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Assessment of Small Bowel Crohn Disease: Noninvasive Peroral CT Enterography Compared with Other Imaging Methods and Endoscopy—Feasibility Study¹

¹ From the Department of Diagnostic Radiology (P.B.W., J.G.F., C.D.J.) and Division of Gastroenterology, Department of Internal Medicine (W.J.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905. From the 2001 RSNA scientific assembly. Received July 19, 2002; revision requested August 29; revision received December 24; accepted January 15, 2003. Address correspondence to J.G.F. (e-mail: fletcher.joel@mayo.edu).

View larger version (18K): [in a new window]   Figure 1. Graph compares adequacy of luminal distention between the two CT enterography protocols.

View larger version (126K): [in a new window]   Figure 2a. Normal appearance of small bowel at transverse CT enterography. (a) Image shows adequate distention of jejunal loops by water. Note the valvulae conniventes (arrowheads). (b) Image in another patient shows distended, normal ileal loops.

View larger version (123K): [in a new window]   Figure 2b. Normal appearance of small bowel at transverse CT enterography. (a) Image shows adequate distention of jejunal loops by water. Note the valvulae conniventes (arrowheads). (b) Image in another patient shows distended, normal ileal loops.

View larger version (118K): [in a new window]   Figure 3a. Typical appearances of active Crohn disease. (a, b) Transverse CT images show segmental luminal narrowing, mural thickening (arrows), mucosal hyperenhancement (arrowhead), mural stratification (in b), and low-grade partial small bowel obstruction in a patient with active Crohn disease. (c) Small bowel follow-through image shows eccentric narrowing and string sign (arrows) in the same bowel loop.

View larger version (116K): [in a new window]   Figure 3b. Typical appearances of active Crohn disease. (a, b) Transverse CT images show segmental luminal narrowing, mural thickening (arrows), mucosal hyperenhancement (arrowhead), mural stratification (in b), and low-grade partial small bowel obstruction in a patient with active Crohn disease. (c) Small bowel follow-through image shows eccentric narrowing and string sign (arrows) in the same bowel loop.

View larger version (123K): [in a new window]   Figure 3c. Typical appearances of active Crohn disease. (a, b) Transverse CT images show segmental luminal narrowing, mural thickening (arrows), mucosal hyperenhancement (arrowhead), mural stratification (in b), and low-grade partial small bowel obstruction in a patient with active Crohn disease. (c) Small bowel follow-through image shows eccentric narrowing and string sign (arrows) in the same bowel loop.

View larger version (104K): [in a new window]   Figure 4a. Active disease seen at CT enterography at ileocolic anastomosis but not at fluoroscopic small bowel examination. (a, b) Image obtained at transverse CT enterography shows mucosal hyperenhancement (arrow) at the ileocolic anastomosis compared with adjacent normal ileum (arrowhead). (c) On image obtained at fluoroscopy, the same anastomosis (arrows) appears normal.

View larger version (101K): [in a new window]   Figure 4b. Active disease seen at CT enterography at ileocolic anastomosis but not at fluoroscopic small bowel examination. (a, b) Image obtained at transverse CT enterography shows mucosal hyperenhancement (arrow) at the ileocolic anastomosis compared with adjacent normal ileum (arrowhead). (c) On image obtained at fluoroscopy, the same anastomosis (arrows) appears normal.

View larger version (150K): [in a new window]   Figure 4c. Active disease seen at CT enterography at ileocolic anastomosis but not at fluoroscopic small bowel examination. (a, b) Image obtained at transverse CT enterography shows mucosal hyperenhancement (arrow) at the ileocolic anastomosis compared with adjacent normal ileum (arrowhead). (c) On image obtained at fluoroscopy, the same anastomosis (arrows) appears normal.

View larger version (128K): [in a new window]   Figure 5a. Fistula seen at CT enterography but not at fluoroscopic small bowel follow-through examination. (a) Image obtained at transverse CT enterography shows mural stratification and mucosal hyperenhancement in the actively inflamed terminal ileum (arrow) and a hyperattenuating enterocutaneous fistula (arrowheads). (b) Spot view of the terminal ileum obtained at fluoroscopy in the same patient shows active ileal disease (arrowheads) but fails to show a fistula.

View larger version (111K): [in a new window]   Figure 5b. Fistula seen at CT enterography but not at fluoroscopic small bowel follow-through examination. (a) Image obtained at transverse CT enterography shows mural stratification and mucosal hyperenhancement in the actively inflamed terminal ileum (arrow) and a hyperattenuating enterocutaneous fistula (arrowheads). (b) Spot view of the terminal ileum obtained at fluoroscopy in the same patient shows active ileal disease (arrowheads) but fails to show a fistula.