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Water enema multidetector CT technique and imaging of diverticulitis and chronic inflammatory bowel diseases.

Norsa AH, Tonolini M, Ippolito S, Bianco R - Insights Imaging (2013)

Bottom Line: A detailed explanation of the technique is provided, including patient preparation, the acquisition protocol, and study interpretation.Ulcerative, indeterminate, or Crohn's colitis can be assessed including longitudinal distribution, mural thickening and enhancement patterns, pseudopolyps, associated perivisceral changes, adjacent organ involvement, and features suggesting carcinoma.Elective WE-MDCT represents a useful complementary technique in patients with impossible, incomplete, or inconclusive endoscopy, can allow study of a stricture's features and the upstream bowel, and helps planning medical, endoscopic, or surgical treatments.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy, alba.norsa@gmail.com.

ABSTRACT

Background: Water enema multidetector computed tomography (WE-MDCT) is currently considered the most accurate imaging modality to provide high-resolution multiplanar visualisation of the colonic wall and surrounding structures.

Methods: This pictorial review presents our experience with WE-MDCT applications outside colorectal tumour staging, particularly for investigating diverticular disease and chronic inflammatory bowel diseases. A detailed explanation of the technique is provided, including patient preparation, the acquisition protocol, and study interpretation.

Results: WE-MDCT allows accurate preoperative visualisation of diverticular disease, acute and complicated diverticulitis. Ulcerative, indeterminate, or Crohn's colitis can be assessed including longitudinal distribution, mural thickening and enhancement patterns, pseudopolyps, associated perivisceral changes, adjacent organ involvement, and features suggesting carcinoma. Elective WE-MDCT represents a useful complementary technique in patients with impossible, incomplete, or inconclusive endoscopy, can allow study of a stricture's features and the upstream bowel, and helps planning medical, endoscopic, or surgical treatments.

Conclusion: Urgent WE-MDCT with limited or no bowel preparation may prove useful in acutely symptomatic patients, as it may obviate a risky or contraindicated endoscopy, can determine disease severity, and allows making correct therapeutic choices.

Teaching points: • Water enema multidetector CT provides high-resolution multiplanar visualisation of the colonic wall. • WE-MDCT allows accurate visualisation of diverticular disease, acute and complicated diverticulitis. • In chronic inflammatory bowel diseases WE-MDCT depicts the distribution, mural and perivisceral changes. • Elective WE-MDCT usefully complements incomplete endoscopy to assess strictures and upstream colon. • Urgent WE-MDCT with limited or no bowel preparation in acute diseases may obviate endoscopy.

No MeSH data available.


Related in: MedlinePlus

Water-enema multidetector CT (WE-MDCT) technique and interpretation in a 40-year-old male with clinical suspicion of acute diverticulitis. Multiplanar contrast-enhanced images show good distension of the rectosigmoid colon (a, b), hypersegmented proximal sigmoid, and distal descending colon with mild diffuse mural thickening and small diverticular outpouchings (arrowheads in a, b, c). Good distension of the upstream transverse and right colon (d–f) with at least one diverticulum in the ascending tract. Perivisceral inflammatory changes and abscess collections are confidently excluded
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Fig1: Water-enema multidetector CT (WE-MDCT) technique and interpretation in a 40-year-old male with clinical suspicion of acute diverticulitis. Multiplanar contrast-enhanced images show good distension of the rectosigmoid colon (a, b), hypersegmented proximal sigmoid, and distal descending colon with mild diffuse mural thickening and small diverticular outpouchings (arrowheads in a, b, c). Good distension of the upstream transverse and right colon (d–f) with at least one diverticulum in the ascending tract. Perivisceral inflammatory changes and abscess collections are confidently excluded

Mentions: WE-MDCT is a reproducible technique that does not need complex post processing or 3D interpretation; therefore, a very short learning curve is to be expected for radiologists who are familiar with abdominal studies [7]. Images are routinely reconstructed along axial, coronal, and sagittal planes; however, the attending radiologist usually reviews the study on a dedicated workstation with the possibility to save arbitrary reconstruction images focussed on the key findings, including oblique or curved-planar reformations. In WE-MDCT, optimal contrast is observed between the well-distended lumen with water density, the enhanced colonic wall, and the normal fat-density pericolonic planes (Fig. 1). Mural thickness should be measured in a non-dependent, well-distended portion. In a well-distended bowel, the normal mural thickness should not exceed 2–3 mm. During exam interpretation, radiologists should carefully search for non-distensible segments along the large bowel with or without prestenotic dilatations (diameter over 5 cm), signs of mural thickening, hyperenhancement, and/or stratification, endoluminal projections, and diverticular outpouchings. Perivisceral fat changes such as increased density, hypervascularisation, adipose proliferation, or adenopathies should be sought. Furthermore, WE-MDCT allows comprehensive imaging of associated or incidental abnormalities involving the abdominal organs, lymph nodes, peritoneum, mesentery, retroperitoneum, lumbar and pelvic skeleton [14].Fig. 1


Water enema multidetector CT technique and imaging of diverticulitis and chronic inflammatory bowel diseases.

Norsa AH, Tonolini M, Ippolito S, Bianco R - Insights Imaging (2013)

Water-enema multidetector CT (WE-MDCT) technique and interpretation in a 40-year-old male with clinical suspicion of acute diverticulitis. Multiplanar contrast-enhanced images show good distension of the rectosigmoid colon (a, b), hypersegmented proximal sigmoid, and distal descending colon with mild diffuse mural thickening and small diverticular outpouchings (arrowheads in a, b, c). Good distension of the upstream transverse and right colon (d–f) with at least one diverticulum in the ascending tract. Perivisceral inflammatory changes and abscess collections are confidently excluded
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3675246&req=5

Fig1: Water-enema multidetector CT (WE-MDCT) technique and interpretation in a 40-year-old male with clinical suspicion of acute diverticulitis. Multiplanar contrast-enhanced images show good distension of the rectosigmoid colon (a, b), hypersegmented proximal sigmoid, and distal descending colon with mild diffuse mural thickening and small diverticular outpouchings (arrowheads in a, b, c). Good distension of the upstream transverse and right colon (d–f) with at least one diverticulum in the ascending tract. Perivisceral inflammatory changes and abscess collections are confidently excluded
Mentions: WE-MDCT is a reproducible technique that does not need complex post processing or 3D interpretation; therefore, a very short learning curve is to be expected for radiologists who are familiar with abdominal studies [7]. Images are routinely reconstructed along axial, coronal, and sagittal planes; however, the attending radiologist usually reviews the study on a dedicated workstation with the possibility to save arbitrary reconstruction images focussed on the key findings, including oblique or curved-planar reformations. In WE-MDCT, optimal contrast is observed between the well-distended lumen with water density, the enhanced colonic wall, and the normal fat-density pericolonic planes (Fig. 1). Mural thickness should be measured in a non-dependent, well-distended portion. In a well-distended bowel, the normal mural thickness should not exceed 2–3 mm. During exam interpretation, radiologists should carefully search for non-distensible segments along the large bowel with or without prestenotic dilatations (diameter over 5 cm), signs of mural thickening, hyperenhancement, and/or stratification, endoluminal projections, and diverticular outpouchings. Perivisceral fat changes such as increased density, hypervascularisation, adipose proliferation, or adenopathies should be sought. Furthermore, WE-MDCT allows comprehensive imaging of associated or incidental abnormalities involving the abdominal organs, lymph nodes, peritoneum, mesentery, retroperitoneum, lumbar and pelvic skeleton [14].Fig. 1

Bottom Line: A detailed explanation of the technique is provided, including patient preparation, the acquisition protocol, and study interpretation.Ulcerative, indeterminate, or Crohn's colitis can be assessed including longitudinal distribution, mural thickening and enhancement patterns, pseudopolyps, associated perivisceral changes, adjacent organ involvement, and features suggesting carcinoma.Elective WE-MDCT represents a useful complementary technique in patients with impossible, incomplete, or inconclusive endoscopy, can allow study of a stricture's features and the upstream bowel, and helps planning medical, endoscopic, or surgical treatments.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy, alba.norsa@gmail.com.

ABSTRACT

Background: Water enema multidetector computed tomography (WE-MDCT) is currently considered the most accurate imaging modality to provide high-resolution multiplanar visualisation of the colonic wall and surrounding structures.

Methods: This pictorial review presents our experience with WE-MDCT applications outside colorectal tumour staging, particularly for investigating diverticular disease and chronic inflammatory bowel diseases. A detailed explanation of the technique is provided, including patient preparation, the acquisition protocol, and study interpretation.

Results: WE-MDCT allows accurate preoperative visualisation of diverticular disease, acute and complicated diverticulitis. Ulcerative, indeterminate, or Crohn's colitis can be assessed including longitudinal distribution, mural thickening and enhancement patterns, pseudopolyps, associated perivisceral changes, adjacent organ involvement, and features suggesting carcinoma. Elective WE-MDCT represents a useful complementary technique in patients with impossible, incomplete, or inconclusive endoscopy, can allow study of a stricture's features and the upstream bowel, and helps planning medical, endoscopic, or surgical treatments.

Conclusion: Urgent WE-MDCT with limited or no bowel preparation may prove useful in acutely symptomatic patients, as it may obviate a risky or contraindicated endoscopy, can determine disease severity, and allows making correct therapeutic choices.

Teaching points: • Water enema multidetector CT provides high-resolution multiplanar visualisation of the colonic wall. • WE-MDCT allows accurate visualisation of diverticular disease, acute and complicated diverticulitis. • In chronic inflammatory bowel diseases WE-MDCT depicts the distribution, mural and perivisceral changes. • Elective WE-MDCT usefully complements incomplete endoscopy to assess strictures and upstream colon. • Urgent WE-MDCT with limited or no bowel preparation in acute diseases may obviate endoscopy.

No MeSH data available.


Related in: MedlinePlus