can you tell them apart on mdct? - scbtmr enterocolitides... · • gasless abdomen: ischemia, bo,...
TRANSCRIPT
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