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Comparison of Multidetector CT and Barium Studies of the Small Bowel: Inflammatory Bowel Disease in Children

Douglas H. Jamieson1, Peter J. Shipman1, David M. Israel2 and Kevan Jacobson2

1 Department of Radiology, Children's Hospital of British Columbia, 4480 Oak St., Vancouver, B. C. V6H 3V4, Canada.
2 Department of Pediatrics, Division of Gastroenterology, Children's Hospital of British Columbia, Vancouver, B. C. V6H 3V4, Canada.



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  		Fig. 1. —Axial multidetector CT image of 15-year-old girl shows diseased ileum (arrow) with wall thickening, mucosal enhancement (well shown with clear intraluminal fluids), and adjacent fibrofatty proliferation. Note diseased sigmoid colon and free fluid in pouch of Douglas.

 


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  		Fig. 2. —Axial multidetector CT image of 12-year-old girl shows diseased terminal ileum (arrow) with wall thickening, transmural enhancement, fibrofatty proliferation, and hyperemia. Note diseased descending colon.

 


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  		Fig. 3. —Reconstructed coronal multidetector CT image of 13-year-old boy shows extensive ileum disease (arrows) with wall thickening, mucosal enhancement, fibrofatty proliferation separating loops, and marked mesenteric hyperemia. Prestenotic dilatation of proximal ileum is present. Reconstructed images provide global extent of disease.

 


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  		Fig. 4. —Reconstructed sagittal oblique multidetector CT image obtained through right flank of 9-year-old boy shows extent of diseased terminal ileum (arrows) with wall thickening, mucosal enhancement, and fibrofatty proliferation. Cecum and ascending colon are spared.

 


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  		Fig. 5. —Reconstructed sagittal multidetector CT image of 12-year-old girl shows extensive distal small-bowel disease (arrows) with wall thickening, mucosal enhancement, fibrofatty proliferation, and hyperemia. Loop separation and wall thickness are well shown in this plane.

 


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  		Fig. 6A. —9-year-old boy with colonic Crohn's disease. Images show subtle nature of discordant terminal ileum findings. Spot image of terminal ileum from barium study of small bowel shows eccentric nodularity prospectively interpreted as inflammatory bowel disease. Review might suggest lymphoid hyperplasia, although cecal pole is contracted and abnormal.

 


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  		Fig. 6B. —9-year-old boy with colonic Crohn's disease. Images show subtle nature of discordant terminal ileum findings. Axial IV contrast–enhanced multidetector CT image shows normal terminal ileum (arrow). Cecum and descending colon show wall thickening and mucosal enhancement.

 


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  		Fig. 7. —Reconstructed coronal IV contrast–enhanced multidetector CT image of 12-year-old girl with Crohn's disease at presentation shows obstructed right ureter (arrows) from right lower quadrant inflammatory mass.

 


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  		Fig. 8. —Reconstructed coronal IV contrast–enhanced multidetector CT image of 15-year-old girl with Crohn's disease at presentation shows extensive disease of terminal ileum and ascending, transverse, and descending colon.

 


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  		Fig. 9A. —Barium study of small bowel and multidetector CT (MDCT) image of 13-year-old boy with colonic Crohn's disease but negative findings for terminal ileum disease on colonoscopy. Barium study of small bowel shows terminal ileum with nodularity, mucosal irregularity, probable fissures, and evidence of wall thickening.

 


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  		Fig. 9B. —Barium study of small bowel and multidetector CT (MDCT) image of 13-year-old boy with colonic Crohn's disease but negative findings for terminal ileum disease on colonoscopy. Axial IV contrast–enhanced MDCT image shows thick-walled terminal ileum with transmural enhancement, adjacent fibrofatty proliferation, and hyperemia (arrow).

 

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