Feature Section, Small Bowel Disease: CT Imaging

As I began my training in Radiology I was fascinated by the art of the performance and interpretation of barium examinations of the luminal tract. I was fortunate to be able to train under, work with and learn from some of the greatest experts in the field including Reed Rice, Roger Harned, David Stephens, Robert MacCarty and Dan Johnson to whom I dedicate this review. Their expertise and love of luminal imaging led me to choose and follow a career in Gastrointestinal Radiology. For many years barium studies were the only method available to examine the small bowel. The development of new technology such as wireless capsule endoscopy has allowed improved detection of subtle small bowel abnormalities and magnified some of the limitations of barium examinations. Subsequently the interest in and the performance of barium small bowel examinations have waned. Over the last few years we have enjoyed a new renaissance in small bowel imaging. At the Mayo Clinic we have seen a significant switch in the imaging paradigm of small bowel disorders from barium studies to crosssectional techniques such as CT. We are again invigorated as we are able to detect subtle and fascinating findings on a daily basis that aid in the clinical management of patients with various disease processes. Radiologists are again making a difference in patient care. It is an honor for me to serve as a Guest Editor for Abdominal Imaging on CT Imaging of the Small Bowel. I have asked several experts on CT Enterography and Enteroclysis to share their experience and provide some insight on how you can implement these exams into your practice so you too may feel the renewed excitement with small bowel imaging. This journal is also unique in that I have included companion articles by expert clinicians (gastroenterology and surgery) in the field of each disease process. These articles will provide a valuable insight into what information the clinician needs to know from the imaging studies to help manage their patient. They will also update us on the most recent information regarding workup algorithms and management options. I think you will find this extremely valuable information for your practice. Dr. J. G. Fletcher begins by reviewing the technique of CT Enterography and discusses some methods being investigated to help reduce the radiation dose in this time of heightened awareness of radiation exposure. Our next authors review the imaging and management of Crohn disease. Drs. Amy Hara and Paul Swartz review the imaging of Crohn disease using CT Enterography. Drs. David Bruining and Edward Loftus review the clinical workup of patients with known or suspected Crohn disease and the various therapeutic options. They also discuss the important role of CT Enterography in deciding appropriate treatment decisions. Our next section focuses on the imaging and evaluation of patients with obscure GI bleeding (OGIB). Dr. James Huprich reviews new and exciting CT Enterography techniques that allow detection of subtle lesions that may be responsible for GI bleeding. Drs. Vijay Singh and Jeffrey Alexander then review the different etiologies responsible for OGIB and workup algorithms including the role of CT Enterography. Our final section focuses on the evaluation of lowgrade small bowel obstruction. Drs. Marc Kohli and Dean Maglinte, a world renowned expert on enteroclysis technique, share with us their technique for performing CT Enteroclysis and the utility in the evaluation of lowgrade small bowel obstruction. Dr. Michael Kendrick concludes the section describing some of the new surgical techniques for treating these patients and the role that CT plays. I hope you will find this review as informative as I have.