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Each month we provide you with
a feature article. This article is authored by one of our
clinicians. Please direct all comments/questions to
info@cdaradiology.com.
CT Enterography - Feature
1007
The small bowel has historically been difficult to examine. Single
contrast barium examinations were the mainstay for many years, but
these investigations have been hampered by low specificity. Barium
enterography has improved diagnostic value in some conditions but
limited by the time intensive nature and the need for a nasogatric
intubation. Endoscopic technique is unable to reach large segments
of the small bowel. Capsule endoscopy shows some promise but also
has limitations.
CT enterography seeks to improve upon the radiographic techniques.
In particular, the cross sectional visualization allows for a
transmural evaluation of the bowel wall, negates the disadvantage of
overlapping bowel loops, and allows for identification of extra
alimentary pathologies.
Patient comfort is significantly improved over barium enterography
as a nasogastric tube is unnecessary. Patients are asked to ingest
1200 ml of Volumen over 1.5 hour period. Unlike many oral agents in
medicine, Volumen is palatable and tastes much like water. Iodinated
contrast material is injected through an IV at 45 seconds to produce
maximal mucosal enhancement.
The most widely studied group of disorders is inflammatory bowel
disease, i.e. Chron’s disease and ulcerative colitis. The extent and
activity of the inflammation can be assessed. The efficacy of
therapy can be monitored. Complications such as fistula and
abscesses can be identified. Although not as widely studied, partial
small bowel obstruction and occult gastrointestinal masses can also
be studied. Occasionally, with protocol manipulations
arterial–venous malformation can be identified.
Author
Brian McNamee, MD
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