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DOI: 10.1148/rg.263055162
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CT Enterography as a Diagnostic Tool in Evaluating Small Bowel Disorders: Review of Clinical Experience with over 700 Cases1

Scott R. Paulsen, BS, James E. Huprich, MD, Joel G. Fletcher, MD, Fargol Booya, MD, Brett M. Young, BS, Jeff L. Fidler, MD, C. Daniel Johnson, MD, John M. Barlow, MD and Franklin Earnest, IV, MD

1 From the Department of Diagnostic Radiology (J.E.H., J.G.F., F.B., J.L.F., C.D.J., J.M.B., F.E.) and the College of Medicine (S.R.P., B.M.Y.), Mayo Clinic, 200 First St SW, Rochester, MN 55905. Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received August 9, 2005; revision requested September 20 and received November 4; accepted November 7. J.G.F. supported in part by Siemens and E-Z-EM, J.L.F. and C.D.J. supported in part by E-Z-EM; all remaining authors have no financial relationships to disclose.

Figure 1
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  		Figure 1.  Charts illustrate the spectrum of CT enterographic findings. Numbers indicate number of cases. PSC = primary sclerosing cholangitis.

 

Figure 2
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  		Figure 2.  Fistula in a 54-year-old man with a 23-year history of Crohn disease requiring multiple surgical resections. Axial CT enterogram demonstrates a large enterocutaneous fistula (arrows) arising from matted loops of the distal ileum. Because no active small bowel inflammation was observed at CT enterography or demonstrated clinically, the patient was simply observed.

 

Figure 3
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  		Figure 3a.  Fistulizing Crohn disease in a 36-year-old woman with a long-standing history of intermittent diarrhea, hematochezia, and nocturnal stools. (a) CT enterogram reveals an ileoileal fistula (arrows) arising from an ileal loop, with asymmetric bowel inflammation that manifests as medial wall thickening and mucosal enhancement (arrowheads). (b) CT enterogram shows the true physiologic lumen (arrow) connecting two adjacent ileal loops. The lumen is slightly cephalad to the fistula.

 

Figure 3
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  		Figure 3b.  Fistulizing Crohn disease in a 36-year-old woman with a long-standing history of intermittent diarrhea, hematochezia, and nocturnal stools. (a) CT enterogram reveals an ileoileal fistula (arrows) arising from an ileal loop, with asymmetric bowel inflammation that manifests as medial wall thickening and mucosal enhancement (arrowheads). (b) CT enterogram shows the true physiologic lumen (arrow) connecting two adjacent ileal loops. The lumen is slightly cephalad to the fistula.

 

Figure 4
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  		Figure 4a.  Enterovesical fistula in a 61-year-old man with Crohn disease, recurrent urinary tract infections, and pneumaturia. (a) CT enterogram shows a small abscess and fistula (arrows) arising between two loops of thickened, inflamed ileum (arrowhead). (b, c) Axial (b) and coronal (c) CT enterograms reveal that the irregularly shaped fistula (arrowheads) courses anterior to a bowel loop (arrows) and extends to the urinary bladder. Air is seen within the bladder, a finding that is consistent with fistula.

 

Figure 4
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  		Figure 4b.  Enterovesical fistula in a 61-year-old man with Crohn disease, recurrent urinary tract infections, and pneumaturia. (a) CT enterogram shows a small abscess and fistula (arrows) arising between two loops of thickened, inflamed ileum (arrowhead). (b, c) Axial (b) and coronal (c) CT enterograms reveal that the irregularly shaped fistula (arrowheads) courses anterior to a bowel loop (arrows) and extends to the urinary bladder. Air is seen within the bladder, a finding that is consistent with fistula.

 

Figure 4
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  		Figure 4c.  Enterovesical fistula in a 61-year-old man with Crohn disease, recurrent urinary tract infections, and pneumaturia. (a) CT enterogram shows a small abscess and fistula (arrows) arising between two loops of thickened, inflamed ileum (arrowhead). (b, c) Axial (b) and coronal (c) CT enterograms reveal that the irregularly shaped fistula (arrowheads) courses anterior to a bowel loop (arrows) and extends to the urinary bladder. Air is seen within the bladder, a finding that is consistent with fistula.

 

Figure 5
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  		Figure 5a.  Perianal fistula in a 39-year-old man with a 17-year history of Crohn disease. Axial CT enterograms demonstrate a persistently draining perianal fistula (arrow) inferior to the subcutaneous external anal sphincter (arrowhead in a).

 

Figure 5
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  		Figure 5b.  Perianal fistula in a 39-year-old man with a 17-year history of Crohn disease. Axial CT enterograms demonstrate a persistently draining perianal fistula (arrow) inferior to the subcutaneous external anal sphincter (arrowhead in a).

 

Figure 6
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  		Figure 6a.  Small bowel strictures in a 39-year-old man with Crohn disease and vomiting. Axial (a) and coronal (b) CT enterograms demonstrate markedly dilated small bowel loops (arrowheads) and multiple inflammatory strictures with mural hyperenhancement and wall thickening (arrow), findings that indicate persistent inflammatory disease. The patient was treated with laparoscopic dilation followed by medical therapy.

 

Figure 6
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  		Figure 6b.  Small bowel strictures in a 39-year-old man with Crohn disease and vomiting. Axial (a) and coronal (b) CT enterograms demonstrate markedly dilated small bowel loops (arrowheads) and multiple inflammatory strictures with mural hyperenhancement and wall thickening (arrow), findings that indicate persistent inflammatory disease. The patient was treated with laparoscopic dilation followed by medical therapy.

 

Figure 7
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  		Figure 7a.  Spectrum of segmental mural hyperenhancement indicating active inflammatory Crohn disease. (a) Active jejunal Crohn disease in a 19-year-old woman. CT enterogram shows mural hyperenhancement (arrows). Compare the normal enhancement of the unaffected small bowel (arrowhead). (b) Active ileal Crohn disease in an asymptomatic 38-year-old man. CT enterogram depicts mural hyperenhancement (arrows) with mural stratification within the thickened bowel wall. Note that the mucosal aspect of the small bowel is thickened and hyperattenuating relative to the serosa. (c) Duodenal Crohn disease in a 42-year-old woman. CT enterogram demonstrates mucosal hyperenhancement (arrows) and stratification (arrowhead). The diagnosis was confirmed at endoscopy. (d, e) Recurrent Crohn disease in a 33-year-old woman. Sequential CT enterograms demonstrate mural wall thickening and mucosal hyperenhancement (arrow in e) in the small bowel adjacent to an ileocolic anastomosis (arrowhead in d). The diagnosis was confirmed at ileoscopy. (Fig 7d and 7e reprinted, with permission, from reference 6.)

 

Figure 7
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  		Figure 7b.  Spectrum of segmental mural hyperenhancement indicating active inflammatory Crohn disease. (a) Active jejunal Crohn disease in a 19-year-old woman. CT enterogram shows mural hyperenhancement (arrows). Compare the normal enhancement of the unaffected small bowel (arrowhead). (b) Active ileal Crohn disease in an asymptomatic 38-year-old man. CT enterogram depicts mural hyperenhancement (arrows) with mural stratification within the thickened bowel wall. Note that the mucosal aspect of the small bowel is thickened and hyperattenuating relative to the serosa. (c) Duodenal Crohn disease in a 42-year-old woman. CT enterogram demonstrates mucosal hyperenhancement (arrows) and stratification (arrowhead). The diagnosis was confirmed at endoscopy. (d, e) Recurrent Crohn disease in a 33-year-old woman. Sequential CT enterograms demonstrate mural wall thickening and mucosal hyperenhancement (arrow in e) in the small bowel adjacent to an ileocolic anastomosis (arrowhead in d). The diagnosis was confirmed at ileoscopy. (Fig 7d and 7e reprinted, with permission, from reference 6.)

 

Figure 7
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  		Figure 7c.  Spectrum of segmental mural hyperenhancement indicating active inflammatory Crohn disease. (a) Active jejunal Crohn disease in a 19-year-old woman. CT enterogram shows mural hyperenhancement (arrows). Compare the normal enhancement of the unaffected small bowel (arrowhead). (b) Active ileal Crohn disease in an asymptomatic 38-year-old man. CT enterogram depicts mural hyperenhancement (arrows) with mural stratification within the thickened bowel wall. Note that the mucosal aspect of the small bowel is thickened and hyperattenuating relative to the serosa. (c) Duodenal Crohn disease in a 42-year-old woman. CT enterogram demonstrates mucosal hyperenhancement (arrows) and stratification (arrowhead). The diagnosis was confirmed at endoscopy. (d, e) Recurrent Crohn disease in a 33-year-old woman. Sequential CT enterograms demonstrate mural wall thickening and mucosal hyperenhancement (arrow in e) in the small bowel adjacent to an ileocolic anastomosis (arrowhead in d). The diagnosis was confirmed at ileoscopy. (Fig 7d and 7e reprinted, with permission, from reference 6.)

 

Figure 7
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  		Figure 7d.  Spectrum of segmental mural hyperenhancement indicating active inflammatory Crohn disease. (a) Active jejunal Crohn disease in a 19-year-old woman. CT enterogram shows mural hyperenhancement (arrows). Compare the normal enhancement of the unaffected small bowel (arrowhead). (b) Active ileal Crohn disease in an asymptomatic 38-year-old man. CT enterogram depicts mural hyperenhancement (arrows) with mural stratification within the thickened bowel wall. Note that the mucosal aspect of the small bowel is thickened and hyperattenuating relative to the serosa. (c) Duodenal Crohn disease in a 42-year-old woman. CT enterogram demonstrates mucosal hyperenhancement (arrows) and stratification (arrowhead). The diagnosis was confirmed at endoscopy. (d, e) Recurrent Crohn disease in a 33-year-old woman. Sequential CT enterograms demonstrate mural wall thickening and mucosal hyperenhancement (arrow in e) in the small bowel adjacent to an ileocolic anastomosis (arrowhead in d). The diagnosis was confirmed at ileoscopy. (Fig 7d and 7e reprinted, with permission, from reference 6.)

 

Figure 7
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  		Figure 7e.  Spectrum of segmental mural hyperenhancement indicating active inflammatory Crohn disease. (a) Active jejunal Crohn disease in a 19-year-old woman. CT enterogram shows mural hyperenhancement (arrows). Compare the normal enhancement of the unaffected small bowel (arrowhead). (b) Active ileal Crohn disease in an asymptomatic 38-year-old man. CT enterogram depicts mural hyperenhancement (arrows) with mural stratification within the thickened bowel wall. Note that the mucosal aspect of the small bowel is thickened and hyperattenuating relative to the serosa. (c) Duodenal Crohn disease in a 42-year-old woman. CT enterogram demonstrates mucosal hyperenhancement (arrows) and stratification (arrowhead). The diagnosis was confirmed at endoscopy. (d, e) Recurrent Crohn disease in a 33-year-old woman. Sequential CT enterograms demonstrate mural wall thickening and mucosal hyperenhancement (arrow in e) in the small bowel adjacent to an ileocolic anastomosis (arrowhead in d). The diagnosis was confirmed at ileoscopy. (Fig 7d and 7e reprinted, with permission, from reference 6.)

 

Figure 8
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  		Figure 8a.  Spectrum of mural stratification in Crohn disease. (a) Ileal inflammation in a 46-year-old woman with a 25-year history of Crohn disease. CT enterogram shows mural stratification with intramural fat surrounded by serosal and mucosal hyperenhancement (arrows), findings that indicate chronic active inflammation in the terminal ileum. (b) Active Crohn disease in a 42-year-old woman. CT enterogram shows ileal mural stratification (arrow) and intramural fluid attenuation (ie, edema). (c) Crohn colitis in a 43-year-old woman. CT enterogram demonstrates Crohn colitis as mural stratification with intramural edema, bowel wall thickening (arrows), and dilatation of the vasa recta (arrowheads). (d) Crohn disease of the neoterminal ileum in a 33-year-old man who had undergone ileocecal resection 19 years earlier. CT enterogram demonstrates mural stratification, which gives a bilaminar appearance to the small bowel wall, with mucosal hyperenhancement and bowel wall thickening with soft-tissue attenuation (arrows), findings that most likely represent inflammatory infiltrate. (e) Active Crohn disease in a 56-year-old woman who presented with malaise, left lower quadrant pain, diarrhea, and intermittent low-grade fever. CT enterogram shows disease in the neoterminal ileum (cf d), with bilaminar mural stratification (arrows) and intramural soft-tissue attenuation.

 

Figure 8
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  		Figure 8b.  Spectrum of mural stratification in Crohn disease. (a) Ileal inflammation in a 46-year-old woman with a 25-year history of Crohn disease. CT enterogram shows mural stratification with intramural fat surrounded by serosal and mucosal hyperenhancement (arrows), findings that indicate chronic active inflammation in the terminal ileum. (b) Active Crohn disease in a 42-year-old woman. CT enterogram shows ileal mural stratification (arrow) and intramural fluid attenuation (ie, edema). (c) Crohn colitis in a 43-year-old woman. CT enterogram demonstrates Crohn colitis as mural stratification with intramural edema, bowel wall thickening (arrows), and dilatation of the vasa recta (arrowheads). (d) Crohn disease of the neoterminal ileum in a 33-year-old man who had undergone ileocecal resection 19 years earlier. CT enterogram demonstrates mural stratification, which gives a bilaminar appearance to the small bowel wall, with mucosal hyperenhancement and bowel wall thickening with soft-tissue attenuation (arrows), findings that most likely represent inflammatory infiltrate. (e) Active Crohn disease in a 56-year-old woman who presented with malaise, left lower quadrant pain, diarrhea, and intermittent low-grade fever. CT enterogram shows disease in the neoterminal ileum (cf d), with bilaminar mural stratification (arrows) and intramural soft-tissue attenuation.

 

Figure 8
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  		Figure 8c.  Spectrum of mural stratification in Crohn disease. (a) Ileal inflammation in a 46-year-old woman with a 25-year history of Crohn disease. CT enterogram shows mural stratification with intramural fat surrounded by serosal and mucosal hyperenhancement (arrows), findings that indicate chronic active inflammation in the terminal ileum. (b) Active Crohn disease in a 42-year-old woman. CT enterogram shows ileal mural stratification (arrow) and intramural fluid attenuation (ie, edema). (c) Crohn colitis in a 43-year-old woman. CT enterogram demonstrates Crohn colitis as mural stratification with intramural edema, bowel wall thickening (arrows), and dilatation of the vasa recta (arrowheads). (d) Crohn disease of the neoterminal ileum in a 33-year-old man who had undergone ileocecal resection 19 years earlier. CT enterogram demonstrates mural stratification, which gives a bilaminar appearance to the small bowel wall, with mucosal hyperenhancement and bowel wall thickening with soft-tissue attenuation (arrows), findings that most likely represent inflammatory infiltrate. (e) Active Crohn disease in a 56-year-old woman who presented with malaise, left lower quadrant pain, diarrhea, and intermittent low-grade fever. CT enterogram shows disease in the neoterminal ileum (cf d), with bilaminar mural stratification (arrows) and intramural soft-tissue attenuation.

 

Figure 8
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  		Figure 8d.  Spectrum of mural stratification in Crohn disease. (a) Ileal inflammation in a 46-year-old woman with a 25-year history of Crohn disease. CT enterogram shows mural stratification with intramural fat surrounded by serosal and mucosal hyperenhancement (arrows), findings that indicate chronic active inflammation in the terminal ileum. (b) Active Crohn disease in a 42-year-old woman. CT enterogram shows ileal mural stratification (arrow) and intramural fluid attenuation (ie, edema). (c) Crohn colitis in a 43-year-old woman. CT enterogram demonstrates Crohn colitis as mural stratification with intramural edema, bowel wall thickening (arrows), and dilatation of the vasa recta (arrowheads). (d) Crohn disease of the neoterminal ileum in a 33-year-old man who had undergone ileocecal resection 19 years earlier. CT enterogram demonstrates mural stratification, which gives a bilaminar appearance to the small bowel wall, with mucosal hyperenhancement and bowel wall thickening with soft-tissue attenuation (arrows), findings that most likely represent inflammatory infiltrate. (e) Active Crohn disease in a 56-year-old woman who presented with malaise, left lower quadrant pain, diarrhea, and intermittent low-grade fever. CT enterogram shows disease in the neoterminal ileum (cf d), with bilaminar mural stratification (arrows) and intramural soft-tissue attenuation.

 

Figure 8
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  		Figure 8e.  Spectrum of mural stratification in Crohn disease. (a) Ileal inflammation in a 46-year-old woman with a 25-year history of Crohn disease. CT enterogram shows mural stratification with intramural fat surrounded by serosal and mucosal hyperenhancement (arrows), findings that indicate chronic active inflammation in the terminal ileum. (b) Active Crohn disease in a 42-year-old woman. CT enterogram shows ileal mural stratification (arrow) and intramural fluid attenuation (ie, edema). (c) Crohn colitis in a 43-year-old woman. CT enterogram demonstrates Crohn colitis as mural stratification with intramural edema, bowel wall thickening (arrows), and dilatation of the vasa recta (arrowheads). (d) Crohn disease of the neoterminal ileum in a 33-year-old man who had undergone ileocecal resection 19 years earlier. CT enterogram demonstrates mural stratification, which gives a bilaminar appearance to the small bowel wall, with mucosal hyperenhancement and bowel wall thickening with soft-tissue attenuation (arrows), findings that most likely represent inflammatory infiltrate. (e) Active Crohn disease in a 56-year-old woman who presented with malaise, left lower quadrant pain, diarrhea, and intermittent low-grade fever. CT enterogram shows disease in the neoterminal ileum (cf d), with bilaminar mural stratification (arrows) and intramural soft-tissue attenuation.

 

Figure 9
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  		Figure 9a.  Mural thickening associated with active Crohn disease. (a) CT enterogram obtained in a 25-year-old man with a 1-year history of Crohn disease who presented with right lower quadrant pain shows thickening of the ileal wall with intermediate attenuation (arrowhead), a finding that suggests inflammatory infiltrate. Mucosal hyperenhancement (arrow) and perienteric fat stranding are also seen. (b) CT enterogram obtained in a 56-year-old woman shows asymmetric thickening of the medial wall of the cecum (arrows), along with the "comb sign" (arrowheads).

 

Figure 9
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  		Figure 9b.  Mural thickening associated with active Crohn disease. (a) CT enterogram obtained in a 25-year-old man with a 1-year history of Crohn disease who presented with right lower quadrant pain shows thickening of the ileal wall with intermediate attenuation (arrowhead), a finding that suggests inflammatory infiltrate. Mucosal hyperenhancement (arrow) and perienteric fat stranding are also seen. (b) CT enterogram obtained in a 56-year-old woman shows asymmetric thickening of the medial wall of the cecum (arrows), along with the "comb sign" (arrowheads).

 

Figure 10
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  		Figure 10.  Active Crohn disease in a 14-year-old patient. The patient had been treated medically since undergoing ileal resection 1 year earlier. Follow-up CT enterogram shows engorged vasa recta producing the comb sign (arrows) involving two ileal loops with asymmetric enhancement and wall thickening.

 

Figure 11
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  		Figure 11.  Crohn disease in an 86-year-old woman who presented with abdominal pain. CT enterogram shows diffuse fibrofatty proliferation surrounding the rectum and displacing the uterus anteriorly.

 

Figure 12
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  		Figure 12a.  Mesenteric abscess. (a) Axial CT enterogram demonstrates mural stratification and thickening in a jejunal loop (arrow), with surrounding fat stranding and a hyperenhancing mesenteric sinus tract (arrowhead). (b) Contiguous axial CT enterogram reveals that the tract ends in a small mesenteric abscess (arrowhead).

 

Figure 12
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  		Figure 12b.  Mesenteric abscess. (a) Axial CT enterogram demonstrates mural stratification and thickening in a jejunal loop (arrow), with surrounding fat stranding and a hyperenhancing mesenteric sinus tract (arrowhead). (b) Contiguous axial CT enterogram reveals that the tract ends in a small mesenteric abscess (arrowhead).

 

Figure 13
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  		Figure 13a.  Active ulcerative colitis with "backwash" ileitis in a 28-year-old woman who presented with intermittent nausea, vomiting, fever, and chills. (a) CT enterogram shows a patulous ileocecal valve (arrows), as well as mural hyperenhancement in the cecal wall (arrowhead). (b, c) Transverse (b) and coronal reformatted (c) CT enterographic images demonstrate pseudopolyps as enhancing tags arising from the luminal mural surface.

 

Figure 13
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  		Figure 13b.  Active ulcerative colitis with "backwash" ileitis in a 28-year-old woman who presented with intermittent nausea, vomiting, fever, and chills. (a) CT enterogram shows a patulous ileocecal valve (arrows), as well as mural hyperenhancement in the cecal wall (arrowhead). (b, c) Transverse (b) and coronal reformatted (c) CT enterographic images demonstrate pseudopolyps as enhancing tags arising from the luminal mural surface.

 

Figure 13
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  		Figure 13c.  Active ulcerative colitis with "backwash" ileitis in a 28-year-old woman who presented with intermittent nausea, vomiting, fever, and chills. (a) CT enterogram shows a patulous ileocecal valve (arrows), as well as mural hyperenhancement in the cecal wall (arrowhead). (b, c) Transverse (b) and coronal reformatted (c) CT enterographic images demonstrate pseudopolyps as enhancing tags arising from the luminal mural surface.

 

Figure 14
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  		Figure 14.  Adenocarcinoma of the jejunum in a 33-year-old man. CT enterogram demonstrates a bulky, heterogeneously enhancing mass (arrow) arising from the proximal jejunum (arrowhead).

 

Figure 15
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  		Figure 15a.  Varied appearances of small bowel carcinoid tumors. (a) CT enterogram demonstrates a submucosal carcinoid tumor (arrows) within a Meckel diverticulum. (b) CT enterogram obtained in a different patient demonstrates a carcinoid tumor (arrow) within the wall of the ileum. (c) CT enterogram obtained in a third patient shows mesenteric metastases from an ileal carcinoid tumor. Note the enhancing, star-shaped mesenteric nodule (arrowhead), with stranding of the mesentery and thickening of the adjacent small bowel wall (arrows). The segmental wall thickening may indicate either a carcinoid carpet lesion or segmental edema. (d) Coronal reformatted CT enterographic image obtained in a fourth patient demonstrates a mesenteric carcinoid tumor (arrows) with hypervascular liver metastases (arrowheads).

 

Figure 15
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  		Figure 15b.  Varied appearances of small bowel carcinoid tumors. (a) CT enterogram demonstrates a submucosal carcinoid tumor (arrows) within a Meckel diverticulum. (b) CT enterogram obtained in a different patient demonstrates a carcinoid tumor (arrow) within the wall of the ileum. (c) CT enterogram obtained in a third patient shows mesenteric metastases from an ileal carcinoid tumor. Note the enhancing, star-shaped mesenteric nodule (arrowhead), with stranding of the mesentery and thickening of the adjacent small bowel wall (arrows). The segmental wall thickening may indicate either a carcinoid carpet lesion or segmental edema. (d) Coronal reformatted CT enterographic image obtained in a fourth patient demonstrates a mesenteric carcinoid tumor (arrows) with hypervascular liver metastases (arrowheads).

 

Figure 15
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  		Figure 15c.  Varied appearances of small bowel carcinoid tumors. (a) CT enterogram demonstrates a submucosal carcinoid tumor (arrows) within a Meckel diverticulum. (b) CT enterogram obtained in a different patient demonstrates a carcinoid tumor (arrow) within the wall of the ileum. (c) CT enterogram obtained in a third patient shows mesenteric metastases from an ileal carcinoid tumor. Note the enhancing, star-shaped mesenteric nodule (arrowhead), with stranding of the mesentery and thickening of the adjacent small bowel wall (arrows). The segmental wall thickening may indicate either a carcinoid carpet lesion or segmental edema. (d) Coronal reformatted CT enterographic image obtained in a fourth patient demonstrates a mesenteric carcinoid tumor (arrows) with hypervascular liver metastases (arrowheads).

 

Figure 15
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  		Figure 15d.  Varied appearances of small bowel carcinoid tumors. (a) CT enterogram demonstrates a submucosal carcinoid tumor (arrows) within a Meckel diverticulum. (b) CT enterogram obtained in a different patient demonstrates a carcinoid tumor (arrow) within the wall of the ileum. (c) CT enterogram obtained in a third patient shows mesenteric metastases from an ileal carcinoid tumor. Note the enhancing, star-shaped mesenteric nodule (arrowhead), with stranding of the mesentery and thickening of the adjacent small bowel wall (arrows). The segmental wall thickening may indicate either a carcinoid carpet lesion or segmental edema. (d) Coronal reformatted CT enterographic image obtained in a fourth patient demonstrates a mesenteric carcinoid tumor (arrows) with hypervascular liver metastases (arrowheads).

 

Figure 16
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  		Figure 16.  Gastrointestinal stromal tumor. CT enterogram shows an exoenteric gastrointestinal stromal tumor (arrows) of the duodenum.

 

Figure 17
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  		Figure 17a.  Peutz-Jeghers syndrome. (a) On a CT enterogram obtained in a 17-year-old boy who presented with signs of intestinal obstruction secondary to intussusception, multiple juvenile hamartomatous polyps (arrows) are visible within the ileum. (b) CT enterogram obtained in an 18-year-old patient demonstrates small bowel intussusception (arrows) resulting from a duodenal polyp.

 

Figure 17
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  		Figure 17b.  Peutz-Jeghers syndrome. (a) On a CT enterogram obtained in a 17-year-old boy who presented with signs of intestinal obstruction secondary to intussusception, multiple juvenile hamartomatous polyps (arrows) are visible within the ileum. (b) CT enterogram obtained in an 18-year-old patient demonstrates small bowel intussusception (arrows) resulting from a duodenal polyp.

 

Figure 18
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  		Figure 18a.  Celiac disease. (a) Coronal reformatted CT enterographic image demonstrates celiac disease with fold reversal. Note the prominent mucosal pattern in the ileal loops within the pelvis (arrows). (b) Coronal reformatted CT enterographic image obtained in a patient with celiac disease and ulcerative jejunitis shows thickened bowel wall with mucosal hyperenhancement (arrows) in the jejunum. (c) CT enterogram obtained in a third patient with celiac disease shows dilatation of multiple loops of jejunum with absence of valvulae conniventes (arrows), findings that indicate villous atrophy.

 

Figure 18
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  		Figure 18b.  Celiac disease. (a) Coronal reformatted CT enterographic image demonstrates celiac disease with fold reversal. Note the prominent mucosal pattern in the ileal loops within the pelvis (arrows). (b) Coronal reformatted CT enterographic image obtained in a patient with celiac disease and ulcerative jejunitis shows thickened bowel wall with mucosal hyperenhancement (arrows) in the jejunum. (c) CT enterogram obtained in a third patient with celiac disease shows dilatation of multiple loops of jejunum with absence of valvulae conniventes (arrows), findings that indicate villous atrophy.

 

Figure 18
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  		Figure 18c.  Celiac disease. (a) Coronal reformatted CT enterographic image demonstrates celiac disease with fold reversal. Note the prominent mucosal pattern in the ileal loops within the pelvis (arrows). (b) Coronal reformatted CT enterographic image obtained in a patient with celiac disease and ulcerative jejunitis shows thickened bowel wall with mucosal hyperenhancement (arrows) in the jejunum. (c) CT enterogram obtained in a third patient with celiac disease shows dilatation of multiple loops of jejunum with absence of valvulae conniventes (arrows), findings that indicate villous atrophy.

 

Figure 19
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  		Figure 19.  Splenic artery pseudoaneurysm. CT enterogram obtained in a patient who presented with abdominal pain shows a thrombosed splenic artery pseudoaneurysm (arrows), an incidental finding that was confirmed at surgery. Note the heavily calcified splenic artery.

 

Figure 20
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  		Figure 20a.  Coronal (a) and axial (b) reformatted images from a CT enteroclysis examination performed on a 64-channel CT system with isotropic spatial resolution demonstrate exquisite anatomic detail, such that the valvulae conniventes can be appreciated throughout the small bowel.

 

Figure 20
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  		Figure 20b.  Coronal (a) and axial (b) reformatted images from a CT enteroclysis examination performed on a 64-channel CT system with isotropic spatial resolution demonstrate exquisite anatomic detail, such that the valvulae conniventes can be appreciated throughout the small bowel.

 




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