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Diagnostic Value of CT Enteroclysis Compared with Conventional Enteroclysis in Patients with Crohn's Disease

¹ Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
² Department of Internal Medicine 4, Division of Gastroenterology, Medical University of Vienna, Vienna, Austria.

View larger version (143K): [in a new window]   Fig. 1A —36-year-old woman with Crohn's disease. Enteroclysis image shows inflammatory contour irregularities of mucosal relief (white arrows) in region of ileocecal valve and terminal ileum; presence of fistula was suspected. In addition, there is stenosis of preterminal ileum (black arrow) with dilatation of prestenotic loop (white arrowhead).

View larger version (127K): [in a new window]   Fig. 1B —36-year-old woman with Crohn's disease. CT enteroclysis image clearly shows small fistula (arrow) between terminal ileum and adjacent ileal loop with severe stranding of surrounding fat tissue.

View larger version (126K): [in a new window]   Fig. 1C —36-year-old woman with Crohn's disease. In addition, CT enteroclysis image shows extension of fistula (arrow) from inflamed cecum to small abscess within adjacent abdominal wall.

View larger version (151K): [in a new window]   Fig. 2A —36-year-old woman with Crohn's disease. Enteroclysis image shows dilatation of ileal loop (arrow) and delayed passage of contrast material, indicating stenosis. Free projection of distal ileal loops in pelvis (arrowhead) is insufficient.

View larger version (93K): [in a new window]   Fig. 2B —36-year-old woman with Crohn's disease. Spot radiograph obtained after A of mucosal relief of terminal ileum shows typical cobblestone-like nodular filling defects and ulcerations (arrow).

View larger version (100K): [in a new window]   Fig. 2C —36-year-old woman with Crohn's disease. CT enteroclysis image shows inflammatory reaction and severe thickening of terminal ileum (arrow) due to histologically proven Crohn's disease.

View larger version (100K): [in a new window]   Fig. 2D —36-year-old woman with Crohn's disease. CT enteroclysis image shows inflammatory thickening and moderate stenosis of terminal ileum with prestenotic dilatation (arrow).

View larger version (106K): [in a new window]   Fig. 2E —36-year-old woman with Crohn's disease. CT enteroclysis image shows another massively inflamed ileal segment (skip lesion) deep in pelvis (arrows), which was not well depicted during enteroclysis. Prestenotic loop (star) shows moderate dilatation next to fundus of uterus.

View larger version (106K): [in a new window]   Fig. 3A —36-year-old woman with Crohn's disease. Double-contrast image of small bowel shows inflammatory changes (white arrows) typical of those of Crohn's disease—that is, with continuous involvement of terminal and preterminal ileum. Rectosigmoid colon is already filled with contrast material (black arrow).

View larger version (107K): [in a new window]   Fig. 3B —36-year-old woman with Crohn's disease. CT enteroclysis image proves inflammatory involvement of long segment of terminal and preterminal ileum (arrow).

View larger version (111K): [in a new window]   Fig. 3C —36-year-old woman with Crohn's disease. CT enteroclysis image shows contrast-enhancing conglomerate tumor (arrow) between ileal loops in pelvis.

View larger version (113K): [in a new window]   Fig. 3D —36-year-old woman with Crohn's disease. In addition, CT enteroclysis images reveal skip lesion in middle third of ileum, showing moderate stenosis (arrow, D) with prestenotic dilatation (arrow, E), which was not depicted during conventional enteroclysis.

View larger version (100K): [in a new window]   Fig. 3E —36-year-old woman with Crohn's disease. In addition, CT enteroclysis images reveal skip lesion in middle third of ileum, showing moderate stenosis (arrow, D) with prestenotic dilatation (arrow, E), which was not depicted during conventional enteroclysis.

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