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Computed Tomography Enterography (CTE)

Computed Tomography Enterography (CTE) is a diagnostic test that, when available, has largely replaced the small bowel follow through as well as enteroclysis as a means to evaluate the small bowel in Crohn's Disease patients. As CTE usually has better quality studies but uses radiation whereas MRE does not, it has been proposed to use CTE for initial diagnosis and then MRE for checkups to reduce radiation exposure.[1]

Contents


The Procedure

A large amount (around one liter) of a low-attenuation agent that you drink is provided that is meant to make the bowel easier to view and distend it. Usually you must drink this within about an hour.

An IV line will be inserted.

You will be placed on the scanner and the test will be conducted while you lay still. An iodinated contrast enhancer is administered through the IV. This can create a warming feeling, make your heart race, and make some feel like they need to urinate.

Expect the entire process, from starting to consume the oral agent to finishing the scan to take about 1.5 hours.

Benefits

- Only takes 1.5 hours versus about 2.5 hours for a small bowel follow through.
- Outstanding resolution
- There can actually be LESS radiation than small bowel follow through or enteroclysis as fluoroscopy can suscept the patient to significant doses of radiation.

Disadvantages

- Ionizing radiation exposure of ~10 to 20 mSv.
- More expensive than small bowel follow through and enteroclysis

CTE Versus other Methods for Detection of CD

In one study, the sensitivity and specificity was as follows, respectively: CTE = 82%/89%; ileocolonoscopy = 83%/100%; capsule endoscopy = 74%/53%; and small bowel follow-through = 65%/94%[1]

In another study comparing CTE with capsule endoscopy (pill cam), it was shown that capsule endoscopy identified Crohn's disease in 12 of 17 patients (71%), ileoscopy in 11 of 17 patients (65%), and CTE in 9 of 17 patients (53%)[2]

In a meta-analysis, it was shown that capsule endoscopy was diagnostic of Crohn's disease in 69% of patients whereas CTE was diagnostic in only 30%.[3]

Crohn's Disease Findings with CTE

- Intestinal wall thickening usually of greater than 3mm.
- Wall hyperenhancement. Some people will experience thickening of the entire wall whereas others may just experience thickening of the inner wall leading to mural stratification which looks like a target.
- Narrowing of the intestines
- Peribowel vascular engorgement which is known as the "Comb Sign"
- Peribowel fat proliferation
- Strictures
- Fistulae
- Abscesses

References


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06-21-2012, 01:27 AM   #1
DustyKat
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I don't know if there are regional differences with this test but the amount of oral contrast required in our case was between 1.5-2 litres within the hour time frame.

The comsumption of contrast was to be ceased if diarrhoea developed.
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06-21-2012, 11:19 AM   #2
David
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1.5-2 liters? That's crazy!

My guess is it's due to different oral agents. I'll keep an eye out for information on that though.
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