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Imaging of Large Bowel with Multidetector Row CT

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Multislice CT

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

The use of high-resolution multidetector CT (MDCT) has revolutionized evaluation of the large bowel in both the acute emergency room setting and in chronic conditions. The physical exam is often limited and CT can help differentiate between conditions that may mimic each other clinically. Patients often present with vague abdominal symptoms, and CT can help elucidate the etiology and help guide management and treatment. The pathology is vast, and some of the more common acute conditions include appendicitis, diverticulitis, inflammatory bowel disease, and bowel obstruction. More recently, CT has also come to play a significant role in the evaluation of acute lower gastrointestinal bleeding. Primary evaluation with CTA has become accepted as an alternative initial screening exam and has been incorporated into the algorithm and work-up of lower gastrointestinal bleeding in many large medical centers. CTA allows for a quick and efficient survey of the abdomen and can triage patients appropriately, ensuring accurate, timely, and safe management.

Considerable improvements have also been made in colorectal cancer screening with CT colonography (CTC, also known as virtual colonoscopy). The American Cancer Society (ACS) and US Preventive Services Task Force (USPSTF) now recognize CTC as an acceptable primary screening option for colorectal cancer, which should pave the way for more widespread usage.

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References

  • Almeida AT, Melao L, Viamonte B, Cunha R, Pereira JM (2009) Epiploic appendagitis: an entity frequently unknown to clinicians–diagnostic imaging, pitfalls, and look-alikes. AJR Am J Roentgenol 193(5):1243–1251

    PubMed  Google Scholar 

  • Artigas JM, Marti M, Soto JA, Esteban H, Pinilla I, Guillen E (2013) Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings. Radiographics 33(5):1453–1470

    PubMed  Google Scholar 

  • Bellini D, Rengo M, De Cecco CN, Iafrate F, Hassan C, Laghi A (2014) Perforation rate in CT colonography: a systematic review of the literature and meta-analysis. Eur Radiol 24(7):1487–1496

    PubMed  Google Scholar 

  • Bodily KD, Fletcher JG, Solem CA, Johnson CD, Fidler JL, Barlow JM, Bruesewitz MR, McCollough CH, Sandborn WJ, Loftus EV Jr, Harmsen WS, Crownhart BS (2006) Crohn disease: mural attenuation and thickness at contrast-enhanced CT Enterography–correlation with endoscopic and histologic findings of inflammation. Radiology 238(2):505–516

    PubMed  Google Scholar 

  • Bond JH (2000) Clinical evidence for the adenoma-carcinoma sequence, and the management of patients with colorectal adenomas. Semin Gastrointest Dis 11(4):176–184

    CAS  PubMed  Google Scholar 

  • Carr NJ, Sobin LH (1996) Unusual tumors of the appendix and pseudomyxoma peritonei. Semin Diagn Pathol 13(4):314–325

    CAS  PubMed  Google Scholar 

  • Carr NJ, McCarthy WF, Sobin LH (1995) Epithelial noncarcinoid tumors and tumor-like lesions of the appendix. A clinicopathologic study of 184 patients with a multivariate analysis of prognostic factors. Cancer 75(3):757–768

    CAS  PubMed  Google Scholar 

  • Chang KJ, Soto JA (2010) Computed tomographic colonography: image display methods. In: A.H. Dachman and A. Laghi (eds) Atlas of virtual colonoscopy. Springer, New York/Dordrecht/Heidelberg/London, pp 111–132

    Google Scholar 

  • Collins DC (1955) A study of 50,000 specimens of the human vermiform appendix. Surg Gynecol Obstet 101(4):437–445

    CAS  PubMed  Google Scholar 

  • Connor SJ, Hanna GB, Frizelle FA (1998) Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 41(1):75–80

    CAS  PubMed  Google Scholar 

  • Dachman AH, Lichtenstein JE, Friedman AC (1985) Mucocele of the appendix and pseudomyxoma peritonei. AJR Am J Roentgenol 144(5):923–929

    CAS  PubMed  Google Scholar 

  • Deans GT, Spence RA (1995) Neoplastic lesions of the appendix. Br J Surg 82(3):299–306

    CAS  PubMed  Google Scholar 

  • Ekbom A, Helmick C, Zack M, Adami HO (1991) The epidemiology of inflammatory bowel disease: a large, population-based study in Sweden. Gastroenterology 100(2):350–358

    CAS  PubMed  Google Scholar 

  • Hananel N, Powsner E, Wolloch Y (1998) Adenocarcinoma of the appendix: an unusual disease. Eur J Surg 164(11):859–862

    CAS  PubMed  Google Scholar 

  • Hatch KF, Blanchard DK, Hatch GF 3rd, Wertheimer-Hatch L, Davis GB, Foster RS Jr, Skandalakis JE (2000) Tumors of the appendix and colon. World J Surg 24(4):430–436

    CAS  PubMed  Google Scholar 

  • Heffernan C, Pachter HL, Megibow AJ, Macari M (2005) Stercoral colitis leading to fatal peritonitis: CT findings. AJR Am J Roentgenol 184(4):1189–1193

    PubMed  Google Scholar 

  • Johnson CD, Chen MH, Toledano AY, Heiken JP, Dachman A, Kuo MD, Menias CO, Siewert B, Cheema JI, Obregon RG, Fidler JL, Zimmerman P, Horton KM, Coakley K, Iyer RB, Hara AK, Halvorsen RA Jr, Casola G, Yee J, Herman BA, Burgart LJ, Limburg PJ (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359(12):1207–1217

    CAS  PubMed  PubMed Central  Google Scholar 

  • Jones B, Fishman EK, Hamilton SR, Rubesin SE, Bayless TM, Cameron JC, Siegelman SS (1986) Submucosal accumulation of fat in inflammatory bowel disease: CT/pathologic correlation. J Comput Assist Tomogr 10(5):759–763

    CAS  PubMed  Google Scholar 

  • Kim HJ, Park SH, Pickhardt PJ, Yoon SN, Lee SS, Yee J, Kim DH, Kim AY, Kim JC, Yu CS, Ha HK (2010) CT colonography for combined colonic and extracolonic surveillance after curative resection of colorectal cancer. Radiology 257(3):697–704

    PubMed  Google Scholar 

  • Lee SS, Ha HK, Yang SK, Kim AY, Kim TK, Kim PN, Lee MG, Myung SJ, Jung HY, Kim JH, Min YI (2002) CT of prominent pericolic or perienteric vasculature in patients with Crohn's disease: correlation with clinical disease activity and findings on barium studies. AJR Am J Roentgenol 179(4):1029–1036

    PubMed  Google Scholar 

  • Lee SS, Oh TS, Kim HJ, Chung JW, Park SH, Kim AY, Ha HK (2011) Obscure gastrointestinal bleeding: diagnostic performance of multidetector CT enterography. Radiology 259(3):739–748

    PubMed  Google Scholar 

  • Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, Dash C, Giardiello FM, Glick S, Levin TR, Pickhardt P, Rex DK, Thorson A, Winawer SJ, G. American Cancer Society Colorectal Cancer Advisory, U. S. M.-S. T. Force, C. American College of Radiology Colon Cancer (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58(3):130–160

    PubMed  Google Scholar 

  • Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126(6):1504–1517

    PubMed  Google Scholar 

  • Macari M, Balthazar EJ, Megibow AJ (1999) The accordion sign at CT: a nonspecific finding in patients with colonic edema. Radiology 211(3):743–746

    CAS  PubMed  Google Scholar 

  • Madwed D, Mindelzun R, Jeffrey RB Jr (1992) Mucocele of the appendix: imaging findings. AJR Am J Roentgenol 159(1):69–72

    CAS  PubMed  Google Scholar 

  • Meyers MA, Volberg F, Katzen B, Alonso D, Abbott G (1973) The angioarchitecture of colonic diverticula. Significance in bleeding diverticulosis. Radiology 108(2):249–261

    CAS  PubMed  Google Scholar 

  • Miettinen M, Sobin LH (2001) Gastrointestinal stromal tumors in the appendix: a clinicopathologic and immunohistochemical study of four cases. Am J Surg Pathol 25(11):1433–1437

    CAS  PubMed  Google Scholar 

  • Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer 97(4):934–959

    PubMed  Google Scholar 

  • Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK (2002) Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc 55(3):307–314

    PubMed  Google Scholar 

  • Nerad E, Lahaye MJ, Maas M, Nelemans P, Bakers FC, Beets GL, Beets-Tan RG (2016) Diagnostic accuracy of CT for local staging of colon cancer: a systematic review and meta-analysis. AJR Am J Roentgenol 207(5):984–995

    PubMed  Google Scholar 

  • Peterson CM, Anderson JS, Hara AK, Carenza JW, Menias CO (2009) Volvulus of the gastrointestinal tract: appearances at multimodality imaging. Radiographics 29(5):1281–1293

    PubMed  Google Scholar 

  • Pickhardt PJ (2006) Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 239(2):313–316

    PubMed  Google Scholar 

  • Pickhardt PJ (2007) Screening CT colonography: how I do it. AJR Am J Roentgenol 189(2):290–298

    PubMed  Google Scholar 

  • Pickhardt PJ, Choi JH (2003) Electronic cleansing and stool tagging in CT colonography: advantages and pitfalls with primary three-dimensional evaluation. AJR Am J Roentgenol 181(3):799–805

    PubMed  Google Scholar 

  • Pickhardt PJ, Levy AD, Rohrmann CA Jr, Kende AI (2002) Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison. Radiology 224(3):775–781

    PubMed  Google Scholar 

  • Pickhardt PJ, Levy AD, Rohrmann CA Jr, Abbondanzo SL, Kende AI (2002) Non-Hodgkin's lymphoma of the appendix: clinical and CT findings with pathologic correlation. AJR Am J Roentgenol 178(5):1123–1127

    PubMed  Google Scholar 

  • Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349(23):2191–2200

    CAS  PubMed  Google Scholar 

  • Pickhardt PJ, Levy AD, Rohrmann CA Jr, Kende AI (2003) Primary neoplasms of the appendix: radiologic spectrum of disease with pathologic correlation. Radiographics 23(3):645–662

    PubMed  Google Scholar 

  • Pickhardt PJ, Hanson ME, Vanness DJ, Lo JY, Kim DH, Taylor AJ, Winter TC, Hinshaw JL (2008) Unsuspected extracolonic findings at screening CT colonography: clinical and economic impact. Radiology 249(1):151–159

    PubMed  Google Scholar 

  • Pickhardt PJ, Hassan C, Halligan S, Marmo R (2011) Colorectal cancer: CT colonography and colonoscopy for detection–systematic review and meta-analysis. Radiology 259(2):393–405

    PubMed  PubMed Central  Google Scholar 

  • Quayle FJ, Lowney JK (2006) Colorectal lymphoma. Clin Colon Rectal Surg 19(2):49–53

    PubMed  PubMed Central  Google Scholar 

  • Ranasinghe I, Parzynski CS, Searfoss R, Montague J, Lin Z, Allen J, Vender R, Bhat K, Ross JS, Bernheim S, Krumholz HM, Drye EE (2016) Differences in colonoscopy quality among facilities: development of a post-colonoscopy risk-standardized rate of unplanned hospital visits. Gastroenterology 150(1):103–113

    PubMed  Google Scholar 

  • Rao PM, Wittenberg J, Lawrason JN (1997) Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology 204(3):713–717

    CAS  PubMed  Google Scholar 

  • Rex DK, Ahnen DJ, Baron JA, Batts KP, Burke CA, Burt RW, Goldblum JR, Guillem JG, Kahi CJ, Kalady MF, O'Brien MJ, Odze RD, Ogino S, Parry S, Snover DC, Torlakovic EE, Wise PE, Young J, Church J (2012) Serrated lesions of the colorectum: review and recommendations from an expert panel. Am J Gastroenterol 107(9):1315–1329 ; quiz 1314, 1330

    Google Scholar 

  • Rosenblat JM, Rozenblit AM, Wolf EL, DuBrow RA, Den EI, Levsky JM (2010) Findings of cecal volvulus at CT. Radiology 256(1):169–175

    PubMed  Google Scholar 

  • Sandor A, Modlin IM (1998) A retrospective analysis of 1570 appendiceal carcinoids. Am J Gastroenterol 93(3):422–428

    CAS  PubMed  Google Scholar 

  • Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH (2006) Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol 186(6):1491–1496

    PubMed  Google Scholar 

  • Singh AK, Gervais DA, Hahn PF, Rhea J, Mueller PR (2004) CT appearance of acute appendagitis. AJR Am J Roentgenol 183(5):1303–1307

    PubMed  Google Scholar 

  • The American College of Radiology (2014) ACR–SAR–SCBT-MR practice parameter for the performance of Computed Tomography (CT) colonography in adults. ACR Practice Parameters and Technical Standards, Reston

    Google Scholar 

  • Thoeni RF, Cello JP (2006) CT imaging of colitis. Radiology 240(3):623–638

    PubMed  Google Scholar 

  • van Eeden S, Offerhaus GJ, Peterse HL, Dingemans KP, Blaauwgeers HL (2000) Gangliocytic paraganglioma of the appendix. Histopathology 36(1):47–49

    PubMed  Google Scholar 

  • Wang H, Chen YQ, Wei R, Wang QB, Song B, Wang CY, Zhang B (2013) Appendiceal mucocele: a diagnostic dilemma in differentiating malignant from benign lesions with CT. AJR Am J Roentgenol 201(4):W590–W595

    PubMed  Google Scholar 

  • Whelan CT, Chen C, Kaboli P, Siddique J, Prochaska M, Meltzer DO (2010) Upper versus lower gastrointestinal bleeding: a direct comparison of clinical presentation, outcomes, and resource utilization. J Hosp Med 5(3):141–147

    PubMed  Google Scholar 

  • Yee J, Rosen MP, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Sudakoff GS, Warshauer DM (2010) ACR Appropriateness Criteria on colorectal cancer screening. J Am Coll Radiol 7(9):670–678

    PubMed  Google Scholar 

  • Yee J, Chang KJ, Dachman AH, Kim DH, McFarland EG, Pickhardt PJ, Cash BD, Bruining DH, Zalis ME (2016) The added value of the CT colonography reporting and data system. J Am Coll Radiol 13(8):931–935

    PubMed  Google Scholar 

  • Zalis ME, Barish MA, Choi JR, Dachman AH, Fenlon HM, Ferrucci JT, Glick SN, Laghi A, Macari M, McFarland EG, Morrin MM, Pickhardt PJ, Soto J, Yee J, C. Working Group on Virtual (2005) CT colonography reporting and data system: a consensus proposal. Radiology 236(1):3–9

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA

    Jay D. Patel MD

  2. Assistant Professor, Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA

    Heather I. Gale MD

  3. Division of Body Imaging, Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA

    Kevin J. Chang MD, FSAR

Authors
  1. Jay D. Patel MD
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  2. Heather I. Gale MD
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  3. Kevin J. Chang MD, FSAR
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Correspondence to Jay D. Patel MD .

Editor information

Editors and Affiliations

  1. Department of Radiology, Universitätsklinikum Tübingen, Tübingen, Baden-Württemberg, Germany

    Konstantin Nikolaou

  2. Department of Diagnostic and Interventional Radiology, University of Freiburg, Freiburg, Germany

    Fabian Bamberg

  3. Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza” – University of Rome, Rome, Italy

    Andrea Laghi

  4. Department of Radiology, Duke University School of Medicine, Durham, NC, USA

    Geoffrey D. Rubin

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Patel, J.D., Gale, H.I., Chang, K.J. (2017). Imaging of Large Bowel with Multidetector Row CT. In: Nikolaou, K., Bamberg, F., Laghi, A., Rubin, G.D. (eds) Multislice CT. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_7

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  • DOI: https://doi.org/10.1007/174_2017_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42585-6

  • Online ISBN: 978-3-319-42586-3

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