E1408. CT Enterocolonography: A Novel Protocol for Bowel Imaging
  1. Oksana Marushchak; University of Toronto
  2. Luis Guimaraes; Joint Department of Medical Imaging; University of Toronto
  3. Satheesh Krishna; Joint Department of Medical Imaging; University of Toronto
  4. Nasir Jaffer; University of Toronto
Current widely used CT imaging techniques for bowel assessment include conventional CT of the abdomen with oral or rectal contrast, CT enterography and CT clonography. While these techniques cover a wide range of clinical indications, some limitations remain.

Educational Goals / Teaching Points
This educational presentation will introduce CT enterocolonography (CTET), a novel protocol for imaging of small bowel and colon that allows detailed visualization of mucosa and intestinal wall. CTEC will be compared and differentiated with existing protocols for bowel imaging and utility of CTEC in practice will be demonstarted through practical examples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CTEC achieves small and large bowel distention with neutral luminal contrast. The patient undergoes a light bowel preparation one day prior to the procedure. Oral mannitol solution, rectal water, intravenous hyoscine butylbromide (Sanofi-Aventis Canada Inc) and iodinated contrast are administered at the time of the exam. Detailed mucosal and mural visualization facilitates assessment of inflammatory bowel disease activity characterization of mucosal and submucosal lesions detected on colonoscopy. CTEC is also useful for assessment of bowel following suboptimal colonoscopy due to bowel strictures, diverticulitis or obstructing neoplasm. It is also a good alternative for patients unable to tolerate colonic insufflation with pressurized air required for CT colonography and colonoscopy. However, lack of fecal tagging with positive contrast increases risk of missing small polyps or small sessile lesions.

CTEC is a novel CT protocol for small and large bowel assessment providing radiologists the ability to characterize mucosal, mural and mesenteric changes. It can supplement traditional colonoscopy and is of particular use in the inflammatory bowel disease population.