Positive contrast agents may limit the ability to view the soft tissue of the bowel.

Water transits very rapidly and may limit bowel distention and soft tissue differentiation.

Permits bowel wall visualization

Helps delineate between intra-lumen, and soft tissue of the bowel wall

Can be used in conjunction with IV contrast

Does not cause artifacts and streaking during volumetric imaging

Does not mask pathology

Does not obscure vasculature and surrounding organs

Figure 1. Crohn’s involving two distinct sites. CT Enterography (CTE) 3D volume-rendered view of an abnormal segment of jejunum in the left upper quadrant demonstrating wall thickening, luminal narrowing and increased vascularity of the bowel wall and surrounding fat. A second site of Crohn’s involvement was identified in the terminal ileum, although this inflammation appeared milder than the jejunal disease. Colonoscopy confirmed ileal disease but could not assess the jejunal disease that was well depicted by CTE with VoLumen oral contrast.

Figure 2. Clip plane editing in 3D can cut away superimposed bowel structures providing an unencumbered view of the pancreatic lesion infiltrating the body of the gland (blue arrow). VoLumen LHV oral prep helped reveal the obstructed pancreatic duct (red arrow).

Figure 3. CTE of a 32-year-old male, post resection of the distal ileum and right colon with an ileo-transverse colostomy. As the red arrows in both images indicate, VoLumen helped reveal recurrent inflammatory changes proximal to the anastamosis.

Figure 4. Ulcerative colitis with backwash ileitis and pseudo-polyp. 25-year-old male presented with diarrhea and diagnosis of ulcerative colitis. VoLumen helped reveal mild wall thickening in the colon, indicated by the blue arrows, as well as a patulous ileocecal valve. Thickening in the terminal ileum, indicated by the red arrow, is secondary to backwash ileitis. A hyper-enhancing nodule which is a pseudo-polyp was found in the ascending colon, as noted by the orange arrow.

Figure 5. Magnified view of distal ileum in patient with Crohn’s. Note the intense enhancement of the distal bowel wall with IV contrast against the VoLumen low-density contrast within the distended ileum. There is stricturing as the ileum traverses the ileocecal valve (arrows).

Figure 6. 3D volume-rendered view of ileovesicular fistula (arrow).

Figure 7a. Axial contrast-enhanced CT image from a PET/CT image showing an enhancing asymmetrical polypoidal thickening of the wall of the antrum causing gastric outlet obstruction. VoLumen LHV oral contrast helped easily demonstrate this condition.

Figure 7b. Coronal fused PET/CT image demonstrating increased FDG activity in the asymmetrical polypoidal thickening of the wall of the antrum. VoLumen helped in the correlation of PET and CT images, and its low density eliminates potential PET attenuation correction artifacts.