Enteroclisi-TC multistrato

Abstract

The authors illustrate the technique for small-bowel imaging using enteroclysis with multidetector-row computed tomography (MDCT), underscoring the important role played by CT in the assessment of the small bowel thanks to the advent of first the spiral and later the multidetector technique. The paper makes a detailed comparison of the various methods that have been used in CT study of the small bowel and proposes a standardised technique to achieve correct distension of bowel loops and adequate evaluation of bowel wall vascularity, making reference to the well-consolidated experiences of the various Italian research groups. The paper accurately describes the different procedures required for CT assessment of the small bowel, from nasojejunal intubation to the selection of the most appropriate acquisition phases for assessment of bowel wall vascularity.

Forty-slice MDCT enteroclysis: evaluation after oral administration of isotonic solution in Crohn’s disease

“…Tuttavia, oltre ai limiti propri della metodica ecografica -la presenza di gas nelle anse e la dipendenza dall'operatore -altre limitazioni all'esecuzione dell'esame sono da riconoscere nei lunghi tempi di esecuzione, quantificati da Parente in un range di 20-60 minuti per esame, e nella possibilità di sottostimare stenosi di basso grado [7]. La tomografia computerizzata (TC), senza o con distensione della anse intestinali (enteroclisi TC), si è proposta come metodica in grado di valutare accuratamente l'interessamento intestinale in questi pazienti, e, più recentemente, numerosi progressi sono stati raggiunti dall'utilizzazione dei più evoluti tomografi multidetettore [8][9][10][11][12][13][14][15]. La necessità dell'intubazione naso-digiunale rende però l'enteroclisi TC scarsamente tollerata, impedendone in alcuni casi l'esecuzione.…”

“…However, in addition to the limitations inherent to US, that is, the presence of bowel gas and operator dependency, further problems include the length of the examination, quantified by Parente et al as 20-60 min per exam, and the risk of underestimating low-grade stenoses [7]. CT, with or without bowel distension (CT enteroclysis), has been proposed as a modality allowing accurate assessment of bowel involvement and, more recently, its performance has been considerably improved by the use of the newer multidetector CT scanners [8][9][10][11][12][13][14][15]. However, the need for nasojejunal intubation makes CT enteroclysis poorly tolerated by patients, so its use is precluded in some cases.…”

The role of nasoenteric intubation in the MR study of patients with Crohn’s disease: our experience and literature review

“…degree of distension of the loops (evaluating both the mean diameter calculated between the two most distended loops and the two least distended loops of the entire length of the small bowel, and distension of all of the small-bowel loops); 2. visualisation of all bowel-wall lesions already identified at endoscopy and conventional enteroclysis; 3. presence of stenosis (>80% reduction in lumen diameter with respect to adjacent loops); 4. dilatation of loops proximal to the stenosis (increase in lumen diameter >2/3 with respect to healthy loops); 5. bowel-wall thickness (diseased loops with thickness >3 mm) [13]; 6. bowel-wall enhancement (diseased loop with wall enhancement greater than that of the wall of healthy loops); 7. type of T/I curve, with a peak >300 indicating active disease [14]; 8. comb sign; 9. presence of enlarged lymph nodes; 10. fibrofatty proliferation; 11. presence of complications (fistulas, abscesses);…”

Multidetector CT in small-bowel neoplasms

“…With regard to CT in studying the small bowel, its actual advantages have only recently been recognised. Introduction of the multidetector technique is also modifying the diagnostic workup of patients with suspected small-bowel disease [4][5][6][7][8], but only few reports have described the use of this method in patients with small-bowel neoplasms [9][10][11][12].…”

“…Per quanto riguarda l'esame TC nello studio dell'intestino tenue, solo da pochi anni sono stati riconosciuti gli effettivi vantaggi della metodica. L'introduzione della tecnica multidetettore sta inoltre modificando l'iter diagnostico nei pazienti con sospetta patologia tenuale [4][5][6][7][8], ma sono stati pubblicati pochi lavori che riportano l'impiego di tale metodica in pazienti con patologia neoplastica tenuale [9][10][11][12].…”