Limits...
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

A 75-year-old woman initially investigated with conventional contrast-enhanced MDCT during a bout of acute diverticulitis (a–c). Severe stratified mural thickening is observed throughout the entire sigmoid colon, with oedematous submucosa, diverticula, perivisceral fat inflammatory changes (*), and fascial fluid (thin arrows). Three weeks later, after conservative treatment, WE-MDCT with limited bowel preparation was performed to plan surgery, when endoscopy was still considered contraindicated. A significant decrease of sigmoid mural thickening and resolution of perivisceral acute inflammatory changes are observed (d–e), allowing limited laparoscopic sigmoid colon resection to be performed. Good distension of the upstream large bowel is achieved, without further abnormalities
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3675246&req=5

Fig3: A 75-year-old woman initially investigated with conventional contrast-enhanced MDCT during a bout of acute diverticulitis (a–c). Severe stratified mural thickening is observed throughout the entire sigmoid colon, with oedematous submucosa, diverticula, perivisceral fat inflammatory changes (*), and fascial fluid (thin arrows). Three weeks later, after conservative treatment, WE-MDCT with limited bowel preparation was performed to plan surgery, when endoscopy was still considered contraindicated. A significant decrease of sigmoid mural thickening and resolution of perivisceral acute inflammatory changes are observed (d–e), allowing limited laparoscopic sigmoid colon resection to be performed. Good distension of the upstream large bowel is achieved, without further abnormalities

Mentions: Acquired with preliminary bowel cleansing, elective WE-MDCT may be a helpful investigation in selected patients with impossible or incomplete endoscopy to visualise preoperatively the distribution of diverticular changes and to explore the upstream colon. The hallmark imaging appearance of uncomplicated diverticulosis is confidently detected, including fluid- and/or air-filled diverticular outpouchings of the colonic wall, usually associated with mural thickening due to muscular hypertrophy and/or spasm (Figs. 1, 2 and 3) [20]. Although diverticula are a common finding, at air CTC equivocal appearances such as thrombus-filled, faecalith, or inverted diverticula may cause significant diagnostic uncertainty, particularly with primary 3D interpretation [21]. WE-MDCT provides optimal presurgical assessment of the severity and extent of colon wall thickening and confident exclusion or identification of perivisceral inflammatory changes (Figs. 1, 2 and 3).Fig. 2


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)

A 75-year-old woman initially investigated with conventional contrast-enhanced MDCT during a bout of acute diverticulitis (a–c). Severe stratified mural thickening is observed throughout the entire sigmoid colon, with oedematous submucosa, diverticula, perivisceral fat inflammatory changes (*), and fascial fluid (thin arrows). Three weeks later, after conservative treatment, WE-MDCT with limited bowel preparation was performed to plan surgery, when endoscopy was still considered contraindicated. A significant decrease of sigmoid mural thickening and resolution of perivisceral acute inflammatory changes are observed (d–e), allowing limited laparoscopic sigmoid colon resection to be performed. Good distension of the upstream large bowel is achieved, without further abnormalities
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: A 75-year-old woman initially investigated with conventional contrast-enhanced MDCT during a bout of acute diverticulitis (a–c). Severe stratified mural thickening is observed throughout the entire sigmoid colon, with oedematous submucosa, diverticula, perivisceral fat inflammatory changes (*), and fascial fluid (thin arrows). Three weeks later, after conservative treatment, WE-MDCT with limited bowel preparation was performed to plan surgery, when endoscopy was still considered contraindicated. A significant decrease of sigmoid mural thickening and resolution of perivisceral acute inflammatory changes are observed (d–e), allowing limited laparoscopic sigmoid colon resection to be performed. Good distension of the upstream large bowel is achieved, without further abnormalities
Mentions: Acquired with preliminary bowel cleansing, elective WE-MDCT may be a helpful investigation in selected patients with impossible or incomplete endoscopy to visualise preoperatively the distribution of diverticular changes and to explore the upstream colon. The hallmark imaging appearance of uncomplicated diverticulosis is confidently detected, including fluid- and/or air-filled diverticular outpouchings of the colonic wall, usually associated with mural thickening due to muscular hypertrophy and/or spasm (Figs. 1, 2 and 3) [20]. Although diverticula are a common finding, at air CTC equivocal appearances such as thrombus-filled, faecalith, or inverted diverticula may cause significant diagnostic uncertainty, particularly with primary 3D interpretation [21]. WE-MDCT provides optimal presurgical assessment of the severity and extent of colon wall thickening and confident exclusion or identification of perivisceral inflammatory changes (Figs. 1, 2 and 3).Fig. 2

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