Application of 256 Multi-Detector Computed Tomography Enterography in Small Bowel Inflammatory Diseases

To discuss the utility of MDCTE for evaluating inflammatory diseases of the small bowel.Materials and methods: At our institution,118 patients(male 53;female 65;mean age 48.5 years) with symptoms of suspected small bowel diseases underwent 256-MDCTE.Pertinent MDCTE and histopathology reports were reviewed.The CT appearances characteristic of small-bowel inflammatory bowel disease are described and illustrated in detail.Associated complications and extraenteric manifestations also are described.Results: Of 118 MDCTEs performed,there were 25 cases of small bowel inflammations(male 13;female 12;mean age 45.5 years).In all 12 cases of Crohn’s diseases,small bowel involvement was typically transmural,with characteristic skip lesions.CT features of active Crohn’s disease include mucosal hyper-enhancement,irregular wall thickening,mural stratification with a prominent vasa recta(comb sign),and mesenteric fat stranding.2 cases of ulcerative colitis characterized by a continuous pattern of bowel wall involvement,starting from the rectum,without evidence of skip lesions.Ulcerative colitis predominantly involved the large bowel but may extend to the terminal ileum.Extra-intestinal manifestations may occur but were uncommon.Mucosal hyper-enhancement along with circumferential and symmetric bowel wall thickening was present.There was mural stratification with enhancement of the inner mucosa and outer muscularis propria.Mesenteric hyperemia was present in the pericolonic fat;MDCTE demonstrated findings suggestive of intestinal tuberculosis in one patient by depicting ulcero-nodular with strictures,edema and thickening of the ileocecal region,the presence of necrotic mesenteric lymph nodes that were adjacent to a small-bowel thickening.There was 1 case of viral gastroenteritis and 7 cases of generalized small bowel enteritis with non-specific MDCTE features include bowel thickening and submucosal edema appreciable in the entire intestine.Mesenteric vessels were regularly opacified.MDCTE gave correct diagnosis in 21 cases,4 missed cases were all generalized small bowel enteritis.Conclusion: Our results demonstrated that MDCTE with peroral and intravenous contrast is useful in assessing small bowel inflammatory diseases;however,further studies are needed to determine and validate the full diagnostic and clinical potential of bowel imaging at MDCTE.