Multidetector-row helical CT enteroclysis

Despite advances in endoscopy, the mesenteric small intestine remains the most challenging segment of the alimentary tube to examine diagnostically. This is because of its length, caliber, and overlap of loops within the peritoneal cavity. Barium enteroclysis or the intubation infusion method of small bowel examination has been shown to overcome most of the inherent limitations of the small bowel follow through (SBFT) and to be the more reliable of the conventional contrast methods of radiographic examination [1]. Experience with CT has shown that the enteroclysis method of examination fails to show important extraintestinal manifestations of small bowel disease [2-4]. A comparison of barium enteroclysis with abdominal CT in small bowel Crohn's disease has shown that the advantages of enteroclysis (demonstration of low-grade obstruction, sinus tracts, fistulae, and ulcerations) were the direct result of the volume challenge to the small bowel generated by the controlled infusion, whereas the advantages of CT were its ability to depict mural and extraintestinal complications of the disease [5]. CT enteroclysis (CT-E) is a method of examining the small intestine that combines the advantages of enteral volume challenge and the ability of cross-sectional imaging and reformatting to depict extraintestinal manifestations of the disease [6]. It is used selectively to answer specific questions concerning the small bowel. Not infrequently, another abdominal radiographic examination, such as a SBFT or a conventional CT of the abdomen and pelvis, precedes this examination. Data on the technical aspects and clinical usefulness of CT-E are fragmentary and preliminary [6]. Because of the ability of multidetector-row helical CT scanners to scan larger volumes at a faster speed with the ability to perform reconstruction following the examination, CT-E has become a more feasible extension of the conventional enteroclysis and CT methods of examining the small intestine. This article reviews the technique and clinical applications of CT-E.