CT enterography

[MissLeopard83]

I visited my GI today for a follow-up after the SIBO breath test and colonoscopy came back normal. I've had an upper GI endoscopy and HIDA scan, too, and those were also normal. I asked my doctor today if we could do a scan of the small bowel since that's the only place he hasn't looked at completely besides the duodenum and terminal ileum. I've read here that inflammation can hide in the jejunum and not be found anywhere else, so I want to completely rule it out. Surprisingly, he was on board and mentioned both a CT enterography and a small bowel follow-through. He wants to do the CTE, but doesn't know if my insurance will cover it, so he has the SBFT as a backup. Apparently, the CTE is more sensitive than the MRE, but there is more radiation involved. I haven't received an appointment yet, but I hope to hear from the scheduling department next week and I have to get in before the end of August due to an insurance change not covering the GI group I'm a patient of.

Anyway, has anyone had the CTE? What was your experience of it? Was it better than the MRE or SBFT?

 

[DustyKat]

My son has had a CTE and MRE but not a SBFT.

The oral prep has improved over the years, although you will still be required to consume a large volume, usually 1500-2000ml in the hour or two prior to the test. The oral prep is required for the CT and MR.

As you have pointed out the difference between the CTE and MRE is that the CT involves radiation and the MRE doesn’t. The other major difference is the time taken to complete the test. The trade off for no radiation is a much longer testing time, CT takes a matter a minutes whereas the MR takes 30-45minutes.

My son didn’t experience any issues with either test and both were accurate in locating the areas of inflammation, complications present and the exact amount of bowel involved.

Good luck! I hope you are able to have your scheduled ASAP.

 

[MissLeopard83]

Since I'm claustrophobic, I think the CTE is probably a good idea if it takes less time than the MRE. When I had an MRI of my head about 10 years ago, it was an open MRI but it was still incredibly difficult. I wonder if the oral solution tastes bad? It can't taste quite as bad as the colonoscopy prep, though. My doctor and nurse are both aware of the pending insurance change. If I don't hear back by Monday afternoon, I'll call on Tuesday to check for updates. I have to put in a time-off request for work, but my boss is amazing and very understanding.

 

[DustyKat]

i think the prep is a bit dependent on where you go.

My son’s first prep was a sugary solution they added to water and it had to be consumed in the hour before the test. When he had his MRE last year it was psyllium in a glass of water every 15 minutes for the 2 hours preceding the test. When we arrived at the X-Ray place they told us that was the old prep and they had now moved to using milk.

If you are claustrophobic then the CT would definitely be your best bet. Good to hear you have a fab boss!

 

[eleanor_rigby]

I had a CT scan and the results were "entirely normal with a healthy surgical join" where I had my bowel resection 4 and a half years ago. But at colonoscopy there were ulcers at my surgical join and I have lots of symptoms like discomfort and pain. How could the CT scan not pick anything up?

 

[DustyKat]

Unfortunately no imaging will ever replace what can be seen with the human eye or with a biopsy.

Scans are more detailed than plain X-Rays. Pill cams can pick up abnormalities that scans don’t but are limited to visualising only the surface of the bowel wall. Scopes are the gold standard as the GI can eye ball the GI tract plus take away physical evidence in the form of biopsies but they are limited to the first and last areas of the small bowel and leaving everything in-between untouched. Each test has its merits but also its pitfalls. That is why it is important with small bowel disease to use a number of tests and criteria when determining where a person is at with their disease.

I understand your frustration with scans missing disease eleanor. My daughter had a CT one week out from emergency surgery, she was undiagnosed at the time, it came back as grossly normal. A week later in theatre they found she a ruptured bowel from Crohn’s, her bowel was a mess and that sure as hell didn’t happen in a week. The surgeons just shook their heads, they too couldn’t understand how it wasn’t picked up by the scan. My mantra ever since has been if the tests are normal but what I am seeing in front me doesn’t match then we keep looking for answers.

 

[lgpcarter]

I have had the CT enterography. Not too bad, except the usual horrors of the prep. They insert a very small tube and put a bit of air/fluid (can;t remember) in there and take a few scans. It is quick and WAAAY better than a SBFT.

 

[MissLeopard83]

I have had the CT enterography. Not too bad, except the usual horrors of the prep. They insert a very small tube and put a bit of air/fluid (can;t remember) in there and take a few scans. It is quick and WAAAY better than a SBFT.

I really hope my insurance approves the scan and doesn't give my GI doctor a lot of grief. That's the problem with an HMO. I'm on board with it and getting a scan of the small bowel was my idea.

 

[Cat-a-Tonic]

As far as what the oral contrast tastes like - my last CT with oral contrast was back in 2010, so it may have changed in the last 6 years, and I'm not sure if different hospitals do different things. But anyway, here's my experience. I was given 3 huge glasses of lemonade with contrast mixed in. It tasted like chemical-y lemonade. That's the best way I can describe it. Like lemonade with maybe some floor cleaner mixed in. Lemonade with a very chemical taste to it. It definitely wasn't as bad as colonoscopy prep, but even so, it was hard to get it all down both because of the chemical taste and the sheer volume of liquid - I was given an hour to drink 3 huge glasses of the stuff. I could only drink a little over 2 glasses, any more than that and I was getting to the danger zone of potentially barfing. Still, that amount ended up being okay, they still did the scan and it was fine.

 

[MissLeopard83]

As far as what the oral contrast tastes like - my last CT with oral contrast was back in 2010, so it may have changed in the last 6 years, and I'm not sure if different hospitals do different things. But anyway, here's my experience. I was given 3 huge glasses of lemonade with contrast mixed in. It tasted like chemical-y lemonade. That's the best way I can describe it. Like lemonade with maybe some floor cleaner mixed in. Lemonade with a very chemical taste to it. It definitely wasn't as bad as colonoscopy prep, but even so, it was hard to get it all down both because of the chemical taste and the sheer volume of liquid - I was given an hour to drink 3 huge glasses of the stuff. I could only drink a little over 2 glasses, any more than that and I was getting to the danger zone of potentially barfing. Still, that amount ended up being okay, they still did the scan and it was fine.

Do you know if the solution was iodine or barium? According to the imaging center website, they use both, but it didn't specify for which test. I'm assuming iodine because that's what the IV contrast contains (also according to the website). It states that I have an hour to drink 1 liter of the oral contrast. I know I'm probably going to have a rough time getting it down since the colonoscopy prep was really difficult to drink due to the amount of liquid I had to drink (1/2 a gallon). Still, I'm glad my insurance approved the test and I have it scheduled for Friday.

 

[Cat-a-Tonic]

I'm honestly not sure, this was like 6 years ago and I don't remember if they told me what it was. It looked just like lemonade so the contrast was clear/colorless as far as I could tell. So that makes me think it probably wasn't iodine, but I honestly don't know for sure.

 

[MissLeopard83]

I'm honestly not sure, this was like 6 years ago and I don't remember if they told me what it was. It looked just like lemonade so the contrast was clear/colorless as far as I could tell. So that makes me think it probably wasn't iodine, but I honestly don't know for sure.

I just looked it up and it looks like the solution, called VoLumen, is a barium based contrast.

https://www.drugs.com/mtm/volumen-oral-and-rectal.html

 

[Cat-a-Tonic]

Yeah, that seems correct. I've had many UTIs over the years, and when I take those iodine-based tablets for symptom relief, I end up peeing a rusty orange color for a couple days. I don't remember any rusty pee after doing the oral contrast, so that also made me think it couldn't have been iodine. Barium seems correct.

 

[MissLeopard83]

My scan is scheduled this morning. I had to wake up early since the imaging center is all the way on the southside of town. I can't wait to get this over with and, hopefully, get some answers. My lower abdomen feels so bloated this morning and I want to go back to sleep.

 

[ronroush7]

I hope you get some answers and can get on the road to remission.

 

[MissLeopard83]

Just got done drinking the first bottle of Volumen. It tastes blueberry flavored. I have 2 more bottles to drink. It's already making me a little nauseous.

 

[ronroush7]

Sorry

 

[MissLeopard83]

Finished the bottles and I am seriously nauseous. I'm ready to get the scan over with.

 

[my little penguin]

Good luck
Ds drank his as well
Thankfully it stayed down

 

[MissLeopard83]

Mine stayed down, fortunately, but I didn't drink all of the 3rd bottle since my stomach was stretched to the max and I knew, if I drank the rest, it was going to come back up. Unfortunately, about 15 minutes later, the tech called me in for the CT and had me drink some in a cup, but she didn't force me to drink it all because of how nauseated I was. I tolerated the iodine IV contrast well with no side effects. The scan was about 15 minutes long. I hope to have the results next week since they have their own radiologist.

I do have to say, though, that I went to the bathroom right after drinking the third bottle and had a LOT of gas and what looked like stringy mucus attached to a very flat BM. It was nasty. I haven't had a BM since.

Anyway, when I got done, I decided to treat myself to lunch (I took the whole day off) and also went to my favorite allergen-free bakery since I rarely get a chance to go there so I stocked up. I started eating my sandwich when I got home and had some weird gurgling in my gut, so I stopped eating to make sure it wasn't going to cause diarrhea. It seems to have stopped, for the most part.

It's difficult to say because I know what it means, but I'm hoping that the scan I had today gives more answers. I don't necessarily want IBD, but I want a diagnosis that matches my symptoms more than IBS by itself.

 

[lgpcarter]

Any results yet?

 

[MissLeopard83]

Not yet, or at least they haven't uploaded them to my patient portal. If I don't hear anything by tomorrow, I'll call my GI doctor's office.

 

[MissLeopard83]

Does anyone here have any experience with a fluid-filled cyst not showing up on either ultrasound or CT? I'm still trying to figure out why my ovarian cyst was not reported on either of the findings for the scans. The only thing that the pathologist mentioned on the CT were two cysts in my kidneys but he noted they were small. The ovarian cyst was the size of a baseball/softball and had to be drained then the tissue was excised laparoscopically. I asked the doctor who performed the surgery and he said he thinks the cyst was leaking fluid to the surrounding tissue (which is probably why I ended up in the ER in August from right lower back pain). It's still mind-boggling how something so big could go unnoticed...

 

[Jabee]

Does anyone here have any experience with a fluid-filled cyst not showing up on either ultrasound or CT? I'm still trying to figure out why my ovarian cyst was not reported on either of the findings for the scans. The only thing that the pathologist mentioned on the CT were two cysts in my kidneys but he noted they were small. The ovarian cyst was the size of a baseball/softball and had to be drained then the tissue was excised laparoscopically. I asked the doctor who performed the surgery and he said he thinks the cyst was leaking fluid to the surrounding tissue (which is probably why I ended up in the ER in August from right lower back pain). It's still mind-boggling how something so big could go unnoticed...

This might be a good resource on the imaging side but not the interpretation side.

https://radiopaedia.org/articles/mature-cystic-ovarian-teratoma

It does seem wild that the radiologist missed seeing something that big, but I think different types of tissues show up differently on imaging studies, sometimes not at all. So there might be room for errors of this magnitude. After all, sometimes scans during pregnancy miss twins! And that also seems impossible.