methylcellulose and Inflammatory-Bowel-Diseases

This article gives an overview of the possibilities of conventional radiography in the diagnosis of inflammatory bowel disease of the small intestine and colon.. For more than 25 years we examine the small bowel employing enteroclysis with barium and methylcellulose and the colon with the usual double-contrast method. In the last 152 months 1560 small bowel enemas were performed. In the last 40 months 410 examinations of the colon were performed.. There is a thirty percent decrease in enteroclysis examinations within the past 5 years,however, the rate of examinations with positive results increased from 46 to 57%. The proportion of the inflammatory small intestinal diseases (not only Crohn's disease) remained constant with 18%.Concerning the examinations of the colon for inflammatory disease we confirmed the diagnosis in seven cases. The radiation exposure for the enteroclysis in inflammatory diseases was 7 mSv, for colon examinations 14 mSv.. Barium examinations, especially of the stomach and colon are decreasing in frequency. Therefore the art of performance and interpretation might get lost.Enteroclysis, however, is still the method of reference for the other imaging methods. The advantages compared to the other imaging methods are the excellent presentation of the details of the mucosal surface and the observation of functional disorders.

Topics: Barium Sulfate; Colitis, Ulcerative; Contrast Media; Crohn Disease; Diagnosis, Differential; Enema; Humans; Ileal Diseases; Inflammatory Bowel Diseases; Methylcellulose; Radiography; Time Factors; Tuberculosis, Gastrointestinal

Our objective was a prospective comparison of MR enteroclysis (MRE) with multidetector spiral-CT enteroclysis (MSCTE). Fifty patients with various suspected small bowel diseases were investigated by MSCTE and MRE. The MSCTE was performed using slices of 2.5 mm, immediately followed by MRE, obtaining T1- and T2-weighted sequences, including gadolinium-enhanced acquisition with fat saturation. Three radiologists independently evaluated MSCTE and MRE searching for 12 pathological signs. Interobserver agreement was calculated. Sensitivities and specificities resulted from comparison with pathological results ( n=29) and patient's clinical evolution ( n=21). Most pathological signs, such as bowel wall thickening (BWT), bowel wall enhancement (BWE) and lymphadenopathy (ADP), showed better interobserver agreement on MSCTE than on MRE (BWT: 0.65 vs 0.48; BWE: 0.51 vs 0.37; ADP: 0.52 vs 0.15). Sensitivity of MSCTE was higher than that of MRE in detecting BWT (88.9 vs 60%), BWE (78.6 vs 55.5%) and ADP (63.8 vs 14.3%). Wilcoxon signed-rank test revealed significantly better sensitivity of MSCTE than that of MRE for each observer ( p=0.028, p=0.046, p=0.028, respectively). Taking the given study design into account, MSCTE provides better sensitivity in detecting lesions of the small bowel than MRE, with higher interobserver agreement.

Topics: Artifacts; Contrast Media; Enema; Female; Gadolinium DTPA; Gastrointestinal Hemorrhage; Humans; Inflammatory Bowel Diseases; Injections, Intravenous; Intestinal Diseases; Intestine, Small; Magnetic Resonance Imaging; Male; Methylcellulose; Middle Aged; Observer Variation; Postoperative Complications; Prospective Studies; Sensitivity and Specificity; Tomography, Spiral Computed

Evaluation as to whether diagnosis of large bowel disease and TNM staging of colorectal carcinoma are possible by colorectal hydrosonography (HUS).. 52 patients with suspected neoplastic or inflammatory large bowel disease, underwent HUS. Before performing abdominal ultrasound, the colon was filled with fluid. Morphological alterations of the bowel wall were judged benign or malignant. Colorectal carcinomas were classified according to the TNM system.. Laparotomy was performed in 46 of 52 patients. Correlation with surgery and histopathology showed that 77% of morphologic alterations of the colonic wall were detected by HUS. While benign lesions of the colonic wall occasionally mimicked malignant disease, colonic carcinomas were reliably diagnosed by HUS, because destruction and invasion of the bowel wall was visible. Carcinomas of the lower part of the rectum, however, were missed in most cases. Accuracy to determine the infiltration depth of colorectal carcinomas was 89%, but hydrosonographic N-staging was unreliable. Inflammatory disease of the large bowel as well as changes complicating the inflammatory bowel disease were accurately diagnosed by HUS.. In selected patients, colorectal HUS is suited for diagnosis and staging of colonic tumours. It also helps to evaluate inflammatory bowel disease, because small and large bowel can be reliably distinguished from each other and the degree of stenosis of inflamed colonic segments becomes visible. Furthermore, HUS increases the visibility of fistulas.

Topics: Colon; Colorectal Neoplasms; Contrast Media; Female; Humans; Inflammatory Bowel Diseases; Male; Methylcellulose; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Rectum; Ultrasonography

Little is known about the factors that determine the extent of dispersion of enema solutions in the colon. To unravel some of the determinants we evaluated a consecutive series of patients with left-sided colitis. 40 ml enema solutions, viscosity 0.062 Pa.s (62 cP) at 37 degrees C were labelled with 10 MBq 99m-technetium human serum albumin microcolloid. Scintigraphic imaging was performed in 35 patients until 2 hours after administration of the enema. In 8 of the 16 patients with limited retrograde spread the study was repeated after doubling the volume (80 ml). We conclude that the extent of dispersion of an enema 0.062 Pa.s solution is highly variable. The basic fluid component for therapeutic 40 ml enemas (viscosity 0.062 Pa.s) reaches the affected area in patients with left sided colitis only in 40% of the cases. Increasing the volume of the enema can be an effective way to increase the retrograde spread up to the affected area in patients with limited retrograde spread. Scintigraphic imaging is a simple and reliable method of checking whether an enema conforms to the requirements of medical treatment. Scintigraphic imaging lasting for 1 hour after administration of the enema appears to suffice.

Topics: Adolescent; Adult; Aged; Colon; Enema; Female; Humans; Inflammatory Bowel Diseases; Male; Methylcellulose; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Viscosity