Virtual Endoscopy of the Small Intestine

  • P. Rogalla
Part of the Medical Radiology book series (MEDRAD)


Despite the development of a so-called intestino-scope, with a calibre as thin as a fibreoptic or electric endoscope (endoscope with a CCD camera at the tip), the small intestine has remained generally inaccessible to complete endoscopic evaluation (Van Dam and Brugge 1999). For a long time, at least since the introduction of the fractionated passage by Pansdorf (1937), radiological diagnostic procedures of the small intestine have played a central role in patient care. Due to the length and position of the small bowel, comprehensive intestinal imaging has posed a difficult challenge. Further complicating this task are the considerable variation in intestinal transit time from person to person, the unforeseeable enteral distribution patterns of contrast medium, and the superimposition of contrast-filled bowel loops upon more posterior segments.


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  1. Adrain AL, Krevsky B (1996) Enteroscopy in patients with gastrointestinal bleeding of obscure origin. Dig Dis 14:345–355.PubMedCrossRefGoogle Scholar
  2. Aschoff AJ, Zeitler H, Merkle EM, Reinshagen M, Brambs HJ, Rieber A (1997) [MR enteroclysis for nuclear spin tomographic diagnosis of inflammatory bowel diseases with contrast enhancement]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 167:387–391.PubMedCrossRefGoogle Scholar
  3. Binswanger RO, Seilink JL (1980) [Enteroclysis: improved and simplified contract media imaging of the small intestine]. Schweiz Med Wochenschr 110:867–869.PubMedGoogle Scholar
  4. Blecker D, Abraham S, Furth EE, Kochman ML (1999) Melanoma in the gastrointestinal tract. Am J Gastroenterol 94:3427–3433.PubMedCrossRefGoogle Scholar
  5. Brzezinski A, Lashner BA (1997): Natural history of Crohn’s disease. In Allan RNJ, Rhodes JM, Hanauer SB (eds), Inflammatory bowel disease, 3rd edn. New York: Churchill Livingstone, pp 475–486.Google Scholar
  6. Ciccarelli O, Welch JP, Kent GG (1987) Primary malignant tumors of the small bowel. The Hartford Hospital experience, 1969–1983. Am J Surg 153:350–354.PubMedCrossRefGoogle Scholar
  7. Crohn BB, Ginzburg L, Oppenheimer GD (1932) Regional ileitis: a pathological-clinical entity. J Am Med Assoc 99:1323–1328.CrossRefGoogle Scholar
  8. Debatin JF, Patak MA (1999) MRI of the small and large bowel. Eur Radiol 9:1523–1534.PubMedCrossRefGoogle Scholar
  9. Descamps C, Schmit A, Van Gossum A (1999) “Missed” upper gastrointestinal tract lesions may explain “occult” bleeding. Endoscopy 31:452–455.PubMedCrossRefGoogle Scholar
  10. Duvoisin B, Schnyder P (1990) [Computerized tomography of the small bowel]. Radiologe 30:280–285.PubMedGoogle Scholar
  11. Ekberg O (1977) Crohn’s disease of the small bowel examined by double contrast technique: a comparison with oral technique. Gastrointest Radiol 1:355–359.PubMedCrossRefGoogle Scholar
  12. Faber SC, Stehling MK, Holzknecht N, Gauger J, Helmberger T, Reiser M (1997) Pathologic conditions in the small bowel: findings at fat-suppressed gadolinium-enhanced MR imaging with an optimized suspension of oral magnetic particles. Radiology 205:278–282.PubMedGoogle Scholar
  13. Fleckenstein P, Pedersen G (1975) The value of the duodenal intubation method (sellink modification) for the radiological visualization of the small bowel. Scand J Gastroenterol 10:423–425.PubMedGoogle Scholar
  14. Fujimura Y, Kamoi R, Iida M (1996) Pathogenesis of aphthoid ulcers in Crohn’s disease: correlative findings by magnifying colonoscopy, electron microscopy, and immunohis-tochemistry. Gut 38:724–732.PubMedCrossRefGoogle Scholar
  15. Gayer G, Zissin R, Apter S, Shemesh E, Heldenberg E (1999) Acute diverticulitis of the small bowel: CT findings. Abdom Imaging 24:452–455.PubMedCrossRefGoogle Scholar
  16. Gershon-Cohen J, Shay H (1939) Barium enteroclysis. AJR Am J Roentgenol 42:456–458.Google Scholar
  17. Glick SN, Teplick SK (1985) Crohn disease of the small intestine: diffuse mucosal granularity. Radiology 154:313–317.PubMedGoogle Scholar
  18. Gmünder U, Wirth W (1970) Doppelkontrastdarstellung. Schweiz Med Wochenschr 100:1236.PubMedGoogle Scholar
  19. Goldblum JR, Petras RE (1997): Histopathology of Crohn’s disease. In Allan RN, Rhodes JM, Hanauer SB (eds), Inflammatory bowel disease, 3rd edn. New York: Churchill Livingstone, pp 311–316.Google Scholar
  20. Grubnic S, Padhani AR, Reveil PB, Husband JE (1999) Comparative efficacy of and sequence choice for two oral contrast agents used during MR imaging. AJR Am J Roentgenol 173:173–178.PubMedCrossRefGoogle Scholar
  21. Ha HK, Lee EH, Lim CH, et al. (1998) Application of MRI for small intestinal diseases. J Magn Reson Imaging 8:375–383.PubMedCrossRefGoogle Scholar
  22. Horton KM, Corl FM, Fishman EK (1999) CT of nonneoplastic diseases of the small bowel: spectrum of disease. J Comput Assist Tomogr 23:417–428.PubMedCrossRefGoogle Scholar
  23. Howe JR, Karnell LH, Menck HR, Scott-Conner C (1999) The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985–1995. Cancer 86:2693–2706.PubMedCrossRefGoogle Scholar
  24. James S, Balfe DM, Lee JK, Picus D (1987) Small-bowel disease: categorization by CT examination. AJR Am J Roentgenol 148:863–868.PubMedCrossRefGoogle Scholar
  25. Kelvin FM, Max RJ, Norton GA, et al. (1979) Lymphoid follicular pattern of the colon in adults. AJR Am J Roentgenol 133:821–825.PubMedCrossRefGoogle Scholar
  26. Laufer I, deSa D (1978) Lymphoid follicular pattern: a normal feature of the pediatric colon. AJR Am J Roentgenol 130:51–55.PubMedCrossRefGoogle Scholar
  27. Lee JK, Marcos HB, Semelka RC (1998) MR imaging of the small bowel using the HASTE sequence. AJR Am J Roentgenol 170:1457–1463.PubMedCrossRefGoogle Scholar
  28. Lichtenstein JE (1987) Radiologie-pathologie correlation of inflammatory bowel disease. Radiol Clin North Am 25:3–24.PubMedGoogle Scholar
  29. Low VHS (1998) The query corner. Bowel wall thickening on CT. Abdom Imaging 23:107–110.PubMedCrossRefGoogle Scholar
  30. Lura A (1951) Enema of the small intestine with special emphasis on the diagnosis of tumors. Br J Radiol 24:264–271.PubMedCrossRefGoogle Scholar
  31. Maccioni F, Rossi P, Gourtsoyiannis N, Bezzi M, Di Nardo R, Broglia L (1997) US and CT findings of small bowel neoplasms. Eur Radiol 7:1398–1409.PubMedCrossRefGoogle Scholar
  32. Madsen SM, Thomsen HS, Munkholm P, Schlichting P, Davidsen B (1997) Magnetic resonance imaging of Crohn disease: early recognition of treatment response and relapse. Abdom Imaging 22:164–166.PubMedCrossRefGoogle Scholar
  33. Madsen SM, Thomsen HS, Schlichting P, Dorph S, Munkholm P (1999) Evaluation of treatment response in active Crohn’s disease by low-field magnetic resonance imaging. Abdom Imaging 24:232–239.PubMedCrossRefGoogle Scholar
  34. Maglinte DD, Burney BT, Miller RE (1982) Lesions missed on small-bowel follow-through: analysis and recommendations. Radiology 144:737–739.PubMedGoogle Scholar
  35. Makita O, Ikushima I, Matsumoto N, Arikawa K, Yamashita Y, Takahashi M (1999) CT differentiation between necrotic and nonnecrotic small bowel in closed loop and strangulating obstruction. Abdom Imaging 24:120–124.PubMedCrossRefGoogle Scholar
  36. Morewood DJ, Whitehouse GH (1986) A comparison of three methods for performing barium follow-through studies of the small intestine. Br J Radiol 59:971–973.PubMedCrossRefGoogle Scholar
  37. Morris AJ (1999) Small-bowel investigation in occult gastrointestinal bleeding. Semin Gastrointest Dis 10:65–70.PubMedGoogle Scholar
  38. Nolan DJ, Cadman PJ, Jeffree MA (1985) Re: Detailed per-oral small-bowel examination versus enteroclysis [letter]. Radiology 157:836–837.PubMedGoogle Scholar
  39. O’Mahony S, Morris AJ, Straiton M, Murray L, MacKenzie JF (1996) Push enteroscopy in the investigation of small-intestinal disease. Qjm 89:685–690.PubMedCrossRefGoogle Scholar
  40. O’Riordan BG, Vilor M, Herrera L (1996) Small bowel tumors: an overview. Dig Dis 14:245–257.PubMedCrossRefGoogle Scholar
  41. Ott DJ, Chen YM, Gelfand DW, Van Swearingen F, Munitz HA (1985a) Detailed per-oral small bowel examination vs. enteroclysis. Part I: Expenditures and radiation exposure. Radiology 155:29–31.PubMedGoogle Scholar
  42. Ott DJ, Chen YM, Gelfand DW, Van Swearingen F, Munitz HA (1985b) Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy. Radiology 155:31–34.PubMedGoogle Scholar
  43. Pansdorf H (1937) Die fraktionierte Dünndarmfüllung und ihre klinische Bedeutung. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 56:627–634.Google Scholar
  44. Pozniak MA, Scanlan KA, Yandow D, Mulligan G (1990) [Current status of small-bowel ultrasound] [published erratum appears in Radiologe 1990 Dec;30(12):597]. Radiologe 30:254–265.PubMedGoogle Scholar
  45. Pribram BO, Kleiber N (1927) Ein neuer Weg zur röntgenologischen Darstellung des Duodenums (Pneumo-duodenum). Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 36:739.Google Scholar
  46. Rieber A, Wruk D, Nussle K, et al. (1998) [MRI of the abdomen combined with enteroclysis in Crohn disease using oral and intravenous Gd-DTPA]. Radiologe 38:23–28.PubMedCrossRefGoogle Scholar
  47. Rogalla P, Mutze S, Hamm B (1996): Body CT: state-of-the-art. Munich: W. Zuckschwerdt.Google Scholar
  48. Rogalla P, Werner Rustner M, Huitema A, van Est A, Meiri N, Hamm B (1998) Virtual endoscopy of the small bowel: phantom study and preliminary clinical results. Eur Radiol 8:563–567.PubMedCrossRefGoogle Scholar
  49. Schatzki R (1988) Small intestinal enema. By Richard Schatzki, 1942. AJR Am J Roentgenol 150:499–507.PubMedCrossRefGoogle Scholar
  50. Sellink JL (1974) Radiologic examination of the small intestine by duodenal intubation. Acta Radiol (Stockh) 15:318–332.Google Scholar
  51. Sellink JL (1976) Proceedings: Why enteroclysis of the small intestine? Br J Radiol 49:288–289.PubMedGoogle Scholar
  52. Sellink JL, Rosenbusch G (1981) [“The ten commandments” for enteroclysis or ten golden rules for proper enteroclysis technique]. Radiologe 21:366–376.PubMedGoogle Scholar
  53. Semelka RC, John G, Kelekis NL, Burdeny DA, Ascher SM (1996) Small bowel neoplastic disease: demonstration by MRI. J Magn Reson Imaging 6:855–860.PubMedCrossRefGoogle Scholar
  54. Serour F, Dona G, Birkenfeld S, Balassiano M, Krispin M (1992) Primary neoplasms of the small bowel. J Surg Oncol 49:29–34.PubMedCrossRefGoogle Scholar
  55. Siegel MJ, Evans SJ, Balfe DM (1988) Small bowel disease in children: diagnosis with CT. Radiology 169:127–130.PubMedGoogle Scholar
  56. Silverman PM (1994): Handbook of helical (spiral) computed tomography: techniques & protocols. Corona Del Mar, CA, USA: Mallinckrodt Medical, Inc. by Med Write, Inc.Google Scholar
  57. Stenbygaard LE, Sorensen JB (1999) Small bowel metastases in non-small cell lung cancer. Lung Cancer 26:95–101.PubMedCrossRefGoogle Scholar
  58. Thoeni RF, Filson RG (1988) Abdominal and pelvic CT: use of oral metoclopramide to enhance bowel opacification. Radiology 169:391–393.PubMedGoogle Scholar
  59. Thoeni RF, Rogalla P (1994) Current CT/MRI examination of the lower intestinal tract. Baillieres Clin Gastroenterol 8:765–796.PubMedCrossRefGoogle Scholar
  60. Van Dam J, Brugge WR (1999) Endoscopy of the upper gastrointestinal tract. N Engl J Med 341:1738–1748.PubMedCrossRefGoogle Scholar
  61. Westerman AM, Wilson JH (1999) Peutz-Jeghers syndrome: risks of a hereditary condition. Scand J Gastroenterol Suppl 230:64–70.PubMedCrossRefGoogle Scholar
  62. Wills JS, Lobis IF, Denstman FJ (1997) Crohn disease: state of the art. Radiology 202:597–610.PubMedGoogle Scholar
  63. Zaman A, Katon RM (1998) Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope. Gastrointest Endosc 47:372–376.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • P. Rogalla
    • 1
  1. 1.Department of Radiology, Charité HospitalHumboldt-Universität zu BerlinBerlinGermany

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