Computer tomography in the diagnosis of small bowel diseases

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Abstract

Introduction. The relevance of the study is caused by the difficulties in diagnosing diseases of the small bowel (SB). Due to the prevalence and widespread introduction of X-ray computed tomography (CT) into clinical practice, its capabilities in the diagnosis of small bowel diseases are of great interest and potential.

Objective. to reveal the possibilities of computed tomography using intravenous bolus contrast enhancement in identifying the symptom of “wall thickening” of the small bowel and its prognostic significance in various nosologies.

Methods. Analysis of the data from MSCT studies performed according to the Protocol for the study of abdominal organs using intravenous bolus contrast enhancement and oral water intake in adult patients from 18 to 87 years of age with small bowel diseases.

Results. The article shows the possibilities of multispiral computed tomography performed according to the standard Protocol in detecting thickening of the SB wall. The range of diseases was determined for which thickening of the SB wall was one of the main radiological symptoms of the lesion. The prognostic significance of this radiological symptom is presented. The features of thickening of the intestinal wall in various diseases and other distinctive features that can be used in the differential diagnosis are described.

Conclusion. Thickening of the wall is a common sign of SB damage, which is convincingly detected in CT studies with bolus contrast enhancement. In our study, the common causes of thickening of the SB wall in primary disease were: Crohn's disease (37%), lymphoma (20%) and anastomosis (13%). However, we determined thickening of the SB wall as a result of primary tumors (adenocarcinoma, sarcoma) in 7% and as a result of a secondary tumor lesion in 18.6% of cases. The considered diseases were different in the degree of thickening of the intestinal wall (from 6 to 70 mm), its spreading (focal thickening — 48%; segmental — 52%), number of affected areas (from 1 to 3) of their localization (proximal-middle or distal section), form of the transition area from the affected part of the intestine to the unchanged one (sharply defined or smooth), the presence or absence of symptoms of intestinal obstruction, and the features of contrast enhancement (severity and type).

About the authors

E. G. Koshelev

Central State Medical Academy of the Office of the President of the Russian Federation; N.I. Pirogov Moscow City Clinical Hospital № 1,

Email: sv_kitaev@yahoo.com
ORCID iD: 0000-0002-5494-0327
SPIN-code: 1596-2537

к.м.н., зав. кафедрой рентгенологии и ультразвуковой диагностики

Russian Federation, Moscow

S. V. Kitayev

Central State Medical Academy of the Office of the President of the Russian Federation; MEDSI

Email: sv_kitaev@yahoo.com

д.м.н., доцент кафедры рентгенологии и ультразвуковой диагностики; врач-рентгенолог КДЦ МЕДСИ на Белорусской

Russian Federation, Moscow

G. Yu. Belyaev

Central State Medical Academy of the Office of the President of the Russian Federation; Outpatient Clinic No. 2 of the Affairs Management Department of the President of the Russian Federation

Email: georgybelyaev@yandex.ru
ORCID iD: 0000-0002-1119-9102
SPIN-code: 2169-5450

к.м.н., доцент кафедры рентгенологии и ультразвуковой диагностики; зав. рентгенологическим отделением 

Russian Federation, Moscow

A. A. Egorov

Outpatient Clinic No. 2 of the Affairs Management Department of the President of the Russian Federation

Email: egorov.scan@gmail.com
ORCID iD: 0000-0002-8609-6319
SPIN-code: 9239-2671

врач-рентгенолог

Russian Federation, Moscow

Olga O. Kurzantseva

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia; City Clinical Hospital of S.P. Botkin

Author for correspondence.
Email: olgakurzan@yandex.ru
ORCID iD: 0000-0003-2648-1677
SPIN-code: 6971-0232

Candidate of medical Sciences, associate professor of radiology and mammalogy ; radiologist 

Russian Federation, Moscow

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2. Fig. 1. Patient, 34 years old. MSCT: Crohn's disease of the stomach, small and large intestine with lesions of the stomach, terminal ileum and cecum. Chronic recurrent course complicated by intestinal obstruction, severe form, high activity, exacerbation phase. Arterial phase of contrast enhancement

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3. Fig. 2. Patient, 34 years old. MSCT: Crohn's disease, multiple lesions of the small and large intestine. Arterial phase of contrast enhancement. Fragments of axial tomograms

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4. Fig. 3. MSCT: Crohn's disease, stage of incomplete remission

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5. Fig. 4. Patient, 36 years old. MSCT: B-cell lymphoma, infiltrative form

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6. Fig. 5. The patient, 46 years old. MSCT: B-cell jejunum lymphoma, nodular form. Anemia

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7. Fig. 6. Patient, 51 years old. MSCT: B-cell lymphoma, polypoid form. Per os intestinal lumen contrast

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8. Fig. 7. Patient, 68 years old. MSCT: primary multiple synchronous lymphoma (mesenteric form). Arterial phase of contrast enhancement

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9. Fig. 8. Patient, 58 years old. MSCT: cancer of the colon. Venous phase of contrast enhancement (on the eve of the contrast of the intestinal lumen per os was performed, therefore, in the lumen of the colon there is a residual contrast medium

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10. Fig. 9. Patient, 53 years old. MSCT: cancer of the distal ileum. Small bowel obstruction

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11. Fig. 10. The patient, 48 years old. MSCT: ileum sarcoma

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12. Fig. 11. The patient, 68 years old. MSCT: stomach cancer. Metastatic lesion of the serous membranes. Intestinal obstruction. Arterial phase of contrast enhancement

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Copyright (c) 2020 Koshelev E.G., Kitayev S.V., Belyaev G.Y., Egorov A.A., Kurzantseva O.O.

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