Brian C. Lucey MD, Presenter: Research grant, E-Z-EM, Inc

Daniel Mishkin MD, Abstract Co-Author: Research grant, E-Z-EM, Inc

Al Ozonoff PhD, Abstract Co-Author: Nothing to Disclose

Jorge Soto, Abstract Co-Author: Research grant, General Electric Company Stockholder, Quantitative Imaging

To evaluate the capability of CTE in the identification of small bowel disease using wireless video capsule endoscopy as the gold standard and to identify the role of CTE in the work up of patients with suspected small bowel pathology.

We prospectively evaluated 40 patients that were referred to a gastroenterologist for investigation of suspected small bowel pathology who were scheduled for VCE. CTE prior to VCE was performed in all cases. CT was performed on a 64 row detector VCT (GE Healthcare, Milwaukee, WI) with 0.625mm collimation through the abdomen and pelvis after 100mL of intravenous contrast. Negative oral contrast, VoLumen ®, 1350mL was given to all patients, consumed over 45 minutes. VCE was performed using a Pill Cam SB Capsule (Given Imaging, Yoqneam, Israel) resulting in approximately 55,000 images that were reviewed on a dedicated workstation. VCE was used as the gold standard. The CTE findings were compared to VCE findings and sensitivity and specificity for CTE were calculated for overall performance and individually based on the indication for the VCE.

5 patients avoided a VCE as a direct result of the CTE findings. Three of these were patients with Crohn disease that showed tight strictures likely to result in capsule retention. Of the remaining 35 patients, the overall sensitivity and specificity (with 95% CI in parenthesis) of CTE for detecting small bowel disease was 25% (9-49%) and 90% (68-99%) respectively. In patients with suspected Crohn disease, the sensitivity and specificity of CTE was 100% (48-100%) and 85% (55-98%) respectively. In patients with obscure GI bleeding, the sensitivity and specificity of CTE was 0% (0-22%) and 100% (59-100%) respectively.

CTE is a valuable imaging modality in the investigation of Crohn disease and abdominal pain. CTE is also valuable as a pre capsule screening examination and helps determine which patients should not undergo VCE. CTE is of more limited value but still has a role in the investigation of obscure GI bleeding.

The results of this study suggest that CTE could be used in the evaluation of suspected small bowel pathology and should be used as a pre VCE screening examination.

Lucey, B, Mishkin, D, Ozonoff, A, Soto, J, Comparison of CT Enterography (CTE) Using 64 Row Detector MDCT with Wireless Video Capsule Endoscopy (VCE) in the Investigation of Small Bowel Disease.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4431971.html