Multidetector Row CT of the Small Bowel

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Technique

There are several challenges in imaging the small bowel. Ideally, CT of the small bowel should include optimal image acquisition, oral contrast and intravenous (IV) contrast administration, and multiplanar reconstruction in the postprocessing phase.

Normal anatomy

The small bowel is an intraperitoneal structure, except for the duodenum, which is retroperitoneal. The total length of the small bowel measures 4 to 5 m in autopsy samples; in vivo its length is approximately 2.5 to 3 m. Its course is complex and has been referred to as “a pond of withering snakes” [24], extending roughly from the left to the right upper quadrant, down to the left lower, and then to the right lower quadrant. It is not possible on MDCT images to distinguish exactly between

Disease

Small bowel diseases are rare. This article discusses the diseases that most commonly affect the small bowel, such as inflammatory bowel disease, obstruction, ischemia, and neoplasm. A recently published single-center study represents the distribution of disease in 107 patients, which were referred for small bowel MDCT in an 18-month period. The distribution of the diseases in this study was as follows: small bowel masses (18%), CD (10%), obstruction (10%), and normal findings in the rest. The

Summary

MDCT is a technique that can be applied routinely to evaluate the small bowel. Thin collimation and fast scanning allow coverage of the whole abdomen within one suspended respiration phase with the use of multiphasic IV contrast administration. These technical options provide source images for multiplanar reconstruction.

Bowel distention is a key element for accurately diagnosing small bowel pathology. CT enterography or CT enteroclysis are currently used but larger studies have to determine the

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      In addition, because small bowel diseases have a low incidence, their appearance is less well known and there is an increased risk of missing them. Ever most of the common diseases in the small bowel, early changes are subtle making their diagnosis difficult (2). Small bowel follow-through and enteroclysis are widely used for small bowel imaging; however, these examinations provide only indirect information about the bowel wall and prone to problems caused by overlapping bowel loops (3).

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      However, the imaging literature of a representative number of the common as well as some of the less common entities is reviewed, and clues to narrowing the differential diagnosis are also provided. Because patients with regional or diffuse small bowel disease present with nonspecific acute, or subacute to chronic, abdominal and pelvic signs and symptoms, unless the clinical suspicion is particularly high for a specific disorder (eg, intramural small bowel hematoma/hemorrhage [ISBH], when noncontrast CT should be performed), or when follow-up is being performed for a known or suspected small bowel disease, such patients typically undergo the routine abdominal/acute abdominal CT protocol of an institution or practice.1–3 At our institutions, for example, such patients typically undergo 16 to more than 64 multidetector CT during the portal venous phase of intravenous (IV) contrast (assuming IV contrast can be administered), either with or without positive oral contrast administration.

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    Dr. Patak is funded by the Swiss Research Foundation.

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