Imaging Pearls ❯ Small Bowel ❯ Imaging Techniques
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- Capsule Endoscopy
- Acquires 50K images in 8hours
- Clinicians can visualize the entire small bowel
- Bailey, AJR;101:2237-2243: 426 exams, only 6.3% of 27 small bowel tumors identified on capsule endoscopy were suggested on the prior radiographic exams.
- Especially useful in patients presenting with GI bleeding
- Can miss bowel lesions due to improper bowel preparation, rapid transit time, presence of blood
- Capsule retention or obstruction may occur.
- “ Multidetector computed tomography (CT) has emerged as the modality of choice for evaluation of patients with severe acute traumatic and nontraumatic conditions causing right lower quadrant pain.”
Beyond Appendicitis: Common and Uncommon Gastrointestinal Causes of Right Lower Quadrant Pain at Multidetector CT
Purysko AS et al.
RadioGraphics 2011; 31:927-947 - CT Evaluation of the Small Bowel
-Axial
-MPR (usually coronal display)
-3D Volume Rendering and MIP - Imaging Techniques
- Small bowel series and conventional enteroclysis
- Computed tomography including CT enteroclysis
- CT angiography
- Tagged RBC study
- Catheter directed angiography
- Capsule endoscopy - MDST of the Small Bowel: Study Protocol and Design
- MDCT 16 slice scanner
- .75 mm collimation
- .75 mm slice thickness
- .5 mm interval reconstructions - "Improvements in CT technology, including the introduction of MDCT and advanced 3D imaging capabilities, have renewed interest in utilizing CT to detect and stage these malignancies."
Multidetector-Row Computed Tomography and 3-Dimensional Computed Tomography Imaging of Small Bowel Neoplasms
Horton KM, Fishman EK
J Comput Assist Tomogr 2004;28:106-116 - "In patients without a small bowel stricture at barium study, more small bowel disease was found at CE when findings were retrospectively compared with barium exam and CT ;’findings."
Small Bowel:Preliminary Comparison of Capsule Endoscopy with Barium Study and CT
Hara AK et al.
Radiology 2004;230:260-265 - Capsule Endoscopy: Limitations
- Will fail in patients with stricture or prior surgery
- Long study times (8 hr pre-study fast and 8 hour recording time)
- Inability to localize lesions to a specific bowel segment
- Lesions are missed