Computed tomography enterography (CT enterography, CTE) is a medical imaging technique which uses computed tomography scanner and contrast media to examine the small bowel.[1] It was first introduced by Raptopoulos et al. in 1997.[2] CT Enterography can be used to assess a variety of problems involving the small bowel, however it is mainly used to diagnose and assess severity of Crohn's disease.[3]
CT enterography should not be confused with CT enteroclysis. In CT enterography contrast media is given orally, and in CT enteroclysis contrast media is administered through a fluoroscopy-guided positioned nasojejunal tube.[3]
CTE provides enough distention of the bowel not present during normal CT imaging to increase the ability to examine in lumen and internal lining of the small intestines.[4] When the small bowel is not properly distended it can be difficult to see if there is a problem in that area.[5] CTE also provides better visualization of extraenteric findings, as well as acute inflammation, of Crohn's disease. These extraenteric findings include, but no limited to, fistulas and abscesses.[5] Additionally, compared with CT enteroclysis, the patient does not need to be sedated for CTE nor requires the invasive step of placing the nasojejunal tube.[3]
Disadvantagesedit
While CTE's main use is in the diagnosis and follow up in Crohn's disease, many of the findings on Crohn's disease found on CTE can be caused by a wide variety of other conditions.[5] Spasm and collapse of the small intestine, which can happen in Crohn's disease, can obscure imaging of that portion of the bowel even with CTE.[5]
Indicationsedit
Suspected small bowel bleeding in a hemodynamically stable patient[6]
At least four hours of no intake of solid foods, patient may have clear liquids. Metoclopramide (Reglan) will be administered to assist with emptying the stomach and increase movement through the small intestines. Large amounts of an oral contrast agent are given to the patient. Neutral contrast agents are preferred over positive contrast agents such as barium. The neutral agents are vitally important for the effective visualization of the lining of the small intestine. Use of positive contrast agents could make it difficult to see any inflammation in the lining. Neutral agents include water, EG electrolyte solution, sugar alcohols, and methylcellulose. Patients are usually able to drink the large of amounts of these agents required for the study without major difficulty.[5] This step is given at increments of 0, 20, 40, and 55 minutes after Reglan dose. Glucagon is given to patient five minutes before they enter the CT scanner to counter act the previous medication and attempt to slow down bowel activity. Intravenous contrast is also given when the patient is on the scanner. The patient will then enter the scanner for the image to be captured.[3]
Use in Crohn's Diseaseedit
CTE is preferred for the examination of Crohn's disease due to its increased spatial resolution and better ability to examine the wall of the small intestine than traditional CT studies of the abdomen and pelvis.[5] Findings on CTE that indicate active inflammation in the small bowel, possibly caused by Crohn's disease, include:
^Diseases of the abdomen and pelvis 2010-2013 : diagnostic imaging and interventional techniques. Jürg Hodler, Gustav Konrad von Schulthess, Ch. L. Zollikofer, International Diagnostic Course in Davos, Nuclear Medicine Statellite Course '"Diamond", Pediatric Satellite Course "Kangaroo". Milano. 2010. ISBN978-88-470-1637-8. OCLC 697276986.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
^Image processing in radiology : current applications. E. Neri, D. Caramella, C. Bartolozzi. Berlin: Springer. 2008. ISBN978-3-540-25915-2. OCLC 233973111.{{cite book}}: CS1 maint: others (link)
^ abcdeDave-Verma, Hetal; Moore, Scott; Singh, Ajay; Martins, Noel; Zawacki, John (November 2008). "Computed Tomographic Enterography and Enteroclysis: Pearls and Pitfalls". Current Problems in Diagnostic Radiology. 37 (6): 279–287. doi:10.1067/j.cpradiol.2007.08.007. PMID 18823868.
^Bhatt, Shuchi; Roy, Satarupa; Bhardwaj, Naveen; Tandon, Anupama; Singh, Vikas Kumar; Jain, Bhupender Kumar; Mandal, Samrat (2017). "Kaleidoscopic View of Bowel Tuberculosis on Multi- Detector Computed Tomography (CT) Enterography – A Novel Technique Unfolding an Archaic Disease". Polish Journal of Radiology. 82: 783–791. doi:10.12659/PJR.903473. ISSN 1899-0967. PMC5894039. PMID 29657645.
^ abcdefghPaulsen, Scott R.; Huprich, James E.; Fletcher, Joel G.; Booya, Fargol; Young, Brett M.; Fidler, Jeff L.; Johnson, C. Daniel; Barlow, John M.; Earnest, Franklin (May 2006). "CT Enterography as a Diagnostic Tool in Evaluating Small Bowel Disorders: Review of Clinical Experience with over 700 Cases". RadioGraphics. 26 (3): 641–657. doi:10.1148/rg.263055162. ISSN 0271-5333. PMID 16702444.
^ abcdePark, Seong Ho; Ye, Byong Duk; Lee, Tae Young; Fletcher, Joel G. (September 2018). "Computed Tomography and Magnetic Resonance Small Bowel Enterography". Gastroenterology Clinics of North America. 47 (3): 475–499. doi:10.1016/j.gtc.2018.04.002. PMID 30115433. S2CID 52019244.
^ abcElsayes, Khaled M.; Al-Hawary, Mahmoud M.; Jagdish, Jagalpathy; Ganesh, Halemane S.; Platt, Joel F. (November 2010). "CT Enterography: Principles, Trends, and Interpretation of Findings". RadioGraphics. 30 (7): 1955–1970. doi:10.1148/rg.307105052. ISSN 0271-5333. PMID 21057129.
^Bruining, David H.; Zimmermann, Ellen M.; Loftus, Edward V.; Sandborn, William J.; Sauer, Cary G.; Strong, Scott A.; Al-Hawary, Mahmoud; Anupindi, Sudha; Baker, Mark E.; Bruining, David; Darge, Kassa (March 2018). "Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease". Gastroenterology. 154 (4): 1172–1194. doi:10.1053/j.gastro.2017.11.274. PMID 29329905.
May 04, 2024
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Computed tomography enterography CT enterography CTE is a medical imaging technique which uses computed tomography scanner and contrast media to examine the small bowel 1 It was first introduced by Raptopoulos et al in 1997 2 CT Enterography can be used to assess a variety of problems involving the small bowel however it is mainly used to diagnose and assess severity of Crohn s disease 3 CT enterographySpecialtyRadiology edit on Wikidata CT enterography should not be confused with CT enteroclysis In CT enterography contrast media is given orally and in CT enteroclysis contrast media is administered through a fluoroscopy guided positioned nasojejunal tube 3 Contents 1 Advantages 2 Disadvantages 3 Indications 4 Protocol 5 Use in Crohn s Disease 6 Contraindications and special considerations 7 See also 8 ReferencesAdvantages editCTE provides enough distention of the bowel not present during normal CT imaging to increase the ability to examine in lumen and internal lining of the small intestines 4 When the small bowel is not properly distended it can be difficult to see if there is a problem in that area 5 CTE also provides better visualization of extraenteric findings as well as acute inflammation of Crohn s disease These extraenteric findings include but no limited to fistulas and abscesses 5 Additionally compared with CT enteroclysis the patient does not need to be sedated for CTE nor requires the invasive step of placing the nasojejunal tube 3 Disadvantages editWhile CTE s main use is in the diagnosis and follow up in Crohn s disease many of the findings on Crohn s disease found on CTE can be caused by a wide variety of other conditions 5 Spasm and collapse of the small intestine which can happen in Crohn s disease can obscure imaging of that portion of the bowel even with CTE 5 Indications editSuspected small bowel bleeding in a hemodynamically stable patient 6 Crohn s disease 6 Initially evaluation and follow up Unexplained diarrhea 6 Small Bowel masses 3 Malignant Adenocarcinoma Carcinoid Lymphoma Gastrointestinal stromal tumor Non malignant Hyperplastic polyps Hamartomatous polyps sencondary to Peutz Jeghers syndrome Adenomas Lipomas Hemangiomas Ectopic gastric or pancreatic tissue Meckel s diverticulumProtocol editAt least four hours of no intake of solid foods patient may have clear liquids Metoclopramide Reglan will be administered to assist with emptying the stomach and increase movement through the small intestines Large amounts of an oral contrast agent are given to the patient Neutral contrast agents are preferred over positive contrast agents such as barium The neutral agents are vitally important for the effective visualization of the lining of the small intestine Use of positive contrast agents could make it difficult to see any inflammation in the lining Neutral agents include water EG electrolyte solution sugar alcohols and methylcellulose Patients are usually able to drink the large of amounts of these agents required for the study without major difficulty 5 This step is given at increments of 0 20 40 and 55 minutes after Reglan dose Glucagon is given to patient five minutes before they enter the CT scanner to counter act the previous medication and attempt to slow down bowel activity Intravenous contrast is also given when the patient is on the scanner The patient will then enter the scanner for the image to be captured 3 Use in Crohn s Disease editCTE is preferred for the examination of Crohn s disease due to its increased spatial resolution and better ability to examine the wall of the small intestine than traditional CT studies of the abdomen and pelvis 5 Findings on CTE that indicate active inflammation in the small bowel possibly caused by Crohn s disease include Mural hyperenhancement 5 Mural stratification 5 Thickening of bowel wall 7 Mesenteric fat stranding 7 Enlarged vasa recta 7 CTE is also used in examining if bowel inflammation improves after therapy and if the disease is progressing in a concerning way 8 Contraindications and special considerations editPregnancy Bowel obstruction Magnetic Resonance Enterography if that patient has a history of many CT scans previously 6 CT of abdomen and pelvis if unable to tolerate oral contrast 6 See also editMR enterography Upper gastrointestinal seriesReferences edit Diseases of the abdomen and pelvis 2010 2013 diagnostic imaging and interventional techniques Jurg Hodler Gustav Konrad von Schulthess Ch L Zollikofer International Diagnostic Course in Davos Nuclear Medicine Statellite Course Diamond Pediatric Satellite Course Kangaroo Milano 2010 ISBN 978 88 470 1637 8 OCLC 697276986 a href Template Cite book html title Template Cite book cite book a CS1 maint location missing publisher link CS1 maint others link Image processing in radiology current applications E Neri D Caramella C Bartolozzi Berlin Springer 2008 ISBN 978 3 540 25915 2 OCLC 233973111 a href Template Cite book html title Template Cite book cite book a CS1 maint others link a b c d e Dave Verma Hetal Moore Scott Singh Ajay Martins Noel Zawacki John November 2008 Computed Tomographic Enterography and Enteroclysis Pearls and Pitfalls Current Problems in Diagnostic Radiology 37 6 279 287 doi 10 1067 j cpradiol 2007 08 007 PMID 18823868 Bhatt Shuchi Roy Satarupa Bhardwaj Naveen Tandon Anupama Singh Vikas Kumar Jain Bhupender Kumar Mandal Samrat 2017 Kaleidoscopic View of Bowel Tuberculosis on Multi Detector Computed Tomography CT Enterography A Novel Technique Unfolding an Archaic Disease Polish Journal of Radiology 82 783 791 doi 10 12659 PJR 903473 ISSN 1899 0967 PMC 5894039 PMID 29657645 a b c d e f g h Paulsen Scott R Huprich James E Fletcher Joel G Booya Fargol Young Brett M Fidler Jeff L Johnson C Daniel Barlow John M Earnest Franklin May 2006 CT Enterography as a Diagnostic Tool in Evaluating Small Bowel Disorders Review of Clinical Experience with over 700 Cases RadioGraphics 26 3 641 657 doi 10 1148 rg 263055162 ISSN 0271 5333 PMID 16702444 a b c d e Park Seong Ho Ye Byong Duk Lee Tae Young Fletcher Joel G September 2018 Computed Tomography and Magnetic Resonance Small Bowel Enterography Gastroenterology Clinics of North America 47 3 475 499 doi 10 1016 j gtc 2018 04 002 PMID 30115433 S2CID 52019244 a b c Elsayes Khaled M Al Hawary Mahmoud M Jagdish Jagalpathy Ganesh Halemane S Platt Joel F November 2010 CT Enterography Principles Trends and Interpretation of Findings RadioGraphics 30 7 1955 1970 doi 10 1148 rg 307105052 ISSN 0271 5333 PMID 21057129 Bruining David H Zimmermann Ellen M Loftus Edward V Sandborn William J Sauer Cary G Strong Scott A Al Hawary Mahmoud Anupindi Sudha Baker Mark E Bruining David Darge Kassa March 2018 Consensus Recommendations for Evaluation Interpretation and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn s Disease Gastroenterology 154 4 1172 1194 doi 10 1053 j gastro 2017 11 274 PMID 29329905 Retrieved from https en wikipedia org w index php title Computed tomography enterography amp oldid 1176394291, wikipedia, wiki, book, books, library,
