Skip to main content
SpringerLink
Log in

CT Enterography

  • Chapter
Endoscopy in Small Bowel Disorders

  • 1377 Accesses

Abstract

CT enterography (CTE) has become a key component for the diagnosis and management of small intestinal diseases and lesions. As a radiologic modality designed to optimize visualization of the small bowel and surrounding structures, it can be utilized for an extremely diverse set of indications. CTE in adult and pediatric Crohn’s disease patients can detect active inflammation, stricturing disease, and penetrating complications, and assess response to medical therapy. It can also demonstrate extraintestinal inflammatory bowel disease manifestations and alternate etiologies for a patient’s symptoms of abdominal pain or diarrhea. Additional CTE applications include the diagnosis of small bowel tumors and vascular lesions in patients with obscure gastrointestinal bleeding. These features have made CTE a vital tool in the clinician’s small bowel imaging armamentarium.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American College of Radiology. Acr appropriateness criteria: Crohn’s disease. http://wwwacrorg/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonGastrointestinalImaging/CrohnsDiseaseDoc5aspx (2008). Accessed 1 Nov 2010.

    Google Scholar 

  2. Fletcher JG, Huprich J, Loftus Jr EV, Bruining DH, Fidler JL. Computerized tomography enterography and its role in small-bowel imaging. Clin Gastroenterol Hepatol. 2008;6(3):283–9.

    Article  PubMed  Google Scholar 

  3. Faubion Jr WA, Fletcher JG, O'Byrne S, Feagan BG, de Villiers WJ, Salzberg B, et al. Emerging biomarkers in inflammatory bowel disease (embark) study identifies fecal calprotectin, serum mmp9, and serum il-22 as a novel combination of biomarkers for Crohn's disease activity: Role of cross-sectional imaging. Am J Gastroenterol. 2013;108:1891–900.

    Article  CAS  PubMed  Google Scholar 

  4. Huprich JE, Fletcher JG, Fidler JL, Alexander JA, Guimaraes LS, Siddiki HA, et al. Prospective blinded comparison of wireless capsule endoscopy and multiphase ct enterography in obscure gastrointestinal bleeding. Radiology. 2011;260(3):744–51.

    Article  PubMed  Google Scholar 

  5. Samuel S, Bruining DH, Loftus Jr EV, Becker B, Fletcher JG, Mandrekar JN, et al. Endoscopic skipping of the distal terminal ileum in Crohn’s disease can lead to negative results from ileocolonoscopy. Clin Gastroenterol Hepatol. 2012;10(11):1253–9.

    Article  PubMed  Google Scholar 

  6. Huprich JE, Barlow JM, Hansel SL, Alexander JA, Fidler JL. Multiphase ct enterography evaluation of small-bowel vascular lesions. AJR Am J Roentgenol. 2013;201(1):65–72.

    Article  PubMed  Google Scholar 

  7. Ajaj W, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC. Oral contrast agents for small bowel MRI: Comparison of different additives to optimize bowel distension. Eur Radiol. 2004;14(3):458–64.

    Article  PubMed  Google Scholar 

  8. Lauenstein T, Schneemann H, Vogt F, Herborn C, Ruhm S, Debatin J. Optimization of oral contrast agents for MR imaging of the small bowel. Radiology. 2003;228:279–83.

    Article  PubMed  Google Scholar 

  9. Young BM, Fletcher JG, Booya F, Paulsen S, Fidler J, Johnson CD, et al. Head-to-head comparison of oral contrast agents for cross-sectional enterography: Small bowel distention, timing, and side effects. J Comput Assist Tomogr. 2008;32(1):32–8.

    Article  PubMed  Google Scholar 

  10. Baker ME, Walter J, Obuchowski NA, Achkar JP, Einstein D, Veniero JC, et al. Mural attenuation in normal small bowel and active inflammatory Crohn’s disease on ct enterography: location, absolute attenuation, relative attenuation, and the effect of wall thickness. AJR Am J Roentgenol. 2009;192(2):417–23.

    Article  PubMed  Google Scholar 

  11. Paulsen SR, Huprich JE, Fletcher JG, Booya F, Young BM, Fidler JL, et al. Ct enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics. 2006;26(3):641–57. discussion 657–662.

    Article  PubMed  Google Scholar 

  12. Schindera ST, Nelson RC, DeLong DM, Jaffe TA, Merkle EM, Paulson EK, et al. Multi-detector row ct of the small bowel: peak enhancement temporal window–initial experience. Radiology. 2007;243(2):438–44.

    Article  PubMed  Google Scholar 

  13. Vandenbroucke F, Mortele KJ, Tatli S, Pelsser V, Erturk SM, de Mey J, et al. Noninvasive multidetector computed tomography enterography in patients with small-bowel Crohn’s disease: is a 40-second delay better than 70 seconds? Acta Radiol. 2007;23:1–9.

    Google Scholar 

  14. Lee SS, Park SH. Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia. Radiol Clin North Am. 2013;51(1):29–43.

    Article  CAS  PubMed  Google Scholar 

  15. Booya F, Fletcher JG, Huprich JE, Barlow JM, Johnson CD, Fidler JL, et al. Active Crohn’s disease: Ct findings and interobserver agreement for enteric phase ct enterography. Radiology. 2006;241(3):787–95.

    Article  PubMed  Google Scholar 

  16. Harisinghani MG, Wittenberg J, Lee W, Chen S, Gutierrez AL, Mueller PR. Bowel wall fat halo sign in patients without intestinal disease. Am J Roentgenol. 2003;181(3):781–4.

    Article  Google Scholar 

  17. Dave M. Crohn's disease with jejunal involvement: predictor of worse outcomes? J Clin Gastroenterol. 2013;47(5):379–80.

    Article  PubMed  Google Scholar 

  18. Flicek KT, Hara AK, De Petris G, Pasha SF, Yadav AD, Johnson CD. Diaphragm disease of the small bowel: a retrospective review of ct findings. AJR Am J Roentgenol. 2014;202(2):W140–5.

    Article  PubMed  Google Scholar 

  19. Macari M, Megibow AJ, Balthazar EJ. A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. AJR Am J Roentgenol. 2007;188(5):1344–55.

    Article  PubMed  Google Scholar 

  20. Altikaya N, Parlakgumus A, Demir S, Alkan O, Yildirim T. Small bowel obstruction caused by intramural hematoma secondary to warfarin therapy: a report of two cases. Turk J Gastroenterol. 2011;22(2):199–202.

    PubMed  Google Scholar 

  21. Scheirey CD, Scholz FJ, Shortsleeve MJ, Katz DS. Angiotensin-converting enzyme inhibitor-induced small-bowel angioedema: clinical and imaging findings in 20 patients. AJR Am J Roentgenol. 2011;197(2):393–8.

    Article  PubMed  Google Scholar 

  22. James S, Balfe DM, Lee JK, Picus D. Small-bowel disease: categorization by ct examination. AJR Am J Roentgenol. 1987;148(5):863–8.

    Article  CAS  PubMed  Google Scholar 

  23. Ames JT, Federle MP. Ct hypotension complex (shock bowel) is not always due to traumatic hypovolemic shock. AJR Am J Roentgenol. 2009;192(5):W230–5.

    Article  PubMed  Google Scholar 

  24. Levy AD, Sobin LH. From the archives of the AFIP: gastrointestinal carcinoids: Imaging features with clinicopathologic comparison. Radiographics. 2007;27(1):237–57.

    Article  PubMed  Google Scholar 

  25. Buckley JA, Fishman EK. Ct evaluation of small bowel neoplasms: spectrum of disease. Radiographics. 1998;18(2):379–92.

    Article  CAS  PubMed  Google Scholar 

  26. Weber NK, Fletcher JG, Fidler JL, Barlow JM, Pruthi S, Loftus EV, Jr., et al. Clinical characteristics and imaging features of small bowel adenocarcinomas in Crohn's disease. Abdom Imaging. 2014 [Epub ahead of print].

    Google Scholar 

  27. Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol. 2002;179(6):1429–35.

    Article  PubMed  Google Scholar 

  28. Booya F, Akram S, Fletcher JG, Huprich JE, Johnson CD, Fidler JL, et al. Ct enterography and fistulizing Crohn’s disease: clinical benefit and radiographic findings. Abdom Imaging. 2009;34(4):467–75.

    Article  PubMed  Google Scholar 

  29. Meyers MA, McGuire PV. Spiral ct demonstration of hypervascularity in Crohn’s disease: “vascular jejunization of the ileum” or the “comb sign”. Abdom Imaging. 1995;20:327–32.

    Article  CAS  PubMed  Google Scholar 

  30. Violi NV, Schoepfer AM, Fournier N, Guiu B, Bize P, Denys A. Prevalence and clinical importance of mesenteric venous thrombosis in the Swiss inflammatory bowel disease cohort. AJR Am J Roentgenol. 2014;203(1):62–9.

    Article  PubMed  Google Scholar 

  31. Pigneur B, Seksik P, Viola S, Viala J, Beaugerie L, Girardet JP, et al. Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis. 2010;16(6):953–61.

    Article  PubMed  Google Scholar 

  32. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785–94.

    Article  PubMed  Google Scholar 

  33. Solem CA, Loftus Jr EV, Fletcher JG, Baron TH, Gostout CJ, Petersen BT, et al. Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc. 2008;68(2):255–66.

    Article  PubMed  Google Scholar 

  34. Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002;8(4):244–50.

    Article  PubMed  Google Scholar 

  35. Bodily KD, Fletcher JG, Solem CA, Johnson CD, Fidler JL, Barlow JM, et al. Crohn disease: mural attenuation and thickness at contrast-enhanced ct enterography–correlation with endoscopic and histologic findings of inflammation. Radiology. 2006;238(2):505–16.

    Article  PubMed  Google Scholar 

  36. Siddiki HA, Fidler JL, Fletcher JG, Burton SS, Huprich JE, Hough DM, et al. Prospective comparison of state-of-the-art MR enterography and ct enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol. 2009;193(1):113–21.

    Article  PubMed  Google Scholar 

  37. Halligan S, Nicholls S, Bartram CI, Walker-Smith JA. The distribution of small bowel Crohn’s disease in children compared to adults. Clin Radiol. 1994;49(5):314–6.

    Article  CAS  PubMed  Google Scholar 

  38. Lenaerts C, Roy CC, Vaillancourt M, Weber AM, Morin CL, Seidman E. High incidence of upper gastrointestinal tract involvement in children with Crohn disease. Pediatrics. 1989;83(5):777–81.

    CAS  PubMed  Google Scholar 

  39. Higgins PD, Caoili E, Zimmermann M, Bhuket TP, Sonda LP, Manoogian B, et al. Computed tomographic enterography adds information to clinical management in small bowel Crohn’s disease. Inflamm Bowel Dis. 2007;13(3):262–8.

    Article  PubMed  Google Scholar 

  40. Bruining DH, Siddiki HA, Fletcher JG, Sandborn WJ, Fidler JL, Huprich JE, et al. Benefit of computed tomography enterography in Crohn's disease: effects on patient management and physician level of confidence. Inflamm Bowel Dis. 2012;18(2):219–25.

    Article  PubMed  Google Scholar 

  41. Israeli E, Ying S, Henderson B, Mottola J, Strome T, Bernstein CN. The impact of abdominal computed tomography in a tertiary referral centre emergency department on the management of patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(5):513–21.

    Article  CAS  PubMed  Google Scholar 

  42. Kerner C, Carey K, Mills AM, Yang W, Synnestvedt MB, Hilton S, et al. Use of abdominopelvic computed tomography in emergency departments and rates of urgent diagnoses in Crohn’s disease. Clin Gastroenterol Hepatol. 2012;10(1):52–7.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Duigenan S, Gee MS. Imaging of pediatric patients with inflammatory bowel disease. AJR Am J Roentgenol. 2012;199(4):907–15.

    Article  PubMed  Google Scholar 

  44. Jaffe TA, Gaca AM, Delaney S, Yoshizumi TT, Toncheva G, Nguyen G, et al. Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn’s disease. AJR Am J Roentgenol. 2007;189(5):1015–22.

    Article  PubMed  Google Scholar 

  45. Guimaraes LS, Fidler JL, Fletcher JG, Bruining DH, Huprich JE, Siddiki H, et al. Assessment of appropriateness of indications for ct enterography in younger patients. Inflamm Bowel Dis. 2010;16(2):226–32.

    Article  PubMed  Google Scholar 

  46. Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, et al. Crohn disease of the small bowel: Comparison of ct enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009;251(3):751–61.

    Article  PubMed  Google Scholar 

  47. Quencer KB, Nimkin K, Mino-Kenudson M, Gee MS. Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging. 2013;38(4):705–13.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Migaleddu V, Quaia E, Scanu D, Carla S, Bertolotto M, Campisi G, et al. Inflammatory activity in Crohn’s disease: CE-US. Abdom Imaging. 2011;36(2):142–8.

    Article  PubMed  Google Scholar 

  49. Ripolles T, Rausell N, Paredes JM, Grau E, Martinez MJ, Vizuete J. Effectiveness of contrast-enhanced ultrasound for characterisation of intestinal inflammation in Crohn’s disease: a comparison with surgical histopathology analysis. J Crohns Colitis. 2013;7(2):120–8.

    Article  PubMed  Google Scholar 

  50. Guidi L, De Franco A, De Vitis I, Armuzzi A, Semeraro S, Roberto I, et al. Contrast-enhanced ultrasonography with sonovue after infliximab therapy in Crohn’s disease. Eur Rev Med Pharmacol Sci. 2006;10(1):23–6.

    CAS  PubMed  Google Scholar 

  51. Quaia E, Cabibbo B, De Paoli L, Toscano W, Poillucci G, Cova MA. The value of time-intensity curves obtained after microbubble contrast agent injection to discriminate responders from non-responders to anti-inflammatory medication among patients with Crohn’s disease. Eur Radiol. 2013;23(6):1650–9.

    Article  PubMed  Google Scholar 

  52. Quaia E, Migaleddu V, Baratella E, Pizzolato R, Rossi A, Grotto M, et al. The diagnostic value of small bowel wall vascularity after sulfur hexafluoride-filled microbubble injection in patients with Crohn’s disease. Correlation with the therapeutic effectiveness of specific anti-inflammatory treatment. Eur J Radiol. 2009;69(3):438–44.

    Article  PubMed  Google Scholar 

  53. Hara AK, Leighton JA, Sharma VK, Fleischer DE. Small bowel: preliminary comparison of capsule endoscopy with barium study and ct. Radiology. 2004;230(1):260–5.

    Article  PubMed  Google Scholar 

  54. Monkemuller K, Neumann H, Meyer F, Kuhn R, Malfertheiner P, Fry LC. A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding. Endoscopy. 2009;41(8):715–7.

    Article  CAS  PubMed  Google Scholar 

  55. Monkemuller K, Olano C, Fry LC, Ulbricht LJ. Small-bowel endoscopy. Endoscopy. 2009;41(10):872–7.

    Article  CAS  PubMed  Google Scholar 

  56. Pennazio M. Bleeding update. Gastrointest Endosc Clin N Am. 2006;16(2):251–66.

    Article  PubMed  Google Scholar 

  57. Ross A, Mehdizadeh S, Tokar J, Leighton JA, Kamal A, Chen A, et al. Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Dig Dis Sci. 2008;53(8):2140–3.

    Article  PubMed  Google Scholar 

  58. Hakim FA, Alexander JA, Huprich JE, Grover M, Enders FT. Ct-enterography may identify small bowel tumors not detected by capsule endoscopy: eight years experience at Mayo Clinic Rochester. Dig Dis Sci. 2011;56(10):2914–9.

    Article  PubMed  Google Scholar 

  59. Huprich JE, Fletcher JG, Alexander JA, Fidler JL, Burton SS, McCullough CH. Obscure gastrointestinal bleeding: Evaluation with 64-section multiphase ct enterography—initial experience. Radiology. 2008;246(2):562–71.

    Article  PubMed  Google Scholar 

  60. Shin JK, Cheon JH, Lim JS, Park JJ, Moon CM, Jeon SM, et al. Long-term outcomes of obscure gastrointestinal bleeding after ct enterography: does negative ct enterography predict lower long-term rebleeding rate? J Gastroenterol Hepatol. 2011;26(5):901–7.

    Article  PubMed  Google Scholar 

  61. Agrawal JR, Travis AC, Mortele KJ, Silverman SG, Maurer R, Reddy SI, et al. Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy. J Gastroenterol Hepatol. 2012;27(4):751–9.

    Article  PubMed  Google Scholar 

  62. Hara AK, Walker FB, Silva AC, Leighton JA. Preliminary estimate of triphasic ct enterography performance in hemodynamically stable patients with suspected gastrointestinal bleeding. AJR Am J Roentgenol. 2009;193(5):1252–60.

    Article  PubMed  Google Scholar 

  63. Davis JS, Ryan ML, Fields JM, Neville HL, Perez EA, Sola JE. Use of ct enterography for the diagnosis of lower gastrointestinal bleeding in pediatric patients. J Pediatr Surg. 2013;48(3):681–4.

    Article  PubMed  Google Scholar 

  64. Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, et al. Meckel’s scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years. Pediatr Surg Int. 2013;29(5):511–7.

    Article  CAS  PubMed  Google Scholar 

  65. Fishman SJ, Burrows PE, Leichtner AM, Mulliken JB. Gastrointestinal manifestations of vascular anomalies in childhood: varied etiologies require multiple therapeutic modalities. J Pediatr Surg. 1998;33(7):1163–7.

    Article  CAS  PubMed  Google Scholar 

  66. Fremond B, Yazbeck S, Dubois J, Brochu P, Garel L, Ouimet A. Intestinal vascular anomalies in children. J Pediatr Surg. 1997;32(6):873–7.

    Article  CAS  PubMed  Google Scholar 

  67. Kaza RK, Platt JF, Al-Hawary MM, Wasnik A, Liu PS, Pandya A. Ct enterography at 80 kvp with adaptive statistical iterative reconstruction versus at 120 kvp with standard reconstruction: image quality, diagnostic adequacy, and dose reduction. AJR Am J Roentgenol. 2012;198(5):1084–92.

    Article  PubMed  Google Scholar 

  68. Allen BC, Baker ME, Einstein DM, Remer EM, Herts BR, Achkar JP, et al. Effect of altering automatic exposure control settings and quality reference mas on radiation dose, image quality, and diagnostic efficacy in MDCT enterography of active inflammatory Crohn’s disease. AJR Am J Roentgenol. 2010;195(1):89–100.

    Article  PubMed  Google Scholar 

  69. Kambadakone AR, Prakash P, Hahn PF, Sahani DV. Low-dose ct examinations in Crohn's disease: impact on image quality, diagnostic performance, and radiation dose. AJR Am J Roentgenol. 2010;195(1):78–88.

    Article  PubMed  Google Scholar 

  70. Sagara Y, Hara AK, Pavlicek W, Silva AC, Paden RG, Wu Q. Abdominal ct: comparison of low-dose ct with adaptive statistical iterative reconstruction and routine-dose ct with filtered back projection in 53 patients. AJR Am J Roentgenol. 2010;195(3):713–9.

    Article  PubMed  Google Scholar 

  71. Del Gaizo AJ, Fletcher JG, Yu L, Paden RG, Spencer GC, Leng S, et al. Reducing radiation dose in ct enterography. Radiographics. 2013;33(4):1109–24.

    Article  PubMed  Google Scholar 

  72. Ehman EC, Yu L, Manduca A, Hara AK, Shiung MM, Jondal D, et al. Methods for clinical evaluation of noise reduction techniques in abdominopelvic ct. Radiographics. 2014;34(4):849–62.

    Article  PubMed  Google Scholar 

  73. Ajaj W, Goyen M, Schneemann H, Kuehle C, Nuefer M, Ruehm SG, et al. Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention. Eur Radiol. 2005;15(7):1400–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Joel G. Fletcher M.D. & Amy B. Kolbe M.D.

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    David H. Bruining M.D.

Authors
  1. Joel G. Fletcher M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amy B. Kolbe M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David H. Bruining M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel G. Fletcher M.D. .

Editor information

Editors and Affiliations

  1. Virginia Mason Medical Center, Digestive Disease Institute, Seattle, Washington, USA

    Richard Kozarek

  2. and Hepatology, Mayo Clinic Division of Gastroenterology, Scottsdale, Arizona, USA

    Jonathan A. Leighton

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Fletcher, J.G., Kolbe, A.B., Bruining, D.H. (2015). CT Enterography. In: Kozarek, R., Leighton, J. (eds) Endoscopy in Small Bowel Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-14415-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-14415-3_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14414-6

  • Online ISBN: 978-3-319-14415-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation