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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

A 65-year-old female with ulcerative colitis, initially investigated with water-soluble contrast enema, shows a “water-pipe” appearance of shortened, narrow left colon with advanced haustral loss (a). After medical treatment, elective WE-MDCT was performed because of incomplete colonoscopy. Discrete, circumferential mural thickening is observed from the rectum to the splenic flexure (arrowheads), corresponding to endoscopic severe disease, with confirmation of several millimetric pseudopolyps (thin arrows) throughout the descending tract. Markedly increased vascularity is seen in the proliferating perirectal and pericolonic fat planes (*). Most of the transverse and right colon appear to be spared
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Fig8: A 65-year-old female with ulcerative colitis, initially investigated with water-soluble contrast enema, shows a “water-pipe” appearance of shortened, narrow left colon with advanced haustral loss (a). After medical treatment, elective WE-MDCT was performed because of incomplete colonoscopy. Discrete, circumferential mural thickening is observed from the rectum to the splenic flexure (arrowheads), corresponding to endoscopic severe disease, with confirmation of several millimetric pseudopolyps (thin arrows) throughout the descending tract. Markedly increased vascularity is seen in the proliferating perirectal and pericolonic fat planes (*). Most of the transverse and right colon appear to be spared

Mentions: Historically, CT has had a limited role in imaging patients with UC because of its low sensitivity for early disease stages. Conversely, in our experience selected patients with UC may benefit from WE-MDCT, for example to determine disease severity in acute conditions when endoscopy is contraindicated because of the increased risk of perforation or exacerbation (Fig. 6), when a discrepancy exists between clinical and endoscopic findings (Fig. 7), or in elective cases with incomplete endoscopic exploration (Figs. 7, 8 and 9) [14].Fig. 6


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 65-year-old female with ulcerative colitis, initially investigated with water-soluble contrast enema, shows a “water-pipe” appearance of shortened, narrow left colon with advanced haustral loss (a). After medical treatment, elective WE-MDCT was performed because of incomplete colonoscopy. Discrete, circumferential mural thickening is observed from the rectum to the splenic flexure (arrowheads), corresponding to endoscopic severe disease, with confirmation of several millimetric pseudopolyps (thin arrows) throughout the descending tract. Markedly increased vascularity is seen in the proliferating perirectal and pericolonic fat planes (*). Most of the transverse and right colon appear to be spared
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3675246&req=5

Fig8: A 65-year-old female with ulcerative colitis, initially investigated with water-soluble contrast enema, shows a “water-pipe” appearance of shortened, narrow left colon with advanced haustral loss (a). After medical treatment, elective WE-MDCT was performed because of incomplete colonoscopy. Discrete, circumferential mural thickening is observed from the rectum to the splenic flexure (arrowheads), corresponding to endoscopic severe disease, with confirmation of several millimetric pseudopolyps (thin arrows) throughout the descending tract. Markedly increased vascularity is seen in the proliferating perirectal and pericolonic fat planes (*). Most of the transverse and right colon appear to be spared
Mentions: Historically, CT has had a limited role in imaging patients with UC because of its low sensitivity for early disease stages. Conversely, in our experience selected patients with UC may benefit from WE-MDCT, for example to determine disease severity in acute conditions when endoscopy is contraindicated because of the increased risk of perforation or exacerbation (Fig. 6), when a discrepancy exists between clinical and endoscopic findings (Fig. 7), or in elective cases with incomplete endoscopic exploration (Figs. 7, 8 and 9) [14].Fig. 6

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