Effect of slice thickness and primary 2D versus 3D virtual dissection on colorectal lesion detection at CT colonography in 452 asymptomatic adults

OBJECTIVE. The objective of our study was to compare the performance of primary 3D search using 360° virtual dissection with primary 2D search using a 2.5- versus a 1.25-mm slice thickness. SUBJECTS AND METHODS. Four hundred fifty-two asymptomatic patients underwent CT colonography (CTC) and colonoscopy. Examinations were reconstructed to 1.25- and 2.5-mm slice thicknesses and interpreted using primary 3D search (360° virtual dissection) and primary 2D search. Two of three experienced reviewers were randomly assigned to each case; 1,808 interpretations were performed. RESULTS. There were 64 adenomas ≥ 6 mm, 26 of which were large adenomas ≥ 1 cm. For adenomas 6-9 mm in diameter, the area under the receiver operating characteristic curve (AUC) using 2.5-mm data sets was 0.66, 0.62, 0.90 and 0.78, 0.69, 0.67 for reviewers 1, 2, and 3, respectively, using primary 3D versus 2D search (p = not significant [NS]). For neoplasms ≥ 10 mm, the AUC using 2.5-mm data sets was 0.74, 0.85, 0.89 and 0.66, 0.86, 0.92 for reviewers 1, 2, and 3 using primary 3D versus 2D search (p = NS). There was no significant difference using 1.25-mm collimation. Double review using both primary 3D and 2D search yielded sensitivities of 84% (16/19) and 95% (18/19) for large neoplasms (≥ 1 cm) using 2.5- and 1.25-mm data sets, respectively. Five of five (100%) adenocarcinomas were identified. The sensitivity of colonoscopy for large neoplasms was 77% (20/26) (20% [1/5] for adenocarcinoma). CONCLUSION. No advantage exists for 1.25- or 2.5-mm slice thickness or for primary 3D versus 2D search at CTC. Double review using primary 3D (virtual dissection) and 2D search reduces interobserver variability and competes with colonoscopy for the detection of large lesions.