Eric C. Ehman1, Siva P. Raman2, Karen M. Horton2, Pamela T. Johnson2, and Elliot K. Fishman2 1Mayo Clinic, Rochester, MN, USA 2Johns Hopkins University, Baltimore, MD, USA Advancements in computed tomography (CT) technology allow scanning of the entire abdomen in a very short period of time, enabling images to be obtained in multiple phases of IV contrast enhancement which optimizes the detection and diagnosis of pathology. PO contrast agents, including neutral agents, such as water, or commercially available volume enhancing agents may be used to visualize the bowel wall, while positive agents such as iodine or barium suspensions may be used to help differentiate small bowel loops from adjacent structures. Finally, volumetric CT dataset acquisitions allow reformatting of images in various planes or even in three dimensions to aid in visualization of pathology. The images shown in this chapter relate to the gastrointestinal tract (Figures 89.1–89.14); the liver (Figures 89.15–89.18); the pancreas (Figures 89.19–89.23); the biliary tract (Figure 89.24); the peritoneum (Figure 89.25); and hernias (Figure 89.26). Figure 89.1 (a) Axial intravenous contrast‐enhanced multidetector computed tomography (MDCT) image reveals a large circumferential esophageal mass (arrows). The mass splays the carina. An esophageal stent is in place (arrowhead). (b) Axial intravenous contrast‐enhanced MDCT image demonstrates bulky mediastinal adenopathy (arrows). The esophageal stent is again noted (arrowhead). Figure 89.2 (a) Axial intravenous contrast‐enhanced MDCT image in a patient with gastric adenocarcinoma shows an infiltrating mass in the gastric body (arrows). There is extension into the gastrohepatic ligament (arrowhead). (b) Coronal volume‐rendered image nicely demonstrates the bulky gastric mass (arrow). Figure 89.3 Intravenous contrast‐enhanced coronal multiplanar reconstruction using water as oral contrast demonstrates a 1.3 cm intramural gastric mass (arrows) compatible with a gastrointestinal stromal tumor. This was an incidental finding. Figure 89.4 Intravenous contrast‐enhanced coronal volume‐rendered image using water as oral contrast demonstrates a 2 cm lobulated mass (arrow) in the second portion of the duodenum. A common bile duct stent is in place (arrowhead). The patient underwent Whipple surgery and pathology revealed adenocarcinoma arising in a tubular adenoma. Figure 89.5 (a) Axial intravenous contrast‐enhanced MDCT image shows a 1.5 cm infiltrating mass (arrow) in the root of the mesentery, compatible with carcinoid. (b) Coronal maximum intensity projection nicely demonstrates encasement of the superior mesenteric artery branches (arrowhead) by the infiltrating tumor (arrows). Figure 89.6 Coronal maximum intensity projection (MIP) images from the arterial phase of a triphasic (arterial, enteric, and delayed) phase enterography exam demonstrate numerous eccentric enhancing masses within the small bowel (arrows). Follow‐up 68
CHAPTER 89
Computed tomography of the gastrointestinal tract
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