standard and poor media copy assistant north america

Various studies have investigated the optimal volume of oral contrast that should be ingested, balancing the need for good distension with patient compliance and side effect profile. However, they found increased side effects such as diarrhoea, vomiting and spasms with increasing volumes (12 ml), without any significant improvement in small bowel distension.

Kuehle et al reported that good small bowel distension could be achieved when using a 1-l solution of 2.5% mannitol/0.2% locust bean gum prior to MR enterography, with relatively minimal side effects. Milk was shown to give similar results as Volumen, but although less expensive and freely available in Europe, it may be deemed unpalatable by many patients when drunk in large volumes. Use of Volumen has been shown to improve the quality of bowel distension compared with water alone, but it remains unlicensed for use in the UK and therefore is not available. Water alone usually results in inadequate distension due to rapid reabsorption, although some authors advocate its use. Water–methylcellulose solution, polyethylene glycol, commercially available low-density barium, 0.1% Volumen (Bracco, Milan, Italy) and milk are examples of neutral oral contrast agents with CT attenuation properties similar to that of water.

Neutral or low-density oral contrast media are a prerequisite for good-quality CT enterography because they maximise contrast between the lumen and enhancing small bowel wall, facilitating assessment of mucosal thickening and wall stratification/enhancement patterns. We will also examine its role relative to other complementary non-ionising radiation radiological tests. This paper will critically review the CT enterography technique and provide practical tips on interpretation to assist radiologists and help them avoid common interpretative pitfalls. Although superior jejunal distension is attained using enteroclysis, the convenience, efficiency and superior patient experience achieved with CT enterography make it the preferred technique at the authors' institutions, and therefore the focus of this review. Several authors have subsequently described similar techniques, which are broadly categorised into CT enterography (where patients drink oral contrast) and CT enteroclysis (luminal contrast is introduced via a nasojejunal tube placed fluoroscopically prior to CT examination). They combined neutral (low-density) oral contrast with “enteric phase” CT to optimise contrast resolution between mucosa and lumen, thereby maximising conspicuity of abnormalities arising from the small bowel wall. In parallel with the development of new endoscopic techniques, rapid progress has been made in cross-sectional imaging technologies, harnessing the power of multidetector row CT (MDCT), MRI and ultrasound, facilitating rapid, accurate and minimally invasive investigation of the small bowel and adjacent tissues.ĬT enterography was first introduced by Raptopoulos et al in 1997 as a modification to “standard” abdomino-pelvic CT examination to specifically examine the small bowel in detail, notably to assess the extent and severity of Crohn's disease.

However, the radiological community has not stood still. Capsule endoscopy, for example, is now generally accepted as first-line investigation for occult gastrointestinal haemorrhage, and increasingly advocated for diagnosis of early Crohn's disease. However, new endoscopic developments-notably the recent introduction of capsule endoscopy and double balloon enteroscopy-are challenging this position. Until recently, diagnosis of small bowel pathology had relied primarily on radiological techniques, in part due to the relative inaccessibility of the small bowel to conventional endoscopy.

Standard and poor media copy assistant north america