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Multislice-CT of the Abdomen pp 283–299Cite as

Small Bowel

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Part of the Medical Radiology book series (Med Radiol Diagn Imaging)

Abstract

Multidetector CT (MDCT), over the past decade, has become the primary imaging modality for evaluating gastrointestinal tract disorders, particularly in the small bowel. MDCT offers panoramic and high-resolution images, it is widespread available and the technique is robust, reproducible and accurate. Careful patient preparation is required, because of the need for bowel distension, achievable through the use of an enteral contrast agent (neutral or positive) delivered either orally (MDCT-enterography) or through a naso-jejunal tube (MDCT-enteroclysis). Scanning protocol is fast and thanks to new devices (automatic dose modulator systems) and/or new image reconstruction methods (iterative algorithms) able to deliver a very low amount of radiation, especially important when imaging young individuals. The most common clinical indication is represented by the evaluation of patients with Inflammatory Bowel Disease, both at the time of the diagnosis and in follow-up, where MDCT is able to provide an accurate balance of the disease: extent of the bowel involvement, assessment of disease activity and potential complications. The detection of small bowel tumours is another important indication where MDCT represents, in some cases, the only method to investigate small bowel loops and in any case the best method for staging neoplastic lesions. An additional reason to perform MDCT of the small bowel is the evaluation of malabsorption syndromes.

Keywords

  • Inflammatory Bowel Disease
  • Small Bowel
  • Celiac Disease
  • Bowel Wall
  • Lean Body Weight

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  • Boudiaf M, Jaff A, Bouhnik Y et al (2004) Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients. Radiology 233:338–344

    CrossRef  PubMed  Google Scholar 

  • Brenner DJ, Hall EJ (2007) Computed tomography: an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    CrossRef  PubMed  CAS  Google Scholar 

  • Caoili EM, Paulson EK (2000) CT of small-bowel obstruction: another perspective using multiplanar reformations. AJR 174:993–998

    PubMed  CAS  Google Scholar 

  • Chiorean MV, Sandrasegaran K, Saxena R et al (2007) Correlation of CT enteroclysis with surgical pathology in Crohn’s disease. Am J Gastroenterol 102:2541–2550

    CrossRef  PubMed  Google Scholar 

  • Ciresi DL, Scholten DJ (1995) The continuing clinical dilemma of primary tumours of the small intestine. Am Surg 61(8):698–702

    PubMed  CAS  Google Scholar 

  • Colombel JF, Solem CA, Booya F et al (2006) Quantitative measurement and visual assessment of ileal Crohn’s disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein. Gut 55(11):1561–1567

    CrossRef  PubMed  CAS  Google Scholar 

  • Dave-Verma H, Moore S, Singh A et al (2008) Computed tomographic enterography and enteroclysis: pearls and pitfalls. Curr Probl Diagn Radiol 37(6):279–287

    CrossRef  PubMed  Google Scholar 

  • De Backer AI, De Schepper AM, Vandevenne JE et al (2001) CT of angioedema of the small bowel. AJR 176:649–652

    PubMed  Google Scholar 

  • Drews BH, Barth TF, Hänle MM et al (2009) Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease. Eur Radiol 19:1379–1386

    CrossRef  PubMed  CAS  Google Scholar 

  • Elsayes KM, Al-Hawary MM, Jagdish J et al (2010) CT enterography: principles, trends, and interpretation of findings. Radiographics 30(7):1955–1970

    CrossRef  PubMed  Google Scholar 

  • Fletcher JG (2009) CT enterography technique: theme and variations. Abdom Imaging 34:283–288

    CrossRef  PubMed  CAS  Google Scholar 

  • Frager DH, Goldman M, Beneventano TC (1983) Computer tomography in Crohn disease. J Comput Assist Tomogr 7:819–824

    CrossRef  PubMed  CAS  Google Scholar 

  • Froehlich JM, Daenzer M, von Weymarn C et al (2008) Aperistaltic effect of hyoscine N-butylbromide versus glucagon on the small bowel assessed by magnetic resonance imaging. Eur Radiol 19(6):1387–1393

    CrossRef  Google Scholar 

  • Glick SN (1987) Crohn’s disease of the small intestine. Radiol Clin North Am 25:25–45

    PubMed  CAS  Google Scholar 

  • Good CA (1963) Tumours of the small intestine. Am J Roentgenol Radium Ther Nucl Med 89:685–705

    PubMed  CAS  Google Scholar 

  • Gore RM, Balthazar EJ, Ghahremani GG et al (1996) CT features of ulcerative colitis and Crohn’s disease. AJR Am J Roentgenol 167:3–15

    PubMed  CAS  Google Scholar 

  • Green PH, Cellier C (2007) Celiac disease. N Engl J Med 357:1731–1743

    CrossRef  PubMed  CAS  Google Scholar 

  • Hara AK, Leighton JA, Heigh RI et al (2006) Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology 238:128–134

    CrossRef  PubMed  Google Scholar 

  • Horton KM, Lawler LP, Fishman EK (2003) CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics 23:1561–1567

    CrossRef  PubMed  Google Scholar 

  • Jaffe TA, Martin LC, Miller CM et al (2007) Abdominal pain: coronal reformations from isotropic voxels with 16-section CT–reader lesion detection and interpretation time. Radiology 242(1):175–181

    CrossRef  PubMed  Google Scholar 

  • Jones B, Bayless TM, Fishman EK et al (1984) Lymphadenopathy in celiac disease: computed tomographic observations. AJR Am J Roentgenol 142:1127–1132

    PubMed  CAS  Google Scholar 

  • Kalra MK, Prasad S, Saini S et al (2002) Clinical comparison of standard-dose and 50% reduced-dose abdominal CT: effect on image quality. AJR Am J Roentgenol 179(5):1101–1106

    PubMed  Google Scholar 

  • Kambadakone AR, Prakash P, Hahn PF et al (2010) Low-dose CT examinations in Crohn’s disease: impact on image quality, diagnostic performance, and radiation dose. AJR Am J Roentgenol 195(1):78–88

    CrossRef  PubMed  Google Scholar 

  • Kelvin FM, Herlinger H (1999) Crohn’s disease. In: Herlinger H, Maglinte DDT, Birnbaum BA (eds) Clinical imaging of the small intestine. Springer, Berlin, pp 259–289

    Google Scholar 

  • Kerr JM (2008) Small bowel imaging: CT enteroclysis or barium enteroclysis? Critically appraised topic. Abdom Imaging 33(1):31–33

    CrossRef  PubMed  Google Scholar 

  • Kim YH, Blake MA, Harisinghani MG et al (2006) Adult intestinal intussusception: CT appearances and identification of a causative lead point. Radiographics 26:733–744

    CrossRef  PubMed  Google Scholar 

  • Macari M, Balthazar EJ (2001) CT of bowel wall thickening: significance and pitfalls of interpretation. AJR 176:1105–1116

    PubMed  CAS  Google Scholar 

  • Macari M, Chandarana H, Balthazar EJ et al (2003) Intestinal ischemia versus intramural hemorrhage: CT evaluation. AJR 180:177–184

    PubMed  Google Scholar 

  • Macari M, Megibow AJ, Balthazar EJ (2007) A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. AJR 188:1344–1355

    CrossRef  PubMed  Google Scholar 

  • Mackalski BA, Bernstein CN (2006) New diagnostic imaging tools for inflammatory bowel disease. Gut 55:733–741

    CrossRef  PubMed  CAS  Google Scholar 

  • Madureira AJ (2004) The Comb Sign. Radiology 230:783–784

    CrossRef  PubMed  Google Scholar 

  • Maglinte DD, Chernish SM, Bessette J et al (1991) Factors in the diagnostic delays of small bowel malignancy. Indiana Med 84(6):392–396

    PubMed  CAS  Google Scholar 

  • Maglinte DD, Siegelman ES, Kelvin FM (2000) MR enteroclysis: the future of small-bowel imaging? Radiology 215:639–641

    PubMed  CAS  Google Scholar 

  • Maglinte DD, Gourtsoyiannis N, Rex D et al (2003) Classification of small bowel Crohn’s subtypes based on multimodality imaging. Radiol Clin North Am 41:285–303

    CrossRef  PubMed  Google Scholar 

  • Maglinte DD, Sandrasegaran K, Lappas JC et al (2007) CT enteroclysis. Radiology 245:661–671

    CrossRef  PubMed  Google Scholar 

  • Mako EK, Mester AR et al (2000) Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn’s disease. Eur J Radiol 35:168–175

    Google Scholar 

  • Marmo R, Rotondano G, Piscopo R et al (2005) Meta-analysis: capsule enteroscopy vs conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther 22:595–604

    CrossRef  PubMed  CAS  Google Scholar 

  • McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26:503–512

    CrossRef  PubMed  Google Scholar 

  • McCollough CH, Primak AN, Braun N et al (2009) Strategies for reducing radiation dose in CT. Radiol Clin North Am 47:27–40

    CrossRef  PubMed  Google Scholar 

  • Migleddu V, Quaia E, Scano D et al (2008) Inflammatory activity in Crohn’s disease: ultrasound findings. Abdom Imaging 33:589–597

    CrossRef  Google Scholar 

  • Minardi AJ Jr, Zibari GB, Aultman DF et al (1998) Small-bowel tumours. J Am Coll Surg 186(6):664–668

    CrossRef  PubMed  Google Scholar 

  • Minordi LM, Vecchioli A, Guidi L et al (2006) Multidetector CT enteroclysis versus barium enteroclysis with methylcellulose in patients with suspected small bowel disease. Eur Radiol 16:1527–1536

    CrossRef  PubMed  Google Scholar 

  • Minordi LM, Vecchioli A, Guidi L et al (2009) CT findings and clinical activity in Crohn’s disease. Clin Imaging 33:123–129

    CrossRef  PubMed  Google Scholar 

  • Minordi LM, Vecchioli A, Mirk P et al (2011) CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease. Br J Radiol 84(998):112–119

    CrossRef  PubMed  CAS  Google Scholar 

  • Negaard A, Paulsen V, Sandvik L et al (2007) A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis. Eur Radiol 17:2294–2301

    CrossRef  PubMed  Google Scholar 

  • North JH, Pack MS (2000) Malignant tumours of the small intestine: a review of 144 cases. Am Surg 66(1):46–51

    PubMed  CAS  Google Scholar 

  • Ott DJ, Chen YM, Gelfand DW et al (1985) Detailed per-oral small bowel examination vs. enteroclysis. Part II: radiographic accuracy. Radiology 155:31–34

    PubMed  CAS  Google Scholar 

  • Patak MA, Mortele KJ, Ros PR (2005). Multidetector row CT of the small bowel. Radiol Clin North Am 43:1063–1077

    Google Scholar 

  • Paulsen S, Huprich J, Fletcher JG et al (2006) CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 26:641–662

    CrossRef  PubMed  Google Scholar 

  • Rajesh A, Maglinte DD (2006) Multislice CT enteroclysis: technique and clinical applications. Clin Radiol 61(1):31–39

    CrossRef  PubMed  CAS  Google Scholar 

  • Ramachandran I, Sinha R, Rajesh A et al (2007) Multidetector row CT of small bowel tumours. Clin Radiol 62(7):607–614

    CrossRef  PubMed  CAS  Google Scholar 

  • Schindera ST, Nelson RC, DeLong DM et al (2007) Multi-detector row CT of the small bowel: peak enhancement temporal window–initial experience. Radiology 243(2):438–444

    CrossRef  PubMed  Google Scholar 

  • Schreyer AG, Geissler A, Albrich H et al (2004) Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol 2:491–497

    CrossRef  PubMed  Google Scholar 

  • Schreyer AG, Hoffstetter P, Daneschnejad M et al (2010) Comparison of conventional abdominal CT with MR-enterography in patients with active Crohn’s disease and acute abdominal pain. Acad Radiol 17(3):352–357

    CrossRef  PubMed  Google Scholar 

  • Silva AC, Lawder HJ, Hara A et al (2010) Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol 194(1):191–199

    CrossRef  PubMed  Google Scholar 

  • Soyer P, Boudiaf M, Dray X et al (2009) CT enteroclysis features of uncomplicated celiac disease: retrospective analysis of 44 patients. Radiology 253(2):416–424

    CrossRef  PubMed  Google Scholar 

  • Tomei E, Marini M, Messineo D et al (2000) Computer tomography of the small bowel in adult celiac disease: the jejunoileal fold pattern reversal. Eur Radiol 10:119–122

    CrossRef  PubMed  CAS  Google Scholar 

  • Tomei E, Diacinti D, Marini M et al (2005) Abdominal CT findings may suggest coeliac disease. Dig Liver Dis 37:402–406

    CrossRef  PubMed  CAS  Google Scholar 

  • Turetschek K, Schober E, Wunderbaldinger P et al (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

    CrossRef  PubMed  Google Scholar 

  • Weskott HP (2008) Emerging roles for contrast-enhanced ultrasound. Clin Hemorheol Microcirc 40:51–71

    PubMed  CAS  Google Scholar 

  • Winter TC, Ager JD, Nghiem HV et al (1996) Upper gastrointestinal tract and abdomen: water as an orally administered contrast agent for helical CT. Radiology 201(2):365–370

    PubMed  CAS  Google Scholar 

  • Wold PB, Fletcher JG, Johnson CD et al (2003) Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy—feasibility study. Radiology 229:275–281

    CrossRef  PubMed  Google Scholar 

  • Zissin R, Hertz M, Bernheim J et al (2004) Small bowel obstruction secondary to Crohn disease: CT findings. Abdom Imaging 29:320–325

    CrossRef  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiological Sciences, Oncology and Pathology, Sapienza-University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Franco Iafrate, Paola Lucchesi, Maria Ciolina & Paolo Baldassari

  2. Department of Radiological Sciences, Oncology and Pathology, Sapienza-University of Rome, Via Franco Faggiana 34, 04100, Latina, Italy

    Marco Rengo & Andrea Laghi

Authors
  1. Franco Iafrate
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  2. Marco Rengo
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  3. Paola Lucchesi
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  4. Maria Ciolina
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  5. Paolo Baldassari
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  6. Andrea Laghi
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Correspondence to Andrea Laghi .

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Editors and Affiliations

  1. , Department of Clinical Radiology, Munich University Hospitals - Grosshader, Marchioninistraße 15, Munich, 81377, Germany

    Christoph Johannes Zech

  2. Department of Oncology, Dept. Transplants and Advanced Technolog, University of Pisa, Via Paradisa 2, Pisa, 56127, Italy

    Carlo Bartolozzi

  3. , Department of Radiology, The University of Chicago, 5841 S. Maryland Ave MC 2026, Chicago, 60611, USA

    Richard Baron

  4. , Department of Clinical Radiology, Munich University Hospitals - Grosshader, Marchioninistraße 15, Munich, 81377, Germany

    Maximilian F. Reiser

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Iafrate, F., Rengo, M., Lucchesi, P., Ciolina, M., Baldassari, P., Laghi, A. (2011). Small Bowel. In: Zech, C., Bartolozzi, C., Baron, R., Reiser, M. (eds) Multislice-CT of the Abdomen. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_429

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  • DOI: https://doi.org/10.1007/174_2011_429

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