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Small Bowel Imaging: Clinical Applications of the Different Imaging Modalities—A Comprehensive Review

DOI: 10.1155/2013/419542

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Abstract:

In the last years, MR and CT techniques have been optimized for small bowel imaging and are playing an increasing role in the evaluation of small bowel disorders. In comparison to traditional barium fluoroscopic examinations, spatial and temporal resolution is now much more improved partially thanks to modern bowel distending agents. However, there is a global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime. Owing to the excellent soft tissue contrast, direct multiplanar imaging capabilities, new ultrafast breath-holding pulse sequences, lack of ionizing radiation, and availability of a variety of oral contrast agents, MR is well suited to play a critical role in the imaging of small bowel disorders. 1. Introduction The small bowel remains a challenging anatomical site to image accurately [1, 2]. Nonspecific clinical presentations from a wide range of localized and systemic disorders confound successful imaging approaches. However, over recent years there have been significant advances in a number of new radiological techniques, which combine with more established approaches to better define small bowel lesions [3–8]. A successful imaging strategy is dependent on using the most appropriate radiology to answer the right clinical question. A number of conventional imaging strategies, such as barium follow-through, have been successfully used to characterize small bowel pathology, but newer techniques, including CT enteroclysis or MR enteroclysis (CTE or MRE), have been introduced and are gaining popularity; moreover, the development of enteric agents to distend the bowel have led to routine visualization of the small bowel lumen, wall, and perienteric tissues using CT and MR modalities [9–15]. For these reasons, CT and MR enterography have been shown to offer improved sensitivity and are replacing barium studies as the preferred diagnostic tests. Cross-sectional imaging techniques overcome the principal disadvantages of conventional enteroclysis that are the limited indirect information on the state of the bowel wall and extramural extension of Crohn’s disease (CD), and its effectiveness may be hindered owing to overlapping bowel loops [16–20]. CT and MRI of the small bowel have become widely accepted at centers dedicated to the diagnosis and treatment of inflammatory bowel disease (IBD), due to the method’s diagnostic efficacy; CT and MR can help to confirm the

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