Abstract
Objective
To report spiral CT imaging features of the vascular alterations observed in active, early, or recurrent Crohn disease of the small bowel and colon.
Methods
Spiral CT examinations of the abdomen and pelvis following oral and intravenous contrast were performed in two cases of active Crohn disease.
Results
Spiral CT features of hypervascularity involving the mesenteric vessels of affected segments of bowel include vascular dilatation, tortuosity, and conspicuous prominence and wide spacing of the vasa recta (the “comb” sign). This is attributed to the factors of increased flow and the fibrofatty proliferation in the mesentery and serosa of the affected bowel.
Conclusion
Clinical application of these observations may enhance the diagnosis of Crohn disease presenting initially or as an acute recurrence in the differential diagnosis from other conditions.
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References
Heiken JP, Brink JA, Vaanier MW. Spiral (helical) CT. Radiology 1993;189:647–656
Heiken JP, Brink JA, Sagel S. Helical CT: abdominal applications. RadioGraphics 1994;14:919–924
Stehling M, Lawrence JA, Weintraub JL, Raptopoulos V. CT angiography: expanded clinical applications. AJR 1994;163:947–955
Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis. JAMA 1932;99:1323–1329
Neuman HW, Bargen JA, Judd ES. A clinical study of two hundred one cases of regional (segmental) colitis. Surg Gynecol Obstet 1954;99:563–571
Morson BC, Lockhart-Mummery HE. Crohn's disease of the colon. Gastroenterol Jpn 1959;92:168–172
Marshak RH, Wolf BS. Chronic ulcerative granulomatous jejunitis and ileojejunitis. Am J Roentgenol 1953;70:93–112
Marshak RH, Bloch C, Wolf BS. The roentgen findings in strictures of the colon associated with ulcerative and granulomatous colitis. AJR 1963;90:709–716
Laufer I, Hamilton J. The radiological differentiation between ulcerative and granulomatous colitis by double contrast radiology. Am J Gastroenterol 1976;66:259–267
Meyers MA. Clinical involvement of mesenteric and antimesenteric borders of small bowel loops. II. Radiologic interpretation of pathological alterations. Gastrointest Radiol 1976;1:49–58
Herlinger H, Maglinte D. Clinical radiology of the small intestine. Philadelphia: WB Saunders. 1989
Boijsen E, Reuter SR. Mesenteric angiography in the evaluation of inflammatory and neoplastic disease of the intestine. Radiology 1966;87:1028–1036
Lunderquist A, Lunderquist A, Knutsson H. Angiography in Crohn's disease of the small bowel and colon. AJR 1967;101:338–344
Knutsson H, Lunderquist A, Lunderquist A. Vascular changes in Crohn's disease. AJR 1968;103:380–385
Brahme F, Lindstrom C. A comparative and pathologic study of intestinal vaso-architecture in Crohn's disease and in ulcerative colitis. Gut 1970;11:928–940
Erickson U, Fagerberg S, Krause U, Olding L. Angiographic studies in Crohn's disease and ulcerative colitis. AJR 1970;110:385–392
Herlinger, H. Angiography of Crohn's disease. Clin Gastroenterol 1972;1:383–408
Branom-Geneiser N, Madayag MA, Grosfeld JL, Becker MH, Rothberg M. Mesenteric angiographic studies in children with regional enteritis. Clin Pediatr 1973;12:640–643
Brahme F, Hildell J. Angiography in Crohn's disease revisited. AJR 1976;12:941–951
Herlinger H. Angiography of colonic Crohn's disease: the zoning sign revisited. Gastrointest Radiol 1978;2:397–400
Frager DH, Goldman M, Benenventano TC. Computed tomography in Crohn's disease. J Comput Assist Tomogr 1983;7:819–824
Goldberg HI, Gore RM, Margulis AR, Moss AA, Baker EL. Computed tomography in the evaluation of Crohn disease. Am J Roentgenol 1983;140:277–282
Gore RM, Marn CS, Kirby DF, Vogelzang RL, Neiman HL. CT findings in ulcerative, granulomatous, and indeterminate colitis. AJR 1984;27:279–284
Gore RM. CT of inflammatory bowel disease. Radiol Clin North Am 1989;27:717–729
Frik W, Persigehl M, Klose K-C. Inflammatory bowel disease and related conditions. In: Meyers MA, ed. Computed tomography of the gastrointestinal tract, including the peritoneal cavity and mesentery. New York: Springer-Verlag. 1986:79–94
Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn's Disease Activity Index. Gastroenterology 1976;70:439–444
van Oostayen JA, Wasser MNJM, van Hogezand RA, Griffioen G, de Roos A. Activity of Crohn disease assessed by measurement of superior mesenteric artery flow with Doppler US. Radiology 1994;193:551–554
Ralls PW, Jeffrey RB Jr. Peritoneal cavity and GI tract. In: Jeffrey RB Jr, Ralls PW, eds. Sonography of the abdomen. New York: Raven Press. 1995:35
Reubi JC, Mazzucchelli L, Laissue JA. Intestinal vessels express a high density of somatostatin receptors in human inflammatory bowel disease. Gastroenterology 1994;106:951–959
Donowitz M. Arachadonic acid metabolites and their role in the inflammatory bowel disease. Gastroenterology 1985;88:580–587
Stallard DJ, Tu RK, Gould MJ, Pozniak MA, Pettersen JC. Minor vascular anatomy of the abdomen and pelvis: a CT atlas. RadioGraphics 1994;14:493–513
Wakefield AJ, Dhillon AP, Rowles PM, Sawyers AM, Pittilo RM, Lewis AAM. Pathogenesis of Crohn's disease: multifocal gastrointestinal infarction. Lancet 1989;2:1057–1062
Lewin KJ, Riddell RH, Weinstein WM. Gastrointestinal pathology and its clinical implications. New York: Igaku-Shoin. 1992:889–890
Wakefield AJ, Sankey EA, Dhillon AP, Sawyers AFM, Sim R, Pittilo RM, Rowles PM, Hudson M, Lewis AAM, Pounder RE. Granulomatous vasculitis in Crohn's disease. Gastroenterology 1991;100:1279–1287
Mapstone NP, Dixon MF. Vasculitis in ileocecal tuberculosis: similarities to Crohn's disease. Histopathology 1992;21:477–479
Williams P, Warwick R, Dyson M, Bannister L. Gray's anatomy. New York: Churchill Livingstone. 1989:772–773
Homan WP, Tang CK, Thorbjarnarson B. Acute massive hemorrhage from intestinal Crohn's disease. Arch Surg 1976;111:901–905
Crohn BB, Yarnis H. Regional ileitis, 2nd ed. New York: Grune & Stratton. 1958:71–72
Sparberg M, Kirsner J. Recurrent hemorrhage in regional enteritis: report of three cases. Am J Dig Dis 1966;2:652–657
McGarrity TJ, Manasse JS, Koch KL, Weidner WA. Crohn's disease and massive lower gastrointestinal bleeding: angiographic appearance and two case reports. Gastroenterology 1987;82:1096–1099
Singer AA. Value of CT in localizing site of gastrointestinal hemorrhage following negative angiography. Abdom Imaging 1995;20:31–32
Marshak RH, Lindner AE. Radiology of the small intestine, 2nd ed. Philadelphia: WB Saunders. 1976:409–450
Reuter SR, Redman HC. Gastrointestinal angiography, 2nd ed. Philadelphia: WB Saunders. 1977:128
Meyers MA, Oliphant M, Teixidor H, Weiser P. Metastatic carcinoma simulating inflammatory colitis. AJR 1975;123:74–83
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Meyers, M.A., McGuire, P.V. Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”. Abdom Imaging 20, 327–332 (1995). https://doi.org/10.1007/BF00203365
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DOI: https://doi.org/10.1007/BF00203365