Small Bowel Imaging Research Articles

Predictive Factors of Significant Findings on Capsule Endoscopy in Patients with Suspected Small Bowel Bleeding.

Background: Small bowel capsule endoscopy (SBCE) is an established non-invasive diagnostic modality for a variety of small bowel pathologies and has a significant role in altering the treatment course. The diagnostic yield of SBCE in the published literature varies widely between 45 and 75%. Furthermore, it is unclear if any patient-related factors predict higher diagnostic yield. The aim of this study is to report the diagnostic yield of SBCE for suspected small bowel disease and identify any predictive factors for identifying significant pathology on SBCE. Method: A retrospective study was conducted at Mubarak Al-Kabeer Hospital in Kuwait for patients who underwent SBCE between October 2013 and February 2022. All patients underwent upper and lower endoscopy prior to referral for SBCE. Patients' medical records were reviewed to determine SBCE indications, results, and complications. The significance of the SBCE finding was classified according to the Saurin system. A logistic regression was performed to characterize baseline predictors for identifying significant pathology on SBCE. Results: Overall, 210 patients underwent SBCE and were included in the analysis. The mean age was 57.9 years (SD 18.5), and 129 (61.4%) were males. The most common indication for SBCE was obscure occult gastrointestinal bleed (75.7%), obscure overt gastrointestinal bleed (28.6%), and investigating gastrointestinal symptoms (7.6%). Adequate bowel preparation was achieved in most patients (88.1%), imaging of the entire small bowel was achieved in 194 patients (92.4%), and no adverse events were recorded. The overall diagnostic yield of SBCE for small bowel disease was 68.1%. The most common findings were vascular lesions in the small bowel (40.0%), small bowel ulcers (22.9%), and erosions (22.9%). On multivariate regression analysis, melena at baseline was significantly associated with increased odds of identifying high-risk lesions (Saurin class P2) (OR 2.1, 95%CI 1.03-4.30, p = 0.04). Conclusions: SBCE is an effective and safe tool for investigating small bowel pathology with a diagnostic yield of 68.1% in carefully selected patients undergoing such a test. Melena at baseline is the strongest predictor of identifying high-risk lesions, and patients with which should be prioritized for SBCE.

The Utility of Patency Capsule in Patients With Crohn’s Disease

Background: Video capsule retention is a complication that can have serious consequences in patients with Crohn’s disease (CD). The patency capsule was developed to detect small bowel strictures. The usefulness of patency capsules in patients who do not have evidence of small bowel disease on imaging is uncertain. Study: This is a multicenter retrospective study of patients with suspected or confirmed CD who underwent a patency capsule study between January 2017 and February 2023. We excluded patients who were lost to follow-up or did not have computerized tomography or magnetic resonance imaging of the abdomen within 180 days before or after the patency capsule study. Results: A total of 105 patients met the inclusion criteria with 69% having a confirmed CD diagnosis. The majority of patients (95/105; 90.5%) passed their patency capsule. A total of 91 patients had their subsequent video capsule endoscopy (VCE), with 96.7% (88/91) successfully passing the capsule. Out of those who passed the VCE, 2 patients had patency capsule retention. Both had normal small bowel imaging. Meanwhile, the 3 patients who had VCE retention had evidence of small bowel disease in their imaging scans. The presence of abnormal small bowel wall thickening or stricture on imaging had a statistically significant association with VCE retention (P=0.02). Conclusion: Our study demonstrated a statistically significant association between small bowel disease on imaging and retention of both patency capsules and VCE. Small bowel imaging in patients with suspected or documented CD had a negative predictive value of 100% for VCE retention.

Role of computed tomography enteroclysis in the evaluation of small bowel diseases

Background: Examining small bowel loops within the peritoneal cavity poses significant challenges because of their length and overlapping nature. Aims and Objectives: This study aimed to evaluate the utility of computed tomography enteroclysis (CTE) in diagnosing small intestinal diseases and to understand its clinical application. Materials and Methods: The study was conducted from November 2019 to October 2021 in 30 patients undergoing CTE treatment. The day before treatment, bowel preparation included a low-residue diet, lots of fluids, an overnight fast of 8–12 h, and laxatives. A 16-slice Aquilion Lightning computed tomography (CT) scanner was used in general hospitals, and a 128-slice GE Healthcare helical CT scanner was used in multispecialty hospitals. Results: Among the 30 patients, 20 (66.7%) were male, and 10 (33.3%) were female, predominantly aged between 30 and 60 years old. Positive findings were noted in 23 patients (76.7%), including intestinal tuberculosis, inflammatory bowel disease, small bowel obstruction, and neoplastic lesions. Various small intestinal pathologies, such as non-specific edema, intussusception, and ischemic bowel disease, were also identified. Conclusion: This raises the standard of current small bowel imaging by delivering suitable intestinal distension using the enteral volume challenge principle and helps identify and characterize small-bowel problems.

Novel ultrasound capsule endoscopy for gastrointestinal scanning: An in vivo animal study.

EUS is an important modality for diagnosis and assessment of gastrointestinal (GI) subepithelial lesions. However, EUS is invasive and operator-dependent and requires sedation in most cases. The newly developed ultrasound capsule endoscopy (USCE) system, with both white-light and ultrasound imaging modalities, is a minimally invasive method for superficial and submucosal imaging of the esophagus. This animal study aimed to evaluate the feasibility and efficacy of the USCE system for upper GI tract and small bowel scanning. Three Bama miniature pigs were selected to scan their esophagus, stomach, small bowel, and simulated submucosal lesions. USCE was performed first, followed by EUS. The feasibility of USCE was measured by obtaining ultrasound images of normal GI walls and submucosal lesions under the guidance of optical viewing. The efficacy of USCE was evaluated by comparing tissue structures and lesion features shown on ultrasound images obtained with both instruments. Under the optical mode of USCE, the GI tract was well visualized, and all simulated lesions were located. Clear ultrasound images of normal GI tract and submucosal lesions were acquired. Ultrasound images of the esophagus, stomach, and small bowel were characterized by differentiated multilayer structures on USCE, which was consistent with the structures displayed on EUS. And the visualization of submucosal lesions, using both USCE and EUS, was characterized by a hypoechoic and well-demarcated mass in the layer of submucosa. This animal study indicated the feasibility and potential clinical efficacy of this USCE for simultaneous optical mucosal visualization and transmural ultrasound imaging of upper GI tract and small bowel, providing possibility of using this technology for a wider range of GI tract.

Small Bowel Capsule Endoscopy and Enteroscopy: A Shoulder-to-Shoulder Race

Traditional methods have their limitations when it comes to unraveling the mysteries of the small bowel, an area historically seen as the “black box” of the gastrointestinal tract. This is where capsule endoscopy and enteroscopy have stepped in, offering a remarkable synergy that transcends the sum of their individual capabilities. From their introduction, small bowel capsule endoscopy and device-assisted enteroscopy have consistently evolved and improved, both on their own and interdependently. Each technique’s history may be told as a success story, and their interaction has revolutionized the approach to the small bowel. Both have advantages that could be ideally combined into a perfect technique: safe, non-invasive, and capable of examining the entire small bowel, taking biopsies, and applying therapeutical interventions. Until the realization of this perfect tool becomes a reality, the key for an optimal approach lies in the right selection of exploration method. In this article, we embark on a journey through the intertwined development of capsule endoscopy and enteroscopy, exploring the origins, technological advancements, clinical applications, and evolving inquiries that have continually reshaped the landscape of small bowel imaging.

Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound?

The incidence of celiac disease (CD) has increased over the last decades in part due to better disease awareness. Small bowel ultrasound (sb US) enables dynamic assessment of the bowel; although this topic has been addressed, the use of sb US in the diagnosis and in the follow-up of CD patients is limited to a few specialized tertiary referral centers. Herein, we aimed at summarizing the available literature on this topic to better define the potential clinical implications of sb US in CD, also through a comparison with other available diagnostic techniques. According to available data, sb US can be of help in confirming or excluding CD in patients with clinical suspicion; specifically, the finding of increased gall bladder volume, free abdominal fluid and enlargement of mesenteric lymph nodes reliably and accurately predicts the diagnosis of CD, whereas the absence of bowel dilatation and increased peristalsis may exclude the diagnosis. However, the place of intestinal US in the diagnostic algorithm of CD is likely to vary depending on the probability of the disease in a given population. There are only a few studies on the role of sb US in complicated CD, even if recent reports suggest a possible clinical role. There is a lack of data on follow-up of CD patients, particularly with the aim of detecting a poor diet adherence. According to current data sb US parameters have been shown to be of value in confirming and excluding the diagnosis of CD. Prospective studies with large sample size are warranted to determine whether to include sb US in the available guidelines for CD diagnosis and monitoring.

Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography, Part II: The Reliable Disclosure of Crohn's Disease and Non-Inflammatory Small Bowel Disorder Plot through MRI Findings.

MRE has become a standard imaging test for evaluating patients with small bowel pathology, but a rigorous methodology for describing and interpreting the pathological findings is mandatory. Strictures, abscess, inflammatory activity, sinus tract, wall edema, fistula, mucosal lesions, strictures, and mesentery fat hypertrophy are all indicators of small bowel damage in inflammatory and non-inflammatory small bowel disease, and they are all commonly and accurately explained by MRE. MRE is a non-invasive modality that accurately assesses the intra-luminal, parietal, and extra-luminal small bowel. Differential MRE appearance allows us to distinguish between Crohn's disease and non-inflammatory small bowel disorder. The purpose of this paper is to present the MRE pathological findings of small bowel disorder.

Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography: Part I: Guidance in Performing and Observing Normal and Abnormal Imaging Findings.

MRE has become a standard imaging test for evaluating patients with small bowel pathology, but the indications, interpretation of imaging findings, methodology, and appropriate use must be standardized and widely known. Several signs of small bowel damage in inflammatory and non-inflammatory small bowel pathology include strictures, abscess, inflammatory activity, sinus tract, wall edema, fistula, mucosal lesions, and mesentery fat hypertrophy, all of which are widely and accurately explained by MRE. MRE is a non-invasive modality that accurately assesses the intra-luminal, parietal, and extra-luminal small bowel. The differential MRE appearance allows us to distinguish between different small bowel pathologies, such as neoplastic and non-neoplastic small bowel diseases. The purpose of this paper is to present the MRE technique, as well as the interpretation of imaging findings, through the approach of a rigorous stepwise methodology.

New solutions for an old problem : Current developments in oral contrast agents

Several radiological societies in Europe have so far spoken out in favor of MRI of the small intestine over CT, since MRI is said to provide more detailed image information. Due to the limited availability of MRI machines, long waiting times arise for many patients who clinically require small bowel imaging. These circumstances guided our search for an improved CT technique that would provide scans that mimic the image impression of T1 sequence in MRI, i.e. with IV contrast-enhanced intestinal wall versus low/no signal lumen. The oral use of fat or oil is poorly tolerated by patients, as is the placement of anaso-duodenal tube for air insufflation. We have now succeeded in creating afoamy drink with 44% air content, which is kept stable by protein together with buffers, and can be easily administered orally. CT with the Lumentin® beverage as bowel filling agent has been tested on healthy adult volunteers; oncology patients; and Crohn's disease patients who, for comparison, also underwent MRI of the small bowel with conventional oral contrast. The results so far with Lumentin® show avery good distribution throughout the entire small intestine with good lumen distension, images with strongly enhanced contrast of the intestinal mucosa, and lesions that are detected at the same or increased frequency as compared with MRI. Side effects were few and mild, and overall fewer than with commonly used oral agents. Lumentin's foamy consistency was unfamiliar to afew patients, but it wasn't difficult to drink. The new and innovative luminal HU-negative contrast agent Lumentin® improves the diagnostic CT image quality. In addition, Lumentin® experimental MRI tests have provided promising results, which are currently leading to further clinical MRI studies.

Successful treatment of postoperative nonobstructive recurrent cholangitis by tract conversion surgery after total pancreatectomy: a case report

BackgroundPostoperative cholangitis is a complication of biliary reconstruction during hepatobiliary pancreatic surgery. Most cases are associated with anastomotic stenosis, but there are also cases of cholangitis without stenosis, and treatment can be difficult, especially in patients with recurrent symptoms. In this report, we describe a case of repeated nonobstructive cholangitis in a patient after total pancreatectomy, in which a good outcome was obtained after performing tract conversion surgery.Case presentationThe patient was a 75-year-old man. He underwent total pancreatectomy for stage IIA cancer of the pancreatic body, hepaticojejunostomy via the posterior colonic route, gastrojejunostomy and Braun anastomosis via the anterior colonic route using the Billroth II method. The patient had a good postoperative course and was receiving adjuvant chemotherapy on an outpatient basis, but he developed his first episode of cholangitis 4 months after surgery. Although conservative treatment with antimicrobial agents was successful, the patient continued to have recurrent biliary cholangitis and was repeatedly admitted and discharged from the hospital. Since stenosis at the anastomosis was suspected, endoscopic observation of the anastomosis was performed using small bowel endoscopy for close examination, but no apparent stenosis was observed. Small bowel imaging indicated a possible influx of contrast medium into the bile duct, and reflux due to food residue was suspected as the cause of cholangitis. Since conservative treatment alone did not suppress the flare-up of symptoms, the decision was made to perform tract conversion surgery for curative purposes. The afferent loop was cut midstream, and jejunojejunostomy was performed downstream. The postoperative course was good, and the patient was discharged on the 10th day after surgery. He is currently an outpatient and has been free of cholangitis symptoms for 4 years without cancer recurrence.ConclusionsAlthough the diagnosis of nonobstructive retrograde cholangitis can be difficult, surgical treatment should be considered in patients with recurrent symptoms and refractory treatment.

The anatomy and physiology of the ileal pouch and its relevance to pouch dysfunction.

For the last 40years, the ileal pouch-anal anastomosis has been used in patients with ulcerative colitis, familial adenomatous polyposis, and occasionally severe constipation to reconstruct the gastrointestinal tract after proctocolectomy. Although the procedure has generally been successful in helping patients avoid an ileostomy, it has come with its own set of problems. These include complications of the surgery such as fistulas and bowel obstruction, persistent inflammation of the pouch known as pouchitis, and functional problems related to the lack of expulsive peristalsis in the pouch. It is this last group of problems that is exacerbated by a poor diet, ill-advised anti-diarrheal medications, anal stenosis and pouch twists. As a consequence, patients with pouch problems are frequently referred for radiologic evaluation, with pouchography, defecation studies, and small bowel imaging commonly requested. In this review, the basic anatomy and physiology of the ileal pouch are discussed to provide a logical baseline against which to measure the anatomy of pouches and its relationship to the symptoms of pouch dysfunction.

Fundamentals of Small Bowel Imaging: What Radiology Residents Should Know

HomeRadioGraphicsVol. 43, No. 2 PreviousNext Gastrointestinal ImagingRadiographics FundamentalsFundamentals of Small Bowel Imaging: What Radiology Residents Should KnowAnup S. Shetty , Anup Bhattacharya, Katerina Konstantinoff, Scott Wilson-Flewelling, David H. Ballard, Mark J. Hoegger, Malak Itani, Vincent M. Mellnick, Mohamed Z. Rajput, Maria Zulfiqar, Dennis BalfeAnup S. Shetty , Anup Bhattacharya, Katerina Konstantinoff, Scott Wilson-Flewelling, David H. Ballard, Mark J. Hoegger, Malak Itani, Vincent M. Mellnick, Mohamed Z. Rajput, Maria Zulfiqar, Dennis BalfeAuthor AffiliationsFrom the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.Address correspondence to A.S.S. (email: [email protected]).Anup S. Shetty Anup BhattacharyaKaterina KonstantinoffScott Wilson-FlewellingDavid H. BallardMark J. HoeggerMalak ItaniVincent M. MellnickMohamed Z. RajputMaria ZulfiqarDennis BalfePublished Online:Jan 12 2023https://doi.org/10.1148/rg.220094MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractA pattern-based approach to small bowel imaging can be useful in potentially narrowing the differential diagnosis and allowing the radiologist to offer a more useful impression.Suggested ReadingsGarzelli L, Nuzzo A, Copin P, et al. Contrast-Enhanced CT for the Diagnosis of Acute Mesenteric Ischemia. AJR Am J Roentgenol 2020;215(1):29–38. Crossref, Medline, Google ScholarGuglielmo FF, Wells ML, Bruining DH, et al. Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms. RadioGraphics 2021;41(6):1632–1656. Link, Google ScholarHa HK, Lee SH, Rha SE, et al. Radiologic features of vasculitis involving the gastrointestinal tract. RadioGraphics 2000;20(3):779–794. Link, Google ScholarJasti R, Carucci LR. Small Bowel Neoplasms: A Pictorial Review. RadioGraphics 2020;40(4):1020–1038. Link, Google ScholarLevine MS, Rubesin SE, Laufer I. Pattern approach for diseases of mesenteric small bowel on barium studies. Radiology 2008;249(2):445–460. Link, Google ScholarMacari M, Megibow AJ, Balthazar EJ. A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. AJR Am J Roentgenol 2007;188(5):1344–1355. Crossref, Medline, Google ScholarMills A, Mellnick VM, Itani M. Imaging of Bowel Wall Thickening in the Hospitalized Patient. Radiol Clin North Am 2020;58(1):1–17. Crossref, Medline, Google ScholarSugi MD, Menias CO, Lubner MG, et al. CT Findings of Acute Small-Bowel Entities. RadioGraphics 2018;38(5):1352–1369. Link, Google ScholarWells ML, Hansel SL, Bruining DH, et al. CT for Evaluation of Acute Gastrointestinal Bleeding. RadioGraphics 2018;38(4):1089–1107. Link, Google ScholarArticle HistoryReceived: Apr 20 2022Revision requested: Mar 26 2022Revision received: June 2 2022Accepted: June 10 2022Published online: Jan 12 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleFundamentals of Small Bowel Imaging: What Radiology Residents Should KnowJan 12 2023Default Digital Object SeriesRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 43, No. 2 Slide PresentationMetrics Altmetric Score PDF download

P556 Surgery in high-risk paediatric Crohn’s Disease treated with up-front anti-TNF agents and long-standing biologic therapy

Abstract Background High-risk (HR) Crohn’s Disease (CD) is associated with high surgical and progression rates. Therefore, recent ESPGHAN guidelines (GL) suggest starting an early anti-TNFα treatment to modify the natural history of the disease. The aim of our study was to evaluate the surgical rate in a population of HR-CD paediatric patients treated with up-front anti-TNFα agents and long-standing biologic therapy Methods This is a retrospective, observational, single-center study conducted at the Paediatric Gastroenterology, Hepatology, and Endoscopy Unit at Policlinico Umberto I Hospital – Sapienza University of Rome. We collected data from all patients diagnosed with CD under 18 years, with a minimum follow-up of 12 months. between June 2008 to July 2022. Patients were then stratified at the diagnosis into HR and LR, based on ESPGHAN GL criteria. Demographic, clinical, laboratory, endoscopic, and imaging data were collected at 6, 12, 24, 36, 48, and 60 months Results 130 patients were enrolled, 76 HR (58%) and 54 LR (42%) [median age 12.5 (IQR) yrs, female 45 (35%), medium follow-up 54±24 months]. The HR group included 39 patients (51%) with panenteric disease, 15 (20%) with a structuring behavior (B2), 3 (4%) with structuring/penetrating disease (B2-B3), and 26 (34%) with perianal involvement (p). Early anti-TNFα agents were started in 80% of patients <6 months from the diagnosis, while 15 (20%) started biological therapy between 6 and 12 months from the diagnosis. All patients continued biologic therapy throughout the study follow-up: 20 (26%) optimized anti-TNF, 25% switched biologic, 11% added an immunomodulator, and 4% combined 2 biological drugs. The surgical rate at 5 years was 29% (n=22) and 29% n=16) in HR and LR groups respectively (p-value 1,0). Eleven % (n=8) of HR patients needed surgical resection, while perianal surgery (seton drainage, fistulotomy, fistulectomy) was performed in 18% (n=14), with no significant difference with LR group [(intestinal resection 18% (10/55), perianal surgery 11% (6/55), p > 0.05]. Perianal disease resulted positively associated with surgical risk (p 0.002, OR 5.62 CI 1.84-17.15) while small bowel imaging at the diagnosis was a protective factor for surgery (p 0.017, OR 0.23 CI 0.07-0.77). No significant difference was found in the interval free from surgery between HR and LR, although HR children mainly needed surgery in the first 12 months after the diagnosis. Conclusion Our data suggest that paediatric patients with HR-CD treated with early anti-TNF agents and long-standing biologic therapy have a similar disease course and surgical risk to those with LR disease. At a 5-year follow-up, one-third of patients needed surgery, mainly in the first year after the diagnosis

Adherence to the New Zealand Pediatric Guideline for the Assessment and Diagnosis of Inflammatory Bowel Disease.

This study aimed to assess the application of the guidelines in a group of children diagnosed with IBD in regards to baseline investigations. This retrospective observational study analyzed the application of recommended baseline investigations included in the NZ guidelines in a group of children aged <16 years diagnosed consecutively with IBD at the 2 NZ tertiary pediatric gastroenterology centers. Fifty children were included from each center. Seventy-two were diagnosed with Crohn's disease (CD), 15 with ulcerative colitis (UC), and 13 were with IBD unclassified. The children with CD had a mean Pediatric Crohn's Disease Activity Index score of 31 and almost half had ileocolonic involvement (47%). The 15 children with UC had a mean PUCAI score of 42, and 13 had pancolonic involvement. All 100 children underwent upper and lower gastrointestinal endoscopy with biopsies, and 92% had magnetic resonance enterography at diagnosis. Iron studies, folate, and vitamin B12 were measured in >70 children. Serum zinc, magnesium, and phosphate were infrequently measured. Current anthropometry was recorded in all children but historical growth data were variably recorded. Vaccination status was also inconsistently recorded. Most of this group of children diagnosed with IBD in 2 NZ centers underwent key recommended investigations at diagnosis including gastrointestinal endoscopy and small bowel imaging. Other baseline assessments, including measurement of micronutrient levels, were completed variably. Measures to enhance consistent baseline assessments are required.

Delayed presentation to regional hospital of gallstone ileus

Gallstone ileus is a rare cause of mechanical intestinal obstruction accounting for less than 1% of obstructions and results from the migration and impaction of a gallstone within the gastrointestinal tract. It is a rare complication of cholelithiasis seen in as little as 0.3% of patients. Morbidity associated with gallstone ileus has been reported as up to 27% and mortality rate has been reported at rates ranging from 7% to 30%, this is attributed to advanced age, and delay to presentation at treatment. An 86-year old male who presented to a rural hospital with signs and symptoms consistent with small bowel obstruction and imaging demonstrating features consistent with gallstone ileus. Diagnosis was made on computed tomography (CT) of a small bowel obstruction secondary to a large impacted gallstone. Our case highlights the ongoing utility and diagnostic value of abdominal X-ray, particularly in rural facilities with limited resources. The case also highlighted the approach of laparoscopic assisted removal of gallstone alone in medically comorbid patients, in rural facilities and particularly in the elderly population who may not be fit for longer initial surgical procedures or subsequent procedures to close choledochoduodenal fistula.

Impact of a Structured Report Template on the Quality of Multislice Spiral Computed Tomography Scan Reports for Small Bowel Diseases: A Preliminary Study

Background: The application of multislice spiral computed tomography (MSCT) scan has improved the diagnosis of small bowel diseases (SBDs). Objectives: This study aimed to develop a structured report (SR) template for SBDs based on MSCT scans and to compare its value with free-text reports (FTRs) by radiologists with different levels of seniority in radiology. Patients and Methods: A total of 120 SBD cases were confirmed based on the clinical manifestations, surgery, colonoscopy, and pathology. An SR template for small bowel imaging was developed, and six radiologists were divided into inexperienced and experienced groups. Sixty cases with small intestinal MSCT data were available for FTRs and another 60 cases for SRs after training. The report accuracy, satisfaction, and completion time were compared between the two reporting methods. Results: The writing time of SRs was significantly shorter than that of FTRs. By using FTRs, the experienced group showed higher levels of sensitivity for all diseases (i.e., intestinal wall, intestinal peripheral artery, blood vessel, bone, and other abdominal organ diseases) (P &lt; 0.05). The experienced group showed a low misdiagnosis rate for all diseases (P &lt; 0.05), except for bone disease (P = 0.161). By using SRs, the experienced group only showed a low misdiagnosis rate for the intestinal wall disease (P &lt; 0.05). High sensitivity for the intestinal wall disease (P &lt; 0.05) and intestinal peripheral artery disease (P = 0.024), along with improved sensitivity for bone lesions (P &lt; 0.05), was reported in this group. In the inexperienced group, SRs improved sensitivity for all diseases (P &lt; 0.05), except for intestinal wall disease (P &gt; 0.05). The satisfaction scores for both inexperienced and experienced groups improved by using SRs (4 vs. 2.6 for the inexperienced group and 4.1 vs. 3.2 for the experienced group; P &lt; 0.05 for both). Conclusion: The SRs were superior to FTRs in terms of writing efficiency, accuracy, and satisfaction. They could improve the accuracy of inexperienced radiologists in diagnosis and help detect SBDs.

Simultaneous dual‐contrast imaging using energy‐integrating detector multi‐energy CT: An in vivo feasibility study

To demonstrate the feasibility of simultaneous dual-contrast imaging in a large animal using a newly developed dual-source energy-integrating detector (EID)-based multi-energy computed tomography (MECT) system. Two imaging tasks that may have potential clinical applications were investigated: head/neck (HN) CT angiography (CTA)/CT venography (CTV) with iodine and gadolinium, and small bowel imaging with iodine and bismuth in domestic swine. Dual-source X-ray beam configurations of 70kV + Au120/Sn120 kV and 70kV + Au140/Sn140 kV were used for the HN-CTA/CTV and small bowel imaging studies, respectively. A test bolus scan was performed for each study. The regions of interest (ROIs) in the carotid artery and jugular vein for HN-CTA/CTV imaging and abdominal aorta for small bowel imaging were used to determine the time-attenuation curves, based on which the timing for contrast injection and the CT scan was determined. In the HN-CTA/CTV study, an MECT scan was performed at the time point corresponding to the optimal arterial enhancement by iodine and the optimal venous enhancement by gadolinium. In the small bowel imaging study, an MECT scan was performed at the optimal time point to simultaneously capture the mesenteric arterial enhancement of iodine and the enteric enhancement of bismuth. Image-based material decomposition was performed to decompose different materials for each study. To quantitatively characterize contrast material separation and misclassification, two ROIs on left common carotid artery and left internal jugular vein in HN-CTA/CTV imaging and three ROIs on superior mesenteric artery, ileal lumen, and collapsed ileum (ileal wall) in small bowel imaging were placed to measure the mean concentration values and the standard deviations. In the HN-CTA/CTV study, common carotid arteries containing iodine and internal/external jugular veins containing gadolinium were clearly delineated from each other. Fine vessels such as cephalic veins and branches of external jugular veins were noticeable but clear visualization was hindered by image noise in gadolinium-specific (CTV) images, as reviewed by a neuroradiologist. In the small bowel imaging study, the mesenteric arteries and collapsed bowel wall containing iodine and the small bowel loops containing bismuth were clearly distinctive from each other in the iodine- and bismuth-specific images after material decomposition, as reviewed by an abdominal radiologist. Quantitative analyses showed that the misclassifications between the two contrast materials were less than 1.7 and 0.1mg/ml for CTA/CTV and small bowel imaging studies, respectively. Feasibility of simultaneous CTA/CTV imaging in head and neck with iodine and gadolinium and simultaneous imaging of arterial and enteric phases of small bowel with iodine and bismuth, using a dual-source EID-MECT system, was demonstrated in a swine study. Compared to iodine and gadolinium in CTA/CTV, better delineation and classification of iodine and bismuth in small bowel imaging were achieved mainly due to wider separation between the corresponding two K-edge energies.

P166 Predictive markers of Crohn’s disease in small bowel capsule endoscopy

Abstract Background To distinguish between functional gastrointestinal disorders like irritable bowel syndrome (IBS) and Crohn’s disease (CD) can be a burden. The diagnosis is based on symptoms and findings in laboratory tests, endoscopy and imaging. As CD can be limited to small bowel, the diagnosis often requires small bowel capsule endoscopy (SBCE), which is time consuming for both the patient and clinician. Methods To answer this problem, we conducted a retrospective study of 374 patients who underwent SBCE for suspected small bowel CD in Turku University Hospital between 2012 and 2020 and gathered data on the patient’s laboratory, imaging and endoscopic findings at the time of SBCE. The patient’s history, medications and procedures related to CD were also documented after SBCE. SBCE findings were graded along CECDAI (Capsule Endoscopy Crohn’s Disease Activity Index) -scoring system. The main goal was to find predictive markers to rule out clinically significant small bowel CD without proceeding to SBCE. Results Small bowel CD was diagnosed in 110 (29.4%) patients (CD-group). The mean follow-up time for the whole population was 4.4 years. Fecal calprotectin (FC), serum albumin (Alb) and erythrocyte sedimentation rate (ESR) were significantly different between CD and non-CD-groups (p=&amp;lt;0.001, 0.025 and 0.022). Hemoglobin (Hb) and C-reactive protein (CRP) had no significant differences between the two groups (p=0.59, 0.24). FC &amp;lt;50ug/g had sensitivity 96.4%, specificity 19.6%, positive predictive value (PPV) 34.6% and negative predictive value (NPV) 92.5% for small bowel CD. 13 (11.8%) patients in CD-group had FC &amp;lt;100ug/g. CECDAI-score has no previously established clear cut-off-value for the diagnosis of CD. In this study 98.2% of patients in CD-group had CECDAI of 3 or more whereas 90.5% of patients in non-CD-group had CECDAI less than 3 (PPV=81.1%, NPV=99.1%). Sensitivity and specificity were the highest between CECDAI 2.5 and 3.5. Small bowel imaging also had relatively low sensitivity (65.1%) and specificity (72.7%) considering small bowel CD (PPV=52.2%, NPV=81.8%). Conclusion These findings underline our experience, that diagnosis of small bowel CD can be difficult. In this study, we found out that clinically relevant small bowel CD is possible even with FC&amp;lt;100ug/g. Based on our results, we suggest for a follow-up with FC before SBCE for patients with no endoscopic ileitis, negative imaging results and FC &amp;lt;50 ug/g. CECDAI-score of 3 would be a reasonable cut-off value for small bowel CD.

P306 Efficacy and tolerance of sodium picosulfate preparation in bowel Magnetic Resonance Imaging in Crohn’s disease

Abstract Background Polyethylene glycol (PEG) is one of the most commonly used bowel preparation for magnetic resonance imaging (MRI) in Crohn’s Disease (CD). Sodium picosulfate (Pico) is a low volume bowel preparation known for its efficacy and higher tolerability for colonoscopy. No study has to date evaluated tolerance and efficacy of Pico preparations for MRI in CD. Aim: To assess for the first time the efficacy and tolerance of Pico preparation compared to PEG preparation for bowel MRI in CD. Methods The study took place in a French university hospital. To assess the efficacy of low volume preparations compared to PEG, we selected consecutive bowel MRI from January to June, 2017 prepared with PEG formulas, and consecutive MRI from January, 2020 to June, 2020 prepared with low-volume Pico formula.The sample size was calculated to assess the non-inferiority of Pico preparation vs PEG. The efficacy endpoint was the quality of bowel distention on a, 5 points scale and by visual analog scale (VAS) by two independent readers. To study Pico preparation tolerability, we performed a prospective survey in CD patients undergoing MRI from October, 2020 to August, 2021. Patients completed a self-administered validated questionnaire on tolerability and a VAS. Results In the efficacy study,84 MRIs were analysed (42 in each PEG and Pico group). There was no significant difference between PEG and Pico preparation regarding jejunum and ileum distention on the, 5 points quality scale. Moreover, we did not find significant difference between PEG and Pico regarding overall quality in the VAS (8.1 ±, 1.4 in PEG group, vs, 8.7 ±, 1.2 in Pico group, by reader, 1 (p=, 0.125);, 6.35 ±, 1 in PEG group, 6.5 ±, 1 in Pico group by reader, 2 (p=0.298)) with a moderate but significant correlation rate between the two readers (r=, 0.45; p&amp;lt;0.001). There was no significant difference regarding ileal diameter between the two preparations with a moderate correlation rate between the two readers (r=0.41; p&amp;lt;0.01). In the prospective study, 38 patients participated in the survey. The bowel preparation intake was completefor, 94.7% of the patients. The mean tolerance was, 6.84/10. Overall, 81.6% of patients were willing to take the same preparation again. Conclusion The study assessed Pico preparation non-inferiority to PEG preparation for small bowel MRI and confirmed low volume bowel preparations good tolerability profile. This suggests that low-volume preparations could be more widely implemented in clinical practice for small bowel imaging in chronic inflammatory bowel disease and thus improve follow-up acceptance.

Computed Tomography Enterography Demonstrates Association to Histopathological Grading of Small Bowel Crohn’s Activity

Introduction: Crohn’s disease (CD) is a lifelong, progressive inflammatory condition of the bowel that adversely influences the quality of life. Diagnosis of CD can be challenging, as there is no trusted gold standard diagnostic procedure. Ileocolonoscopy cannot investigate the entire small bowel due to small bowel morphology. Multislice Computed Tomography (MSCT) improves small bowel imaging and has established a crucial role for Computed Tomography Enterography (CTE). Objective: This study investigated an association between CTE and histopathology in the evaluation of the activity of small bowel CD. Materials and Methods: A retrospective study was used to collect eligible cases. The sample size was a consecutive sampling of 98 patients with known CD. The patients underwent biopsy by ileocolonoscopy-guided retrograde terminal ileum intubation. Subjects were scanned with CTE for confirmation of the diagnosis, detection of complications, and further evaluation of CD. A Chi-Square test was performed to determine the association between CTE radiological pathological findings and CTE grading. Results: The peak prevalence of Crohn’s activity occurred between the ages of 20–30 years. Definitive clinical presentations of CD include diarrhea, abdominal pain, and weight loss, frequently followed by a chronic deteriorating progression, with distinct variations in the type and severity of symptoms. Fisher exact test showed that there is a statistically significant association between radiological pathological findings of CTE and CTE diagnostic grading of CD (0.05, 2-sided). Moreover, there is a relationship between radiological pathological findings of CTE and histopathological findings. Conclusions: The CTE radiological pathological findings demonstrate an association with the histopathological findings of CD. The CTE findings may be helpful for the differential diagnosis and planning of treatment strategy.