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.     

CT enteroclysis in incomplete small bowel obstruction

The timing of surgical intervention as well as the optimal method of radiologic investigation for patients with incomplete, open loop small bowel obstruction has changed over the past two decades. This review focuses on the role of computed tomographic enteroclysis in the evaluation of patients with suspected small bowel obstruction. The technique of examination is described and an overview of its clinical applications and imaging controversy are presented.     

Functional imaging of the pelvic floor

The clinical treatment of patients with anorectal and pelvic floor dysfunction is often difficult. Dynamic cystocolpoproctography (DCP) has evolved from a method of evaluating the anorectum for functional disorders to its current status as a functional method of evaluating the global pelvic floor for defecatory disorders and pelvic organ prolapse. It has both high observer accuracy and a high yield of positive diagnoses. Clinicians find it a useful diagnostic tool that can alter management decisions from surgical to medical and vice versa in many cases. Functional radiography provides the maximum stress to the pelvic floor, resulting in levator ani relaxation accompanied by rectal emptying-which is needed to diagnose defecatory disorders. It also provides organ-specific quantificative information about female pelvic organ prolapse-information that usually can only be inferred by means of physical examination. The application of functional radiography to the assessment of defecatory disorders and pelvic organ prolapse has highlighted the limitations of physical examination. It has become clear that pelvic floor disorders rarely occur in isolation and that global pelvic floor assessment is necessary. Despite the advances in other imaging methods, DCP has remained a practical, cost-effective procedure for the evaluation of anorectal and pelvic floor dysfunction. In this article, the authors describe the technique they use when performing DCP, define the radiographic criteria used for diagnosis, and discuss the limitations and clinical utility of DCP.     

Pelvic floor disorders: what’s the best test?

Pelvic floor dysfunctions represent a common health problem affecting particularly post-menopausal women impacting significantly the quality of life. A large number of these patients suffer for many years without proper treatment often due to the lack of objective findings necessary to plan proper treatment. Because abnormalities of the different pelvic compartments are frequently associated, thorough diagnostic characterization of how many compartments are affected is paramount in order to plan the management approach that can include a multidisciplinary surgical approach. This pictorial essay will review the different imaging methods used for the characterization of these disorders, how to do them and its rationale providing a clinically understandable interpretation with clinical correlates and a correlation between fluoroscopic and MR defecography in order to illustrate the strengths and shortcomings of each. The need to use a standardized, reliable, and clinically understandable method of quantification has become more obvious in the last decades with the increasing rate of scientific and professional interchanges. A review of the grading systems used to convey the imaging findings also highlights the importance of using a standardized tool for comparing and communicating clinical findings understandable to referring physicians with proven inter-observer and intra-observer agreement of the examinations.     

Benefits of routine use of coronal and sagittal reformations in multi-slice CT examination of the abdomen and pelvis

AIM: To evaluate the usefulness of coronal and sagittal reformations from isotropic abdomino-pelvic computed tomography (CT) examinations. METHODS: Fifty consecutive abdomino-pelvic CT examinations were reconstructed into two sets of axial source images: 0.9 mm section width with 0.45 mm reconstruction interval (isotropic) and 4 mm section width with 3 mm reconstruction interval. The isotropic dataset was reformatted into coronal and sagittal stacks with 4 mm section widths. Three readers independently reviewed the three image sets with 4 mm section widths. The coronal and sagittal reformations were compared with the axial images, in the same sitting, for depiction of lesions in various abdominal organs. RESULTS: There was better visualization of lesions in the liver, kidneys, mesentery, lumbar spine, major abdominal vessels, urinary bladder, diaphragm and hips on the coronal reformations compared with source axial images (p<0.05). Sagittal reformations scored better than axial source images for showing lesions in the liver, thoracic spine, abdominal vessels, uterus, urinary bladder, diaphragm and hips (p<0.05). The coronal and sagittal series showed significant additional information in 23 and 17% of patients, respectively. CONCLUSION: Radiologists should consider the routine review of at least one additional plane to the axial series in the interpretation of abdomino-pelvic CT studies.     

Enteroclysis--a technique for examining the small bowel

Small bowel follow-through is the most commonly performed radiographic procedure for evaluation of the small bowel. However, recent advances in intubation and infusion techniques and the availability of improved barium suspensions have renewed interest in small bowel enteroclysis. Enteroclysis represents a significant improvement in the method of small bowel examination, yielding accurate diagnosis of a wide variety of lesions as well as confident demonstration of small bowel normality. Successful enteroclysis requires meticulous attention to technical and procedural details. The techniques of enteroclysis examination, diagnostic advantages, and clinical indications are elucidated in this review.     

Real-time video/voice technology for direct review of remote ambulatory care ultrasound examinations: Clinical feasibility

This study was conducted to compare the diagnosis made during real-time review of remote ultrasound video transmitted over a citywide fiberoptic network to the diagnosis made after the radiologist viewed the filmed ultrasound examination.An ultrasound machine was connected to the citywide fiberoptic network and then to our hospital network. Diagnoses made on the basis of 827 obstetric and gynecologic ultrasound examinations performed 7 miles from our institution on patients who underwent direct real-time monitoring via a fiberoptic network were compared with the diagnoses rendered on the real-time assessment. Referring physician satisfaction and network-related problems were monitored.Over a period of 19 months, 630 obstetric and 197 pelvic ultrasound examinations were performed and monitored. The diagnosis made on realtime remote monitoring by the ultrasound radiologist was similar to the diagnosis rendered after review of filmed examinations in all cases. The method was well received by both patients and referring clinicians. There was no fiberoptic network-related downtime.Diagnostic impressions made during remote real-time review are reliable; remote real-time video/voice technology can replace direct hands-on manipulation of the ultrasound transducer by the radiologist for review of remote ambulatory care obstetric and gynecologic ultrasound examinations.     

Oral cholecystography in contemporary gallstone imaging: a review

The introduction of nonoperative alternatives to elective cholecystectomy in the management of gallstones has resurrected use of oral cholecystography (OCG). This article reviews basic principles involved in the proper performance of OCG and interpretation of the resulting images. The role of OCG in the current management of gallstones is discussed.