CT enterography: technical and interpretive pitfalls

CT enterography is a first-line test at many institutions to investigate potential small bowel disorders. While numerous articles have focused on the ability of CT enterography to diagnose and stage Crohn’s disease, small bowel neoplasia, and malabsorptive or vascular disorders, this article reviews...

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Bibliographic Details
Published in:Abdominal imaging 2015-06, Vol.40 (5), p.1081-1096
Main Authors: Barlow, John M., Goss, Brian C., Hansel, Stephanie L., Kolbe, Amy B., Rackham, Joshua L., Bruining, David H., Fletcher, Joel G.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Diagnostic Errors
Female
Gastroenterology
Hepatology
Humans
Image Processing, Computer-Assisted
Imaging
Intestinal Diseases - diagnostic imaging
Intestine, Small - diagnostic imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Pictorial Essay
Radiology
Reproducibility of Results
Tomography, X-Ray Computed
Young Adult
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Summary:CT enterography is a first-line test at many institutions to investigate potential small bowel disorders. While numerous articles have focused on the ability of CT enterography to diagnose and stage Crohn’s disease, small bowel neoplasia, and malabsorptive or vascular disorders, this article reviews CT enterography limitations, technical and interpretive pitfalls, image review tactics, and complementary radiologic and endoscopic examinations to improve diagnostic accuracy. CT enterography limitations include its inability to demonstrate isolated mucosal abnormalities such as aphthous ulcers and its use of ionizing radiation. The most common technical pitfall of CT enterography is inadequate small bowel distention resulting from inadequate ingestion, gastric retention, or rapid small bowel transit of a large volume of neutral enteric contrast material. Additionally, segments of jejunum are frequently collapsed. Interpretive pitfalls commonly result from peristaltic contractions, transient intussusception and opaque intraluminal debris. Opaque debris is especially problematic during multiphasic CT enterography performed to identify potential small bowel sources of obscure gastrointestinal bleeding. False-negative examinations may result from inadequate radiation dose. Examinations complementary to CT enterography include small bowel follow through, enteroclysis, CT enteroclysis, MR enterography, MR enteroclysis, capsule endoscopy, and balloon-assisted endoscopy. Properly performed and accurately interpreted CT enterography contributes to the diagnosis and management of small bowel disease by itself and as a complement to other radiologic and optical small bowel imaging examinations.
ISSN:0942-8925
2366-004X
1432-0509
2366-0058
DOI:10.1007/s00261-015-0364-5