Suspected Anastomotic Recurrence of Crohn Disease after Ileocolic Resection: Evaluation with CT Enteroclysis

Abstract

http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091165/-/DC1.

Small bowel adenocarcinoma in Crohn disease: CT-enterography features with pathological correlation

“…We found that this condition may display various features. The most important result of our study, however, is that in some cases, the tumor is not visible, and the presentation is similar to those observed in benign fibrostenosis [13,14] or acute inflammation [9,10,13,15].…”

“…CT-enterography images obtained after intravenous administration of iodinated contrast material were analyzed with respect to the presence of mural hyperenhancement [9,10,14], mural stratification [10,14,28], heterogeneous enhancement [10,28], comb sign, and small bowel masses [10,29]. Mural hyperenhancement on CT-enterography images was considered to be present when segmental enhancement in all or part of the wall of the small bowel was greater than that in the adjacent loops of the small bowel at visual assessment [10].…”

Crohn’s disease: prevalence of intestinal and extraintestinal manifestations detected by computed tomography enterography with water enema

“…In our study, isolated ileal distribution (52.4%) was prevalent over both ileocolic (23.5%) and colonic (15.8%) ones, and in anastomotic recurrences the neoterminal ileum was affected in all cases. A recent study has demonstrated the utility of CTE in the assessment of the ileocolic anastomosis in CD [2], underscoring that CTE is superior to endoscopy in the evaluation of the ileal side, which is not accessible by lower endoscopy in 1/3 of cases. In this regard our CTE-WE allows a good assessment of both sides of the anastomosis providing simultaneous distension of small and large bowel.…”

“…Upper gastrointestinal (gastroduodenal) forms are rarely observed [1]. In CD recurrence after bowel resection surgery, there is a predilection for the neoterminal ileum [2,3].…”

“…Currently, the advantages of CT over MR imaging include greater availability, higher spatial resolution and, in particular, the ability to simultaneously depict bowel wall inflammation, extraenteric complications, and abdominal organs in shorter examination times. Computed tomography enterography (CTE) combined with ileocolonoscopy represents in many centers the first line approach to the evaluation of CD patients, which is also considered a promising imaging tool for detection of anastomotic recurrence [2] and extraintestinal manifestations [16]. The main disadvantage of CTE is ionizing radiation exposure, but the development of new, promising techniques of dose optimization and reduction will probably overcome this problem [17].…”