Prestenotic Dilatation Research Articles

PTU-081 Faecal Calprotectin And Ileal Crohn’s Disease: Correlation With A Small Bowel Mri Score For Disease Activity

IntroductionSmall bowel MRI (SBMRI) is the current standard for assessing ileal inflammation in Crohn’s disease. Faecal calprotectin (FC) is closely correlated with colonic inflammation, but is thought to be of...

881 Effects of Telmisartan in Anal Sphincter Physiology in Asymptomatic Volunteers and Patients With Anal Sphincter Hypertension With Chronic Proctalgia

Background. Small intestine contrast ultrasonography (SICUS) can detect intestinal damage in patients with Crohn's disease (CD). We evaluated the diagnostic accuracy of SICUS in determining the site, extent, and complications of CD, compared with magnetic resonance (MR)-enterography as the standard. Methods. We performed a retrospective analysis of 52 patients with CD [(M=33; median age: 23, CD site: ileal 35 (67%), ileocolonic 13 (25%), jejuno-ileal, 3 (6%), colonic 1 (2%); behaviour: non-stricturing non-penetrating 8 (15%), structuring 27 (52%), penetrating 17 (33%); previous surgery 21 (40%); clinical indications: disease assessment 46 (89%), obstructive symptoms 6 (11%)] evaluated by SICUS and MRenterography 3 months apart, between January 2011 and October 2013. We evaluated disease site (based on bowel wall thickness), extent of lesions, presence of complications (stenosis, prestenotic dilation, abscess, or fistulas) using MR-Enterography as the standard. Sensitivity, specificity, and diagnostic accuracy were calculated. We determined the correlations in maximum wall thickness and disease extent in the small bowel between results from SICUS and MR-Enterography. Results. SICUS identified the site of small bowel CD with 96% sensitivity, 60% specificity, and 92% diagnostic accuracy; it identified the site of colon CD with 70% sensitivity, 92% specificity, and 87% diagnostic accuracy. Results from SICUS and MR-enterography correlated in determination of bowel wall thickness (rho=0.51) and disease extent (rho=0.72; P<.0001 for both). SICUS detected ileal stenosis with 90% sensitivity, 92% specificity, and 90% diagnostic accuracy, and pre-stenotic dilation with 66% sensitivity, 80% specificity, and 71% diagnostic accuracy. SICUS detected abscesses with 100% sensitivity, 100% specificity, and fistulas with 80% sensitivity, 81% specificity, and 81% diagnostic accuracy. Conclusion. SICUS identified lesions and complications in CD patients with high levels of sensitivity, specificity, and accuracy compared to MRenterography. SICUS might be used as an imaging tool as part of a focused diagnostic and follow up examination of patients with CD.

Sa1113 In Crohn's Disease (CD) Patients Small Bowel Prestenotic Dilatation Is Not Related to Severity Degree of Stricture

6 in operated patients (ns). Length of strictures was 5.6±3.4 cm at surgery, 5.7±4.1 cm at SICUS (n.s). Pre-stenotic dilatation was present in 49/81(60%) and 15/37(40.5%) strictures in non-operated and operated patients, respectively (n.s). The length and lumen diameter of strictures were 5±5 cm and 6±1 mm in non-operated and 6.6±5 cm and 5.2±1.8 mm in operated patients (n.s), respectively. There was no significant difference in the stricture site and location of CD at diagnosis, between operated and non-operated patients . Conclusions. Site, length, and degree of luminal narrowing of stricture do not differ between CD patients requiring and not requiring surgery. Severity of stricture does not appear to be the only factor of obstructive symptoms requiring surgery. It is likely that other factors contribute with stricture to indicate surgery. 1) Cosnes J et al IBD 2002; 2) Pallotta N et al IBD 2011

Sa1112 Pre-Operative Diarrhea and Length of Distal/Terminal Ileal Resection Do Not Predict Post-Operative Diarrhea in Crohn's Disease Patients

6 in operated patients (ns). Length of strictures was 5.6±3.4 cm at surgery, 5.7±4.1 cm at SICUS (n.s). Pre-stenotic dilatation was present in 49/81(60%) and 15/37(40.5%) strictures in non-operated and operated patients, respectively (n.s). The length and lumen diameter of strictures were 5±5 cm and 6±1 mm in non-operated and 6.6±5 cm and 5.2±1.8 mm in operated patients (n.s), respectively. There was no significant difference in the stricture site and location of CD at diagnosis, between operated and non-operated patients . Conclusions. Site, length, and degree of luminal narrowing of stricture do not differ between CD patients requiring and not requiring surgery. Severity of stricture does not appear to be the only factor of obstructive symptoms requiring surgery. It is likely that other factors contribute with stricture to indicate surgery. 1) Cosnes J et al IBD 2002; 2) Pallotta N et al IBD 2011

Clinical characteristics and imaging features of small bowel adenocarcinomas in Crohn's disease.

Small bowel adenocarcinoma is uncommon in patients with Crohn's disease but has an extremely poor prognosis. There is a paucity of data on the clinical characteristics and radiologic features of this entity. We sought to update our institutional experience with small bowel adenocarcinoma occurring in the setting of Crohn's disease and to systematically re-examine pre-operative imaging findings. Medical records were abstracted to identify all patients with Crohn's disease and small bowel adenocarcinoma who were evaluated at Mayo Clinic, Rochester, Minnesota and Mayo Clinic, Scottsdale, Arizona between 1976 and 2012. Clinical, demographic, and outcomes data were obtained for each patient. Pre-diagnosis radiologic imaging was re-evaluated by two gastrointestinal radiologists. Thirty-four patients (21 males) were identified. Median ages at Crohn's disease and cancer diagnoses were 22.4 and 52.9 years, respectively. Median follow-up after cancer diagnosis was 272.0 days; 22 patients (64.7%) had persistent or recurrent adenocarcinoma at last follow-up. 1- and 2-year mortality rates were 29.6% and 48.0%. Pre-operative imaging studies were available for re-review in 14 cases. Features concerning for malignancy included annular mass, nodularity at the extraluminal margins of the mass, and perforation. Nearly all tumors arose in regions of chronic inflammation and caused luminal narrowing with pre-stenotic dilatation. Small bowel adenocarcinoma is rare in patients with Crohn's disease but results in significant mortality. CT or MR imaging findings can be suggestive of the pre-operative diagnosis, but it is usually diagnosed at an advanced stage with laparotomy.

P289 Anaemia and iron deficiency in pediatric inflammatory bowel disease

thickness and disease extent in the small bowel between results from SICUS and MR-Enterography. Results: SICUS identified the site of small bowel CD with 96% sensitivity, 60% specificity, and 92% diagnostic accuracy; it identified the site of colon CD with 70% sensitivity, 92% specificity, and 87% diagnostic accuracy. Results from SICUS and MR-enterography correlated in determination of bowel wall thickness (rho=0.51) and disease extent (rho=0.72; P< 0.0001 for both). SICUS detected ileal stenosis with 90% sensitivity, 92% specificity, and 90% diagnostic accuracy, and pre-stenotic dilation with 66% sensitivity, 80% specificity, and 71% diagnostic accuracy. SICUS detected abscesses with 100% sensitivity, 100% specificity, and fistulas with 80% sensitivity, 81% specificity, and 81% diagnostic accuracy. Conclusions: SICUS identified lesions and complications in CD patients with high levels of sensitivity, specificity, and accuracy compared to MR-enterography. SICUS might be used as an imaging tool as part of a focused diagnostic and follow up examination of patients with CD.

P134 Small bowel prestenotic dilatation is not related to severity degree of stricture and to surgical indication in Crohn's disease (CD) patients

P134 Small bowel prestenotic dilatation is not related to severity degree of stricture and to surgical indication in Crohn's disease (CD) patients

Accuracy of Small-Intestine Contrast Ultrasonography, Compared With Computed Tomography Enteroclysis, in Characterizing Lesions in Patients With Crohn's Disease

Small-intestine contrast ultrasonography (SICUS) is a radiation-free technique that can detect intestinal damage in patients with Crohn's disease (CD). We evaluated the diagnostic accuracy of SICUS in determining the site, extent, and complications of CD, compared with computed tomography (CT) enteroclysis as the standard. We performed a retrospective analysis of data from 59 patients with CD evaluated by SICUS and CT enteroclysis 3 months apart, between January 2007 and April 2012. We evaluated disease site (based on bowel wall thickness), extent of lesions, and presence of complications (stenosis, prestenotic dilation, abscess, or fistulas) using CT enteroclysis as the standard. Sensitivity, specificity, and diagnostic accuracy were calculated. We determined the correlations in maximum wall thickness and disease extent in the small bowel between results from SICUS and CT enteroclysis. SICUS identified the site of small bowel CD with 98% sensitivity, 67% specificity, and 95% diagnostic accuracy; it identified the site of colon CD with 83% sensitivity, 97.5% specificity, and 93% diagnostic accuracy. Results from SICUS and CT enteroclysis correlated in determination of bowel wall thickness (rho, 0.79) and disease extent (rho, 0.89; P < .0001 for both). SICUS detected ileal stenosis with 95.5% sensitivity, 80% specificity, and 91.5% diagnostic accuracy, and prestenotic dilation with 87% sensitivity, 67% specificity, and 75% diagnostic accuracy. SICUS detected abscesses with 78% sensitivity, 100% specificity, and 97% diagnostic accuracy, and fistulas with 78.5% sensitivity, 95.5% specificity, and 91.5% diagnostic accuracy. SICUS identified lesions and complications in patients with CD with high levels of sensitivity, specificity, and accuracy compared with CT enteroclysis. SICUS might be used as an imaging tool as part of a focused diagnostic examination of patients with CD.

Compressive syndrome of internal jugular veins in multiple sclerosis: does it matter?

Condition known as chronic cerebrospinal venous insufficiency (CCSVI) is characterized by insufficient cerebral vein drainage in patients with multiple sclerosis (MS) and internal jugular vein (IJV), vertebral and/or azygos veins stenoses. However, external compression on the IJV was not clearly described as a potential cause of CCSVI. We aim to present a case of CCSVI in a patient with MS caused by bilateral IJV inverted valves combined with IJV external compression by carotid bulb. A 31-year-old female patient was admitted to our institute for IJV and vertebral veins morphological and haemodynamical assessment after being treated for MS for the last 14 years. Colour Doppler ultrasonography showed right IJV prestenotic dilation and inverted valves in both IJV. Computerized tomography angiography showed bilateral IJV compression by carotid bulb. Haemodynamical Doppler parameters showed that external IJV compression significantly contributed to CCSVI occurrence. Bilateral IJV confluence percutaneous angioplasty (PTA) was done, and the patient was discharged for further neurological examination. Partial carbon dioxide pressure was significantly lower in the distal part of both IJV following PTA and oxygen saturation increased. In the case presented, PTA of the IJV confluence resulted in haemodynamic improvement despite the presence of IJV external compression.

Sa1846 Sequential T2 Relaxometry as a Non-Invasive Assessment of Transmural Inflammation in a Murine Model of Chronically Relapsing Colitis

Background Anti-TNF therapy induces mucosal healing in patients with Crohn's disease, but the effects on transmural inflammation, stenosis and complications are largely unknown. MRI offers excellent imaging of transmural and peri-visceral lesions in Crohn's disease. Objective To assess the evolution of small bowel disease activity and complications in Crohn's disease patients treated with anti-TNF agents using serial MRI scans. Methods We performed a retrospective study of patients with Crohn's disease who had undergone serial MRI scans (T1-weighted preand post-contrast and T2-weighted sequences) while receiving anti-TNF treatment (infliximab or adalimumab). Patients were grouped as clinical responders or nonresponders based on a review of medical records. MRI scoring was performed blinded to clinical, laboratory and endoscopic data. Stricturing lesions were evaluated using simplified scoring systems of inflammation (Steward et al.) and stenosis (Fornasa et al.). Inflammation was scored using mural thickness, contrast enhancement, pattern of enhancement, mural and perimural T2 signal. At the level of stenosis, T2 signal intensity, post-contrast T1 enhancement and prestenotic dilatation was quantified. Complications were scored evaluating penetrating lesions, abscesses and/or fistulas. Results Twenty-one consecutive patients were studied (71% female) with a median age of 33 years (range 19-58 years), the median disease duration was 12 years (range 3-35 years) and the median time between initial and first follow-up MRI was 110 weeks (range 14-299 weeks). Forty-two small bowel MRI scans were evaluated in 13 clinical non-responders and 8 responders. In all patients, median inflammation scores decrease from 10 (range 6-15) on initial MRI, to 8 (range 1-13) on follow up MRI (p=0.168). In the responder group, 7/8 (86%) of the patients had reduced inflammation on follow-up MRI during anti-TNF treatment (p=0.0571). In this group the first MRI detected complicated disease in 2/8 (25%) of the patients which resolved at followup MRI. Severity of stenosis was significantly reduced between serial MRI scans (p=0.0148). In the non-responder group only 23% showed decreased inflammatory scores between serial MRI scans (non-significant). 3/13 patients had stricturing and penetrating lesions which was unchanged during the disease course as indicated by serial MRI scans. No change was seen in severity of stenosis. Conclusion A reduction in both small bowel inflammation and inflammatory stenosis on serial MRI scans correlates with clinical responses to anti-TNF treatment in Crohn's disease. Hence, anti-TNF antibodies not only produce mucosal, but also transmural healing, as well as reduction in stenosis. MRI can be used as a complementary approach to measure transmural healing in order to improve the clinical management in Crohn's disease patients.

Unusual technique for caustic esophagitis

We present this case because of its rarity, as we have not found anything similar in young non-neoplastic patients. We describe the case of a 36 years-old woman with long-term dysphagia for solids. Her past medical history reveals an esophagoplasty with subcutaneous colon interposition, which was performed in Romania 15 years before, due to caustic stricture. Stenosis of the cologastric anastomosis, after an occlusive episode, required reintervention in 2008. Currently she only tolerates pureed food. Physical examination showed a scar on the left side of her neck, which extended through the chest and abdomen (a large median laparotomy scar). An esophago-gastroduodenal series was done (Fig. 1), which displayed: “Upper esophageal stricture with pre-stenotic dilatation; the barium contrast material flowed passively into the stomach”. Subsequently, CT scans of the cervical, thoracic and abdominal areas were performed using i.v. contrast with the following results (Fig. 2): “cologastric anastomosis consisting of colon subcutaneous transposition and reentry to abdominal cavity to reach the gastric body”. A gastroscopy demonstrated a recessed area 24 cm below the dental arch, with remaining food debris and a concavity to the left which was not accessible. The patient was not dilated because of lack of wall thickness and perforation risk. Currently awaiting surgery. Discussion

Bowel Imaging in Children: A Comprehensive Look Using US and MRI

Identify MRE features of colonic strictures in children/young adults with Crohn's disease.Included are patients with colonic strictures on colonoscopy imaged with MRE. Bowel wall thickening (BWT) with luminal narrowing, pre-stenotic dilatation (PSD), bowel wall enhancement, and diffusion restriction were evaluated.All potential strictures (n = 12) had BWT with luminal narrowing on MRE. 8/12 had PSD, meeting our MRE stricture criteria. MRE diagnosed 8/12 colonic strictures compared to colonoscopy but was concordant with findings in all surgical patients.Strictures on MRE did not always agree with colonoscopy, but when correlating with surgery, MRE findings were all concordant.

Esophageal leiomyomatosis 25 years after myotomy for achalasia

BACKGROUND: Esophageal leiomyomatosis is a rare hamartomatous disorder with cumulative proliferation of the smooth muscle layer of the esophagus causing stenosis and slowly progressive dysphagia. Children and young adults are predominantly affected by this condition. METHODS: Case report. RESULTS: We report about an unusual case of esophageal leiomyomatosis in a 30-year-old female patient with a history of achalasia with Heller myotomy and partial posterior fundoplication as a child. The radiological and endoscopic findings revealed a big circumferential tumor of the gastroesophageal junction with prestenotic dilation. The diagnosis was complicated by the large extension of the tumor and the unusual medical history of the patient mimicking a malign neoplasm. The surgical treatment consisted of esophageal resection with gastric pull-up. To the best of our knowledge, this case report is the first description of the unusual coincidence of an achalasia as a child and an esophageal leiomyomatosis as an adult. CONCLUSIONS: Esophageal leiomyomatosis is an interesting differential diagnosis for all those dealing with patients with diseases of the esophagus.

Late colonic stent perforation following chemotherapy

A 67-year-old patient was diagnosed as having a tumor at the splenic flexure of the colon with multiple liver metastases. They were treated with four consecutive cycles of FOX chemotherapy (leucovorin, 5-fluorouracil, and oxaliplatin). A computed tomography (CT) scan of the abdomen showed regression of liver metastases; however, the patient had obstipation, and prestenotic dilation of the colon was observed. A Wallstent enteral endoprosthesis (Boston Scientific International, Natick, MA, USA) was placed, with subsequent normal passage of stool ([Fig. 1]). Following the procedure the patient continued with chemotherapy. One month later, the patient was admitted with nausea, vomiting, and diarrhea. Gastroscopy revealed that the proximal end of the Wallstent endoprosthesis had perforated the stomach. The endoscope could pass through the endoprosthesis, and in this way it reached the descending colon ([Fig. 2]).

Severity of postoperative recurrence in crohnʼs disease: Correlation between endoscopic and sonographic findings

Crohn's disease (CD) recurrence is currently assessed by ileocolonoscopy. Small intestine contrast ultrasonography (SICUS) visualizes the small bowel lesions in CD, although its role after curative resection is undefined. We aimed to investigate the accuracy of SICUS in assessing CD recurrence after ileocolonic resection when using ileocolonoscopy as a gold standard. The correlation between the bowel wall thickness (BWT) measured by SICUS and the endoscopic score of recurrence was also assessed. The analysis included 72 CD patients with ileocolonic resection requiring ileocolonoscopy, undergoing SICUS within 6 months. Recurrence was assessed by ileocolonoscopy using the Rutgeerts' score. SICUS was performed after PEG ingestion and findings compatible with recurrence included: increased BWT (>3 mm), bowel dilation (>25 mm) or stricture (<10 mm). Ileocolonoscopy detected recurrence in 67/72 (93%) patients. SICUS detected findings compatible with recurrence in 62/72 (86%) patients (5 false negative (FN), 4 false positive (FP), 1 true negative (TN), 62 true positive (TP)), showing a 92.5% sensitivity, 20% specificity, and 87.5% accuracy for detecting CD recurrence. The BWT detected by SICUS was correlated with the Rutgeerts' score (P = 0.0001; r = 0.67). The median BWT, the extent of the ileal lesions, and the prestenotic dilation were higher in patients with an endoscopic degree of recurrence >or=3 versus <or=2 (P < 0.001) and the lumen diameter was lower in patients with a Rutgeerts' score >or=3 versus <or=2 (P < 0.0001). : Although SICUS and ileocolonoscopy provide different views of the small bowel, SICUS shows a significant correlation with the endoscopic findings. SICUS may represent an alternative noninvasive technique for assessing CD recurrence after ileocolonic resection.

The Early Use of Immunosuppression Reduces Morbidity in Patients With Moderately Severe or Severe Crohn's Disease

The Early Use of Immunosuppression Reduces Morbidity in Patients With Moderately Severe or Severe Crohn's Disease

Imaging features of portal biliopathy: Frequency of involvement patterns with emphasis on MRCP

Purpose To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. Materials and methods Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP ( n = 16) studies accompanied by MR portography ( n = 13), dynamic CE CT ( n = 3) or dynamic CE MRI ( n = 2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. Results All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. Conclusion MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

Immunoglobulin G4 associated cholangitis: Description of an emerging clinical entity based on review of the literature

During the last decade, patients with steroid responsive sclerosing cholangitis have been described in a number of case reports and a few cases series. These patients meet diagnostic criteria for primary sclerosing cholangitis (PSC) but seem to have a better prognosis and are often, but not always, associated with autoimmune pancreatitis (AIP). Unlike biliary strictures in PSC, most PSC-like biliary strictures seen in association with AIP respond well to steroids and some have been shown to resolve after immunosuppressive treatment during prolonged follow-up. In addition, steroid-responsive dominant bile duct lesions, sometimes mimicking infiltrating hilar cholangiocarcinoma, without pancreatic abnormalities have also been reported. Here we review the literature on this emerging clinical entity and suggest that this condition of steroid responsive biliary strictures be named Immunoglobulin G4 (IgG4) Associated Cholangitis (IAC). We performed an electronic database search of MEDLINE for case reports and case series of sclerosing cholangitis with pancreatitis and/or pancreatic mass (1960–July 2006). Articles were limited to English and these case reports and cases series were reviewed and all references on the combination of sclerosing cholangitis and pancreatitis as well as IgG4 positive cholangitis without pancreatic involvement not identified by our original search were obtained. Terminology and Definition

1067: From esophagus to rectum: Diagnostic benefits and limits of conventional transcutaneous ultrasound

Transcutaneous ultrasonography (US) is an excellent modality not only in imaging the gastrointestinal tract (GIT) but in evaluating its functions as well by observing peristalsis and the quantity and quality of intestinal contents. The normal wall structures in US are depicted as three layers. The first part of the GIT, the cervical esophagus, is well delineable behind the left lobe of the thyroid gland (rare behind the right lobe). The esophageal mid-portion is covered and not accessible to US, whereas the terminal esophagus and the cardia can be defined in almost every individual. In patients with dysphagia, routine US examination should focus on this area, looking for the general features of GIT pathology: asymmetric wall thickening with partial or complete loss of the layered structures (“pathological cocarde”) mostly rule echopoor, with a loss of peristaltic movements, and a prestenotic dilatation and pathologically enhanced fluid contents. These pathologies mean in the stomach a sometimes considerable wall thickening, due to malignancies of various origins (which of course cannot be differentiated by means of US). Once they form an obstacle, a gastric retention will follow, or other clinical signs will prompt diagnostic efforts. The duodenum as the first part of the small intestine, hardly delineable in normal conditions, is often involved in pancreatitis with an overall swelling of its wall structures with good visibility. This holds true in other diffuse inflammatory reactions of the small intestine as well as e.g., in gluten sensitive enteropathy or in less a degree in severe infectious enteritis. Subileus or ileus will be detected by US earlier than by X-ray diagnostics, since US is not depending from separating gas formations, dilatation and pathological peristalsis are directly and repeatedly easily demonstrated by US. Finding the obstacle, for example in Crohn‘s disease, needs a more detailed examination but it is as a rule possible to find the site of the intestinal blockade (be it by compression or by luminal obstruction) and to either define the true nature of the blockage or to give at least a good differential diagnostic approach to the most probable reason(s). Ileocecal junction and the valve are as a rule not visible in healthy individuals. In augmented intestinal liquid filling, however, they can be defined easily including their possible pathology. Appendicitis, still sometimes a really difficult clinical diagnosis, can be defined in the classic cases without a problem, confirming the clinical findings and quickening the indication for operation. Colon pathology, both in inflammatory and in tumorous processes, is an ideal target for clinical ultrasonography as well, predicting quite often the endoscopic findings. Hydrocolonosonography is another early variant of virtual colonoscopy, a merely considered but true fact with the drawback of too low an economic challenge or promise. In conclusion, intestinal US, starting with the esophagus and ending with the rectum, is an ideal noninvasive diagnostic approach in GIT disease, and an optimum partner for endoscopical intestinal diagnosis.

Diagnostic Value of CT Enteroclysis Compared with Conventional Enteroclysis in Patients with Crohn's Disease

The objective of our study was to assess the diagnostic value of CT enteroclysis compared with conventional enteroclysis in patients with Crohn's disease. Fifty consecutive patients (26 women, 24 men; mean age, 36.3 years; age range, 18-52 years) with histologically proven Crohn's disease underwent CT enteroclysis and conventional enteroclysis (median time interval, 21.7 days) during a symptomatic stage of their disease. Both techniques were compared with regard to diagnostic yield in assessing the presence and extent of disease. Imaging findings were compared with surgery, follow-up examinations, or both. CT enteroclysis and conventional enteroclysis were successfully performed in all 50 patients. Crohn's disease-associated radiographic changes were found in 44 patients (88%) using CT enteroclysis and in 42 patients (84%) using conventional enteroclysis. Significantly more Crohn's disease-associated abnormalities were diagnosed with CT enteroclysis than with enteroclysis (p < 0.01). Minimal inflammatory changes of the mucosa were diagnosed in 44 patients (88%) using CT enteroclysis and in 42 patients (84%) using enteroclysis. Both imaging methods depicted stenotic bowel segments in 34 patients (68%), and prestenotic dilatation was diagnosed in 20 patients (40%) with CT enteroclysis and in 15 (30%) with enteroclysis. Fistulas were found in 18 patients (36%) with CT enteroclysis and in eight (16%) with enteroclysis (p < 0.01). Skip lesions could be seen in 17 (34%) and three patients (6%), respectively (p < 0.01). Conglomeration of bowel loops tumors was diagnosed with CT enteroclysis in 13 patients (26%) and in three patients (6%) using conventional enteroclysis (p < 0.01). Only CT enteroclysis depicted abscesses in eight patients (16%) (p < 0.01). CT enteroclysis proved to be significantly superior to conventional enteroclysis in depicting Crohn's disease-associated intra- and extramural abnormalities. CT enteroclysis is the imaging method of choice and should replace enteroclysis in patients with Crohn's disease.