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Clinical Significance of Poor CT Enhancement of the Thickened Small-Bowel Wall in Patients with Acute Abdominal Pain

¹ All authors: Department of Radiology, Chi Mei Medical Center, 901 Chung Hwa Rd., Tainan 71010, Taiwan, Republic of China.
² Department of Radiological Technology, Central Taiwan University of Science of Technology, Taiwan, Republic of China.

View larger version (103K): [in a new window]   Fig. 1A —62-year-old man with sepsis. Unenhanced (A) and enhanced (B) CT scans. Longitudinal sections of thickened small bowel show inner layer (arrow) before and after IV contrast administration. Intense inner-layer enhancement is noted.

View larger version (100K): [in a new window]   Fig. 1B —62-year-old man with sepsis. Unenhanced (A) and enhanced (B) CT scans. Longitudinal sections of thickened small bowel show inner layer (arrow) before and after IV contrast administration. Intense inner-layer enhancement is noted.

View larger version (92K): [in a new window]   Fig. 1C —62-year-old man with sepsis. Unenhanced (C) and enhanced (D) CT scans. Cross-section of small bowel (arrow) shows similar inner layer changes as in A and B.

View larger version (99K): [in a new window]   Fig. 1D —62-year-old man with sepsis. Unenhanced (C) and enhanced (D) CT scans. Cross-section of small bowel (arrow) shows similar inner layer changes as in A and B.

View larger version (109K): [in a new window]   Fig. 2A —48-year-old woman with septic shock. Unenhanced CT scan shows thickened wall (arrow) has density similar to body wall muscles.

View larger version (119K): [in a new window]   Fig. 2B —48-year-old woman with septic shock. Enhanced CT scan shows thickened wall (arrow) has homogeneous enhancement and is brighter than body wall muscles.

View larger version (114K): [in a new window]   Fig. 3A —76-year-old man with internal hernia. Unenhanced CT scan shows circumferentially thickened wall (arrowhead) has density slightly higher than body wall muscles. Adjacent thickened wall (arrow) is darker than muscles.

View larger version (113K): [in a new window]   Fig. 3B —76-year-old man with internal hernia. Enhanced CT scan shows same segment (arrowhead) as that seen in A has slightly lower density than muscles. Adjacent segment (arrow) shows obviously enhanced inner layer.

View larger version (120K): [in a new window]   Fig. 4A —42-year-old man with thrombosis of superior mesenteric vein. Unenhanced (A) and enhanced (B) CT scans. Presence of inner-layer enhancement (arrowheads) is in distinct contrast from absence of inner-layer enhancement (arrows) in continuous small-bowel segment.

View larger version (119K): [in a new window]   Fig. 4B —42-year-old man with thrombosis of superior mesenteric vein. Unenhanced (A) and enhanced (B) CT scans. Presence of inner-layer enhancement (arrowheads) is in distinct contrast from absence of inner-layer enhancement (arrows) in continuous small-bowel segment.

View larger version (112K): [in a new window]   Fig. 5A —53-year-old man with thrombosis of superior mesenteric vein. Unenhanced (A) and enhanced (B) CT scans. Soft-tissue-density hemorrhagic wall (arrowheads) does not show inner-layer enhancement. Less damaged small bowel (arrows) shows faint whole-layer enhancement.

View larger version (113K): [in a new window]   Fig. 5B —53-year-old man with thrombosis of superior mesenteric vein. Unenhanced (A) and enhanced (B) CT scans. Soft-tissue-density hemorrhagic wall (arrowheads) does not show inner-layer enhancement. Less damaged small bowel (arrows) shows faint whole-layer enhancement.

View larger version (112K): [in a new window]   Fig. 5C —53-year-old man with thrombosis of superior mesenteric vein. Enhanced (C) and enhanced (D) CT scans. Cross-sectioned (left arrow) and longitudinal-sectioned (right arrow) small bowel shows absence of inner-layer enhancement. Hemorrhagic wall was nearly isodense to abdominal wall muscles on unenhanced image and became hypodense on enhanced image.

View larger version (116K): [in a new window]   Fig. 5D —53-year-old man with thrombosis of superior mesenteric vein. Enhanced (C) and enhanced (D) CT scans. Cross-sectioned (left arrow) and longitudinal-sectioned (right arrow) small bowel shows absence of inner-layer enhancement. Hemorrhagic wall was nearly isodense to abdominal wall muscles on unenhanced image and became hypodense on enhanced image.

View larger version (10K): [in a new window]   Fig. 6 —Flowchart shows clinical outcomes of patients without inner-layer enhancement of thickened small-bowel wall (group A).

View larger version (11K): [in a new window]   Fig. 7 —Flowchart shows clinical outcomes of patients with inner-layer enhancement of thickened small-bowel wall (group B).

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