Here, the risks outweigh the added benefits of optimized bowel visualization, and this imaging choice should be avoided when acutely ill. If, however, the patient is relatively asymptomatic, CT enteroclysis may be an appropriate option with excellent diagnostic performance. CT Enterography CT enterography represents a CT examination with a specialized protocol. Neutral contrast by mouth is given in large amounts over a set time period to promote optimal distention of the small bowel [19-21]. Combined with other technical modifications, including thin collimation, multiplanar reconstruction, and IV contrast, this protocol maximizes the technique to depict inflammatory changes in the small bowel related to CD [20,22,23]. CT enterography is well suited to evaluate a potential acute flare or complication of CD. However, if the patient cannot tolerate the contrast requirements of the enterography technique, standard CT may be an option (although less sensitive, the findings of an acute flare are likely not subtle if the patient is acutely ill and unable to tolerate the contrast volume of CT enterography). The overall diagnostic performance for CT enterography is excellent. When an endoscopic standard is utilized, sensitivity for CD ranges from 75% to 90%, with a specificity of >90% [24-27]. The diagnosis of acute inflammation is made through visualization of thickened small bowel with mural stratification, as well as extraenteric processes that include engorged vasa recti/vasculature and surrounding inflammatory stranding [25,26,32-34]. Because CT enterography is a cross-sectional imaging modality, assessment for the possible complications of CD, including obstruction, abscess, and fistula, can be made similar to the ability of standard CT abdomen and pelvis [28,35-37]. Ultimately, the decision to select CT enterography versus a standard CT abdomen and pelvis is dependent on the ability to tolerate the oral contrast requirements of CT enterography.
Crohn Disease. Here, the risks outweigh the added benefits of optimized bowel visualization, and this imaging choice should be avoided when acutely ill. If, however, the patient is relatively asymptomatic, CT enteroclysis may be an appropriate option with excellent diagnostic performance. CT Enterography CT enterography represents a CT examination with a specialized protocol. Neutral contrast by mouth is given in large amounts over a set time period to promote optimal distention of the small bowel [19-21]. Combined with other technical modifications, including thin collimation, multiplanar reconstruction, and IV contrast, this protocol maximizes the technique to depict inflammatory changes in the small bowel related to CD [20,22,23]. CT enterography is well suited to evaluate a potential acute flare or complication of CD. However, if the patient cannot tolerate the contrast requirements of the enterography technique, standard CT may be an option (although less sensitive, the findings of an acute flare are likely not subtle if the patient is acutely ill and unable to tolerate the contrast volume of CT enterography). The overall diagnostic performance for CT enterography is excellent. When an endoscopic standard is utilized, sensitivity for CD ranges from 75% to 90%, with a specificity of >90% [24-27]. The diagnosis of acute inflammation is made through visualization of thickened small bowel with mural stratification, as well as extraenteric processes that include engorged vasa recti/vasculature and surrounding inflammatory stranding [25,26,32-34]. Because CT enterography is a cross-sectional imaging modality, assessment for the possible complications of CD, including obstruction, abscess, and fistula, can be made similar to the ability of standard CT abdomen and pelvis [28,35-37]. Ultimately, the decision to select CT enterography versus a standard CT abdomen and pelvis is dependent on the ability to tolerate the oral contrast requirements of CT enterography.