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Reply to "Unenhanced MDCT Findings of Acute Bowel Ischemia"

University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

 
WEB—This is a Web exclusive article.

My colleagues and I thank Dr. De Filippo and colleagues [1] for their interest in our article [2]. They commented that in some small-bowel disease, there may be benefit in performing unenhanced CT before performing contrast-enhanced CT [1].

We completely agree with De Filippo et al. [1] on the value of unenhanced CT in evaluating some small-bowel disease such as gastrointestinal bleeding or bowel ischemia. As is well known, acute hematoma or acute vascular occlusion showing relatively higher attenuation can be easily depicted on unenhanced CT. In assessing chronic mesenteric ischemia, the presence of atherosclerotic calcified plaque at or near the origins of proximal splanchnic arteries is also easily shown on unenhanced CT [3]. However, we do not think that successful evaluation of patients with suspected bowel ischemia can be made using unenhanced CT alone. Although the presence of portomesenteric venous gas and pneumatosis of the bowel indicates an acute bowel infarct and can be depicted on unenhanced CT as mentioned, contrast-enhanced CT is essential to determine and manage the primary cause of bowel infarction [4].

For these reasons, we routinely perform unenhanced CT in patients with suspected gastrointestinal bleeding or bowel ischemia. Details of the CT protocol for this purpose were described in our article [2]: To evaluate mesenteric ischemia and gastrointestinal bleeding, three-phase CT (unenhanced, arterial, and delayed) is performed without oral contrast material. Additionally, as described in the same article [2], in patients with suspected small-bowel obstruction, two-phase CT (unenhanced and delayed contrast-enhanced) is performed to exclude bowel infarction. Actually, we use three patterns of CT protocols in evaluating patients with suspected small-bowel disease (3D CT intestine_general, 3D CT intestine_ bowel obstruction, and 3D CT intestine_GI bleeding or ischemia) and tailor the CT protocol and 3D reconstruction techniques in detail to each patient to obtain optimal diagnostic images.

Nevertheless, in our article [2], the value of unenhanced CT might be underestimated because it was not our intention to address the well-known significance of CT in evaluating small-bowel disease but to stress the value of 3D imaging and positive oral contrast material as a new technique. We thank Dr. De Filippo and colleagues [1] for their timely comments reminding readers of the diagnostic value of unenhanced CT.

References

Top References

 

1. De Filippo M, Sagone C, Zompatori M. Unenhanced MDCT findings of acute bowel ischemia. (letter) AJR 2008;190; [web] W271[Free Full Text]
2. Hong SS, Kim AY, Byun JH, et al. MDCT of small-bowel disease: value of 3D imaging. AJR 2006;187 : 1212-1221[Abstract/Free Full Text]
3. Kim AY, Ha HK. Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies. Radiol Clin North Am2003; 41:327 -342[CrossRef][Medline]
4. Rha SE, Ha HK, Lee SH, et al. CT and MR imaging findings of bowel ischemia from various primary causes. RadioGraphics2000; 20:29 -42[Abstract/Free Full Text]

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