction of native from contrast-enhanced dark-lumen MR colonography data sets as a beneficial supplement to the exam. (c) 2005 Wiley-Liss, Inc.