Abstract
Objective: The purpose of this study was to demonstrate the role of CT enterography in detection and characterization of small bowel diseases.
Material and Methods: A total of 65 patients (mean age 41 years; range, 16-70 years), including 42 males and 23 females who were suspected of having small bowel disorders on the basis of clinical examination underwent CT enterography examination on a 64-slice CT Scanner prospectively using neutral oral contrast (Polyethylene glycol).
Results: The mean distensionof the small intestine was 1.8cm in jejunum and 2.3 cm in ileum. Out of 65 patients, 32 patients (49%) presented with abnormal small bowel thickening. Intestinal tuberculosis was the most common diagnosis in 11 cases (16.9%). Ileocaecal junction was involved predominantly in 81%cases and 81% cases of tuberculosis depicted homogenous enhancement with either focal (46%) or segmental (54%) involvement. Small bowel tumors were seen in 9 cases with majority of them adenocarcinoma (7 cases). Malignancy was associated with marked asymmetric thickening in 81%cases, focal thickening in 54% cases, and heterogenous enhancement in 91% cases.
Conclusion: CT enterography is an effective modality to evaluate small bowel disorders. It can not only assess mural and intraluminal small bowel pathologies but also assess extraintestinal findings so as to make correct diagnosis.
References
- Wold PB, Fletcher JG, Johnson CD, Sandborn WJ. Assessment of small bowel Crohn disease: non-invasive peroral CT enterography compared with other imaging methods and endoscopy—feasibility study. Radiology 2003;229:275–81.
- Maglinte DD, O’Connor K, Bessette J, Chernish SM, Kelvin FM. The role of the physician in the late diagnosis of primary malignant tumors of the small intestine. Am J Gastroenterol 1991;86:304
- Maglinte DD, Hallett RL, Rex D, Chua GT, Kelvin FM, Harmon B, Lappas J. Imaging of small bowel Crohn’s disease: Can abdominal CT replace barium radiography? Emergency Radiology 2001;8(3):127–33.
- Paulsen SR, Huprich JE, Fletcher JG, Booya F, Young BM, Fidler JL, et al. CT enterography as a diagnostic tool in evaluating small b owel disorders: review of clinical experience with over 700 cases. Radiographics. 2006;26(3):641-62.
- Macari M, Megibow AJ, Balthazar EJ. A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. AJR Am J Roentgenol 2007;188(5):1344–55.
- Megibow AJ, Babb JS, Hecht EM, Cho JJ, Houston C, Boruch MM, Williams AB. Evaluation of bowel distention and bowel wall appearance by using neutral oral contrast agent for multi-detector row CT. Radiology 2006;238(1):87–95.
- Baker ME, Hara AK, Platt JF, Maglinte DD, Fletcher JG. CT enterography for Crohn’s disease: optimal technique and imaging issues. Abdom Imaging 2015;40(5):938–952.
- Al-Hawary MM, Kaza RK, Platt JF. CT enterography: concepts and advances in Crohn’s disease imaging. RadiolClin North Am 2013;51(1):1–16.
- Paulsen SR, Huprich JE, Fletcher JG, Booya F, Young BM, Fidler JL, et al. CT enterography as a diagnostic tool in evaluating small b owel disorders: review of clinical experience with over 700 cases. Radiographics. 2006;26(3):641-62.
- Young BM, Fletcher JG, Booya F, Paulsen S, Fidler JJ, Johnson CD, et al. Head-to-head comparison of oral contrast agents for cross-sectional enterography: small bowel distention, timing, and side effects. J Comput Assist Tomogr 2008;32:32-8.
- Kalra N, Agrawal P, Mittal V, Kochhar R, Gupta V, Nada R, et al. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis. ClinRadiol. 2014; 69:315–22.
- Minordi LM, Vecchioli A, Mirk P, Bonomo L. CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease. Br J Radiol 2011;84:112-19.
- Fletcher, J.G., Huprich, J.E., Loftus, E.V. et al, Computerized tomography enterography and its role in small-bowel imaging. Clin Gastroenterol Hepatol. 2008;6:283–289.
- Balthazar EJ, Gordon R, Hulnick D. Ileocaecal tuberculosis: CT and radiologic evaluation. AJR Am J Roentgenol 1990;154:499- 503.
- Schindera ST, Nelson RC, DeLong DM, Jaffe TA, Merkle EM, Paulson EK, Thomas J, et al. Multi–detector row CT of the small bowel: peak enhancement temporal window—initial experience. Radiology 2007; 243:438–44.
- Megally HI, Elmalah HEM, Seifeldein GS, Abbas NA, Elamin HA. The Egyptian Society of Radiology and Nuclear Medicine 2015;46:1-8.
Corresponding Author
Neeti Aggarwal
Associate Professor Radiodiagnosis
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.62
