Computed Tomography Enterography and Magnetic Resonance Enterography: The Future of Small Bowel Imaging

ABSTRACT

In the last 5 years, computed tomography enterography (CTE) and to a lesser extent magnetic resonance enterography (MRE) have supplanted the routine small bowel series and enteroclysis in the evaluation of many small bowel diseases, especially Crohn's disease. Both CTE and MRE use similar methods of bowel lumen opacification and distension and both have distinct advantages and disadvantages. Both have been most extensively studied in patients with Crohn's disease. What is certain is that these cross-sectional examinations have largely replaced the historic fluoroscopic examinations in the evaluation of the small bowel.

KEYWORDS

Computed tomography enterography - magnetic resonance enterography - Crohn's disease - chronic obscure gastrointestinal bleeding

REFERENCES

• 1 Prokop M. Multislice CT: technical principles and future trends.  Eur Radiol. 2003;  13(Suppl 5) M3-M13
• 2 Horton K M, Fishman E K. Volume-rendered 3D CT of the mesenteric vasculature: normal anatomy, anatomic variants, and pathologic conditions.  Radiographics. 2002;  22(1) 161-172
• 3 Horton K M, Fishman E K. The current status of multidetector row CT and three-dimensional imaging of the small bowel.  Radiol Clin North Am. 2003;  41(2) 199-212
• 4 Raptopoulos V, Davis M A, Davidoff A et al.. Fat-density oral contrast agent for abdominal CT.  Radiology. 1987;  164(3) 653-656
• 5 Angelelli G, Macarini L, Fratello A. Use of water as an oral contrast agent for CT study of the stomach.  , [letter] AJR Am J Roentgenol. 1987;  149(5) 1084
• 6 Gossios K J, Tsianos E V, Demou L L et al.. Use of water or air as oral contrast media for computed tomographic study of the gastric wall: comparison of the two techniques.  Gastrointest Radiol. 1991;  16(4) 293-297
• 7 Minami M, Kawauchi N, Itai Y, Niki T, Sasaki Y. Gastric tumors: radiologic-pathologic correlation and accuracy of T staging with dynamic CT.  Radiology. 1992;  185(1) 173-178
• 8 Winter III T C, Freeny P C, Nghiem H V. Extrapancreatic gastrinoma localization: value of arterial-phase helical CT with water as an oral contrast agent.  AJR Am J Roentgenol. 1996;  166(1) 51-52
• 9 Winter T C, Ager J D, Nghiem H V, Hill R S, Harrison S D, Freeny P C. Upper gastrointestinal tract and abdomen: water as an orally administered contrast agent for helical CT.  Radiology. 1996;  201(2) 365-370
• 10 Lomas D J, Graves M J. Small bowel MRI using water as a contrast medium.  Br J Radiol. 1999;  72 994-997
• 11 Minowa O, Ozaki Y, Kyogoku S, Shindoh N, Sumi Y, Katayama H. MR imaging of the small bowel using water as a contrast agent in a preliminary study with healthy volunteers.  AJR Am J Roentgenol. 1999;  173 581-582
• 12 Rieber A, Aschoff A, Nussle K et al.. MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis.  Eur Radiol. 2000;  10 1377-1382
• 13 Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Maris T, Prassopoulos P. MR imaging of the small bowel with a true-FISP sequence after enteroclysis with water solution.  Invest Radiol. 2000;  35 707-711
• 14 Patak M A, Froehlich J M, von Weymarn C, Ritz M A, Zollikofer C L, Wentz K. Non-invasive distension of the small bowel for magnetic-resonance imaging.  Lancet. 2001;  358 987-988
• 15 Laghi A, Carbone I, Catalano C et al.. Polyethylene glycol solution as an oral contrast agent for MR imaging of the small bowel.  AJR Am J Roentgenol. 2001;  177 1333-1334
• 16 Lauenstein T C, Schneemann H, Vogt F M, Herborn C U, Ruhm S G, Debatin J F. Optimization of oral contrast agents for MR imaging of the small bowel.  Radiology. 2003;  228 279-283
• 17 Ajaj W, Goehde S C, Schneemann H, Ruehm S G, Debatin J F, Lauenstein T C. Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension.  Eur Radiol. 2004;  14 458-464
• 18 Kuehle C A, Ajaj W, Ladd S C, Massing S, Barkhausen J, Lauenstein T C. Hydro-MRI of the small bowel: effect of contrast volume, timing of contrast administration, and data acquisition of bowel distension.  AJR Am J Roentgenol. 2006;  187 W375-W385
• 19 Megibow A J, Babb J S, Hecht E M et al.. Evaluation of bowel distension and bowel wall appearance by using neutral oral contrast agent for multi-detector row CT.  Radiology. 2006;  238 87-95
• 20 Reittner P, Goritschnig T, Petritsch W et al.. Multiplanar spiral CT enterography in patients with Crohn's disease using a negative oral contrast material: initial results of a noninvasive imaging approach.  Eur Radiol. 2002;  12(9) 2253-2257
• 21 Doerfler O C, Ruppert-Kohlmayr A J, Reittner P, Hinterleitner T, Petritsch W, Szolar D H. Helical CT of the small bowel with an alternative oral contrast material in patients with Crohn disease.  Abdom Imaging. 2003;  28(3) 313-318
• 22 Arslan H, Etlik Ö, Kayan M et al.. Peroral CT enterography with lactulose solution: preliminary observations.  AJR Am J Roentgenol. 2005;  185 1173-1179
• 23 Kuo P H, Kanal E, Abu-Alfa A K, Cowper S E. Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis.  Radiology. 2007;  242 647-649
• 24 Sadowski E A, Bennett L K, Chan M R et al.. Nephrogenic systemic fibrosis: risk factors and incidence estimation.  Radiology. 2007;  243 148-157
• 25 Collidge T A, Thomson P C, Mark P B et al.. Gadolinium-enhanced MR imaging and nephrogenic systemic fibrosis: retrospective study of a renal replacement therapy cohort.  Radiology. 2007;  245 168-175
• 26 Kanal E, Broome D R, Martin D R, Thomsen H S. Response to the FDA's May 23, 2007, Nephrogenic Systemic Fibrosis update.  Radiology. 2008;  246 11-15
• 27 Fidler J. MR imaging of the small bowel.  Radiol Clin North Am. 2007;  45 317-331
• 28 Jaffe T A, Gaca A M, Delaney S et al.. Radiation dose from small-bowel follow-through and abdominopelvic MDCT in Crohn's disease.  AJR Am J Roentgenol. 2007;  189 1015-1022
• 29 Siddiki H, Fletcher J G, Bruining D et al.. Performance of lower-dose CT enterography for detection of inflammatory Crohn's disease. Paper SSA10–02. Paper presented at: 93rd Scientific Session of the Radiological Society of North America November 25–30, 2007 Chicago, IL;
• 30 Rajesh A, Maglinte D DT. Multislice CT enteroclysis: technique and applications.  Clin Radiol. 2006;  61 31-39
• 31 Parrish F J. Small bowel CT-enteroclysis: Technique, pitfalls and pictorial review.  Australas Radiol. 2006;  50 289-297
• 32 Maglinte D DT, Sandrasegaran K, Lappas J C. CT enteroclysis: techniques and applications.  Radiol Clin North Am. 2007;  45 289-301
• 33 Maglinte D DT, Sandrasegaran K, Lappas J C, Chiorean M. CT enteroclysis.  Radiology. 2007;  245 661-671
• 34 Maglinte D D, Siegelman E S, Kelvin F MMR. Enteroclysis: the future of small-bowel imaging?.  Radiology. 2000;  215 639-641
• 35 Hara A K, Leighton J A, Sharma V K et al.. Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT.  Radiographics. 2005;  25 697-718
• 36 Paulsen S R, Huprich J E, Fletcher J G et al.. CT Enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases.  Radiographics. 2006;  26 641-657
• 37 Paulson S R, Huprich J E, Hara A K. CT enterography: noninvasive evaluation of Crohn's disease and obscrure gastrointestinal bleeding.  Radiol Clin North Am. 2007;  45 303-315
• 38 Wold P B, Fletcher J G, Johnson C D et al.. Assessment of small bowel crohn disease: noninvasive peroral Extrapancreatic gastrinoma localization: value of arterial-phase helical CT with water as an oral contrast agent.  AJR Am J Roentgenol. 1996;  enterography compared with other imaging methods and endoscopy-feasibility study.  Radiology. 2003;  229 275-281
• 39 Hara A K, Leighton J A, Sharma V K, Fleischer D E. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT.  Radiology. 2004;  230 260-265
• 40 Hara A K, Leighton J A, Heigh R I et al.. Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy.  Radiology. 2006;  238 128-134
• 41 Bodily K D, Fletcher J G, Solem C A et al.. Crohn disease: mural attenuation and thickness at contrast-enhanced ct enterography – correlation with endoscopic and histologic findings of inflammation.  Radiology. 2006;  238 505-516
• 42 Maglinte D DT. Science to practice: do mural attenuation and thickness at contrast-enhanced CT enterography correlate with endoscopic and histologic findings of inflammation in Crohn disease?.  Radiology. 2006;  238 381-382
• 43 Booya F, Fletcher J G, Huprich J E et al.. Active Crohn disease: CT Findings and interobserver agreement for enteric phase CT enterography.  Radiology. 2006;  241 787-795
• 44 Baker M E, Walter J, Obuchoski N A et al.. Contrast-enhanced CT enterography in normal small bowel and Crohn's Disease. Differences in wall enhancement and wall thickness. Paper SSA10–04. Paper presented at: 93rd Scientific Session of the Radiological Society of North America November 25–30, 2007 Chicago, IL;
• 45 Vogel J, Moreira A, Baker M et al.. CT enterography for Crohn's disease: accurate preoperative diagnostic imaging.  Dis Colon Rectum. 2007;  50 1761-1769
• 46 Makó E K, Mester ÁR, Tarján Zs et al.. Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn's disease.  Eur J Radiol. 2000;  35 168-175
• 47 Hassan C, Cerro P, Zullo A, Spina C, Morini S. Computed tomography enteroclysis in comparison with ileoscopy in patients with Crohn's disease.  J Colorectal Dis. 2003;  18 121-125
• 48 Boudiaf M, Jaff A, Soyer P et al.. Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients.  Radiology. 2004;  233 338-344
• 49 Florie J, Wasser M NJM, Arts-Cieslik K, Akkerman E M, Siersema P D, Stoker J. Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn's disease.  AJR Am J Roentgenol. 2006;  186 1384-1392
• 50 Umschaden H W, Szolar D, Gasser J et al.. Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings.  Radiology. 2000;  215 717-725
• 51 Sempere G A, Martinez S V, Medina C E et al.. MRI evaluation of inflammatory activity in Crohn's disease.  AJR Am J Roentgenol. 2005;  184 1829-1835
• 52 Solem C A, Loftus E V, Fletcher J G et al.. Small bowel (SB) imaging in Crohn's disease (CD): a prospective, blinded, 4-way comparison trial.  Gastroenterology. 2005;  128 A74
• 53 Treister S L, Leighton J A, Leontiadis D E et al.. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease.  Am J Gastroenterol. 2006;  101 954-964
• 54 Voderholzer W A, Beinhoelz J, Rogalla P et al.. Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis.  Gut. 2005;  54 369-373
• 55 Golder S K, Schreyer A G, Endlicher E et al.. Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease.  Int J Colorectal Dis. 2006;  21 97-107
• 56 Graham D Y, Opekun A R, Willingham F F et al.. Visible small-intestinal mucosal injury in chronic NSAID users.  Clin Gastroenterol Hepatol. 2005;  3 55-59
• 57 Goldstein J L, Eisen G M, Lewis B et al.. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprozole and placebo.  Clin Gastroenterol Hepatol. 2005;  3 133-141
• 58 Lashner B A. Sensitivity-specificity trade-off for capsule endoscopy in IBD: is it worth it?.  Am J Gastroenterol. 2006;  101 965-966
• 59 Choi D, Jin Lee S, Ah Cho Y et al.. Bowel wall thickening in patients with Crohn's disease: CT patterns and correlation with inflammatory activity.  Clin Radiol. 2003;  58 68-74
• 60 Colombel J F, Solem C A, Sandborn W J et al.. Quantitative measurement and visual assessment of ileal Crohn's disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein.  Gut. 2006;  55 1561-1567
• 61 Lee S S, Ha H K, Yang S K et al.. CT of prominent pericolic or perienteric vasculature in patients with Crohn's disease: correlation with clinical disease activity and findings on barium studies.  AJR Am J Roentgenol. 2002;  179 1029-1036
• 62 Florie J, Horsthuis K, Hommes D W et al.. Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn's disease.  Clin Gastroenterol Hepatol. 2005;  3 1221-1228
• 63 Chiorean M V, Sandrasegaran K, Saxena R, Maglinte D D, Nakeeb A, Johnson C S. Correlation of CT enteroclysis with surgical pathology in Crohn's disease.  Am J Gastroenterol. 2007;  102 2541-2550
• 64 Daperno M, D'Haens G D, Van Assche G et al.. Development and validation of a new simplified endoscopic activity score for Crohn's disease: the SES-CD.  Gastrointest Endosc. 2004;  60 505-512
• 65 Raju G S, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding.  Gastroenterology. 2007;  133 1697-1717
• 66 Voderholzer W A, Ortner M, Rogalla P, Beinholzl J, Lochs H. Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis.  Endoscopy. 2003;  35 1009-1014
• 67 Johanssen S, Boivin M, Lochs H et al.. The yield of wireless capsule endoscopy in the detection of neuroendocrine tumors in comparison with CT enteroclysis.  Gastrointest Endosc. 2006;  63 660-665
• 68 Pilleul F, Penigaud M, Milot L et al.. Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis.  Radiology. 2006;  241 796-801
• 69 Huprich J E, Fletcher J G, Fidler J L, Alexander J A, Diddiki H, McCollough C H. A prospective comparison of multiphase CT enterography with wireless capsule endoscopy in management of obscure GI bleeding. Paper SSA 10–05. Paper presented at: 93rd Scientific Session of the Radiological Society of North America November 25–30, 2007 Chicago, IL;