Computed tomography of Crohn’s disease: The role of three dimensional technique

Abstract

the proper use of 3-D technique (including volume rendering and maximum intensity projection) as a routine component of enterography interpretation can play a vital role in improving diagnostic accuracy.© 2013 Baishideng. All rights reserved. Key words:Crohn's disease; Computed tomography angiography; Multidetector computed tomography; Three dimensional technique; Volume rendering; Maximum intensity projection; Fistula; Dose reduction Core tip: Advancements in computed tomography (CT) enterography protocol design, three dimensional (3-D) post-processing software, and CT scanner technology have allowed increasing accuracy in diagnosis, and the acquisition of studies at a much lower radiation dose. The cases in this review will illustrate that the use of 3-D technique, proper enterography protocol design, and a detailed understanding of the different manifestations of Crohn's disease are all critical in properly diagnosing the full range of possible complications in Crohn's patients. INTRODUCTIONCrohn's disease, a form of transmural inflammatory bo wel disease affecting over 1.5 million Americans and Eu ropeans, remains a difficult entity to diagnose clinically: While involvement of any segment of the gastrointestinal tract is possible, the disease most often affects the mes enteric small bowel, making direct endoscopic evaluation and biopsy difficult. Moreover, symptoms tend to be nonspecific, and there are no clinical symptoms or labora AbstractCrohn's disease, a transmural inflammatory bowel disease, remains a difficult entity to diagnose clinically. Over the last decade, multidetector computed tomography (CT) has become the method of choice for noninvasive evaluation of the small bowel, and has proved to be of significant value in the diagnosis of Crohn's disease. Advancements in CT enterography protocol design, three dimensional (3-D) post-processing software, and CT scanner technology have allowed increasing accuracy in diagnosis, and the acquisition of studies at a much lower radiation dose. The cases in this review will illustrate that the use of 3-D technique, proper enterography protocol design, and a detailed understanding of the different manifestations of Crohn's disease are all critical in properly diagnosing the full range of possible complications in Crohn's patients. In particular, CT enterography has proven to be effective in identifying involvement of the small and large bowel (including active inflammation, stigmata of chronic inflammation, and Crohn's-related bowel neoplasia) by Crohn's disease, as well as the extra-enteric manifestations of the disease, including fistulae, sinus tracts, abscesses, and urologic/hepatobiliary/osseous complications. Moreover, Raman SP et al . 3-D MDCT imaging of Crohn's disease

The Additional Diagnostic Value of the Three-dimensional Volume Rendering Imaging in Routine Radiology Practice

“…This can be linked directly to the evolution of computer hardware [3, 7]. The 3DVR technique takes the entire volume of data, shows the contributions of each voxel along a line from the viewer's eye through the data set, and displays the resulting composite for each pixel of the display [4, 8]. The VR technique has been implemented both in specialized hardware and software for more readily available systems.…”

“…Thus, 3D images can be rendered in real-time at rates exceeding 5-10 frames/sec. The incorporation of information from the entire volume can lead to greater fidelity of data; however, more powerful computers are required to perform VR modality at a reasonable speed [4, 8, 9]. We think that the broader availability of computer systems will allow for the widespread use of 3DVR in routine radiology practice in the near future.…”

“…Indeed, the surgeons will someday have their own interactive volume displays, which suggests how the role of radiology will rest more firmly on shared resources and expanded communication. Thus, the role of 3DVR in radiology continues to grow rapidly [4, 6, 8-11].…”

The prevalence of oral lesions in patients with inflammatory bowel disease

“…CTE was introduced in 1997 as a modified version of the abdominal CT to evaluate small bowel changes in patients with Crohn's disease (53). Over the years the technology has improved to limit radiation exposure and provide better imaging (54). In comparison to endoscopy and barium studies, this technique is useful, non-invasive, well tolerated and easily performed (53).…”

Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review

“…Multi-detector computed tomography (MDCT) is the first-line imaging modality for various conditions ranging from acute bleedings [ 1 ] and acute intestinal ischemia [ 2 ] to Crohn’s disease [ 3 ] and gastrointestinal cancer [ 4 , 5 ]. While MDCT is based on X-ray emissions of one energy level, dual-energy computed tomography (DECT) acquires datasets at two different energy levels, either through emission or through separation at the detector level, providing new imaging and reconstruction possibilities [ 6 ].…”