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Biscaldi E, Barra F, Leone Roberti Maggiore U, Ferrero S. Other imaging techniques: Double-contrast barium enema, endoscopic ultrasonography, multidetector CT enema, and computed tomography colonoscopy. Best Pract Res Clin Obstet Gynaecol 2020; 71:64-77. [PMID: 32698994 DOI: 10.1016/j.bpobgyn.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
Double-contrast barium enema (DCBE), transrectal endoscopic ultrasonography (REU), multidetector computerized tomography enema (MDCT-e), and computed tomography colonoscopy (CTC) have been successfully used for the diagnosis of bowel endometriosis. DCBE provides a complete overview of the entire colon and allows detecting cecal nodules. The accuracy of DCBE is operator dependent and, thus, it may have low specificity. It does not allow identifying the cause of the mass effect. DCBE requires the administration of barium and exposure to radiation. REU precisely estimates the distance between the rectosigmoid nodule and the anal verge. However, it allows investigating only the distal part of rectosigmoid, it misses anterior pelvic lesions, and it has poor sensitivity for the diagnosis of endometriomas. MDCT-e is accurate and reproducible in diagnosing intestinal endometriosis and in assessing its characteristics: the largest diameter of the nodule, the distance between the distal part of the nodule and the anal verge, and depth of infiltration of endometriosis in the intestinal wall. MDCT-e requires the administration of iodinated contrast medium (CM) and the exposure to radiations. CTC has good performance in the diagnosis of rectosigmoid endometriosis. It allows estimating the degree of intestinal stenosis CTC, and the distance between the intestinal endometriotic nodule and the anal verge. It requires exposure to radiations, and it may require the administration of an iodinated CM.
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Affiliation(s)
- Ennio Biscaldi
- Department of Radiology, Galliera Hospital, via Mura delle Cappuccine 14, Genova, 16128, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | | | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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Tonolini M, Ippolito S. Imaging the operated colon using water-enema multidetector CT, with emphasis on surgical anastomoses. Insights Imaging 2018; 9:413-423. [PMID: 29633171 PMCID: PMC6108969 DOI: 10.1007/s13244-018-0612-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 01/07/2023] Open
Abstract
Water-enema multidetector CT (WE-MDCT) provides a detailed multiplanar visualisation of mural, intra- and extraluminal abnormalities of the large bowel, relying on preliminary bowel cleansing, retrograde luminal distension, pharmacological hypotonisation and intravenous contrast enhancement. In patients with a history of colorectal surgery for either carcinoma or Crohn's disease (CD), WE-MDCT may also be performed via a colostomy, which allows depicting the anatomy and position of the residual large bowel and evaluates the calibre, length, mural and extraluminal features of luminal strictures. Therefore, WE-MDCT may prove useful as a complementary technique after incomplete or inconclusive colonoscopy to assess features and suspected abnormalities of the surgical anastomosis, particularly when endoscopic or surgical interventions are being planned. This pictorial essay presents the WE-MDCT technique and pitfalls, the expected appearances after different colic surgeries and the imaging features of benign anastomotic disorders (fibrotic stricture, kinking, inflammatory ulcer) and of locally recurrent tumours and CD. TEACHING POINTS • Water-enema multidetector CT (WE-MDCT) effectively visualises the operated colon • Complementary to endoscopy, WE-MDCT may helpfully depict abnormalities of surgical anastomoses • WE-MDCT allows assessment of strictures' features and abnormalities of the upstream bowel • Technical pitfalls, normal postsurgical findings and benign anastomotic disorders are presented • WE-MDCT allows detecting relapsing Crohn's disease, recurrent and metachronous tumours.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Sonia Ippolito
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
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Romdhane H, Marzouk I, Mzoughi Z, Cheikh M, Dridi M, Fadhl H, Ennaifer R, Belhadj N. Value of water enema computed tomography in elderly symptomatic patients. Arab J Gastroenterol 2017; 18:235-237. [PMID: 29241725 DOI: 10.1016/j.ajg.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Colonoscopy remains the gold standard for the examination of the colon. However, its use in the elderly is not well tolerated, and there is often a need for general anaesthesia, thus increasing the risk, especially if there are co-morbidities. Water enema computed tomography has been suggested to be a satisfactory alternative as a non-invasive, fast and effective means for the diagnosis of colorectal supra-centimetric lesions. The aim of our study was to assess the performance of water enema computed tomography as first-line examination by calculating its negative predictive value (NPV) for the diagnosis of supra-centimetric lesions in symptomatic elderly referred to colonoscopy. PATIENTS AND METHODS This was a prospective study including 57 symptomatic patients older than 65 years. All patients were explored by water enema computed tomography at first, followed by colonoscopy, and responded to a questionnaire on the tolerance to the preparation and both procedures. RESULTS The mean age of patients was 73 years. The M:F sex ratio was 1.59. The most frequent indication for colonoscopy was bowel disorders associated with abdominal pain (30%). Water enema computed tomography allowed the diagnosis of tumours (n = 2), polyps (n = 6), diverticulosis (n = 7), inflammatory wall thickening (n = 1) and extra-colic lesions (n = 28). NPV of water enema computed tomography for supra-centimetric lesions was 96.5%. Sensitivity and specificity were 87.3% and 98%, respectively. However, for sub-centimetric lesions, water enema computed tomography had a low sensitivity estimated at 6%, specificity at 89.9%, positive predictive value at 91.9% and NPV at 27.7%. CONCLUSION Water enema computed tomography has proven to be a valuable and non-invasive method indicated as a first-line examination in case of colonic symptoms in the elderly to diagnose supra-centimetric lesions.
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Affiliation(s)
- Heyfa Romdhane
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Imen Marzouk
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Radiologiy Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Zeineb Mzoughi
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; General Surgery Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia.
| | - Meriem Cheikh
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Meriem Dridi
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Radiologiy Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Houcem Fadhl
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Rym Ennaifer
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
| | - Najet Belhadj
- Tunis Manar University, Faculty of Medecine of Tunis, 1007 Tunis, Tunisia; Gastroenterology Departement, Mongi Slim Hospital, Sidi Daoued La Marsa, Tunisia
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Minordi LM, Scaldaferri F, Marra RS, Pecere S, Larosa L, Poscia A, Gasbarrini A, Vecchioli A, Bonomo L. Enterography CT without and with water enema in patients with Crohn’s disease: Results from a comparative observational study in comparison with endoscopy. Eur J Radiol 2016; 85:404-13. [DOI: 10.1016/j.ejrad.2015.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/12/2015] [Accepted: 11/22/2015] [Indexed: 12/31/2022]
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Degree of colonic distension: intrapatient comparison between CT colonography and CT with water enema. Clin Imaging 2015; 40:425-30. [PMID: 27133680 DOI: 10.1016/j.clinimag.2015.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Compare colonic distension using CT colonography (CTC) and CT with water enema (CTWE) in the same patients. METHODS AND MATERIALS Twenty-seven patients who underwent both CTC and CTWE, considering separately supine (CTC-S) and prone (CTC-P) acquisition of CTC were included. The colon was divided into six segments, performing both a qualitative and quantitative analysis. RESULTS Adequate distension of sigmoid colon was more frequently achieved with CTC-P and CTWE compared to CTC-S (P<.05). CTC-P and CTWE showed better distension of the left colon compared to CTC-S (P<.01 and P=.03 regarding sigmoid colon, respectively; P=.01 and P=.03 regarding descending colon, respectively). CONCLUSIONS Computed tomography (CT) studies of the colon should be customized to fulfill the clinical query.
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Abstract
PURPOSE Water-enema multidetector computed tomography (WE-MDCT) is a technique for the localization and preoperative T- and N-stage assessments of colon cancer. It may be a useful tool for planning surgery. The primary aim of this study was to evaluate the diagnostic accuracy of WE-MDCT for T-staging and its ability to locate tumors for laparoscopy planning. The secondary aim was to assess reading reproducibility and diagnostic accuracy for the preoperative determination of N-stage. METHODS We performed a study to evaluate preoperative WE-MDCT for surgical planning in patients with symptomatic colon adenocarcinomas who underwent surgery between June 2010 and January 2014. A radiologist and a surgeon read the WE-MDCTs separately. Results were compared with colonoscopy and the surgical specimen. RESULTS Seventy-one patients (42 men (59.1%); mean age 73.1 years (range 45 to 95)) were included. Seventy-six tumors were assessed. The intraclass correlation coefficient (ICC) for location as determined by surgery and that determined by WE-MDCT was 1, and the ICC for location between colonoscopy and WE-MDCT was 0.85 (95% CI 0.75-0.91). For T-stage determination, sensitivity was 96 and 94% and specificity 83 and 88% for readers 1 and 2, respectively. The T-stage assessment allowed for the programing of surgical access and showed good sensitivity and specificity for the assessment of invasion in adjacent organs. CONCLUSION WE-MDCT is relatively easy to perform, and its results can be read effectively by radiologists and surgeons. WE-MDCT indicated the location of tumors perfectly and permitted a good determination of their T-stage. The technique is thus pertinent for the planning of laparoscopic surgery for colon cancer.
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Accuracy of water-enema multidetector computed tomography (WE-MDCT) in colon cancer staging: a prospective study. ACTA ACUST UNITED AC 2014; 39:941-8. [DOI: 10.1007/s00261-014-0150-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Sibileau E, Boulay-Coletta I, Jullès MC, Benadjaoud S, Oberlin O, Zins M. Appendicitis and diverticulitis of the colon: Misleading forms. Diagn Interv Imaging 2013; 94:771-92. [PMID: 23759294 DOI: 10.1016/j.diii.2013.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Norsa AH, Tonolini M, Ippolito S, Bianco R. Water enema multidetector CT technique and imaging of diverticulitis and chronic inflammatory bowel diseases. Insights Imaging 2013; 4:309-20. [PMID: 23508934 PMCID: PMC3675246 DOI: 10.1007/s13244-013-0239-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/08/2013] [Accepted: 02/19/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Water enema multidetector computed tomography (WE-MDCT) is currently considered the most accurate imaging modality to provide high-resolution multiplanar visualisation of the colonic wall and surrounding structures. METHODS This pictorial review presents our experience with WE-MDCT applications outside colorectal tumour staging, particularly for investigating diverticular disease and chronic inflammatory bowel diseases. A detailed explanation of the technique is provided, including patient preparation, the acquisition protocol, and study interpretation. RESULTS WE-MDCT allows accurate preoperative visualisation of diverticular disease, acute and complicated diverticulitis. Ulcerative, indeterminate, or Crohn's colitis can be assessed including longitudinal distribution, mural thickening and enhancement patterns, pseudopolyps, associated perivisceral changes, adjacent organ involvement, and features suggesting carcinoma. Elective WE-MDCT represents a useful complementary technique in patients with impossible, incomplete, or inconclusive endoscopy, can allow study of a stricture's features and the upstream bowel, and helps planning medical, endoscopic, or surgical treatments. CONCLUSION Urgent WE-MDCT with limited or no bowel preparation may prove useful in acutely symptomatic patients, as it may obviate a risky or contraindicated endoscopy, can determine disease severity, and allows making correct therapeutic choices. TEACHING POINTS • Water enema multidetector CT provides high-resolution multiplanar visualisation of the colonic wall. • WE-MDCT allows accurate visualisation of diverticular disease, acute and complicated diverticulitis. • In chronic inflammatory bowel diseases WE-MDCT depicts the distribution, mural and perivisceral changes. • Elective WE-MDCT usefully complements incomplete endoscopy to assess strictures and upstream colon. • Urgent WE-MDCT with limited or no bowel preparation in acute diseases may obviate endoscopy.
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Affiliation(s)
- Alba H. Norsa
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
- Radiology, Sant’Ambrogio Clinical Institute, Via Faravelli, Milan, Italy
| | - Massimo Tonolini
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Sonia Ippolito
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
| | - Roberto Bianco
- Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
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Paparo F, Garlaschi A, Biscaldi E, Bacigalupo L, Cevasco L, Rollandi GA. Computed tomography of the bowel: a prospective comparison study between four techniques. Eur J Radiol 2012; 82:e1-e10. [PMID: 22999647 DOI: 10.1016/j.ejrad.2012.08.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/28/2012] [Accepted: 08/26/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The major objective was to prospectively compare the grade of bowel distension obtained with four different computed tomography (CT) techniques dedicated for the examination of the small intestine (CT enteroclysis [CTE] and enterography [CTe]), of the colon (CT with water enema [CT-WE]), or both (CTe with water enema [CTe-WE]). The secondary objective was to assess patients' tolerance toward each CT protocol. MATERIALS AND METHODS Recruitment was designed to obtain four groups of the same number of patients (30). Each group corresponded to a specific CT technique, for a total of 120 consecutive outpatients (65 male and 55 female, mean age 51.09 ± 13.36 years). CTE was performed after injection of methylcellulose through a nasojejunal tube, while in the CTe protocol a polyethylene glycol electrolyte solution was orally administered to patients prior to the CT acquisition. In the CT-WE protocol intraluminal contrast (water) was administered only by a rectal enema, while CTe-WE technique included both a rectal water enema and oral ingestion of neutral contrast material to obtain a simultaneous distension of small and large bowel. CT studies were reviewed in consensus by two gastrointestinal radiologists who performed a quantitative and qualitative analysis of bowel distension on a per segment basis. The presence and type of adverse effects were recorded. RESULTS CTE provided the best distension of jejunal loops (median diameter 27 mm, range 17-32 mm) when compared to all the other techniques (p<0.0001). The frequency of patients with an adequate distension of the terminal ileum was not significantly different among the four groups (p=0.0608). At both quantitative and qualitative analysis CT-WE and CTe-WE determined a greater and more consistent luminal filling of the large intestine than that provided by both CTE and CTe (p<0.0001 for all colonic segments). Adverse effects were more frequent in patients belonging to the CTE group (p<0.0028). CONCLUSIONS CTE allows an optimal distension of jejunal loops, but it is the most uncomfortable CT protocol. When performing CT-WE, an adequate retrograde distension of the terminal ileum was provided in a particularly high percentage of patients. CTe-WE provides a simultaneous optimal distension of both small and large bowel.
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Affiliation(s)
- Francesco Paparo
- Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy
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Colon cancer: comprehensive evaluation with 64-section CT colonography using water enema as intraluminal contrast agent-a pictorial review. Clin Imaging 2012; 36:113-25. [PMID: 22370132 DOI: 10.1016/j.clinimag.2011.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 06/17/2011] [Indexed: 01/16/2023]
Abstract
Sixty-four-section CT colonography with water enema combines intracolonic neutral contrast agent with high-resolution CT images of the abdomen. Owing to submillimeter isotropic voxels, high-quality reformatted images are obtained. High-resolution images offer added value for the detection and localization of colonic lesions, evaluation of the local extent of the disease, and depiction, if any, of synchronous colorectal lesions and distant metastases. Sixty-four-section CT colonography with water enema has a major role in the evaluation of patients with colon cancer before planning therapy. It can be used to complement failed or incomplete colonoscopy and investigate the colon in elderly patients.
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Detection of colorectal tumors with water enema-multidetector row computed tomography. ACTA ACUST UNITED AC 2012; 37:1092-100. [DOI: 10.1007/s00261-012-9844-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ridereau-Zins C, Pilleul F, Gandon Y, Laurent V. CT colonography: Why? When? How? Diagn Interv Imaging 2012; 93:2-9. [DOI: 10.1016/j.diii.2011.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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