ENTEROCOLITIDESENTEROCOLITIDES

CAN YOU TELL THEM APARTCAN YOU TELL THEM APARTON MDCT?ON MDCT?

Richard M. Gore, MDRichard M. Gore, MDNorth Shore University Medical CenterNorth Shore University Medical Center

University of ChicagoUniversity of ChicagoEvanston, IllinoisEvanston, Illinois

SCBT/MR 2010SCBT/MR 2010San Diego, CaliforniaSan Diego, California

March 8, 2010March 8, 201013:4013:40--14:0014:00

ENTEROCOLITISENTEROCOLITIS

↑↑WORLD WIDE TRAVELWORLD WIDE TRAVEL↑↑CROHNS DISEASECROHNS DISEASE

ANTIBIOTICSANTIBIOTICSAIDSAIDS

CHEMOTHERAPYCHEMOTHERAPYTRANSPLANTATIONTRANSPLANTATIONAGING POPULATIONAGING POPULATION

HEPATITIS CHEPATITIS C

RADIOLOGIC EVALUATIONRADIOLOGIC EVALUATION

•• USUS•• MRMR•• SCINTIGRAPHYSCINTIGRAPHY•• BEBE•• KUBKUB•• CTCT

USE OF PLAIN FILM TOUSE OF PLAIN FILM TODETERMINE CT TECHNIQUEDETERMINE CT TECHNIQUE

•• BIG DISTENDED LOOPS:BIG DISTENDED LOOPS: BO vs ILEUS vs BO vs ILEUS vs TOXIC MEGACOLON TOXIC MEGACOLON ------ IV CONTRAST ONLYIV CONTRAST ONLY

•• GASLESS ABDOMEN:GASLESS ABDOMEN: ISCHEMIA, BO, ISCHEMIA, BO, FULMINANT COLITIS WITH FLUIDFULMINANT COLITIS WITH FLUID------IV IV CONTRAST ONLYCONTRAST ONLY

•• CROHNCROHN’’S DISEASE COMPLICATIONS OR S DISEASE COMPLICATIONS OR NORMAL, NORMAL, ““NON SPECIFICNON SPECIFIC”” GAS PATTERN: GAS PATTERN: ORAL AND IV CONTRASTORAL AND IV CONTRAST

•• CROHNCROHN’’S DISEASE ACTIVITY:S DISEASE ACTIVITY: IV CONTRAST IV CONTRAST AND NEUTRAL CONTRAST (VOLUMEN) AND NEUTRAL CONTRAST (VOLUMEN)

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT PATTERNMURAL ENHANCEMENT PATTERN•• LENGTH OF INVOLVEMENTLENGTH OF INVOLVEMENT•• DEGREE OF MURAL THICKENINGDEGREE OF MURAL THICKENING•• PATENCY OF MESENTERIC VESSELSPATENCY OF MESENTERIC VESSELS•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC MESENTERIC CHANGESCHANGES

•• LUMEN CONTENTSLUMEN CONTENTS

•• HOMOGENEOUSHOMOGENEOUS•• HETEROGENEOUSHETEROGENEOUS•• MIXEDMIXED

LENGTH OF INVOLVEMENT:LENGTH OF INVOLVEMENT:FOCAL < 5 cmFOCAL < 5 cm

•• AdenocarcinomaAdenocarcinoma

LENGTH OF INVOLVEMENT:LENGTH OF INVOLVEMENT:FOCAL < 5FOCAL < 5--10 cm10 cm

•• DiverticulitisDiverticulitis•• CrohnCrohn’’s diseases disease•• IschemiaIschemia

LENGTH OF INVOLVEMENT:LENGTH OF INVOLVEMENT:SEGMENTAL < 10SEGMENTAL < 10--30 cm30 cm

•• IschemiaIschemia•• Submucosal Submucosal

hemorrhagehemorrhage•• RadiationRadiation•• InfectionInfection•• CrohnCrohn’’s diseases disease•• LymphomaLymphoma

LENGTH OF INVOLVEMENT:LENGTH OF INVOLVEMENT:DIFFUSEDIFFUSE

•• Infectious Infectious enterocolitisenterocolitis

•• Ulcerative colitisUlcerative colitis•• Edema from low Edema from low

protein and protein and cirrhosiscirrhosis

•• Systemic lupus Systemic lupus erythematosiserythematosis

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

CT FEATURESCT FEATURES

•• MURAL ENHANCEMENT MURAL ENHANCEMENT PATTERNPATTERN

•• LENGTH OF LENGTH OF INVOLVEMENTINVOLVEMENT

•• DEGREE OF MURAL DEGREE OF MURAL THICKENINGTHICKENING

•• PATENCY OF PATENCY OF MESENTERIC VESSELSMESENTERIC VESSELS

•• MESENTERIC CHANGESMESENTERIC CHANGES•• LUMEN CONTENTSLUMEN CONTENTS

WHITEWHITE GRAYGRAY TARGETTARGETWATERWATER

TARGETTARGETFATFAT

GASGAS

TYPE 1: WHITETYPE 1: WHITE

•• NORMAL NORMAL ENHANCEMENT IN ENHANCEMENT IN NORMAL BOWELNORMAL BOWEL

TYPE 1: WHITETYPE 1: WHITE

•• VASODILATION VASODILATION WITH HYPEREMIA WITH HYPEREMIA ACUTE IBDACUTE IBD

•• INJURY TO INTRAINJURY TO INTRA--MURAL VESSELS MURAL VESSELS CONTRAST LEAK: CONTRAST LEAK: SHOCK BOWEL, RESHOCK BOWEL, RE--PERFUSION AFTER PERFUSION AFTER ISCHEMIAISCHEMIA

•• HEMORRHAGEHEMORRHAGE

TYPE 2: GRAYTYPE 2: GRAY

•• HOMOGENEOUS HOMOGENEOUS ENHANCEMENT ENHANCEMENT ~SK MUSCLE~SK MUSCLE

•• CHRONIC CROHNCHRONIC CROHN’’S S DISEASEDISEASE

•• ISCHEMIAISCHEMIA•• NEOPLASMNEOPLASM

TYPE 3: TARGETTYPE 3: TARGET--WATERWATER

•• Portal hypertensionPortal hypertension•• Pseudomembranous Pseudomembranous •• TyphlitisTyphlitis•• InfectionsInfections•• AIDSAIDS•• Acute UCAcute UC•• Acute CDAcute CD•• IschemiaIschemia

TYPE 4: TARGET TYPE 4: TARGET --FATFAT

•• CHRONIC UCCHRONIC UC•• CHRONIC CDCHRONIC CD•• OBESE PTsOBESE PTs•• CHEMOTHERAPYCHEMOTHERAPY

TYPE 5TYPE 5-- PNEUMATOSISPNEUMATOSIS

•• ISCHEMIAISCHEMIA•• INFECTIONINFECTION•• TRAUMATRAUMA•• BENIGN CAUSES BENIGN CAUSES

CONNECTIVE TISSUE CONNECTIVE TISSUE IBD IBD OBSTRUCTION OBSTRUCTION COPDCOPD

WHITEWHITE

NL BOWELNL BOWELIBD HYPEREMIAIBD HYPEREMIASHOCK BOWELSHOCK BOWELREPERFUSED ISCHEMIAREPERFUSED ISCHEMIA

ThickThick-- venousvenousThinThin-- arterialarterial

GRAYGRAY

CHRONIC CDCHRONIC CDNEOPLASMNEOPLASMISCHEMIA (Arterial)ISCHEMIA (Arterial)

TARGETTARGETWATERWATER

ACUTE IBDACUTE IBDINFECTIONSINFECTIONSISCHEMIAISCHEMIARADIATIONRADIATIONPORTAL HTNPORTAL HTNTYPHLITISTYPHLITISPSEUDO COLITISPSEUDO COLITIS

TARGETTARGETFATFAT

CHRONIC UCCHRONIC UCCHRONIC CDCHRONIC CDOBESE PTOBESE PTCHEMOCHEMO

GASGAS

INFECTIONINFECTIONINFARCTIONINFARCTIONTRAUMATRAUMABENIGN CAUSESBENIGN CAUSES