Computerized Tomography Enterography and Its Role in Small-Bowel Imaging  Joel G. Fletcher, James Huprich, Edward V. Loftus, David H. Bruining, Jeff L. Fidler  Clinical Gastroenterology and Hepatology  Volume 6, Issue 3, Pages 283-289 (March 2008) DOI: 10.1016/j.cgh.2007.12.049 Copyright © 2008 AGA Institute Terms and Conditions

Figure 1 Asymmetric mural hyperenhancement in Crohn’s disease. Note additional presence of intramural fat, indicating there also has been chronic inflammation. Clinical Gastroenterology and Hepatology 2008 6, 283-289DOI: (10.1016/j.cgh.2007.12.049) Copyright © 2008 AGA Institute Terms and Conditions

Figure 2 (A) Enterocolic fistula (arrows) arising from the top of an inflamed jejunal loop (large arrowhead) and connecting to the hepatic flexure. (B) The proximal jejunum shows mural stratification (large arrow), with the distal jejunum being decompressed (arrowhead). (B) Engorged vasa recta (or the comb sign; small arrows) supply the (C) mildly inflamed proximal jejunal loop (arrows), which contains an enterolith (arrowhead). Clinical Gastroenterology and Hepatology 2008 6, 283-289DOI: (10.1016/j.cgh.2007.12.049) Copyright © 2008 AGA Institute Terms and Conditions

Figure 3 Ileal carcinoid with typical mesenteric metastasis. (A) Axial image shows an ileal loop with focal mural thickening and enhancement (arrowhead) associated with a soft-tissue mesenteric mass with excentric calcifications and stranding to adjacent small-bowel loops (arrow). (B) Coronal image shows similar findings (bowel loops, arrowheads; mesenteric metastasis, arrow). The surgical specimen showed a cluster of mural carcinoids with metastases to local nodes. Clinical Gastroenterology and Hepatology 2008 6, 283-289DOI: (10.1016/j.cgh.2007.12.049) Copyright © 2008 AGA Institute Terms and Conditions

Figure 4 Active bleeding at multiphase CT enterography. (A) Arterial, (B) enteric, and (C) delayed phase images show progressive focal contrast accumulation (arrows in A, B, and C) in an ileal angiodysplasia confirmed at intraoperative endoscopy. (C) Additional focus (arrows) of contrast on delayed image is also presumed to be active bleeding. Clinical Gastroenterology and Hepatology 2008 6, 283-289DOI: (10.1016/j.cgh.2007.12.049) Copyright © 2008 AGA Institute Terms and Conditions

Figure 5 Potential for dramatic radiation dose reduction at CT enterography shown using dual-energy CT enterography. (A) Normal dose CT enterography is achieved by combining the output from 2 radiograph tubes (each with half the normal dose), and shows mild wall thickening and mural hyperenhancement in the ascending colon (arrow) compared with the normal enhancement in the descending colon (arrowhead). (B) The 140-kV tube and (C) the 80-kV tube also are diagnostic, but were performed at half the radiation dose. Note the increased conspicuity of the iodine signal showing mural enhancement at the lower tube energy. Clinical Gastroenterology and Hepatology 2008 6, 283-289DOI: (10.1016/j.cgh.2007.12.049) Copyright © 2008 AGA Institute Terms and Conditions