from a small-bowel series reveals the abnormal loop to be recurrent Crohn's disease in the neoterminal ileum proximal to an ileotransverse colostomy.

Sensitivity, specificity, accuracy, and positive and negative predictive values were all in excess of 90% in at least one study [97]. Results from evaluating postoperative patients have not been quite as accurate, with reported sensitivities from 78 to 82% and specificities ranging from 91 to 100%, respectively [98,99]. Findings included a bowel wall thickness exceeding 5 mm, luminal narrowing with a hyperdense rim, decreased compressibility of the wall, decreased peristalsis, and a gradual transition from normal to abnormal appearing bowel. All layers of the bowel wall were symmetrically thickened in patients with Crohn's disease, and this was a good differentiator of inflammatory bowel disease from neoplastic processes [99]. Mural stratification, similar to that described shortly for CT imaging, allows visualization of the mucosal, submucosal, and muscularis propria layers [100] (Fig. 5.27). When seen, mural stratification means that edema, not fibrosis, is still present and that the

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