CT enterography

Computed tomographic (CT) enterography is a non-invasive technique for diagnosis of small bowel disorders.

  • evaluates the entire thickness of the bowel wall
  • offers information about the surrounding mesentery, the mesenteric vasculature and the perienteric fat
  • useful in the assessment of the solid organs and provides global overview of the abdomen 1
  • exposure to ionizing radiation

Adequate luminal distension is necessary as collapsed bowel loops may mimic pathology. CT enterography utilizes two types of contrast:

  • neutral oral contrast agents 1,3
    • these have attenuation similar to that of water e.g. water, PEG electrolyte solution, methyl cellulose
    • intravenous contrast is used with neutral agents
    • these agents allow better assessment of mucosal enhancement, mural thickness as well as mesenteric vasculature, this is important especially in the evaluation of Crohn's disease 2
  • positive contrast agents  3
    • such as a dilute (1%) barium solutions
    • they are not routinely used in CT enterography
    • pathologic mural enhancement and intestinal hemorrhage are obscured by positive contrast agents
    • mainly used to detect lower grades of small bowel obstruction and internal fistula
Procedure 

Actual procedure will vary depending on institutional protocol/guidelines but below is a typical description 1, 2:

  1. Abstain from all food and drink 4-6 hours before the exam.
  2. Patients drink about 1.5- 2 L of oral contrast over 40-60 minutes.
  3. Administration of intravenous contrast injection at a rate 4 ml/sec.
  4. CT scanning is ideally performed on a multi-detector computed tomography (MDCT) scanner about 45-65 seconds after contrast material injection in a single (venous) phase or dual (arterial & venous) phases for the evaluation of mesenteric vasculature or GI tract bleeding.
  5. Data interpretation with the use of axial and coronal reformatted images for proper evaluation.
  • inflammatory bowel disease and its complications e.g. Crohn's disease or ulcerative colitis
  • small bowel tumors, including benign tumors (e.g. hamartomatous or hyperplastic polyps) or malignant tumors (e.g. adenocarcinoma, carcinoid, lymphoma and gastrointestinal stromal tumors)
  • mesenteric ischemia and gastrointestinal tract bleeding
  • Coeliac disease 1, 2
CT examinations
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Article information

rID: 30358
Sections: Approach, Physics
Synonyms or Alternate Spellings:
  • Computed tomographic (CT) enterography

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Cases and figures

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    Case 1: normal CT enterography arterial phase
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    Case 1: portal venous phase
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    Case 2: Crohn's disease
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    Case 3: Crohn's disease
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    Case 4: Crohn's disease with small bowel obstruction
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