Advertisement

European Radiology

, Volume 16, Issue 7, pp 1527–1536 | Cite as

Multidetector CT enteroclysis versus barium enteroclysis with methylcellulose in patients with suspected small bowel disease

  • Laura Maria MinordiEmail author
  • Amorino Vecchioli
  • Luisa Guidi
  • Paoletta Mirk
  • Luisa Fiorentini
  • Lorenzo Bonomo
Gastrointestinal

Abstract

The purpose of this study was to evaluate the diagnostic accuracy of multidetector-CT enteroclysis (MDCT-E) versus barium enteroclysis with methylcellulose (BE) in clinically selected patients with suspected small bowel disease. We prospectively studied 52 patients who underwent unenhanced and contrast-enhanced multidetector CT (16 rows) after administration of 2–2.5 l of methylcellulose by naso-jejunal tube. BE was performed after administration of barium 60% w/v (200–250 ml) and methylcellulose (1–2 l). Patients with radiological signs of Crohn’s disease were classified into the following subtypes: active, fibrostenotic, fistulising/perforating, reparative or regenerative subtypes. Twenty-eight patients also underwent endoscopy. The radiological prevalent subtype was the active subtype. The sensitivity, specificity and diagnostic accuracy of MDCT-E versus BE was 83%, 100% and 89%, respectively. BE showed five false negative CT cases due to early Crohn’s disease; endoscopy confirmed positive cases of the CT and the BE, but showed one false negative case of the BE. Together, MDCT enteroclysis and BE permitted the diagnosis of Crohn’s disease in 30 patients, adhesions in one patient, lymphoma in two patients and carcinoid tumours in two patients. In conclusion, MDCT-E permits good representation of pathological patterns. Early stages of Crohn’s disease are better evaluated by BE.

Keywords

CT enteroclysis Crohn’s disease Multidetector CT Small bowel disease 

References

  1. 1.
    Birnbaum BA (1999) Computed tomography of the small bowel. Technique and principles of interpretation. In: Herlinger H, Maglinte DDT, Birnbaum BA (eds) Clinical imaging of the small intestine. Springer, Berlin Heidelberg New York, pp 153–166Google Scholar
  2. 2.
    Bender GN, Timmons JH, Williard WC, Carter J (1996) Computed tomographic enteroclysis: one methodology. Invest Radiol 31:43–49CrossRefPubMedGoogle Scholar
  3. 3.
    Maglinte DD, Gourtsoyiannis N, Rex D, Howard TJ, Kelvin FM (2003) Classification of small bowel Crohn’s subtypes based on multimodality imaging. Radiol Clin North Am 41:285–303CrossRefPubMedGoogle Scholar
  4. 4.
    Liangpunsakul S, Chadalawada V, Rex DK, Maglinte D, Lappas J (2003) Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis. Am J Gastroenterol 98:1295–1298CrossRefPubMedGoogle Scholar
  5. 5.
    Hara AK, Leighton JA, Sharma VK, Fleisher DE (2004) Small bowel: preliminary comparison of capsule endoscopy with barium study and CT. Radiology 230:260–265PubMedCrossRefGoogle Scholar
  6. 6.
    Maglinte DDT, Hallett RL, Rex D (2001) Imaging of small bowel Crohn’s disease: can abdominal CT replace barium radiography? Emerg Radiol 8:127–133CrossRefGoogle Scholar
  7. 7.
    Klöppel R, Thiele J, Bosse J (1992) The Sellink CT method. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 156:291–292PubMedCrossRefGoogle Scholar
  8. 8.
    Scholten ET, Ziedses des Plantes BG, Falke TH (1995) Computed tomography of the large bowel wall. Choice of slice thickness and intraluminal contrast medium. Invest Radiol 5:275–284CrossRefGoogle Scholar
  9. 9.
    Rollandi GA, Curone PF, Biscaldi E, Nardi F, Bonifacino E, Conzi R, Derchi LE (1999) Spiral CT of the abdomen after distension of small bowel loops with transparent enema in patients with Crohn’s disease. Abdom Imaging 24:544–549PubMedCrossRefGoogle Scholar
  10. 10.
    Turetschek K, Schober E, Wunderbaldinger P, Bernhard C, Schima W, Puespoek A, Vogelsang H, Moeschl P, Mostbeck G (2002) Findings at helical CT enteroclysis in symptomatic patients with Crohn disease: correlation with endoscopic and surgical findings. J Comput Assist Tomogr 26:488–492 CrossRefPubMedGoogle Scholar
  11. 11.
    Wold PB, Fletcher JG, Johnson CD, Sandborn WJ (2003) Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy-feasibility study. Radiology 229:275–281PubMedCrossRefGoogle Scholar
  12. 12.
    Makò EK, Mester AR, Tarjan Z, Karlinger K, Toth G (2000) Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn’s disease. Eur J Radiol 35:168–175PubMedCrossRefGoogle Scholar
  13. 13.
    Rust GF, Sackman M, Eisele O, Reiser M (2001) Virtual large intestine imaging with multi-level CT. Pain free coloscopy that works! MMW Fortschr Med 143:32–36PubMedGoogle Scholar
  14. 14.
    Balthazar EJ (2002) Evaluation of the small intestine by computed tomography. In: Gourtsoyiannis NC (ed) Radiological imaging of the small intestine. Springer, Berlin Heidelberg New York, pp 87–130Google Scholar
  15. 15.
    Horton KM, Eng J, Fishman EK (2000) Normal enhancement of the small bowel: evaluation with spiral CT. J Comput Assist Tomogr 24:67–71CrossRefPubMedGoogle Scholar
  16. 16.
    Maglinte DD, Lappas JC, Heitkamp DE, Bender GN, Kelvin FM (2003) Technical refinements in enteroclysis. Radiol Clin North Am 41:213–229PubMedCrossRefGoogle Scholar
  17. 17.
    Kelvin FM, Herlinger H (1999) Crohn’s disease. In: Herlinger H, Maglinte DDT, Birnbaum BA (eds) Clinical imaging of the small intestine. Springer, Berlin Heidelberg New York, pp 259–289Google Scholar
  18. 18.
    Horton KM, Fishamn EK (2003) The current status of multidetector row CT and three-dimensional imaging of the small bowel. Radiol Clin North Am 41:199–212PubMedCrossRefGoogle Scholar
  19. 19.
    Raptopoulos V, Schwatz RK, McNicholas MM, Movson J, Pearlman J, Joffe N (1997) Multiplanar helical CT enterography in patients with Crohn’s disease. AJR Am J Roentgenol 169:1545–1550PubMedGoogle Scholar
  20. 20.
    Schmidt S, Chevallier P, Charalon M, Bessoud B, Verdun FR, Frascarolo P, Schnyder P, Denys A (2005) Multidetector CT enteroclysis: comparison of the reading performance for axial and coronal views. Eur Radiol 15:238–246PubMedCrossRefGoogle Scholar
  21. 21.
    Romano S, De Lutio E, Rollandi GA, Romano L, Grassi R, Maglinte DD (2005) Multidetector computer tomography enteroclysis (MDCT-E) with neutral enteral and IV contrast enhancement in tumor detection. Eur Radiol 15:1178–1183CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Laura Maria Minordi
    • 1
    Email author
  • Amorino Vecchioli
    • 1
  • Luisa Guidi
    • 2
  • Paoletta Mirk
    • 1
  • Luisa Fiorentini
    • 1
  • Lorenzo Bonomo
    • 1
  1. 1.Dipartimento di Bioimmagini e Scienze RadiologicheIstituto di RadiologiaRomeItaly
  2. 2.Dipartimento di Medicina InternaIstituto di Gastroenterorologia, UCSCRomeItaly

Personalised recommendations