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Imaging the small bowel

Murphy, Kevin P.a,b; McLaughlin, Patrick D.a,b; O’Connor, Owen J.a,b; Maher, Michael M.a,b

Current Opinion in Gastroenterology: March 2014 - Volume 30 - Issue 2 - p 134–140
doi: 10.1097/MOG.0000000000000038
SMALL INTESTINE: Edited by Fergus Shanahan

Purpose of review Radiologic investigations continue to play a pivotal role in the diagnosis of pathologic conditions of the small intestine despite enhancement of capsule endoscopy and double-balloon endoscopy. Imaging techniques continue to evolve and new techniques in MRI in particular, are being developed.

Recent findings Continued advances in computed tomography (CT) and MRI techniques have reinforced the importance of these imaging modalities in small bowel assessment. The more invasive enteroclysis technique yields better small bowel distension for both CT and MRI when compared with peroral enterography, but no clinically significant difference is seen in terms of diagnostic accuracy. Recent concern regarding radiation exposure means that MRI is gaining in popularity. Fluoroscopic studies such as barium follow through and small bowel enteroclysis are being replaced by the cross-sectional alternatives. Contrast-enhanced ultrasound is showing results comparable with CT and MRI, but concern remains regarding reproducibility, especially outside centres that specialize in advanced sonographic techniques.

Summary CT and MRI enterography are comparable first-line modalities for patients with suspected small bowel disease, but magnetic resonance enterography is favoured given the absence of ionizing radiation. Capsule endoscopy is a reasonable alternative investigation in exploration of chronic gastrointestinal blood loss, but is best kept as a second-line test in patients with other symptoms.

aDepartment of Radiology, Cork University Hospital

bDepartment of Radiology, University College Cork, Wilton, Cork, Ireland

Correspondence to Professor Michael M. Maher, Cork University Hospital & University College Cork, Cork, Ireland. Tel: +353 21 4920274; fax: +353 21 4920319; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins