MDCT of Small-Bowel Disease: Value of 3D Imaging
Seong Sook Hong1,2,
Ah Young Kim1,
Jae Ho Byun1,
Hyung Jin Won1,
Pyo Nyun Kim1,
Moon-Gyu Lee1 and
Hyun Kwon Ha1
1 Department of Radiology, Asan Medical Center, University of Ulsan College of
Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea.
2 Present address: Department of Radiology, Soonchunhyang University Hospital,
Seoul, Korea.
View larger version (118K):
[in a new window]
|
Fig. 1A —56-year-old man with acute mesenteric ischemia. Emboli or
thrombi are not definitively shown on axial arterial phase CT image.
|
|
View larger version (130K):
[in a new window]
|
Fig. 1B —56-year-old man with acute mesenteric ischemia. Oblique
coronal plane of volume-rendered image shows large embolus (thick
arrow) and extensive vascular occlusion (arrowheads) along
superior mesenteric artery and its branches, with multifocal renal infarction
(thin arrows). Because this patient suffered from longstanding severe
heart failure, mesenteric ischemia was conservatively managed with
anticoagulant drugs.
|
|
View larger version (180K):
[in a new window]
|
Fig. 2A —43-year-old man with acute mesenteric ischemia. MDCT
volume-rendered image of arterial phase clearly shows no evidence of arterial
emboli.
|
|
View larger version (187K):
[in a new window]
|
Fig. 2B —43-year-old man with acute mesenteric ischemia.
Volume-rendered delayed phase image shows extensive thrombosis of superior
mesenteric vein (arrowheads) and its tributaries with adjacent
infarcted bowel segment (thin arrows). Development of periportal
collateral vessels (thick arrow) is also noted. Patient underwent
segmental resection of ileal bowel loops because of transmural infarction.
|
|
View larger version (159K):
[in a new window]
|
Fig. 3A —36-year-old man with chronic mesenteric ischemia. Thick-slab
volume-rendered image of contrast-enhanced MDCT dramatically shows small
pseudoaneurysm (arrow) in proximal origin portion of superior
mesenteric artery.
|
|
View larger version (168K):
[in a new window]
|
Fig. 3B —36-year-old man with chronic mesenteric ischemia. On
multiplanar reconstruction image, extensive thrombosis (arrowheads)
is well shown yet is not evident on thick-slab volume-rendered image
(A). These findings were consistently depicted on follow-up CT scans
for 1 year without interval change (not shown).
|
|
View larger version (129K):
[in a new window]
|
Fig. 4A —55-year-old man with intermittent abdominal pain. Initial
contrast-enhanced CT scan shows partial opacification of tributary of superior
mesenteric vein (arrow), mimicking mesenteric venous occlusion.
|
|
View larger version (129K):
[in a new window]
|
Fig. 4B —55-year-old man with intermittent abdominal pain. Axial CT
image of delayed phase reveals full opacification of this mesenteric venous
structure (arrow), indicating pseudoocclusion by systemic
hypotension.
|
|
View larger version (174K):
[in a new window]
|
Fig. 5 —56-year-old man with asymptomatic atherosclerotic plaque. On
combined image of maximal intensity projection and surface shaded display,
focal vascular narrowing of proximal superior mesenteric artery is observed
because of small defect (arrow), suggesting atherosclerotic plaque.
Similar multiple focal defects (arrowheads) are also seen along
abdominal aorta, indicating underlying chronic atherosclerotic vascular
disorder.
|
|
View larger version (151K):
[in a new window]
|
Fig. 6 —31-year-old woman with acute onset of mid upper abdominal
pain and intestinal obstruction after blunt trauma. On volume-rendered image
after ingestion of diluted water-soluble oral contrast medium, abrupt luminal
narrowing (thin arrows) with distended proximal bowel loops is
clearly identified in duodenum (D). Adjacent perienteric hematoma (H) is also
shown with segmental duodenal wall thickening and perienteric infiltration
(arrowheads) indicating posttraumatic change. Opacification of distal
bowel loops also suggests incomplete bowel obstruction (thick arrow).
S = stomach.
|
|
View larger version (128K):
[in a new window]
|
Fig. 7 —33-year-old man with acute postoperative small-bowel
obstruction. Linear alignment of stricture sites (arrowheads) is
shown on posterior view of thick-slab volume-rendered image obtained after
digital removal of bone structures. These multifocal strictures, located along
an imaginary perpendicular line, suggest presence of postoperative adhesive
band that was confirmed at surgery.
|
|
View larger version (100K):
[in a new window]
|
Fig. 8 —Small-bowel obstruction in 46-year-old man who underwent
segmental resection of ileum. Thick-slab volume-rendered image obtained after
ingestion of diluted water-soluble oral contrast medium shows metallic
surgical clips (arrows) and adjacent collapsed bowel loops
(arrowheads), indicating transition point of small intestinal
obstruction.
|
|
View larger version (126K):
[in a new window]
|
Fig. 9 —67-year-old woman with complete small-bowel obstruction. On
thick-slab volume-rendered image of contrast-enhanced MDCT after ingestion of
water-soluble oral contrast medium, complete bowel obstruction (O) at proximal
jejunum is shown with masslike, multiconcentric bowel-wall thickening
(arrows). In conjunction with hepatic metastases
(arrowheads) and mesenteric lymphadenopathy, this masslike wall
thickening indicates intussusception by intestinal metastasis.
Sonography-guided biopsy of mesenteric node revealed distant metastasis from
lung cancer.
|
|
View larger version (144K):
[in a new window]
|
Fig. 10A —27-year-old man with acute intestinal obstruction. Thick-slab
volume-rendered image obtained after ingestion of diluted water-soluble oral
contrast medium shows markedly dilated small-bowel loops (S) with diffuse fold
thickening, but passage of oral contrast medium is not interrupted or delayed
through large intestine (L). No definite pathologic obstruction site is
shown.
|
|
View larger version (135K):
[in a new window]
|
Fig. 10B —27-year-old man with acute intestinal obstruction. Thin-slice
volume-rendered image shows suspicious multifocal stenotic segments
(arrows) along small intestine. Tentative diagnosis based on CT scan
was low-grade small-bowel obstruction of unknown cause due to nonspecific
findings. However, cause of small-bowel obstruction proved to be persimmon
bezoar that was extracted just before CT. No abnormal small-intestine findings
were detected on small-bowel follow-through examination 3 months later (not
shown).
|
|
View larger version (172K):
[in a new window]
|
Fig. 11A —35-year-old woman with relapsed active Crohn's disease.
Thin-slab volume-rendered image provides excellent topographic information
regarding perienteric abscess and fistulous tract formation (arrows)
resulting from relapsed ileocecal Crohn's disease (IC). Deformed terminal
ileum and cecum show strongly enhanced bowel walls, suggesting active
inflammation.
|
|
View larger version (146K):
[in a new window]
|
Fig. 11B —35-year-old woman with relapsed active Crohn's disease.
Multiplanar reconstruction image using a minimal intensity projection clearly
shows multidirectional fistulous tracts (arrowheads) and active
abscesses (a).
|
|
View larger version (160K):
[in a new window]
|
Fig. 12A —38-year-old man with longstanding Crohn's disease. Thick-slab
volume-rendered image obtained after ingestion of diluted water-soluble oral
contrast medium shows segmental bowel aggregation and multifocal strictures
(dotted circle). Eccentric bowel-wall thickening with perienteric
infiltration (arrows) is also seen along mesenteric border.
|
|
View larger version (155K):
[in a new window]
|
Fig. 12B —38-year-old man with longstanding Crohn's disease. Thick-slab
volume-rendered image with a surface shaded display shows longitudinal linear
ulcerations along mesenteric border (arrows) of multifocal small
intestines and pseudosacculations (arrowheads).
|
|
View larger version (160K):
[in a new window]
|
Fig. 13A —43-year-old woman with malignant gastrointestinal stromal
tumor arising from jejunum. Coronal thick-slab volume-rendered image shows
well-demarcated, exophytic growing mass (arrows) with large central
ulceration originating from jejunum (J).
|
|
View larger version (157K):
[in a new window]
|
Fig. 13B —43-year-old woman with malignant gastrointestinal stromal
tumor arising from jejunum. Thick-slab volume-rendered image mimicking maximum
intensity projection shows tumor-supplying mesenteric branches (thin
arrows) of superior mesenteric artery and enlarged draining veins
(arrowheads) from mass (thick arrows).
|
|
View larger version (160K):
[in a new window]
|
Fig. 14 —37-year-old man with obscure gastrointestinal bleeding. In
this patient, two attempts at RBC scans yielded negative results. This coronal
maximum-intensity-projection image obtained from arterial phase of MDCT shows
direct extravasation of contrast material into proximal jejunal loop
(arrow). At surgery, bleeding focus was confirmed to be
angiodysplasia of proximal jejunum.
|
|
View larger version (133K):
[in a new window]
|
Fig. 15A —55-year-old man with obscure gastrointestinal bleeding. Axial
CT image obtained from arterial phase MDCT shows highly enhanced, tortuous
vascular structure (arrows) along bowel wall of distal ileum.
|
|
View larger version (162K):
[in a new window]
|
Fig. 15B —55-year-old man with obscure gastrointestinal bleeding.
Thick-slab volume-rendered image shows vascular structure of distal ileum
(arrows) with hypertrophied supplying arteries (arrowheads).
There is an early draining vein (not shown). From these confirmatory CT
features, mass was diagnosed as arteriovenous malformation of distal
ileum.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2006 by the American Roentgen Ray Society.
