title: Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis.
abstract: OBJECTIVE
  To prospectively evaluate the sensitivity and specificity of contrast material-enhanced and water-enhanced multidetector computed tomographic (CT) enteroclysis in depicting small-bowel neoplasms in symptomatic patients, with endoscopic, tissue, and follow-up findings as reference standards.
  
  
  METHODS
  The study protocol was approved by the Human Research Committee of the institution, and all patients gave written informed consent. Two hundred nineteen patients (108 male, 111 female; age range, 17-98 years; mean, 53.1 years) with clinical suspicion of small-bowel neoplasm underwent contrast- and water-enhanced multidetector CT enteroclysis after normal findings of upper and lower gastrointestinal endoscopy. The prospective interpretations of CT enteroclysis results include evaluation of focal bowel wall thickening, small-bowel masses, small-bowel stenosis, mesenteric stranding, enlarged mesenteric lymph nodes, and visceral metastasis. Positive enteroclysis findings were compared with results of pathologic examination after surgical (n = 35) or endoscopic (n = 20) procedures. Negative results were compared with results of surgery (n = 8), enteroscopy (n = 15), capsule endoscopy (n = 14), and clinical follow-up (n = 127). Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated on a per-patient basis with 95% confidence intervals.
  
  
  RESULTS
  Findings of CT enteroclysis were positive in 55 cases and negative in 164. The overall sensitivity and specificity in identifying patients with small-bowel lesions were 84.7% and 96.9%, respectively. The negative and positive predictive values were 94.5% and 90.9%, respectively. Findings of pathologic examination confirmed small-bowel tumor in 50 patients with carcinoid tumor (n = 19), adenocarcinoma (n = 7), lymphoma (n = 5), jejunal adenoma (n = 9), stromal tumor (n = 5), ectopic pancreas (n = 2), angiomatous mass (n = 2), or metastasis (n = 1). Five examinations resulted in false-positive findings.
  
  
  CONCLUSIONS
  Contrast- and water-enhanced multidetector CT enteroclysis had an overall accuracy of 84.7% for depiction of small-bowel neoplasms.
authors.affiliation: Department of Radiology, Hôpital Universitaire E. Herriot, 3 Place d'Arsonval, 69003 Lyon, France. frank.pilleul@chu-lyon.fr
authors.forename: Frank
authors.initials: F
authors.lastname: Pilleul
authors.forename: Marianne
authors.initials: M
authors.lastname: Penigaud
authors.forename: Laurent
authors.initials: L
authors.lastname: Milot
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Saurin
authors.forename: Jean-Alain
authors.initials: JA
authors.lastname: Chayvialle
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Valette
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol