Multiplanar helical CT enterography in patients with Crohn's disease

Abstract

Objective: The purpose of this study was to assess the feasibility and usefulness of helical CT with multiplanar reformations in revealing complications in patients with Crohn's disease.

Subjects and methods: Twenty-two patients with Crohn's disease and clinically suspected complications underwent helical CT enterography. The imaging protocol began with the administration of a large volume (1600 ml) of oral contrast material followed by helical scanning with axial and multiplanar two-dimensional coronal projections. Three independent observers assessed the adequacy of bowel opacification and the contribution of two-dimensional coronal projections to the interpretation of axial images. CT enterography was compared with conventional barium studies in 14 patients. Statistical analysis included repeated measures analysis of variance, the Wilcoxon signed-rank test, and the McNemar test.

Results: The large oral contrast medium dose was well tolerated and provided optimal bowel opacification in 21 of 22 patients. The addition of multiplanar to conventional axial images did not reveal additional abnormalities; however, multiplanar imaging significantly improved observers' confidence in their interpretation of imaging and in their assessment of the extent of bowel wall thickening (p < .01). Interobserver agreement was 78%. Findings on helical CT were comparable with those on barium studies in nine of 14 patients, superior to those on barium studies in four patients, and inferior in one patient.

Conclusion: CT enterography is a useful technique for bowel imaging. In patients with complicated Crohn's disease, multiplanar imaging improves confidence in assessing the presence and extent of disease. CT enterography is complementary and often superior to conventional barium studies.