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CT Imaging of Colitis¹

¹ From the Departments of Radiology (R.F.T.) and Medicine (J.P.C.), University of California San Francisco, 505 Parnassus Ave, PO Box 0628, San Francisco, CA 94143-0628; and Departments of Radiology (R.F.T.) and Medicine (J.P.C.), Division of Gastroenterology, San Francisco General Hospital, San Francisco, Calif. Received May 13, 2005; revision requested July 12; revision received July 26; accepted September 6; final version accepted October 4; final review and update by R.F.T. March 3, 2006. Address correspondence to R.F.T. (e-mail: Ruedi.Thoeni{at}radiology.ucsf.edu).

Computed tomography (CT) is widely used to assess patients with nonspecific abdominal pain or who are suspected of having colitis. The authors recommend multidetector CT with oral, rectal, and intravenous contrast material and thin sections, which can accurately demonstrate inflammatory changes in the colonic wall and help assess the extent of disease. In most cases, the final diagnosis of the type of colitis is based on clinical and laboratory data and colonoscopic and biopsy findings, but specific CT features help narrow the differential diagnosis. Ulcerative colitis is distinguished from granulomatous colitis (Crohn disease) in terms of location of involvement, extent and appearance of colonic wall thickening, and type of complications. Ulcerative colitis and Crohn disease (granulomatous colitis) are rarely associated with ascites, which is often seen in infectious, ischemic, and pseudomembranous colitis. Pseudomembranous colitis also demonstrates marked wall thickening and, occasionally, skip areas but is associated with broad-spectrum antibiotic treatment or chemotherapy. Neutropenic colitis is characterized by right-sided colonic and ileal involvement, whereas ischemic colitis is characterized by vascular distribution pattern and history. Diverticulitis is a focal asymmetric process with fascial thickening and inflamed diverticula. Dilatation of a thick-walled appendix with increased enhancement and adjacent stranding suggests appendicitis, but inflammatory changes may extend to the cecum and terminal ileum. Epiploic appendagitis is a focal rim-enhancing area next to the colon, usually without any substantial colonic wall thickening.

© RSNA, 2006

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