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  • Title: Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis.
    Author: Pilleul F, Penigaud M, Milot L, Saurin JC, Chayvialle JA, Valette PJ.
    Journal: Radiology; 2006 Dec; 241(3):796-801. PubMed ID: 17053201.
    Abstract:
    PURPOSE: To prospectively evaluate the sensitivity and specificity of contrast material-enhanced and water-enhanced multidetector computed tomographic (CT) enteroclysis in depicting small-bowel neoplasms in symptomatic patients, with endoscopic, tissue, and follow-up findings as reference standards. MATERIALS AND METHODS: The study protocol was approved by the Human Research Committee of the institution, and all patients gave written informed consent. Two hundred nineteen patients (108 male, 111 female; age range, 17-98 years; mean, 53.1 years) with clinical suspicion of small-bowel neoplasm underwent contrast- and water-enhanced multidetector CT enteroclysis after normal findings of upper and lower gastrointestinal endoscopy. The prospective interpretations of CT enteroclysis results include evaluation of focal bowel wall thickening, small-bowel masses, small-bowel stenosis, mesenteric stranding, enlarged mesenteric lymph nodes, and visceral metastasis. Positive enteroclysis findings were compared with results of pathologic examination after surgical (n = 35) or endoscopic (n = 20) procedures. Negative results were compared with results of surgery (n = 8), enteroscopy (n = 15), capsule endoscopy (n = 14), and clinical follow-up (n = 127). Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated on a per-patient basis with 95% confidence intervals. RESULTS: Findings of CT enteroclysis were positive in 55 cases and negative in 164. The overall sensitivity and specificity in identifying patients with small-bowel lesions were 84.7% and 96.9%, respectively. The negative and positive predictive values were 94.5% and 90.9%, respectively. Findings of pathologic examination confirmed small-bowel tumor in 50 patients with carcinoid tumor (n = 19), adenocarcinoma (n = 7), lymphoma (n = 5), jejunal adenoma (n = 9), stromal tumor (n = 5), ectopic pancreas (n = 2), angiomatous mass (n = 2), or metastasis (n = 1). Five examinations resulted in false-positive findings. CONCLUSION: Contrast- and water-enhanced multidetector CT enteroclysis had an overall accuracy of 84.7% for depiction of small-bowel neoplasms.
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