Evaluation of Role of Ct Enterography in the Diagnosis of Small Bowel Pathology

Abstract

Background: Aim: This study prospectively evaluates the role of CT Enterography(CTE) in diagnosis of small bowel pathology.

Materials and Methods: This prospective observational study was conducted on 42 consecutive patients with suspected small bowel pathology. CTE was performed using polyethylene glycol(PEG) as oral neutral contrast agent. After ingestion of 2 L of PEG solution, plain and dual phase contrast CT scan was performed on all patients. Raw data and reconstructed images were studied on PACS workstation and degree of small bowel distension was assessed, abnormal small bowel was identified and studied in detail to arrive at a diagnosis. Statistical analysis was performed and sensitivity, specificity, PPV, NPV and accuracy were calculated by comparison of CTE with surgery and histopathology as Gold Standard.

Results: In our study,age of the patient ranged from 18 to 75 years,maximum number of subjects were between 21 and 40 years of age. Abnormal small bowel was diagnosed in 15/42 (35.7%) patients. CTE correctly diagnosed Crohn’s disease in 5/6 cases (83%), small bowel adhesions in 4/4 cases (100%) and TB in 1/1 case (100%). We found that the overall accuracy of CTE in diagnosis of small bowel pathology was good. Sensitivity of CTE was found to be 100% for Crohn’s, bowel adhesions and abnormal small bowel in general and specificity to be 97.06%, 100% and 96.30 % respectively.However, the sensitivity for tuberculosis was found to be low, only 50% while specificity was 100.0%. This was in comparison with reference standard of surgery and/ or histopathology.

Conclusion: CTE with large volume of PEG electrolyte solution as neutral oral contrast agent provides optimal luminal distension and adequate small bowel separation, thus enabling identification of mural changes, mucosal hyperenhancement, luminal as well as extraluminal abnormalities and active site of bleeding in cases of Gastro-intestinal bleed. In our study, we found CTE to be a highly sensitive and specific method for diagnosing small bowel pathology in accordance with other studies in the literature.