Review
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World J Radiol. May 28, 2013; 5(5): 193-201
Published online May 28, 2013. doi: 10.4329/wjr.v5.i5.193
Computed tomography of Crohn’s disease: The role of three dimensional technique
Siva P Raman, Karen M Horton, Elliot K Fishman
Siva P Raman, Karen M Horton, Elliot K Fishman, Department of Radiology, Johns Hopkins University School of Medicine, Johns Hoplins Outpatient Center, Baltimore, MD 21287, United States
Author contributions: All three authors contributed to the writing and editing of this manuscript; Raman SP was the primary author of the paper; Both Horton KM and Fishman EK played a major role in image selection.
Correspondence to: Siva P Raman, MD, Department of Radiology, Johns Hopkins University School of Medicine, Johns Hoplins Outpatient Center, Room 3251, 601 N Caroline Street, Baltimore, MD 21287, United States. srsraman3@gmail.com
Telephone: +1-410-9555173 Fax: +1-410-6140341
Received: January 7, 2013
Revised: April 18, 2013
Accepted: May 17, 2013
Published online: May 28, 2013
Abstract

Crohn’s disease, a transmural inflammatory bowel disease, remains a difficult entity to diagnose clinically. Over the last decade, multidetector computed tomography (CT) has become the method of choice for non-invasive evaluation of the small bowel, and has proved to be of significant value in the diagnosis of Crohn’s disease. Advancements in CT enterography protocol design, three dimensional (3-D) post-processing software, and CT scanner technology have allowed increasing accuracy in diagnosis, and the acquisition of studies at a much lower radiation dose. The cases in this review will illustrate that the use of 3-D technique, proper enterography protocol design, and a detailed understanding of the different manifestations of Crohn’s disease are all critical in properly diagnosing the full range of possible complications in Crohn’s patients. In particular, CT enterography has proven to be effective in identifying involvement of the small and large bowel (including active inflammation, stigmata of chronic inflammation, and Crohn’s-related bowel neoplasia) by Crohn’s disease, as well as the extra-enteric manifestations of the disease, including fistulae, sinus tracts, abscesses, and urologic/hepatobiliary/osseous complications. Moreover, the proper use of 3-D technique (including volume rendering and maximum intensity projection) as a routine component of enterography interpretation can play a vital role in improving diagnostic accuracy.

Keywords: Crohn’s disease, Computed tomography angiography, Multidetector computed tomography, Three dimensional technique, Volume rendering, Maximum intensity projection, Fistula, Dose reduction

Core tip: Advancements in computed tomography (CT) enterography protocol design, three dimensional (3-D) post-processing software, and CT scanner technology have allowed increasing accuracy in diagnosis, and the acquisition of studies at a much lower radiation dose. The cases in this review will illustrate that the use of 3-D technique, proper enterography protocol design, and a detailed understanding of the different manifestations of Crohn’s disease are all critical in properly diagnosing the full range of possible complications in Crohn’s patients.