IMAGING OF COLITIS Ruedi F. Thoeni, M. D. University of California, San Francisco IMAGING OF COLITIS IMAGING OF COLITIS Ruedi F. Thoeni, M. D Ruedi F. Thoeni, M. D . . University of California, San Francisco University of California, San Francisco SCBT-MR Summer Practicum, Williamsburg, 2009 SCBT SCBT - - MR MR Summer Practicum, Williamsburg, 2009 Summer Practicum, Williamsburg, 2009
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IMAGING OF COLITIS R… · •• 16 (15%) had infectious colitis16 (15%) had infectious colitis •• 39 (36.4%) had ischemic colitis •• 6 (5.6%) had miscellaneous (diverticulitis,6
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IMAGING OF COLITIS
Ruedi F. Thoeni, M. D.University of California, San Francisco
IMAGING OF COLITISIMAGING OF COLITIS
Ruedi F. Thoeni, M. DRuedi F. Thoeni, M. D..University of California, San FranciscoUniversity of California, San Francisco
DIAGNOSIS IN SUSPECTED COLITISDIAGNOSIS IN SUSPECTED COLITIS
• Clinical presentation• Laboratory tests• Detection by imaging• Clinical confirmation for specific
type without or with colonoscopy
•• Clinical presentationClinical presentation•• Laboratory testsLaboratory tests•• Detection by imagingDetection by imaging•• Clinical confirmation for specific Clinical confirmation for specific
type without or with colonoscopytype without or with colonoscopy
• Contrast Materials:– Oral contrast : 3 bottles of 450 ml of VoLumen
or 2.2% Gastrografin (3 x 10 mL/450 of water)– IV contrast: 3-4 cc/sec for 150 ml– Rectal contrast: water
• Important:– for suspected perforation use positive contrast
(40 cc of Conray 60% in 1000 mL normalsaline: use 500-1000 mL)
•• Contrast Materials:Contrast Materials:–– Oral contrast :Oral contrast : 33 bottles of 450 ml ofbottles of 450 ml of VoLumenVoLumen
or 2.2% Gastrografin (3 x 10 mL/450 of water)or 2.2% Gastrografin (3 x 10 mL/450 of water)–– IV contrast:IV contrast: 33--4 cc/sec for 150 ml4 cc/sec for 150 ml–– Rectal contrast: Rectal contrast: waterwater
•• Important:Important:–– for suspected perforation use positive contrastfor suspected perforation use positive contrast
(40 cc of(40 cc of Conray Conray 60% in 1000 mL normal60% in 1000 mL normalsaline: usesaline: use 500500--1000 mL)1000 mL)
ABD/PEL WITH MDCT FOR COLITISABD/PEL WITH MDCT FOR COLITIS
• 16 (64) - slice MDCT:Detector configuration: 16 (64) x 0.625 mm, axialreconstruction thickness and interval: 5 mm
•• Important:Important:•• Coronal and sagittal Coronal and sagittal MPRsMPRs:: use 0.625 mm slices,use 0.625 mm slices,
reconstruct at 3 mm and send to PACSreconstruct at 3 mm and send to PACS•• Delayed scans (5 min) optionalDelayed scans (5 min) optional: for possible : for possible perfperf..
ABD/PEL WITH MDCT FOR COLITISABD/PEL WITH MDCT FOR COLITIS
• Infarcts in liver, spleen, kidneys• Occlusion of SMA or branches• Thrombosis of mesenteric vessels • Air in mesenteric vessels, hepatic
portal veins
•• Infarcts in liver, spleen, kidneysInfarcts in liver, spleen, kidneys•• Occlusion of SMA or branchesOcclusion of SMA or branches•• Thrombosis of mesenteric vessels Thrombosis of mesenteric vessels •• Air in mesenteric vessels, hepatic Air in mesenteric vessels, hepatic
COLONOSCOPY FOR COLONIC COLONOSCOPY FOR COLONIC THICKENING ON CT (THICKENING ON CT (N = 107)N = 107)
• 8 (7.4%) with new Dx of colonic carcinoma• 10 (9.3%) had a new Dx of IBD• 16 (15%) had infectious colitis• 39 (36.4%) had ischemic colitis • 6 (5.6%) had miscellaneous (diverticulitis,
proctitis, appendicitis)• 28 (26.1%) no abnormality found
•• 8 (7.4%) with new 8 (7.4%) with new DxDx of colonic carcinomaof colonic carcinoma•• 10 (9.3%) had a new 10 (9.3%) had a new DxDx of IBDof IBD•• 16 (15%) had infectious colitis16 (15%) had infectious colitis•• 39 (36.4%) had ischemic colitis 39 (36.4%) had ischemic colitis •• 6 (5.6%) had miscellaneous (diverticulitis,6 (5.6%) had miscellaneous (diverticulitis,
proctitis, appendicitis)proctitis, appendicitis)•• 28 (26.1%) no abnormality found28 (26.1%) no abnormality found
Wolff JH, Rubin A, Potter JD, Wolff JH, Rubin A, Potter JD, LattimoreLattimore W, W, ResnickResnick MB, Murphy BL, Moss SF. Clinical significance of MB, Murphy BL, Moss SF. Clinical significance of colonoscopiccolonoscopic findings findings associated with colonic thickening on computed tomography: is coassociated with colonic thickening on computed tomography: is colonoscopy warranted when thickening is detected? J lonoscopy warranted when thickening is detected? J ClinClinGastroenterolGastroenterol 2008; 42: 4722008; 42: 472--475.475.
TAKE HOME MESSAGETAKE HOME MESSAGE
• Wall thickening nonspecific• Ascites favors infectious or ischemic colitis• UC + most infectious colitis: