Crohn Disease of the Small Bowel: Spiral CT Evaluation After Oral Hyperhydration with Isotonic Solution

Mazzeo, Salvatore; Caramella, Davide; Battolla, L; Melai, L; P, Masolino; Bertoni, Michele; Giusti, Patrizia; Cappelli, Carla; Bartolozzi, Carlo

doi:10.1097/00004728-200107000-00017

Cited by 69 publications

(61 citation statements)

References 12 publications

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“…In accordance with other authors [6], we decided to use a solution of PEG as an oral hypodense contrast medium. The choice of PEG is based on the fact that it is a well-known solution in widespread use for the preparation of endoscopic studies.…”

Section: Discussionmentioning

confidence: 89%

“…We are aware that there is no agreement in the literature about the usefulness of performing intestinal preparation before CT examination. Many authors [1,6,11] advise a light diet free of fruit and vegetables for 2 days before CT and the L M Minordi, A Vecchioli, P Mirk and L Bonomo administration of laxatives the day before. A few authors [12,13] advise fasting for 8-12 h prior to CT. We have been recommending our intestinal preparation for radiological study since 1980 and since 2000 for CT examination, and have found that the intestinal loops are usually clean so we plan to continue recommending this preparation.…”

Section: Discussionmentioning

confidence: 99%

“…Positive contrast agents allow intestinal loops to be delimited and help verify whether an expansive process is intra-or extraluminal, but they do not allow, given their high density, accurate evaluation of wall characteristics and they interfere with possible angiography-like threedimensional (3D) reconstructions [5]. Low-density agents are to be preferred because they allow better depiction of wall enhancement between the hypodensity of the intraluminal fluid and the hypodensity of the extraluminal fat and do not interfere with angiography-like 3D reconstructions [6].…”

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confidence: 99%

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CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

Minordi¹,

Vecchioli²,

Mirk³

et al. 2011

BJR

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Objective: The aim of the study is to compare CT enterography with polyethylene glycol solution (PEG-CT) with CT enteroclysis (CT-E) in patients with suspected small bowel disease. Methods: 145 patients underwent abdominal contrast-enhanced 16-row multidetector CT after administration of 2000 ml of PEG by mouth (n575) or after administration of 2000 ml of methylcellulose by nasojejunal tube (n570). Small bowel distension, luminal and extraluminal findings were evaluated and compared with small bowel followthrough examination in 60 patients, double contrast enema in 50, surgery in 25 and endoscopy in 35. Statistical evaluation was carried out by x 2 testing. For both techniques we have also calculated the effective dose and the equivalent dose in a standard patient. Results: Crohn's disease was diagnosed in 64 patients, neoplasms in 16, adhesions in 6. Distension of the jejunum was better with CT-E than PEG-CT (p,0.05: statistically significant difference). No significant difference was present for others sites (p.0.05). Evaluation of pathological ileal loops was good with both techniques. The values of sensitivity, specificity and diagnostic accuracy were respectively 94%, 100% and 96% with CT-E, and 93%, 94% and 93% with PEG-CT. The effective dose for PEG-CT was less than the dose for the CT-E (34.7 mSv vs 39.91 mSv). Conclusion: PEG-CT shows findings of Crohn's disease as well as CT-E does, although CT-E gives better bowel distension, especially in the jejunum, and has higher specificity than PEG-CT.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

Minordi¹,

Vecchioli²,

Mirk³

et al. 2011

BJR

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“…In 2007, Mazzeo et al [50] reported that in over 20% of patients CT enterography was inadequate owing to poor distension. However, a smaller study performed by Wold et al [8] showed no significant difference in distension between CT enteroclysis and enterography.…”

Section: Comparing Ct Enterography With Other Modalitiesmentioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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ABSTRACT. CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation. Until recently, diagnosis of small bowel pathology had relied primarily on radiological techniques, in part due to the relative inaccessibility of the small bowel to conventional endoscopy. However, new endoscopic developments-notably the recent introduction of capsule endoscopy and double balloon enteroscopy-are challenging this position. Capsule endoscopy, for example, is now generally accepted as first-line investigation for occult gastrointestinal haemorrhage, and increasingly advocated for diagnosis of early Crohn's disease. However, the radiological community has not stood still. In parallel with the development of new endoscopic techniques, rapid progress has been made in crosssectional imaging technologies, harnessing the power of multidetector row CT (MDCT), MRI and ultrasound, facilitating rapid, accurate and minimally invasive investigation of the small bowel and adjacent tissues.CT enterography was first introduced by Raptopoulos et al [1] in 1997 as a 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 [1,2]. They combined neutral (low-density) oral contrast with ''enteric phase'' CT to optimise contrast resolution between mucosa and lumen, thereby maximising conspicuity of abnormalities arising from the small bowel wall. Several authors have subsequently described similar techniques, which are broadly categorised into CT enterography (where patients drink oral contrast) and CT enteroclysis (luminal contrast is introduced via a nasojejunal tube placed fluoroscopically prior to CT examination). Although superior jejunal distension is attained using enteroclysis, the convenience, efficiency and superior patient experience achieved with CT enterography make it the preferred technique at the authors' institutions, and therefore the focus of this review. This paper will critically review the CT enterography technique and provide practical tips on interpretation to assist radiologists and help them avoid common interpretative pitfalls. We will also examine its role relative to other complementary non-ionising radiation radiological tests. TechniqueThe technique of CT enterography combines small bowel distension with a neutral or low-density oral contrast mixture and abdomino-pelvic CT examination during the enteric phase following administration of intravenous contrast. Patients drink approximately 1.5-2 l of oral contrast over 45-60 min. Patient comp...

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“…Whereas both MRI [7] and MDCT enteroclysis [8] allow optimal lumen distension, oral administration of contrast agent with the proper choice of oral contrast material and adequate timing can produce good results [9,10], is more patient-friendly and less time consuming. For MDCT, the choice of oral contrast agent is usually determined by the anatomical SI region of interest and the clinical question to be answered ( Figure 1).…”

Section: Mdctmentioning

confidence: 99%

Malignant tumours of the small intestine: a review of histopathology, multidetector CT and MRI aspects

Anzidei¹,

Napoli²,

Zini³

et al. 2011

BJR

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ABSTRACT. Small bowel neoplasms, including adenocarcinoma, carcinoid tumour, lymphoma and gastrointestinal stromal tumours, represent a small percentage of gastrointestinal cancers, yet are among those with the poorest prognosis compared with other gastrointestinal malignancies. Unclear clinical scenarios and difficult radiological diagnosis often delay treatment with negative effects on patient survival. Recently, multidetector CT (MDCT) and MRI have been introduced as feasible and accurate diagnostic techniques for the identification and staging of small bowel neoplasms. These techniques are gradually replacing conventional barium radiography as the tool of choice. However, the inherent technical and physiological challenges of small bowel imaging require a familiarity with patient preparation and scan protocols. Adequate knowledge of the histopathology and natural evolution of small bowel neoplasms is also important for differential diagnosis. The aim of this article is to review MDCT and MRI protocols for the evaluation of small bowel tumours and to provide a concise yet comprehensive guide to the most relevant imaging features relative to histopathology.

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Crohn Disease of the Small Bowel: Spiral CT Evaluation After Oral Hyperhydration with Isotonic Solution

Abstract: Our method allowed adequate distension of the small bowel for spiral CT studies, thus resulting in a safe and effective alternative to small-bowel spiral CT enema, which can be used in patients that refuse the nasojejunal balloon catheter.

Cited by 69 publications

References 12 publications

CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

CT enterography: review of technique and practical tips

Malignant tumours of the small intestine: a review of histopathology, multidetector CT and MRI aspects

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