CTE with Neutral Enteral and iv Constrast

The enteral contrast agents used with CTE are water, 0.5% methyl cellulose and dilute barium (VoLumen®, EZ EM Inc., Westbury, NY). All of these agents have been used successfully by many practitioners. Methyl cellulose was used initially by some radiologists because of its perceived slower absorption compared to water [20]. We also initially used methyl cellulose, but currently prefer water. Water is not absorbed has fast that a collapsed small bowel results, and is eliminated quickly. In a busy tertiary care facility practice, performing an average of four CTE a day, we have not yet had a patient develop complications with the use of water. VoLumen® has a flavoring agent and additives to decrease absorption. Taste is not an issue with enteroclysis. The spread of acquisition with multislice CT technology has caused the development of fast rate of enteral infusion using an hypotonic agent to keep the small intestine distended. The lower attenuation of water compared with methyl cellulose and VoLumen® contrasts well with the mucosal enhancement produced by the iv contrast agent and allows a global look at all abdominal and pelvic organs (Fig. 1). Both methyl cellulose and VoLumen® (which also contains gum and dilute barium) have a slightly higher attenuation than water. All have been used successfully without complications. We prefer

Fig. 1. Neutral enteral contrast CTE in 47-year-old female with Crohn's disease and abdominal pain. Coronal reformatting of isotropic resolution acquisition showed no small bowel abnormality. Incidental hypervascular liver mass (arrow) with scar (white arrowhead) was demonstrated, later proven to be focal nodular hyperplasia. Note dark and bright stripes (black arrowhead) adjacent to the nasoduodenal tube. This (Feldkamp) artifact is due to the offcenter modulation of pixel noise in the z position when dealing with a wide cone beam (40-channel CT was used in this study). The artifact is most obvious on coronal or sagittal reformats at sites where X-ray attenuation changes rapidly along the z direction

Fig. 1. Neutral enteral contrast CTE in 47-year-old female with Crohn's disease and abdominal pain. Coronal reformatting of isotropic resolution acquisition showed no small bowel abnormality. Incidental hypervascular liver mass (arrow) with scar (white arrowhead) was demonstrated, later proven to be focal nodular hyperplasia. Note dark and bright stripes (black arrowhead) adjacent to the nasoduodenal tube. This (Feldkamp) artifact is due to the offcenter modulation of pixel noise in the z position when dealing with a wide cone beam (40-channel CT was used in this study). The artifact is most obvious on coronal or sagittal reformats at sites where X-ray attenuation changes rapidly along the z direction

VoLumen® for the oral hyperhydration method (CT en-terography - a non-enteral volumed challenged examination). We prefer water for CTE because of its viscosity, which allows us to infuse faster at a slower infusion rate, decreasing the incidence of vomiting. Its lower attenuation and cost are additional factors. The amount and rate of administration of iv contrast depends on the radiologist's individual preference. We prefer CT acquisition during the late arterial/early portal venous phase where maximum intestinal mucosal enhancement occurs [21].

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