CT Enterography as a Diagnostic Tool in Evaluating Small Bowel Disorders: Review of Clinical Experience with over 700 Cases

Paulsen, S; Huprich, James E.; Fletcher, Joel G.; Booya, Fargol; Young, Brett M.; Fidler, Jeff L.; Johnson, C. Daniel; Barlow, John M.; Earnest, Franklin

doi:10.1148/rg.263055162

Cited by 401 publications

(307 citation statements)

References 45 publications

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“…The regression of inflammatory activity of CD at the strictureplasty site has been well documented by radiological, ultrasonographic, endoscopic or histological investigations [27][28][29][30][31] . During a reoperation, the surgeon can ap-…”

Section: Discussionmentioning

confidence: 98%

Is lymphatic status related to regression of inflammation in Crohn's disease?

Tonelli

Giudici²,

Liscia³

2012

WJGS

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AIM:To investigate the status of the lymphatic vessels in the small bowel affected by Crohn's disease (CD) at the moment of surgery. METHODS:During the period January 2011-June 2011, 25 consecutive patients affected by CD were operated on in our Institution. During surgery, Patent Blue Ⅴ was injected subserosally and the way it spread along the subserosa of the intestinal wall, through the mesenterial layers towards the main lymphatic collectors and eventually to the lymph nodes was observed and recorded. Since some patients had been undergone strictureplasty at previous surgery, we also examined the status of intestinal lymph vessels after previous strictureplasties. The same procedure was performed in a control group of 5 patients affected by colorectal cancer. Length of lesions, caliber, maximal thickness of the diseased intestinal wall, thickness of the wall at injection site and thickness of the mesentery were evaluated at surgery. RESULTS:We observed three features after the injection of Patent Blue Ⅴ in the intestinal loops: (1) Macroscopically healthy terminal ileum of patients with CD or colon cancer showed thin lymphatic vessels linearly directed toward the mesentery; (2) In mild lesions in which the intestinal wall did not reach 8 mm of thickness, we observed short, wide and tortuous lymphatic vessels directed longitudinally along the intestinal axis toward disease-free areas and then transversally toward the mesentery; and (3) Injection in the severely affected lesions, that had a thickness of the intestinal wall over 10 mm, did not show any feature of lymphatic vessels at least on the subserosal surface. There was a correlation between the thickness of the parietal wall and the severity of the lymphatic alterations. Normal lymphatic vessels were observed at previous strictureplasties in the presence of complete regression of the inflammation. CONCLUSION:Injection of Patent Blue Ⅴ in the intestinal wall could help distinguish healthy tracts of the small bowel from those macroscopically borderline.

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Section: Discussionmentioning

confidence: 98%

Is lymphatic status related to regression of inflammation in Crohn's disease?

Tonelli

Giudici²,

Liscia³

2012

WJGS

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“…Notably, the literature suggests that VoLumen (compared to other neutral and positive contrast media) provides the best distension of the small bowel. Neutral contrast agents, which are near water density (but are not absorbed as rapidly as ingested water), are effective in distending the small bowel, but at the same time, allow detailed evaluation of small bowel wall thickness, density, and enhancement, without any negative impact upon 3D postprocessing [1,8] . Several different protocols have been described in the literature regarding the administration of oral contrast media for CT enterography, including protocols solely comprised of VoLumen, protocols with a combination of water and VoLumen, and protocols composed almost entirely of water [9] .…”

Section: Ct Enterography Techniquementioning

confidence: 99%

“…Notably, however, intramural fat deposi tion is a nonspecific finding that can be seen not only in other causes of chronic bowel inflammation, but also in the setting of obesity, steroid use, and diabetes [8] . As a result of the disease's preferential involvement of the mesenteric side of the bowel, asymmetric fibrosis and pseudosacculations along the mesenteric border are also common in the chronic setting [6] .…”

Section: Chronic Bowel Diseasementioning

confidence: 99%

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

Raman

Horton²,

Fishman³

2013

WJR

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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

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“…El hallazgo de engrosamiento masiforme asimétrico en relación al íleon distal, asociado a una lesión quística con componente hemorrágico es altamente sugerente de esta patología. En el diagnóstico diferencial debe considerarse patología neoplásica y menos probablemente inflamatoria; esta última por lo general determina un engrosamiento parietal concéntrico con estratificación de la pared (19) .…”

Section: Caso Radiologico Para Diagnosticounclassified

Dolor Colico Y Distension Abdominal

Avaria¹,

O'Brien

2008

Rev. chil. radiol.

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CT Enterography as a Diagnostic Tool in Evaluating Small Bowel Disorders: Review of Clinical Experience with over 700 Cases

Cited by 401 publications

References 45 publications

Is lymphatic status related to regression of inflammation in Crohn's disease?

Is lymphatic status related to regression of inflammation in Crohn's disease?

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

Dolor Colico Y Distension Abdominal

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