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CT enterography: technical and interpretive pitfalls

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Abstract

CT enterography is a first-line test at many institutions to investigate potential small bowel disorders. While numerous articles have focused on the ability of CT enterography to diagnose and stage Crohn’s disease, small bowel neoplasia, and malabsorptive or vascular disorders, this article reviews CT enterography limitations, technical and interpretive pitfalls, image review tactics, and complementary radiologic and endoscopic examinations to improve diagnostic accuracy. CT enterography limitations include its inability to demonstrate isolated mucosal abnormalities such as aphthous ulcers and its use of ionizing radiation. The most common technical pitfall of CT enterography is inadequate small bowel distention resulting from inadequate ingestion, gastric retention, or rapid small bowel transit of a large volume of neutral enteric contrast material. Additionally, segments of jejunum are frequently collapsed. Interpretive pitfalls commonly result from peristaltic contractions, transient intussusception and opaque intraluminal debris. Opaque debris is especially problematic during multiphasic CT enterography performed to identify potential small bowel sources of obscure gastrointestinal bleeding. False-negative examinations may result from inadequate radiation dose. Examinations complementary to CT enterography include small bowel follow through, enteroclysis, CT enteroclysis, MR enterography, MR enteroclysis, capsule endoscopy, and balloon-assisted endoscopy. Properly performed and accurately interpreted CT enterography contributes to the diagnosis and management of small bowel disease by itself and as a complement to other radiologic and optical small bowel imaging examinations.

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Acknowledgment

We thank Ms. Sally Reinhart for her assistance with preparation of this manuscript.

Conflict of interest

None of the authors has any disclosures related to this article.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    John M. Barlow, Brian C. Goss, Amy B. Kolbe, Joshua L. Rackham & Joel G. Fletcher

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Stephanie L. Hansel & David H. Bruining

Authors
  1. John M. Barlow
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  2. Brian C. Goss
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  3. Stephanie L. Hansel
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  4. Amy B. Kolbe
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  5. Joshua L. Rackham
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  6. David H. Bruining
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  7. Joel G. Fletcher
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Correspondence to John M. Barlow.

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Barlow, J.M., Goss, B.C., Hansel, S.L. et al. CT enterography: technical and interpretive pitfalls. Abdom Imaging 40, 1081–1096 (2015). https://doi.org/10.1007/s00261-015-0364-5

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  • DOI: https://doi.org/10.1007/s00261-015-0364-5

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