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Image textures in computed tomography colonography (CTC) have great potential for differentiating non-neoplastic from neoplastic polyps and thus can advance the current CTC detection-only paradigm to a new level with diagnostic capability. However, image textures are frequently compromised, particularly in low-dose CT imaging. Furthermore, texture feature extraction may vary, depending on the polyp spatial orientation variation, resulting in variable results. To address these issues, this study proposes an adaptive approach to extract and analyze the texture features for polyp differentiation. Firstly, derivative (e.g. gradient and curvature) operations are performed on the CT intensity image to amplify the textures with adequate noise control. Then Haralick co-occurrence matrix (CM) is used to calculate texture measures along each of the 13 directions (defined by the first and second order image voxel neighbors) through the polyp volume in the intensity, gradient and curvature images. Instead of taking the mean and range of each CM measure over the 13 directions as the so-called Haralick texture features, Karhunen-Loeve transform is performed to map the 13 directions into an orthogonal coordinate system so that the resulted texture features are less dependent on the polyp orientation variation. These simple ideas for amplifying textures and stabilizing spatial variation demonstrated a significant impact for the differentiating task by experiments using 384 polyp datasets, of which 52 are non-neoplastic polyps and the rest are neoplastic polyps. By the merit of area under the curve of receiver operating characteristic, the innovative ideas achieved differentiation capability of 0.8016, indicating the CTC diagnostic feasibility. [ABSTRACT FROM AUTHOR]