A Pattern Approach to the Abnormal Small Bowel: Observations at MDCT and CT Enterography

Macari, Michael; Megibow, Alec J.; Balthazar, Emil J.

doi:10.2214/ajr.06.0712

Cited by 158 publications

(198 citation statements)

References 44 publications

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Section: Imaging Findingsmentioning

confidence: 69%

“…Absence of stratification on T2-weighted images with stratified enhancement on T1-weighted images is often due to fibrosis, which is a typical longstanding CD [29,33,35,44] . This sign (stratified enhancement) also can be seen on MSCT (multi-slice CT) images [45,46] .Increased vascularity of the vasa recta (comb sign) is a sign of active inflammation. It arises from the combination of vascular engorgement of vasa recta and fibro-fatty proliferation and is demonstrated as multiple tubular, tortuous opacities on mesenteric side of ileum, aligned as the teeth of a comb [29] .…”

mentioning

confidence: 89%

“…Abscesses and phlegmon are well demonstrated at fat-saturated T2-weighted MR imaging and can be distinguished reliably, which aids in management planning. Fistulas and sinus tracts are also depicted, however, the reported sensitivity of MR imaging for depicting sinus tracts is 50%-75% when a conventional enteroclysis study is used as a reference [32,39,45] . Mesenteric lymphadenopathy ranging from 3 to 8 mm in size is depicted at MR imaging with a true fast imaging with steady state precession (FISP) or T2-weighted turbo spin-echo sequence [32,41] .…”

Section: Imaging Findingsmentioning

confidence: 99%

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Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

Zhu¹,

Xu²,

Gong³

et al. 2008

WJG

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High soft tissue contrast resolution, acquisition of multi-planar images and the possibility to obtain functional information make magnetic resonance an interesting imaging technique to evaluate the small bowel disease. The absence of ionizing radiation is an important feature of magnetic resonance imaging (MRI) examinations because inflammatory diseases such as Crohn's disease (CD) are studied most frequently, which are prevalent among children and young adults. MRI, using modern equipment and a rigorous technical approach, can offer detailed morphologic information and functional data on the small bowel. This article discusses the MRI protocols for small bowel and the MR imaging findings of small bowel diseases, such as CD and small bowel neoplasms. There are two main approaches for MRI of the small bowel: (1) study following oral administration of contrast material; and (2) study with distension of lumen obtained with contrast material that is introduced through a naso-jejunal tube (MR enteroclysis). Oral contrast agents for small bowel MRIOral contrast agents can be classified into positive, negative and biphasic categories according to their action on the signal intensity of bowel lumen.A positive agent is a paramagnetic substance that produces a high signal intensity on T1-weighted sequences. It reduces T1 relaxation time without, or only minimally, influencing T2 relaxation time. Because of the water content of the contrast solution, it also results in high signal intensity on T2-weighted images. Positive contrast agents include paramagnetic substances, such as gadolinium chelates, ferrous and manganic ions and manganese ions [12][13][14][15][16] . The use of positive oral contrast agents has been abandoned almost completely because a hyperintense lumen does not enable a clear differentiation with inflammatory parietal enhancement.A negative agent is a substance that produces a low signal intensity on T1-and T2-weighted sequences. These substances induce local inhomogeneity in the magnetic field that affects T1 and T2 relaxation time. T2 effects predominate and are caused by spin dephasing with a consequent loss of signal intensity. Negative contrast agents include perfluorooctyl bromide [17] , iron oxides [15,18] , and oral magnetic particles [14,15] . Barium sulfate, if used at high concentrations, can be considered a negative contrast agent [19] . Negative contrast agents are more favorable if hyperintense signal of the bowel wall and the surrounding fat tissue signs of acute inflammation have to be detected on T2-weighted sequences [15] . However, magnetic susceptibility on gradient echo sequences may alter image quality on breath-held T1-weighted images.The term "biphasic" recently was introduced to define those substances that show different signal intensities depending on different sequences [20] . The first group (hyperintense signal on T1-weighted images and hypointense signal on T2-weighted images) included manganese and substances that contain manganese, and gadolinium chelates, w...

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Section: Imaging Findingsmentioning

confidence: 69%

mentioning

confidence: 89%

Section: Imaging Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

Zhu¹,

Xu²,

Gong³

et al. 2008

WJG

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show abstract

“…The pattern approach for interpreting abnormalities detected on CT enterography was popularized by Macari et al 3 The criteria include location of abnormality in duodenum/jejunum/ileum, degree and symmetry of wall thickening, pattern of contrast enhancement, location of pathology within the bowel wall (mucosal/submucosal/serosal) and associated abnormality in the adjacent mesentery or vessels.…”

Section: Discussionmentioning

confidence: 99%

Utility of CT enterography in the evaluation of small bowel pathologies

et al. 2017

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INTRODUCTIONBarium follow through and enteroclysis were the radiological investigations of choice for evaluation of small bowel pathologies for many decades. They could display luminal and mucosal abnormalities well but could not demonstrate the state of the bowel wall and extension of the disease process outside the bowel. 1CT scan was able to overcome this particular limitation and demonstarte bowel well thickening and associated extraluminal changes such as inflammatory change, lymphadenopathy or local metastatic tumour spread from small bowel neoplasms. But conventional CT lacked the mucosal detail of small bowel barium studies CT enterography was first introduced by Raptopoulos et al, as modification to standard abdomino-pelvic CT examination to specifically examine the small bowel in detail, notably to assess the extent and severity of Crohn's disease.2 They combined neutral (low-density) oral contrast with "enteric phase" CT to optimize contrast resolution between mucosa and lumen, thereby maximizing conspicuity of abnormalities arising from the small bowel wall. ABSTRACTBackground: Radiology has been the primary investigation tool for small intestine because of technical challenges in endoscopy. Barium studies and computed tomography (CT) have been the most useful modalities over the years; however, neither is a complete investigation by itself. CT enterography offers the possibility of a single comprehensive radiological evaluation. The present study was undertaken to study the accuracy of CT enterography in characterising various small bowel pathologies. Methods: A total of 84 patients clinically suspected or known to have small intestinal disease underwent CT enterography on a 64 slice MDCT. The radiologic findings were correlated with clinical, endoscopy, histopathology and operative findings. Results: A wide variety of pathologies can be diagnosed accurately on CT enterography. In our study, majority of the patients had non-neoplastic pathologies (79%). Neoplastic lesions were detected in 21% of the patients of which 14% were malignant. There was good correlation between CT enterography and endoscopy, histopathology and operative findings. The ability of CT enterography to differentiate acute inflammation from chronic changes is valuable in management of Crohn's disease. Conclusions: CT enterography should be considered as the investigation of choice for radiological evaluation of small bowel pathologies as it provides a comprehensive evaluation of the disease process.

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“…MDCT enterography combined advantages of better spatial and temporal resolution of multidetector CT with oral intake of large volume of negative oral contrast to depict mucosal and submucosal pathology in detail. Excellent visualization of the entire wall thickness and of mucosa, depiction of detailed information about extent and severity of disease process have made CT enterography the primary imaging modality in evaluation of bowel wall disease (4,5,6) .…”

Section: Introductionmentioning

confidence: 99%

CT Enterography for diagnosis of Small Bowel Disorders

Aggarwal¹,

Radiodiagnosis²

2018

jmscr

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A Pattern Approach to the Abnormal Small Bowel: Observations at MDCT and CT Enterography

Abstract: This review shows how a systematic pattern approach can be used to narrow the differential diagnosis when an abnormal small-bowel loop is detected on MDCT.

Cited by 158 publications

References 44 publications

Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

Utility of CT enterography in the evaluation of small bowel pathologies

CT Enterography for diagnosis of Small Bowel Disorders

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