CT enterography: noninvasive evaluation of Crohn's disease and obscure gastrointestinal bleed

CT enterography (CTE) is a noninvasive imaging test using neutral intraluminal contrast and intravenous contrast to evaluate the small bowel. Multiphasic imaging is used in evaluating obscure gastrointestinal bleeding (OGIB), and single-phase enteric imaging is used for all other indications, including Crohn's disease (CD). CTE findings of CD include bowel wall thickening, mucosal hyperenhancement, and mural stratification. CTE findings of angiodyplasias include a vascular tuft visible during arterial phase and an early draining mesenteric vein. Early studies indicate that CTE is superior to barium examination in the evaluation of CD and is complementary to capsule endoscopy in the evaluation of OGIB.     

多层螺旋CT在小肠Crohn病中的应用研究

目的 探讨MSCT双期动态增强扫描在小肠Crohn病中的应用价值.方法 45例经综合方法 诊断,并通过临床治疗证实的小肠Crohn病患者均行MSCT双期动态增强扫描,并在ADW4.2工作站进行后处理.测量患病肠段在不同期相内的CT值,采用方差分析比较其CT值;并测量各期相内患病肠段与正常肠段的CT值筹值,以差别10 HU为界,划分病例数,将不同期相内的病例数采用卡方检验进行比较.结果病变肠段平扫平均CT值为(39.3±3.7)HU,动脉期为(74.8±13.8)HU,门静脉期为(90.2±12.3)HU,差异有统计学意义(F=258.87,P<0.01).病变肠段平扫与动脉期和门静脉期CT值两两比较,差异均有统计学意义(P<0.05).45例中,平扫CT值差值≤10 HU和>10 HU者分别为44和1例,动脉期分别为6和39例,门静脉期分别为2和43例,经X2检验,平扫与动脉期间差异有统计学意义(X2=32.49,P<0.01),平扫与门静脉期间差异有统计学意义(X2=39.22,P<0.01),动脉期与门静脉期间差异无统计学意义(X2=1.10,P>0.05).增强扫描使病灶显示更为清楚,大大提高了小肠Crohn病的检出率.结论 MSCT双期动态增强扫描可对小肠Crohn病作出初步诊断,并可对病变进行全面评价.     

Crohn disease in the pediatric patient: CT evaluation

Computed tomographic (CT) scans and medical records of 25 children (age range, 10-18 years) with pathologically proved Crohn disease were reviewed to better define the role of CT in the management of pediatric patients with Crohn disease. CT findings included small bowel thickening (range, 5-10 mm) (n = 20), colonic wall thickening (range, 6-15 mm) (n = 15), and small bowel dilation (n = 5). Mesenteric abnormalities such as adenopathy and focal fatty proliferation were seen in 11 to 18 patients, respectively. Extraluminal complications were easily identified with CT. Abscesses were noted in seven patients, inflammatory masses in four, and perirectal or perineal inflammation in 10. Fistulas were detected in four patients. The authors conclude that CT should be the initial imaging study performed in children with known Crohn disease and a changing pattern of clinical symptoms.     

Abdominal complications of Crohn's disease: CT features

Crohn's disease is characterized by transmural inflammation and chronic disorder of the gastrointestinal tract. Abdominal complications of Crohn's disease are frequent and quite variable and their diagnosis is commonly performed with CT. The purpose of this article is to review the CT features of the abdominal complications of Crohn's disease, including ileocolitis, abscess, phlegmon, fistula, bowel obstruction, portal vein gas, colonic distention, as well as urinary, hepatobiliary and pancreatic complications.     

Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning

The purpose of this study was to evaluate the use of gadolinium and barium-enhanced magnetic resonance (MR) imaging in detecting intestinal and extraintestinal Crohn's disease and compare MRI with contrast-enhanced helical computed tomography (CT). Twenty-six patients with Crohn's disease underwent imaging examinations, including gadolinium-enhanced, fat suppressed fast multiplanar spoiled gradient-recalled (FMPSPGR) MR imaging with oral 2% barium sulfate and rectal water and with helical CT using i.v. and positive (13) or negative (13) intestinal contrast material. MR images and CT scans were reviewed separately by two radiologists for bowel wall thickness and enhancement, presence of abscess, phlegmon, and fistula. MR images and CT scans were then compared side by side. Surgical, endoscopic, and histopathologic findings and results of barium studies were reviewed to determine the location and severity of involvement of intestinal Crohn's disease. Depiction of mural thickening and/or enhancement was superior on the MR images, which showed 55 (85%) and 52 (80%) of 65 abnormal bowel segments for the two observers, compared with helical CT, which showed 39 (60%) and 42 (65%; P < 0.001, P < 0.05) of bowel segments affected by Crohn's disease. Segments of bowel with moderate or marked mural thickening were depicted equally on MR imaging and helical CT. In mildly diseased segments of bowel, with only slight thickening and enhancement, MR imaging depicted 22 (79%) and 19 (68%) of 28 segments, compared with helical CT, which depicted 9 (32%; P < 0.01), and 13 (46%; P > 0.05) of 28 segments. In the side-by side comparison, MR imaging was preferred over helical CT for depicting normal bowel wall (MR 71%, CT 4%, equal 25%; P < 0.001), mural thickening (MR 41%, CT 11% equal 48%; P < 0.01), mural enhancement (MR 89%, equal 11%; P < 0.001), and overall GI tract evaluation (MR 52%, CT 10%, equal 38%; P < 0.001). Gadolinium-enhanced MR imaging with oral dilute barium sulfate and rectal water depicts intestinal and extraintestinal changes of Crohn's disease and shows promise as a clinically useful tool.     

Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn's disease

INTRODUCTION: During the last few decades introducing many of new radiologic methods, diagnostic conditions and facilities of Crohn's disease has became markedly improved. Appropriate using of these technics definitely modifies the management of patients with known or suspected Crohn's disease serving reliable information about extent, severity and possible complications of disease. Enteroclysis and Computed tomography are the two major and basic methods to disclose or confirme diagnosis of Crohn's disease, obtain appropriate inforination about disease either with mucosal, transmural or extraintestinal manifestation. METHODS AND PATIENTS: We evaluated 281 patients who were referred in our institution under suspition of Crohn's disease. Enteroclysis and abdominal spiral CT in all cases were carried out usually within 1 week. The 172 patients underwent abdominal spiral CT as the primary examination to evaluate diagnostic value of spiral CT in this entity, while 109 patiens had enteroclysis followed by abdominal CT. In 11 cases we also perforined CT enteroclysis with administration of 0.5% methylcellulose solution thorough nasojejunal tube controlled by electric motor driven contrast pump. Results were compared with final clinical, pathological or surgical data were available. RESULTS: From the 281 patients eventually 74 proved Crohn's disease; sensitivity and specificity of enteroclysis proved to be 96 and 98%, while spiral CT sensitivity and specificity was 94 and 95%, respectively. Enteroclysis was superior to the spiral CT in demonstration of early lesions and functional disorders, while spiral CT proved to be essential in evaluation of transmural and extraintestinal complications. CONCLUSIONS: Regarding enteroclysis and spiral CT as complementary methods, they provide excellent results in diagnosis of Crohn's disease.     

CT enteroclysis in small bowel Crohn's disease

The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.     

Crohn's disease: CT enterography manifestations before and after treatment

Purpose

The purpose of this study was to determine whether CT enterography (CTE) changes of Crohn's disease (CD) after treatment correlated with clinical remission.

Materials and methods

We retrospectively studied 50 known CD patients (male: 35; female: 15) with clinical remission in a period of 3 years (2005–2008). CD was diagnosed by clinical, enteroscopic and pathologic manifestations. Clinical remission was identified by experienced gastroenterologists using the combing criteria of clinical, endoscopy and laboratory tests. First CTE and endoscopy exams were performed during their first hospitalization in our hospital meanwhile CD diagnosis was made during that time. Repeated CTE and endoscopy exams were done after treatment. CTE findings were determined by two experienced radiologists with double-blind approach. Each patient was analyzed for the CTE parameters including bowel wall attenuation, bowel wall thickening (>3 mm), bowel wall thickening types (type A: multilayered mural stratification; type B: two layers with strong mucosal enhancement and prominent low-density submucosa; type C: two layers without strong mucosal enhancement; type D: homogeneous enhancement) comb sign, luminal stenosis (mild: luminal diameter 2–3 cm; moderate: luminal diameter 1–2 cm; severe: luminal diameter < 1 cm) and the presence of extraenteric complications (such as fistulas and abscess). All the quantitative parameters were measured three times by each review.

Results

After treatment, bowel wall thickening was attenuated in 88% of CD patients. Thickness of bowel wall was decreased from 8.8 ± 2.8 mm to 6.4 ± 1.9 mm (P < 0.001). CT value of bowel wall in portal stage was also declined from 90.0 ± 15.4 (HU) to73.4 ± 14.2 (HU (P < 0.001). The percentage of patients with type A or B bowel wall thickening was decreased from 78.7% to 35.4%, while those with type C or D thickening was increased from 21.2% to 64.6% (P < 0.001). The percentage of patients with comb sign was decreased from 88% to 60% (P = 0.001). The percentage of patients with moderate or severe luminal stenosis was reduced from 74% to 32% (P < 0.001). The ROC (receiver operating characteristic) analysis showed bowel wall attenuation (A_z = 0.89) and bowel wall thickness (A_z = 0.81) were the two best parameters to predict disease activity, and combining of these two values was better than using them solely (κ = 0.71, P < 0.001). The bowel wall attenuation (OR = 9.56, P < 0.001) and bowel wall thickness (OR = 3.32, P = 0.001) were significantly correlated with the disease activity in the following logistic regression analysis.

Conclusion

Therapeutic effect of CD and disease activity can be properly evaluated by CTE.     

Peptic ulcer disease: CT evaluation

The authors retrospectively describe the computed tomographic (CT) findings in 35 patients with peptic ulcer disease. Three of eight patients with gastritis or duodenitis had bowel-wall thickening. Ten of the remaining 27 patients had CT evidence of ulcer perforation (n = 2) or penetration (n = 8), four cases of which were unsuspected clinically. Both patients with acute free perforation had pneumoperitoneum, and one showed free extravasation of orally administered contrast material. The precise site of perforation could not be established in either case with CT. The eight patients with ulcer penetration had CT evidence of bowel-wall thickening (n = 3) and inflammatory changes in adjacent soft tissues and organs (n = 8), including the pancreas (n = 4), liver (n = 1), and lesser omentum (n = 1). Ulcer craters were seen in only two. The CT findings of penetration can mimic other disease processes. CT was not useful in detecting uncomplicated peptic ulcer disease.     

Medical management of Crohn's disease: A guide for radiologists

The choice of therapies for Crohn's disease has expanded greatly over the past 30 years. Increasingly it is important that we attempt to identify subgroups of patients who will benefit most from each type of therapy. This article reviews the therapeutic options currently available, organized by the goal the practitioner hopes to achieve. Imaging is one critical way of aiding the classification of Crohn's disease by attempting to accurately determine the location, extent and, most importantly, the nature of the disease.     

CT findings and clinical activity in Crohn's disease

The aim of this study was to evaluate clinical correlations of CT signs in proven Crohn's disease. Fifty patients were studied by means of multidetector CT. Clinical activity was assessed using Crohn's disease activity index (CDAI) score and some laboratory parameters. All patients with CDAI>150 had CT study scored as pathological. Seventy-nine percent of patients with CDAI<150 showed abnormalities in CT exam. CT findings correlate with some parameters of disease activity, thus underlining the usefulness of performing CT enteroclysis in Crohn's disease patients.     

CT enterography: Principles,technique and utility in Crohn's disease

CT enterography is a modification of conventional CT technique optimized for the evaluation of small bowel. This technique utilizes multidetector scanners with high spatial and temporal resolution; multiplanar reconstructions; and large volumes of enteric contrast to provide bowel distension. This article discusses the essential principles of the exam and its use in the evaluation of Crohn's disease of the small bowel.     

Venous thromboembolic disease: CT evaluation.

Helical and multidetector CT has proven to be a valuable imaging modality for both pulmonary embolism and deep venous thrombosis. This paper will review the sensitivity and specificity of CT and discuss diagnostic algorithms utilizing CT and more established imaging technologies.     

MRI evaluation of inflammatory activity in Crohn's disease

OBJECTIVE: We wanted to assess the capability of MRI to quantitatively evaluate the therapeutic response to Crohn's disease (CD) relapse. SUBJECTS AND METHODS: Twenty patients with histologically proven CD were prospectively evaluated with MRI and ileocolonoscopy over a 2-year period. The MRI protocol included axial and coronal T2-weighted and contrast-enhanced T1-weighted sequences. MRI examinations were performed twice, once during an acute relapse of CD and the other at clinical remission. The terminal ileum and colon were divided into six segments/patient, and the endoscopy and histology findings were considered the standard of reference. These were compared on a segmental basis with the quantitative MRI findings regarding wall thickness and contrast enhancement. The results obtained in active and remission CD phases were likewise compared with the findings in 10 control subjects who underwent complete ileocolonoscopy for other reasons and had no pathological findings on ileocolonoscopy. RESULTS: Fifty three of 120 (44.2%) bowel segments showed pathologic changes on endoscopy and histology consistent with CD in active phase. On changing from the active disease phase to clinical remission, a significant decrease was observed in the wall thickness and contrast enhancement of the affected bowel wall. In the active phase of CD, the pathologic bowel segments presented with significantly greater contrast enhancement and wall thickness values compared with the healthy segments of CD and controls. On converting clinically into remission, contrast enhancement tended to normalize, whereas bowel wall thickness remained increased compared with the controls. CONCLUSION: MRI is able to detect pathologic bowel segments in CD, as it allows the measurement of significant variations in wall thickness and contrast enhancement on changing from the active phase of the disease to remission.     

Ultrasound, CT, and MRI in Crohn's disease

Colonoscopy and Barium contrast studies continue to be the techniques of choice for the evaluation of mucosal lesions in Crohn's disease. However, these techniques have limited capacity for demonstrating the transmural and extramural extension of the disease. Although ultrasound, CT, and MRI cannot detect early lesions, these techniques satisfactorily show parietal and extraparietal changes caused by the disease, thus complementing the information provided in conventional studies. These three techniques enable the evaluation of the pathological segments, the presence of stenosis and dilatation, and extramural disease (fibrofatty proliferation, fistulae, phlegmons, and abscesses). This information is essential for classifying each patient into one of the three subtypes of Crohn's disease (inflammatory, stenotic, or fistulating). These techniques also enable the evaluation of signs that indicate inflammatory activity (hyperemia, wall enhancement, and increased mesenteric vascularization), and this information, together with the subtype, will determine the treatment. Ultrasound, CT, and MRI should be included in the complete evaluation of the patient with Crohn's disease, together with clinical examination, laboratory tests, and conventional imaging studies. We review the role of ultrasound, CT, and MRI in the diagnosis and evaluation of Crohn's disease, describing patient preparation and examination protocols, as well as the findings in these three techniques. We also discuss the advantages and limitations of each of these techniques and their current clinical roles in this context.     

Whole-body SPECT/CT for bone scintigraphy: diagnostic value and effect on patient management in oncological patients

Purpose

This study was designed to assess the additional value of SPECT/CT of the trunk used in conjunction with conventional nuclear imaging and its effects on patient management in a large patient series.

Methods

In 353 patients, whole-body scintigraphy (WBS), SPECT, and SPECT/CT were prospectively performed for staging and restaging. SPECT/CT of the trunk was performed in all patients. In the 308 evaluable patients (211 with breast cancer, 97 with prostate cancer), clinical follow-up was used as the gold standard. Bone metastases were confirmed in 72 patients and excluded in 236. Multistep analyses per lesion and per patient were performed. Clinical relevance was expressed in terms of downstaging and upstaging rates on a per-patient basis.

Results

In the total patient group, sensitivities, specificities, and negative and positive predictive values on a per-patient basis were 93 %, 78 %, 95 % and 59 % for WBS, 94 %, 71 %, 97 % and 53 % for SPECT, and 97 %, 94 %, 97 % and 88 % for SPECT/CT, respectively. In all subgroups, specificity and positive predictive value were significantly (p?<?0.01) better with SPECT/CT. Downstaging of metastatic disease in the total, breast cancer and prostate cancer groups using SPECT/CT was possible in 32.1 %, 33.8 % and 29.5 % of patients, respectively. Upstaging in previously negative patients by additional SPECT/CT was observed in three breast cancer patients (2.1 %). Further diagnostic imaging procedures for unclear scintigraphic findings were necessary in only 2.5 % of patients. SPECT/CT improved diagnostic accuracy for defining the extent of multifocal metastatic disease in 34.6 % of these patients.

Conclusions

SPECT/CT significantly improved the specificity and positive predictive value of bone scintigraphy in cancer patients. In breast cancer patients, we found a slight increase in sensitivity. SPECT/CT had a significant effect on clinical management because of correct downstaging and upstaging, better definition of the extent of metastases, and a reduction in further diagnostic procedures.     

64层CTA对外周动脉阻塞性疾病的诊断和治疗指导

目的以常规DSA为参照标准,评价64层CTA对外周血管疾病病人狭窄-闭塞病变的诊断和治疗指导。材料与方法研究方案获机构审查委员会批准,所有病人均签署知情同意书。共212例有症状的外周血管疾病病人分别行