Utility of CT enterography in the evaluation of small bowel pathologies

Abstract

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.