Radiology of the Small Intestine

Imaging Assessment of Paediatric Crohn’s Disease: a Literature Review

“…25 Multiple films are obtained with the patient in supine position, during different degrees of rotation and after compression, thus evaluating bowel mobility and flexibility. 23,[25][26][27][28] Small bowel enteroclysis can detect functional signs of CD, such as hyper-or hypo-mobility and the presence of intraluminal exudate, which results in barium flocculation appearing as blurred interfaces between the intraluminal barium and the mucosa. 25 Small bowel enteroclysis can also detect organic signs, including thickened straightened or nodular mucosal folds due to submucosal oedema secondary to lymphatic obstruction; pseudopolyps, presenting as well-defined round or oval filling defects; aphthous ulcers, presenting as shallow depressions (1-2 mm in diameter) with a surrounding radiolucent halo; or a combination of these features, giving a "cobblestone appearance".…”

“…25 Small bowel enteroclysis can also detect organic signs, including thickened straightened or nodular mucosal folds due to submucosal oedema secondary to lymphatic obstruction; pseudopolyps, presenting as well-defined round or oval filling defects; aphthous ulcers, presenting as shallow depressions (1-2 mm in diameter) with a surrounding radiolucent halo; or a combination of these features, giving a "cobblestone appearance". [25][26][27][28] Small bowel enteroclysis can also readily identify strictures, mesenteric fat creeping, fistulas, and prefistulas. Strictures appear with the so-called "string sign".…”

“…[25][26][27][28] Differently from any other imaging technique, small bowel enteroclysis is unable to detect the presence of abscesses, since they are not directly connected to the bowel lumen, and thus cannot be filled with contrast medium. [25][26][27][28] A large dose of radiation is needed to perform small bowel enteroclysis and small bowel follow-through. Because of this, and the advent of more modern and safe imaging modalities, conventional radiology has been almost totally abandoned in diagnosis and follow-up of CD.…”

Mesenteric border linear ulcer in Crohn disease: historical, radiologic, and pathologic perspectives

“…The linear ulcer along the concave border may extend over a few or many centimeters and can be continuous or interrupted. It is ideally shown by double-contrast enteroclysis but can be identified on single-contrast follow-through study, provided compression of appropriate degree is used [10]. It is best shown in profile, occupying the mesenteric border, at times with extension into the mesentery [11].…”