Abdominal CT enterography as an imaging tool for chronic diarrhea: Review of technique and diagnostic criteria

• Published in: Egyptian journal of radiology and nuclear medicine 2015-06, Vol.46 (2), p.275-286
• Main Authors: El-Kalioubie, Mona, Ali, Rasha
• Format: Article
• Language: English
• Subjects: Chronic diarrhea; Computed tomography; Crohn’s disease; Enterography; Small bowel
• ISSN: 0378-603X
• DOI: 10.1016/j.ejrnm.2015.02.012

Our aim was to evaluate the role of multi-slice CT enterography in chronic diarrhea and its degree of correlation with endoscopy and histopathology. 50 patients with chronic diarrhea (23 Crohn’s disease, 3 ulcerative colitis, 5 Tuberculous enteritis, 1 Entamoeba infestation, 4 Celiac disease, 5 lymphoma and 10 miscellaneous) were evaluated by CT enterography. Quantitative image analysis included evaluation of bowel caliber and wall thickness. Qualitative analysis included anatomical localization of lesions, assessment of mucosal hyper-enhancement, adhesions, fistula, pattern reversal, lymphadenopathy and other extra-parietal alterations. Accuracy, sensitivity, specificity, PPV, NPV were calculated for Crohn’s, sensitivity and PPV were calculated for lymphoma. Most Crohn’s lesions affected the ileum, while ulcerative colitis affected the colon with involvement of the terminal ileum. Celiac disease affected the jejunum primarily while the ileum was the site of predilection in lymphoma. CT enterography showed a sensitivity of 100%, specificity 0%, PPV 69.70%, NPV 0% and an accuracy of 69.70% for Crohn’s. In lymphoma, sensitivity and PPV were both 100%. The miscellaneous intestinal lesions were categorized as 1 true positive and 9 false negative cases. CT enterography is a valuable tool in the diagnostic armamentarium of bowel disorders presenting with chronic diarrhea.