CT Imaging of Colitis

Abstract

Computed tomography (CT) is widely used to assess patients with nonspecific abdominal pain or who are suspected of having colitis. The authors recommend multidetector CT with oral, rectal, and intravenous contrast material and thin sections, which can accurately demonstrate inflammatory changes in the colonic wall and help assess the extent of disease. In most cases, the final diagnosis of the type of colitis is based on clinical and laboratory data and colonoscopic and biopsy findings, but specific CT features help narrow the differential diagnosis. Ulcerative colitis is distinguished from granulomatous colitis (Crohn disease) in terms of location of involvement, extent and appearance of colonic wall thickening, and type of complications. Ulcerative colitis and Crohn disease (granulomatous colitis) are rarely associated with ascites, which is often seen in infectious, ischemic, and pseudomembranous colitis. Pseudomembranous colitis also demonstrates marked wall thickening and, occasionally, skip areas but is associated with broad-spectrum antibiotic treatment or chemotherapy. Neutropenic colitis is characterized by right-sided colonic and ileal involvement, whereas ischemic colitis is characterized by vascular distribution pattern and history. Diverticulitis is a focal asymmetric process with fascial thickening and inflamed diverticula. Dilatation of a thick-walled appendix with increased enhancement and adjacent stranding suggests appendicitis, but inflammatory changes may extend to the cecum and terminal ileum. Epiploic appendagitis is a focal rim-enhancing area next to the colon, usually without any substantial colonic wall thickening.

Shiga Toxin-Producing E. Coli O104:H4 Outbreak 2011 in Germany: Radiological Features of Enterohemorrhagic Colitis

“…All infectious types of colitis share the radiological features of wall thickening, pericolic stranding, and various degrees of ascites [12 -15]. In most infectious forms of colitis the distribution is contiguous or pancolic [12,13,22]. This is in contrast to the findings of this study, where the majority of patients presented with segmental involvement.…”

“…Pseudomembranous colitis also demonstrates marked wall thickening, but can be clinically differentiated due to its association with broad-spectrum antibiotic treatment and the detection of clostridium difficile toxin in the stool. Neutropenic colitis is characterized by right-sided colonic and ileal involvement, which was never observed in the patients of this study with STEC O104:H4 infection [12]. Diverticulitis can be discriminated, since the process is focal and asymmetric with fascial thickening and inflamed diverticula [25].…”

Ischemic Colitis: Surging Waves of Update

“…Pneumatosis coli or pneumatosis intestinalis can be diagnosed by demonstrating air bubbles in the colonic or intestinal wall. The gas bubbles are arranged in a linear trend and are best visualized with the window settings for bone or lung (Jones et al 1982;Balthazar et al 1999;Barkhausen et al 1999;Horton et al 2000;Horton and Fishman 2001;Wiesner and Willi 2001;Thoeni and Cello 2006). MRI is mostly useful for magnetic resonance angiography, particularly in individuals with compromised renal function.…”

Ischemic Colitis after Hemorrhagic Shock Due to Obstetrical Reasons

“…Plain abdominal radiographs are generally insensitive and they often show generalized bowel distension and air-filled bowel loops as in our patient. And the most common finding of CT in the evaluation of ischemic colitis is segmental circumferential wall thickening [5].…”