Improving Conspicuity Of The Canine Gastrointestinal Wall Using Dual Phase Contrast-Enhanced Computed Tomography: A Retrospective Cross-Sectional Study

Fitzgerald E, Lam R, Drees R.

Veterinary Radiology & Ultrasound 2017;58:151-162.

Gastrointestinal (GI) disease is a common clinical complaint in small animal patients; computed tomography (CT) examinations enable a global overview of the GI tract and associated structures. Previously, the GI wall has been reportedly identified from serosa to mucosa in 77% of standard postcontrast CT studies and wall layers seen in ultrasound have not been distinguished. Inconsistent strong contrast enhancement of the inner layer of the GI mucosal surface was noted on dual phase CT studies acquired in our institution, which increased the visibility of the GI tract and disease processes. The aim of this retrospective, observational, cross-sectional study was to determine the optimal portal vein attenuation for maximizing GI wall conspicuity using dual phase contrast-enhanced CT. Patients with abdominal CT for a non-GI related disease were included. In a pilot study, 175 GI segments from 35 CT studies were graded for presence of mucosal surface enhancement (MSE). The strongest mucosal surface enhancement grade correlated with portal vein attenuation of 43–150 HU; this value was used as inclusion criterion in the main study. A total of 441 GI segments were evaluated in 42 CT studies postcontrast for GI wall conspicuity. The GI wall was conspicuous in 56.7% precontrast, 84.5% at 30s, and 77.3% late postcontrast; 4.7% of segments were removed due to motion blur. At 30 s distinct mucosal surface enhancement was seen in the small intestine and gastric mucosal surface enhancement was poor. Findings supported the use of dual phase contrast-enhanced CT for improving conspicuity of the GI wall.