CT Enterography: Diagnosing Crohn's and Bowel Diseases

If you have been diagnosed with Crohn's disease, inflammatory bowel disease (IBD), or unexplained abdominal symptoms, your doctor may order a CT enterography. This specialized CT scan is designed to provide detailed images of the small intestine — an area that is difficult to evaluate with standard imaging or endoscopy.

What Is CT Enterography

CT enterography (CTE) is a CT scan optimized for visualizing the small bowel. Unlike a standard abdominal CT, CTE uses a large volume of oral contrast to distend the small intestine, allowing radiologists to see the bowel wall clearly and detect inflammation, strictures, and other abnormalities.

The American College of Radiology considers CT enterography one of the primary imaging tools for evaluating known or suspected Crohn's disease because it can visualize the entire length of the small intestine (about 20 feet), detect wall thickening and inflammation, identify strictures (narrowing) and fistulas (abnormal connections), and assess disease activity and complications.

Conditions CT Enterography Can Detect

Crohn's Disease

Crohn's is a chronic inflammatory condition that can affect any part of the digestive tract but most commonly involves the small intestine and colon. According to the Crohn's & Colitis Foundation, about 780,000 Americans live with Crohn's disease.

CT enterography helps diagnose Crohn's by showing wall thickening and enhancement (signs of active inflammation), narrowing or strictures that may cause obstruction, fistulas connecting the bowel to other organs or the skin, and abscesses or collections of infection.

It also helps monitor disease activity over time and assess response to treatment.

Small Bowel Obstruction

When the small intestine is blocked — whether by scar tissue, a tumor, or a hernia — CT enterography shows the location and cause of the obstruction. This information is critical for surgical planning.

Small Bowel Tumors

Though rare, tumors of the small intestine can occur. CTE can detect masses and help determine whether they are benign or potentially malignant.

Celiac Disease Complications

In patients with celiac disease who have persistent symptoms despite a gluten-free diet, CT enterography can evaluate for complications such as refractory celiac disease, ulcerative jejunitis, or lymphoma.

How to Prepare

CT enterography requires specific preparation to ensure the small bowel is adequately distended:

1. Nothing to eat for 4 to 6 hours before the exam
2. Drink oral contrast — You will be given a large volume of oral contrast (usually 1 to 1.5 liters) to drink over about an hour before the scan
3. Arrive early — Plan to arrive 60 to 90 minutes before your scheduled scan time to complete the oral prep
4. IV contrast — An intravenous line will be placed for injection of contrast during the scan
5. Inform staff of any allergies, kidney disease, or diabetes

The oral contrast used for CT enterography is different from the barium used for older fluoroscopic studies — it is a low-density solution designed to distend the bowel without obscuring detail.

What to Expect During the Exam

1. Check in early — Allow time for oral prep
2. Drink the contrast — Consumed gradually over about an hour
3. Lie on the scanner table — You may be positioned on your stomach or back
4. IV contrast injection — Administered through your IV during the scan
5. Breath holds — Brief breath holds ensure sharp images
6. Scan time — The actual CT takes only seconds, but total visit time is about 90 minutes to 2 hours

After the exam, you can eat and drink normally. You may experience mild bloating from the large amount of fluid, which resolves quickly.

Understanding Your Results

A board-certified radiologist reviews your images and sends a detailed report to your gastroenterologist or referring physician. The report describes the bowel wall thickness, enhancement patterns, any strictures or fistulas, and overall disease activity.

For Crohn's patients, follow-up CT enterography or MRI enterography may be recommended periodically to monitor disease progression and treatment response.

Schedule Your CT Enterography

At Advanced Medical Imaging, we offer CT enterography with experienced technologists and radiologists who specialize in gastrointestinal imaging. If your doctor has ordered this exam, call (727) 398-5999 or schedule online to arrange your appointment.