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(Radiographics. 2002;22:1093-1107.)
© RSNA, 2002

EDUCATION EXHIBIT

Algorithmic Approach to CT Diagnosis of the Abnormal Bowel Wall1

Jack Wittenberg, MD, Mukesh G. Harisinghani, MD, Kartik Jhaveri, MD, Jose Varghese, MD and Peter R. Mueller, MD

1 From the Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. Received February 15, 2002; revision requested March 11 and received April 10; accepted April 16. Address correspondence to J.W. (e-mail: jwittenberg@partners.org).

Computed tomography demonstrates intestinal wall abnormalities that can be analyzed by categorizing attenuation changes in the intestinal wall and transposing morphologic characteristics learned from barium studies. These attenuation patterns include white, gray, water halo sign, fat halo sign, and black. The white pattern represents avid contrast material enhancement that uniformly affects most of the thickened bowel wall. If the bowel wall is enhanced to a degree equal to or greater than that of venous opacification in the same scan, it should be classified in the white attenuation pattern. Common diagnoses with this pattern include idiopathic inflammatory bowel diseases and vascular disorders. The gray pattern is defined as a thickened bowel wall with limited enhancement whose homogeneous attenuation is comparable with that of enhanced muscle. This pattern is used to differentiate between benign and malignant disease, but it is the least specific of the patterns and should be combined with morphologic observations. The water halo sign indicates stratification within a thickened bowel wall that consists of either two or three continuous, symmetrically thickened layers. Common diagnoses with this sign include idiopathic inflammatory bowel diseases, vascular disorders, infectious diseases, and radiation damage. The fat halo sign refers to a three-layered target sign of thickened bowel in which the middle or "submucosal" layer has a fatty attenuation. Common diagnoses with this sign include Crohn disease in the small intestine and idiopathic inflammatory bowel diseases in the colon. Black attenuation is the equivalent of pneumatosis, and this pattern is commonly seen in ischemia, infection, and trauma.

© RSNA, 2002

Index Terms: Computed tomography (CT), tissue characterization, 74.12112, 75.12112 • Intestines, CT, 74.12112, 75.12112


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