Helical CT of the small bowel with an alternative oral contrast material in patients with Crohn disease

Doerfler, Otto; Ruppert-Kohlmayr, A.; Reittner, Pia; Hinterleitner, Thomas; Petritsch, Wolfgang; Szolar, Dieter

doi:10.1007/s00261-002-0040-4

Cited by 46 publications

(31 citation statements)

References 11 publications

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“…Air, administered either orally through delayed-release effervescent substances or rectally, for the study of the terminal ileum, has produced satisfactory results in the demonstration of intraluminal and mural diseases, but the excessive difference between its density (2800 HU) and that of the enhanced intestinal wall (100-135 HU) often gives rise to artefacts, which have limited its use. Recently, some authors proposed the oral use of Mucofalk, which contains fibre from the outer shell seeds of podorozhnika, Plantago ovata; these seeds retain water in quantities much greater than their weight [17]. In contrast, Maglinte et al [4] proposed a suspension of 0.1% barium sulphate (Volumen) for oral use.…”

Section: Discussionmentioning

confidence: 99%

CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

Minordi¹,

Vecchioli²,

Mirk³

et al. 2011

BJR

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Objective: The aim of the study is to compare CT enterography with polyethylene glycol solution (PEG-CT) with CT enteroclysis (CT-E) in patients with suspected small bowel disease. Methods: 145 patients underwent abdominal contrast-enhanced 16-row multidetector CT after administration of 2000 ml of PEG by mouth (n575) or after administration of 2000 ml of methylcellulose by nasojejunal tube (n570). Small bowel distension, luminal and extraluminal findings were evaluated and compared with small bowel followthrough examination in 60 patients, double contrast enema in 50, surgery in 25 and endoscopy in 35. Statistical evaluation was carried out by x 2 testing. For both techniques we have also calculated the effective dose and the equivalent dose in a standard patient. Results: Crohn's disease was diagnosed in 64 patients, neoplasms in 16, adhesions in 6. Distension of the jejunum was better with CT-E than PEG-CT (p,0.05: statistically significant difference). No significant difference was present for others sites (p.0.05). Evaluation of pathological ileal loops was good with both techniques. The values of sensitivity, specificity and diagnostic accuracy were respectively 94%, 100% and 96% with CT-E, and 93%, 94% and 93% with PEG-CT. The effective dose for PEG-CT was less than the dose for the CT-E (34.7 mSv vs 39.91 mSv). Conclusion: PEG-CT shows findings of Crohn's disease as well as CT-E does, although CT-E gives better bowel distension, especially in the jejunum, and has higher specificity than PEG-CT.

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Section: Discussionmentioning

confidence: 99%

CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

Minordi¹,

Vecchioli²,

Mirk³

et al. 2011

BJR

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“…WCE on the other hand allows for excellent visualization of the SB mucosa, but its specificity is lower than other methods [6] , it does not clearly localise the lesions, histology cannot be taken, and there is a small but definite capsule retention rate contraindicating its use in SB strictures [7] . CTE has been well described [8] , has good sensitivity (71%-95%) and impressive specificity (90%-98%) and is superior to conventional enteroclysis [9] . The use of ionising radiation in CTE in a generally young patient cohort, however, is not ideal.…”

Section: Introductionmentioning

confidence: 99%

Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology

Lawrance¹,

Welman²,

Shipman³

et al. 2009

WJG

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AIM:To determine whether magnetic resonance imaging (MRI) can be used to categorize small bowel Crohn's disease (SB CD) into groups that correlate with response to medical therapy and surgical pathology. METHODS:Data was collected from all patients with MRI evidence of SB CD without significant colonic disease over a 32-mo period. Two radiologists, blinded to clinical findings, evaluated each MRI and grouped them based on bowel wall thickness and wall enhancement. These categories were: (1) "fibrosis", (2) "mild segmental hyper-enhancement and mild wall thickening", (3) "mild segmental hyper-enhancement and marked wall thickening", (4) "marked segmental transmural hyper-enhancement". Patient response to additional medical therapy post-MRI was prospectively determined at 8-wk. Non-responders underwent endoscopy and were offered therapeutic endoscopy or surgery. Surgical pathology was assessed against the MRI category. RESULTS:Fifty-five patients were included. Females and category "2" patients were more likely, and patients with luminal narrowing and hold-up less likely, to respond to medical therapy (P < 0.05). Seventeen patients underwent surgery. The surgical pathological findings of fibrosis and the severity of inflammation correlated with the MRI category in all cases. CONCLUSION:Our findings suggest that SB CD can be grouped by the MRI findings and that these groups are associated with patients more likely to respond to continued medical therapy. The MRI categories also correlated with the presence and level of intestinal inflammation and fibrosis on surgical pathology, and may be of prognostic use in the management of CD patients.

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“…The stomach is variable in shape and is often not distended. The small bowel is a long, tortuous, and tubular organ whose loops often overlap and are variable in their position (1). With the introduction of multidetector-row CT (MDCT), the entire abdomen and pelvis can be scanned during a short breathhold such that blurring due to motion is minimized.…”

mentioning

confidence: 99%

“…Furthermore, spatial resolution is improved and isotropic with the use of thin collimation (2). However, regardless of the technique used, the stomach and small bowel need to be distended for their lumen and walls to be evaluated (1,3). The stomach can be examined fluoroscopically; and the small bowel with enteroclysis, a relatively invasive method using fluoroscopy or CT, that requires infusing contrast medium directly into the small bowel via a nasojejunal tube (4).…”

mentioning

confidence: 99%

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

Oliva¹,

Ertürk²,

Ichikawa

et al. 2012

Journal of the Belgian Society of Radiology

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Objective: When examining patients with contrast-enhanced multidetector-row CT, we determined if the stomach and small bowel were visualized and distended better with a neutral barium sulphate suspension than with positive barium sulphate suspension or water. Materials and methods: After obtaining approval from our institutional review board, 156 patients (women: 84; mean age: 54 yrs) with no history of gastrointestinal tract disease were randomized prospectively to receive orally either 900 ml of neutral (0.1%w/v) barium sulphate suspension (n = 53), 900 ml of positive (2.1%w/v) barium sulphate suspension (n = 53), or 900 ml of water (n = 50), prior to undergoing contrast-enhanced abdominal and pelvic multidetector-row CT. Two independent radiologists evaluated the stomach, and small bowel, for luminal distension and wall visualization, using a five point scale. Results were compared using Kruskal-Wallis and Mann-Whitney U tests. Results: The walls of the stomach, and small bowel were visualized better in patients who were administered neutral barium sulphate suspension than those who were administered either positive barium sulphate suspension (p < 0.01) or water (p < 0.01). In patients who received neutral barium sulphate suspension, the stomach and small bowel were distended better compared to patients administered water (p < 0.01); the stomach, duodenum, and ileum were distended better compared to patients administered positive barium sulphate suspension (p < 0.05). Conclusions: When examining patients with intravenous contrast-enhanced abdominal and pelvic multidetector-row CT, orally administered neutral barium sulphate suspension allows the gastrointestinal tract to be visualized and distended better than either positive barium sulphate suspension, or water.

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Helical CT of the small bowel with an alternative oral contrast material in patients with Crohn disease

Abstract: Mucofalk CT is a simple, rapid, noninvasive, and accurate method of evaluating extramucosal manifestations of Crohn disease. The tubeless procedure improved patients' comfort and decreased time, cost, and radiation exposure.

Cited by 46 publications

References 11 publications

CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

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