[Computed tomography in the diagnosis of inflammatory bowel disease -- methodology of MSCT and clinical results].
OBJECTIVE
This paper discusses the diagnostic yield of multislice computed tomography (MSCT) in inflammatory bowel disease.


METHODS
Contrast media are administered intraluminally (colon, small intestine) and intravenously (triple contrast CT). Filling of small bowel is achieved by means of jejunal tube ("Sellink CT") or via the oral route. Pharmacological relaxation of the intestine decreases motion artifact. Intraluminal contrast media consist of either hyperdense, "positive" or hypodense, "negative" liquids.


RESULTS
Thin-slice MSCT of the entire abdomen allows high-quality post processing (MPR, thin-slice MIP). Due to superior distension, Sellink CT improves estimation of stenosis or changes in thickness and contrast of bowel wall. Positive contrast is superior in the detection and preoperative localization of abscess, fistula or conglomerate tumour, because it accurately differentiates between intra- and extraluminal structures.However, negative contrast facilitates quantitative evaluation of bowel wall thickening or enhancement and demonstrates gastrointestinal bleeding.


CONCLUSIONS
MSCT of the small intestine is superior to conventional enteroclysis, especially in the diagnosis of mesenterial or other extraintestinal disease. As a side effect, the colon is assessed in the same examination. Radiation dose is less in MSCT (7.8-13.3 mSv) than in conventional fluoroscopy (13.99+/-7.57 mSv). MSCT can be performed as an alternative or adjunct to colonoscopy, if endoscopic access is restricted. It is already the imaging modality of choice in acute diverticulitis.
Bitterling
H
H
Institut für Klinische Radiologie, Innenstadt, Klinikum der Universität München, Munich. harro.bitterling@radin.med.uni-muenchen.de
Rock
C
C
Reiser
M
M
D000284:Administration, Oral; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D003424:Crohn Disease / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004238:Diverticulitis / Q000000981:diagnostic imaging; D004733:Enema; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging*; D007275:Injections, Intravenous; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008297:Male; D011829:Radiation Dosage; D036542:Tomography, Spiral Computed / Q000379:methods*
D003287:Contrast Media