In fact, the importance of contrast can be underscored by the emphasis on determining the optimal timing of imaging following IV contrast administration as opposed to comparisons between IV contrast and noncontrast CT [22]. A prior meta-analysis that evaluated CT performance included studies that were all conducted with IV contrast [25]. There is clear consensus that noncontrast CT holds poorer performance compared against a CT with IV contrast. CT Enteroclysis CT enteroclysis is a CT-based examination in which a nasoduodenal tube is placed to allow controlled distention of the small bowel. Typically, neutral contrast is continuously infused into the small bowel during CT, and IV contrast is also administered. This procedure typically allows for better distention of the small bowel compared with oral ingestion at CT enterography [43,44]. Because of the active infusion, stenoses are more readily determined [43]. Crohn Disease The overall diagnostic performance for CT enteroclysis is excellent (ie, >85% sensitivity, >90% specificity) [45- 47], and this examination has been used as a reference standard for other modalities in various studies [41,47]. However, it is important to remember that detection of subtle evidence for CD is not needed in this clinical variant in which the patient is presenting acutely with a suspected flare or complication. Similar to other CT-based options, the assessment for the possible complications of CD, including obstruction, abscess, and fistula, can be made because of its underlying cross-sectional nature without additional advantage from the dedicated enteroclysis protocol. In this specific variant, CT enteroclysis may be limited because it is dependent on the clinical acuity or severity of presentation. With a significant acute flare or complication, the patient would poorly tolerate CT enteroclysis because of the marked demands on the patient related to the placement of the nasoduodenal tube and need for active infusion of oral contrast.
Crohn Disease. In fact, the importance of contrast can be underscored by the emphasis on determining the optimal timing of imaging following IV contrast administration as opposed to comparisons between IV contrast and noncontrast CT [22]. A prior meta-analysis that evaluated CT performance included studies that were all conducted with IV contrast [25]. There is clear consensus that noncontrast CT holds poorer performance compared against a CT with IV contrast. CT Enteroclysis CT enteroclysis is a CT-based examination in which a nasoduodenal tube is placed to allow controlled distention of the small bowel. Typically, neutral contrast is continuously infused into the small bowel during CT, and IV contrast is also administered. This procedure typically allows for better distention of the small bowel compared with oral ingestion at CT enterography [43,44]. Because of the active infusion, stenoses are more readily determined [43]. Crohn Disease The overall diagnostic performance for CT enteroclysis is excellent (ie, >85% sensitivity, >90% specificity) [45- 47], and this examination has been used as a reference standard for other modalities in various studies [41,47]. However, it is important to remember that detection of subtle evidence for CD is not needed in this clinical variant in which the patient is presenting acutely with a suspected flare or complication. Similar to other CT-based options, the assessment for the possible complications of CD, including obstruction, abscess, and fistula, can be made because of its underlying cross-sectional nature without additional advantage from the dedicated enteroclysis protocol. In this specific variant, CT enteroclysis may be limited because it is dependent on the clinical acuity or severity of presentation. With a significant acute flare or complication, the patient would poorly tolerate CT enteroclysis because of the marked demands on the patient related to the placement of the nasoduodenal tube and need for active infusion of oral contrast.