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By David J. Vining (auth.), Abraham H. Dachman MD (eds.)

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Ileocecal valve. (A) 3D endoluminal view shows polypoid-filling defect in the cecum (arrow). Morphology is most consistent with the ileocecal valve. However, masses can occur on or near the valve, so 2D confmnation is helpful. (B) Coronal CT image shows terminal ileum entering the cecum at this level, confirming ileocecal valve (arrow). FIGURE distended colon, they do not appear as occlusive lesions. Rather, when evaluated from an endoluminal 3D perspective, these external structures compressing the wall may appear to represent focal neoplasms.

3). In fiber optic colonoscopy, the tip of the colonoscope can be manually diverted to look in between each fold. However, to do this in virtual colonoscopy requires hardware and software capable of real-time rendering as well as considerable operator time and skill. The limitations in surface viewing and perspective distortion were the main motivations for developing alternative approaches to virtual endoscopy that utilize multiple, midrange ( -60°) FOV virtual cameras with different orientations to displayas much as the local colon topology as possible.

Primary reliance on 3D "virtual colonoscopy" techniques has the appeal of truly simulating conventional colonoscopy. Several workstation vendors using either surface- or volumerendered images are incorporating a centerline that the computer will generate automatically followed by a movie of the endoluminal view traversing this centerline. One can then navigate through the colon, either forward or backward, and stop to evaluate suspicious abnormalities. Optimization of review parameters such as threshold and lighting are software specifics and for the purpose of this discussion we will assume they have been optimized.

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