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Comparative Study
. 2011 Feb;84(998):112-9.
doi: 10.1259/bjr/71649888. Epub 2010 Oct 19.

CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease

L M Minordi  1 , A Vecchioli, P Mirk, L Bonomo
Affiliations
Comparative Study

CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease

L M Minordi et al. Br J Radiol. 2011 Feb.

Abstract

Objective: The aim of the study is to compare CT enterography with polyethylene glycol solution (PEG-CT) with CT enteroclysis (CT-E) in patients with suspected small bowel disease.

Methods: 145 patients underwent abdominal contrast-enhanced 16-row multidetector CT after administration of 2000 ml of PEG by mouth (n = 75) or after administration of 2000 ml of methylcellulose by nasojejunal tube (n = 70). Small bowel distension, luminal and extraluminal findings were evaluated and compared with small bowel follow-through examination in 60 patients, double contrast enema in 50, surgery in 25 and endoscopy in 35. Statistical evaluation was carried out by χ² testing. For both techniques we have also calculated the effective dose and the equivalent dose in a standard patient.

Results: Crohn's disease was diagnosed in 64 patients, neoplasms in 16, adhesions in 6. Distension of the jejunum was better with CT-E than PEG-CT (p<0.05: statistically significant difference). No significant difference was present for others sites (p>0.05). Evaluation of pathological ileal loops was good with both techniques. The values of sensitivity, specificity and diagnostic accuracy were respectively 94%, 100% and 96% with CT-E, and 93%, 94% and 93% with PEG-CT. The effective dose for PEG-CT was less than the dose for the CT-E (34.7 mSv vs 39.91 mSv).

Conclusion: PEG-CT shows findings of Crohn's disease as well as CT-E does, although CT-E gives better bowel distension, especially in the jejunum, and has higher specificity than PEG-CT.

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Figures

Figure 1
Figure 1
CT enteroclysis coronal image (a) shows better distension of the jejunal loops (J) than CT enterography with polyethylene glycol (PEG-CT) coronal image (b).
Figure 2
Figure 2
CT enteroclysis (MIP reconstruction) shows clearly the comb sign (white arrows) associated to the thickening of the last ileal loop (black arrow).
Figure 3
Figure 3
CT enterography with polyethylene glycol shows a polyp (arrow) in the last ileal loop of a patient with Peutz–Jeghers syndrome.
Figure 4
Figure 4
CT enteroclysis shows a large parietal mass (arrow) with ulceration. Surgical report: adenocarcinoma.
Figure 5
Figure 5
An example of false-positive case. CT enterography with polyethylene glycol shows a small bowel loop with narrowing (arrow) but the endoscopy did not show any alterations.
Figure 6
Figure 6
An example of a false-negative CT case. (a) No alterations of the last ileal loop were present in CT enteroclysis (arrow); C, colon; LIL, last ileal loop. (b) Barium study performed after CT examination showed some erosions and ulcers in the last ileal loop (arrow).
See this image and copyright information in PMC

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