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CT enterography for Crohn’s disease: optimal technique and imaging issues

Abstract

CT enterography (CTE) is a common examination for patients with Crohn’s disease. In order to achieve high quality, diagnostic images, proper technique is required. The purpose of this treatise is to review the processes and techniques that can optimize CTE for patients with suspected or known Crohn’s disease. We will review the following: (1) how to start a CT enterography program; (2) workflow issues, including patient and ordering physician education and preparation; (3) oral contrast media options and administration regimens; (4) intravenous contrast media injection for uniphasic and multiphasic studies; (5) CTE radiation dose reduction strategies and the use of iterative reconstruction in lower dose examinations; (6) image reconstruction and interpretation; (7) imaging Crohn’s patients in the acute or emergency department setting; (8) limitations of CTE as well as alternatives such as MRE or barium fluoroscopic examinations; and (9) dictation templates and a common nomenclature for reporting findings of CTE in Crohn’s disease. Many of the issues discussed are summarized in the Abdominal Radiology Society Consensus MDCT Enterography Acquisition Protocol for Crohn’s Disease

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Acknowledgments

We would like to thank the many other members of the Crohn’s Disease Focus Group of the Society of Abdominal Radiology who contributed thoughts and ideas that are incorporated in this document: Mahmoud Al-Hawary, Suhda Anupindi, David Bruining, Kassa Darge, Jonathan Dillman, David Einstein, Jeff Fidler, Michael Gee, Flavius Gugliemo, Tracy Jaffe, Seong Ho Park, Daniel Podberesky, Jordi Rimola, Dushyant Sahani, Jorge Soto, Stuart Taylor, and last but not least Alec Megibow, whose foresight and leadership helped propel small bowel imaging into the 21st Century.

Conflict of interest

Dr. Baker receives support from Siemens Healthcare in the form of salary support, software, and hardware to investigate radiation dose reduction in CT and has informal consultations with Bracco. Dr. Fletcher receives support from Siemens Healthcare in the form of grant support. Dr. Maglinte is a consultant for Cook Inc. Drs. Hara and Platt has no conflicts of interest.

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Baker, M.E., Hara, A.K., Platt, J.F. et al. CT enterography for Crohn’s disease: optimal technique and imaging issues. Abdom Imaging 40, 938–952 (2015). https://doi.org/10.1007/s00261-015-0357-4

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Keywords

  • CT Enterography
  • Technique and issues