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Masselli G, Guida M, Laghi F, Polettini E, Gualdi G. Magnetic Resonance of Small Bowel Tumors. Magn Reson Imaging Clin N Am 2019; 28:75-88. [PMID: 31753238 DOI: 10.1016/j.mric.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. Magnetic resonance (MR) imaging is rapidly increasing clinical acceptance to evaluate the small bowel and can be the initial imaging method to investigate small bowel diseases. MR examinations may provide the first opportunity to detect and characterize tumors of the small bowel. Intraluminal and extraluminal MR findings, combined with contrast enhancement and functional information, allow accurate diagnoses and consequently characterization of small bowel neoplasms. This article describes the MR findings of primary small bowel neoplasms and the MR findings for the differential diagnosis are discussed.
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Affiliation(s)
- Gabriele Masselli
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy.
| | - Marianna Guida
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesca Laghi
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Elisabetta Polettini
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Gianfranco Gualdi
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
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Gatti M, Allois L, Carisio A, Dianzani C, Garcia Martinez M, Ruggirello I, Varello S, Darvizeh F, Faletti R. Magnetic resonance enterography. MINERVA GASTROENTERO 2019; 65:319-334. [PMID: 31760740 DOI: 10.23736/s1121-421x.19.02639-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Crohn's disease is a condition of chronic inflammation that may involve any part of the gastrointestinal tract, although it more frequently affects the terminal ileum. Longstanding inflammation may lead to several bowel complications including obstruction, stricture, fistula and abscesses which often necessitate surgery. Cross-sectional imaging methods such as computed tomography and magnetic resonance imaging are being utilized more frequently to assess mural and extramural inflammatory bowel disease manifestations. Magnetic resonance enterography (MRE) for assessment of small bowel is optimal because of absence of ionizing radiation, better soft tissue contrast, development of motion-free sequences and high resolution images. A typical protocol includes pre and postcontrast sequences utilizing an enteric contrast agent for adequate bowel distention and an antiperistaltic agent. Overall, MRE allows the evaluation of disease activity, extraenteric complication and response to therapy with a great impact on patient management. In this review we discuss the features of MRE from patient's preparation and exam protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy -
| | - Luca Allois
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Andrea Carisio
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Chiara Dianzani
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Maria Garcia Martinez
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Irene Ruggirello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Sara Varello
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Fatemeh Darvizeh
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
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3
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Nisa K, Lim SY, Shinohara M, Osuga T, Yokoyama N, Tamura M, Nagata N, Sasaoka K, Dermlim A, Leela-Arporn R, Morita T, Sasaki N, Morishita K, Nakamura K, Ohta H, Takiguchi M. Evaluation of duodenal perfusion by contrast-enhanced ultrasonography in dogs with chronic inflammatory enteropathy and intestinal lymphoma. J Vet Intern Med 2019; 33:559-568. [PMID: 30784123 PMCID: PMC6430930 DOI: 10.1111/jvim.15432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background Contrast‐enhanced ultrasonography (CEUS) can be used to evaluate intestinal perfusion in healthy dogs. It is helpful for diagnosing and monitoring inflammatory bowel disease in humans and could be useful for dogs with chronic intestinal diseases. Objectives To examine duodenal perfusion in dogs with chronic inflammatory enteropathy (CIE) and intestinal lymphoma. Animals Client‐owned dogs with CIE (n = 26) or intestinal lymphoma (n = 7) and dogs with gastrointestinal signs but histopathologically normal duodenum (controls, n = 14). Methods In this cross‐sectional study, dogs with CIE were classified into remission (n = 16) and symptomatic (n = 10) groups based on clinical scores determined at the time of CEUS. The duodenum was scanned after IV injection of Sonazoid® (0.01 mL/kg). CEUS‐derived perfusion parameters, including time‐to‐peak, peak intensity (PI), area under the curve (AUC), and wash‐in and wash‐out rates were evaluated. Results The PI was significantly higher in the symptomatic CIE group (median (range); 105.4 (89.3‐128.8) MPV) than in the control group (89.9 (68.5‐112.2) MPV). The AUC was significantly higher in the symptomatic CIE group (4847.9 (3824.3‐8462.8) MPV.sec) than in the control (3448.9 (1559.5‐4736.9) MPV.sec) and remission CIE (3862.3 (2094.5‐6899.0) MPV.sec) groups. The PI and clinical score were positively correlated in the CIE group. No significant differences in perfusion parameters were detected between the lymphoma and CIE groups or the lymphoma and control groups. Conclusions and Clinical Importance The PI and AUC can detect duodenal inflammation and hence are potentially useful for excluding a diagnosis of CIE.
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Affiliation(s)
- Khoirun Nisa
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Sue Yee Lim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan.,Gastrointestinal Laboratory, Department of Small Animal Clinical Science, Texas A&M University, Texas
| | - Masayoshi Shinohara
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuyuki Osuga
- Veterinary Teaching Hospital, Graduate school of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Nozomu Yokoyama
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan.,Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Masahiro Tamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Noriyuki Nagata
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuyoshi Sasaoka
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Angkhana Dermlim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Rommaneeya Leela-Arporn
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Tomoya Morita
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Graduate school of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kensuke Nakamura
- Veterinary Teaching Hospital, Graduate school of Veterinary Medicine, Hokkaido University, Sapporo, Japan.,Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Ohta
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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Khatri G, Coleman J, Leyendecker JR. Magnetic Resonance Enterography for Inflammatory and Noninflammatory Conditions of the Small Bowel. Radiol Clin North Am 2018; 56:671-689. [PMID: 30119767 DOI: 10.1016/j.rcl.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Magnetic resonance enterography (MRE) is an effective noninvasive tool for evaluation of inflammatory and noninflammatory conditions of the small bowel. MRE allows for repeated evaluation of patients with Crohn disease without exposure to ionizing radiation, and can be used to assess disease status and direct management. MRE also allows evaluation of neoplastic and other nonneoplastic conditions of the small bowel. Adequate patient preparation and acquisition techniques are required for optimal image quality.
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Affiliation(s)
- Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jay Coleman
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - John R Leyendecker
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Gupta MK, Khatri G, Bailey A, Pinho DF, Costa D, Pedrosa I. Endoluminal contrast for abdomen and pelvis magnetic resonance imaging. Abdom Radiol (NY) 2016; 41:1378-98. [PMID: 26907710 DOI: 10.1007/s00261-016-0668-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance (MR) imaging of the abdomen and pelvis can be limited for assessment of different conditions when imaging inadequately distended hollow organs. Endoluminal contrast agents may provide improved anatomic definition and detection of subtle pathology in such scenarios. The available routes of administration for endoluminal contrast agents include oral, endorectal, endovaginal, intravesicular, and through non-physiologic accesses. Appropriate use of endoluminal contrast agents requires a thorough understanding of the clinical indications, available contrast agents, patient preparation, and interaction of the contrast agent with the desired MR imaging protocol. For example, biphasic oral enteric contrast agents are preferred in MR enterography as their signal properties on T1- and T2-weighted imaging allow for evaluation of both intraluminal and bowel wall pathology. In specific situations such as with MR enterography, MR defecography, and accurate local staging of certain pelvic tumors, the use of an endoluminal contrast agent is imperative in providing adequate diagnostic imaging. In other clinical scenarios, the use of an endoluminal contrast agent may serve as an indispensable problem-solving tool.
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Affiliation(s)
- Mohit K Gupta
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - April Bailey
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Daniella F Pinho
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Daniel Costa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Masselli G, Di Tola M, Casciani E, Polettini E, Laghi F, Monti R, Bernieri MG, Gualdi G. Diagnosis of Small-Bowel Diseases: Prospective Comparison of Multi-Detector Row CT Enterography with MR Enterography. Radiology 2015; 279:420-31. [PMID: 26599801 DOI: 10.1148/radiol.2015150263] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively compare the accuracies of computed tomographic (CT) enterography and magnetic resonance (MR) enterography for the detection and characterization of small-bowel diseases. MATERIALS AND METHODS The institutional review board approved the study protocol, and informed consent was obtained from all participants. From June 2009 to July 2013, 150 consecutive patients (81 men and 69 women; mean age, 38.8 years; range, 18-74 years), who were suspected of having a small-bowel disease on the basis of clinical findings and whose previous upper and lower gastrointestinal endoscopy findings were normal, underwent CT and MR enterography. Two independent readers reviewed CT and MR enterographic images for the presence of small-bowel diseases, for differentiating between inflammatory and noninflammatory diseases, and for extraenteric complications. The histopathologic findings of surgical (n = 23) and endoscopic (n = 32) biopsy specimens were used as the reference standard; the results of video-capsule endoscopy (n = 36) and clinical follow-up (n = 59) were used only to confirm the absence of small-bowel disease. RESULTS MR and CT enterography were successfully performed in all 150 patients. Overall sensitivity, specificity, and accuracy, respectively, in identifying patients with small-bowel lesions were 75.9% (41 of 54), 94.8% (91 of 96), and 88.0% (132 of 150) for CT enterography and 92.6% (50 of 54), 99.0% (95 of 96), and 96.7% (145 of 150) for MR enterography. The sensitivity of MR enterography was significantly higher than that of CT enterography for the detection of both overall small-bowel diseases (P = .0159) and neoplastic diseases (P = .0412) but not for the detection of inflammatory diseases (P > .99) or noninflammatory and nonneoplastic diseases (P = .6171). CONCLUSION MR enterography is more accurate than CT enterography in the detection of small-bowel diseases; MR enterography was more accurate in detecting neoplastic diseases in particular.
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Affiliation(s)
- Gabriele Masselli
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marco Di Tola
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Emanuele Casciani
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Elisabetta Polettini
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca Laghi
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Riccardo Monti
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Giulia Bernieri
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianfranco Gualdi
- From the Department of Radiology (G.M., E.C., E.P., F.L., R.M., G.G.), Department of Internal Medicine and Medical Specialities (M.D.T.), and Department of General and Special Surgery (M.G.B.), Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
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Obstructive small bowel metastasis from uterine leiomyosarcoma: a case report. Case Rep Obstet Gynecol 2014; 2014:603097. [PMID: 24716034 PMCID: PMC3970249 DOI: 10.1155/2014/603097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/15/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents.
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Masselli G, Polettini E, Laghi F, Monti R, Gualdi G. Noninflammatory conditions of the small bowel. Magn Reson Imaging Clin N Am 2013; 22:51-65. [PMID: 24238132 DOI: 10.1016/j.mric.2013.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Magnetic resonance (MR) imaging has been playing an evolving role in evaluating noninflammatory small-bowel conditions, such as tumors and malabsorption syndrome. MR imaging has shown to be superior to other diagnostic methods in identifying tumors of the small bowel. MR enterography and MR enteroclysis are both valid for studying noninflammatory conditions of the small intestine, although MR enteroclysis may be considered the modality of choice because of its accuracy in the diagnosis of small-bowel neoplasms. Intraluminal and extraluminal MR findings, combined with contrast-agent enhancement and functional information, help to make an accurate diagnosis and consequently to characterize small-bowel diseases.
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Affiliation(s)
- Gabriele Masselli
- Radiology Department, Umberto I hospital, Sapienza University, Via del Policlinico 155, Rome 00161, Italy.
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9
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Small Bowel Imaging: Clinical Applications of the Different Imaging Modalities—A Comprehensive Review. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/419542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the last years, MR and CT techniques have been optimized for small bowel imaging and are playing an increasing role in the evaluation of small bowel disorders. In comparison to traditional barium fluoroscopic examinations, spatial and temporal resolution is now much more improved partially thanks to modern bowel distending agents. However, there is a global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime. Owing to the excellent soft tissue contrast, direct multiplanar imaging capabilities, new ultrafast breath-holding pulse sequences, lack of ionizing radiation, and availability of a variety of oral contrast agents, MR is well suited to play a critical role in the imaging of small bowel disorders.
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Masselli G, Casciani E, Polettini E, Laghi F, Gualdi G. Magnetic resonance imaging of small bowel neoplasms. Cancer Imaging 2013; 13:92-9. [PMID: 23524074 PMCID: PMC3607252 DOI: 10.1102/1470-7330.2013.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Magnetic resonance (MR) imaging is rapidly increasing clinical acceptance to evaluate the small bowel and can be the initial imaging method to investigate small bowel diseases. MR examinations may provide the first opportunity to detect and characterize tumours of the small bowel. Intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel neoplasms. MR enteroclysis should be recommended for the initial investigation in patients suspected of having small bowel tumours. In this article, the MR findings of primary small bowel neoplasms are described and the MR findings for the differential diagnosis are discussed.
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Affiliation(s)
- Gabriele Masselli
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy.
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11
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Amzallag-Bellenger E, Oudjit A, Ruiz A, Cadiot G, Soyer PA, Hoeffel CC. Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease. Radiographics 2013; 32:1423-44. [PMID: 22977028 DOI: 10.1148/rg.325115088] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of cross-sectional imaging techniques for the noninvasive evaluation of small-bowel disorders is increasing. The effectiveness of magnetic resonance (MR) enterography for the evaluation of Crohn disease, in particular, is well described in the literature. In addition, MR enterography has an evolving though less well documented role to play in the evaluation of other small-bowel diseases, including various benign and malignant neoplasms arising in isolation or in polyposis syndromes such as Peutz-Jeghers, inflammatory conditions such as vasculitis and treatment-induced enteritis, infectious processes, celiac disease, diverticular disease, systemic sclerosis, and bowel duplication. MR enterography may be useful also for the evaluation of intermittent and low-grade small-bowel obstructions. Advantages of MR imaging over computed tomography (CT) for enterographic evaluations include superb contrast resolution, lack of associated exposure to ionizing radiation, ability to acquire multiplanar primary image datasets, ability to acquire sequential image series over a long acquisition time, multiphasic imaging capability, and use of intravenous contrast media with better safety profiles. MR enterography also allows dynamic evaluations of small-bowel peristalsis and distensibility of areas of luminal narrowing and intraluminal masses by repeating sequences at different intervals after administering an additional amount of the oral contrast medium. Limitations of MR enterography in comparison with CT include higher cost, less availability, more variable image quality, and lower spatial resolution. The advantages and disadvantages of MR enterography performed with ingestion of the oral contrast medium relative to MR enteroclysis performed with infusion of the oral contrast medium through a nasoenteric tube are less certain.
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Affiliation(s)
- Elisa Amzallag-Bellenger
- Department of Radiologic Imaging, Hôpital Robert Debré, Avenue du Général Koenig, 51092 Reims, France.
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12
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Abstract
Small-bowel radiology has undergone dramatic changes in the past 2 decades. Despite important recent advances in small-bowel endoscopy, radiologic imaging remains important for patients suspected of having or with established small-bowel disease. Cross-sectional imaging techniques (computed tomography and magnetic resonance [MR] imaging), used to investigate both extraluminal abnormalities and intraluminal changes, have gradually replaced barium contrast examinations, which are, however, still used to examine early mucosal disease. MR imaging techniques clearly highlight endoluminal, mural and extramural enteric details and provide vascular and functional information, thereby enhancing the diagnostic value of these techniques in small-bowel diseases. Two MR imaging based techniques are currently utilized: MR enteroclysis and MR enterography. In enteroclysis, enteric contrast material is administered through a nasoenteric tube, whereas in enterography, large volumes of enteric contrast material are administered orally. MR enteroclysis ensures consistently better luminal distention than does MR enterography in both the jejunum and the ileum and more accurately depicts endoluminal abnormalities and early disease, particularly at the level of the jejunal loops. Moreover, MR enteroclysis provides a high level of accuracy in the diagnosis and exclusion of small-bowel inflammatory and neoplastic diseases and can be used for the first radiologic evaluation, while MR enterography may effectively be used to follow up both Crohn disease patients without jejunal disease and in pediatric patients where nasogastric intubation might be a problem. MR enteroclysis may also reveal subtle transition points or an obstruction in the lower small bowel, which may escape detection when more routine methods, including enterography, are used. MR imaging offers detailed morphologic information and functional data of small-bowel diseases and provides reliable evidence of normalcy, thereby allowing the diagnosis of early or subtle structural abnormalities and guiding treatment and decisions in patient care.
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Affiliation(s)
- Gabriele Masselli
- Department of Radiology, Università di Roma Sapienza, Viale del Policlinico, Rome, Italy.
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13
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Soyer P, Boudiaf M, Fishman EK, Hoeffel C, Dray X, Manfredi R, Marteau P. Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives. Crit Rev Oncol Hematol 2010; 80:10-30. [PMID: 21035353 DOI: 10.1016/j.critrevonc.2010.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 12/13/2022] Open
Abstract
This article describes the recent advances in radiological imaging of malignant neoplasms of the mesenteric small bowel and provides an outline of new trends and perspectives that can be anticipated. The introduction of multidetector row technology, which allows the acquisition of submillimeter and isotropic voxels, has dramatically improved the capabilities of computed tomography in the investigation of the mesenteric small bowel. This technology combined with optimal filling of small bowel loops through the use of appropriate enteral contrast agents has markedly changed small bowel imaging. Computed tomography-enteroclysis, which is based on direct infusion of enteral contrast agent into the mesenteric small bowel through a naso-jejunal tube, provides optimal luminal distension. By contrast, computed tomography-enterography is based on oral administration of enteral contrast agent. These two techniques are now well-established ones for the detection and the characterization of small bowel neoplasms. During the same time, combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging has gained wide acceptance for the evaluation of patients with suspected small bowel neoplasms. Rapid magnetic resonance imaging sequences used in combination with specific enteral contrast agents generate superb images of the mesenteric small bowel so that magnetic resonance-enteroclysis and magnetic resonance-enterography are now considered as effective diagnostic tools for both the detection and the characterization of neoplasms of the mesenteric small bowel. Recent improvements in image post-processing capabilities help obtain realistic three-dimensional representations of tumors and virtual enteroscopic views of the small bowel that are useful for the surgeon and the gastroenteroenteologist to plan surgical or endoscopic interventions. Along with a better knowledge of the potential and limitations of wireless capsule endoscopy and new endoscopic techniques, these recent developments in radiological imaging reasonably suggest that substantial changes in the investigation of small bowel tumors may be anticipated in a near future, thus potentially create a new paradigm shift after standard small bowel follow-through study has been universally abandoned.
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Affiliation(s)
- Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP and Université Diderot-Paris, France.
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Malignant small-bowel neoplasms: spectrum of disease on MR imaging. Radiol Med 2010; 115:1279-91. [PMID: 20852962 DOI: 10.1007/s11547-010-0576-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 01/05/2010] [Indexed: 02/07/2023]
Abstract
Malignant neoplasms of the small bowel are among the rarest types of cancer, accounting for only 2% of all gastrointestinal neoplasms. Owing both to the intrinsic difficulty of common radiographic and endoscopic methods in visualising the entire small bowel and the lack of typical physical findings, a delay in diagnosis is common. Recently, magnetic resonance (MR) imaging has become a widely accepted imaging modality in the study of suspected small-bowel neoplasms due to its ability to depict, without exposure to ionising radiation and with excellent soft-tissue contrast, intraluminal disorders in conjunction with mural, extraparietal and regional abnormalities. The aim of this pictorial review is to illustrate the MR appearance of malignant small-bowel neoplasms.
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Böcker U, Dinter D, Litterer C, Hummel F, Knebel P, Franke A, Weiss C, Singer MV, Löhr JM. Comparison of magnetic resonance imaging and video capsule enteroscopy in diagnosing small-bowel pathology: localization-dependent diagnostic yield. Scand J Gastroenterol 2010; 45:490-500. [PMID: 20132082 DOI: 10.3109/00365520903567817] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE New technology has considerably advanced the diagnosis of small-bowel pathology. However, its significance in clinical algorithms has not yet been fully assessed. The aim of the present analysis was to compare the diagnostic utility and yield of video-capsule enteroscopy (VCE) to that of magnetic resonance imaging (MRI) in patients with suspected or established Crohn's disease (Group I), obscure gastrointestinal blood loss (Group II), or suspected tumors (Group III). MATERIAL AND METHODS Forty-six out of 182 patients who underwent both modalities were included: 21 in Group I, 20 in Group II, and five in Group III. Pathology was assessed in three predetermined sections of the small bowel (upper, middle, and lower). The McNemar and Wilcoxon tests were used for statistical analysis. RESULTS In Group I, lesions were found by VCE in nine of the 21 patients and by MRI in six. In five patients, both modalities showed pathology. In Group II, pathological changes were detected in 11 of the 20 patients by VCE and in eight patients by MRI. In five cases, pathology was found with both modalities. In Group III, neither modality showed small-bowel pathology. For the patient groups combined, diagnostic yield was 43% with VCE and 30% with MRI. The diagnostic yield of VCE was superior to that of MRI in the upper small bowel in both Groups I and II. CONCLUSION VCE is superior to MRI for the detection of lesions related to Crohn's disease or obscure gastrointestinal bleeding in the upper small bowel.
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Affiliation(s)
- Ulrich Böcker
- University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Masselli G, Polettini E, Casciani E, Bertini L, Vecchioli A, Gualdi G. Small-bowel neoplasms: prospective evaluation of MR enteroclysis. Radiology 2009; 251:743-50. [PMID: 19304922 DOI: 10.1148/radiol.2513081819] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively evaluate the accuracy of magnetic resonance (MR) enteroclysis in the detection of small-bowel neoplasms in symptomatic patients, with conventional endoscopy, tissue specimen, capsule endoscopy, conventional enteroclysis, and follow-up findings as reference standards. MATERIALS AND METHODS The study protocol was approved by the human research committee, and all patients gave written informed consent. One hundred fifty patients (83 male, 67 female; mean age, 42.6 years; age range, 17-84 years) who were clinically suspected of having small-bowel neoplasm and whose previous upper and lower gastrointestinal endoscopy findings were normal underwent MR enteroclysis. The MR enteroclysis findings were prospectively evaluated for the presence of focal bowel wall thickening, small-bowel masses, and small-bowel stenosis. Positive MR enteroclysis findings were compared with histopathologic examination results obtained after surgical (n = 19) or endoscopic (n = 2) procedures. Negative MR enteroclysis results were compared with the results of enteroscopy (n = 5), capsule endoscopy (n = 53), or conventional enteroclysis with subsequent clinical follow-up (n = 71). The diagnostic performance of MR enteroclysis was analyzed on a per-patient basis. RESULTS MR enteroclysis was successfully completed in all 150 patients and enabled correct detection of 19 small-bowel neoplasms, which were confirmed at histopathologic examination: three carcinoid neoplasms, two adenocarcinomas, two stromal tumors, five lymphomas, one angiomatous mass, three small-bowel metastases, one leiomyoma, one adenoma, and one lipoma. Overall sensitivity, specificity, and accuracy in identifying patients with small-bowel lesions were 86% (19 of 22), 98% (126 of 128), and 97% (145 of 150), respectively. Two MR enteroclysis examinations yielded false-positive findings, and three yielded false-negative findings. CONCLUSION MR enteroclysis is an accurate modality for detecting small-bowel neoplasms in symptomatic patients.
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Affiliation(s)
- Gabriele Masselli
- Department of Radiology, Umberto I Hospital, La Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy.
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Affiliation(s)
- Andrea Laghi
- Department of Radiological Sciences, Sapienza, University of Rome, Polo Pontino, ICOT Hospital, Latina, Italy.
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Schmid-Tannwald C, Zech C, Panteleon A, Sommer W, Auernhammer C, Herrmann K. Morphologisches Erscheinungsbild neuroendokriner Tumoren des Dünndarms im MR-Enteroklysma. Radiologe 2009; 49:242-5, 248-51. [DOI: 10.1007/s00117-008-1783-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Masselli G, Gualdi G. Evaluation of small bowel tumors: MR enteroclysis. ACTA ACUST UNITED AC 2008; 35:23-30. [PMID: 19096749 DOI: 10.1007/s00261-008-9490-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 11/13/2008] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) of the small bowel has become widely accepted at centers dedicated to the diagnosis and treatment of inflammatory bowel disease, due to the method's diagnostic efficacy. MR enteroclysis is an imaging modality that combines the advantages of enteroclysis and multiplanar MR and allows the detection and the manifestations of small bowel diseases wherever they are located (intraluminal, intramural, or extramural). Magnetic resonance enteroclysis (MRE) is an emerging technique used for the detection and evaluation of small bowel neoplasms. This article illustrates the imaging appearances of small bowel tumors on MRI and the usefulness of MR enteroclysis in the diagnosis and categorization of these tumors, also discussing the role of MRE in comparison with other diagnostic modalities.
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Affiliation(s)
- Gabriele Masselli
- Radiology Dea Department, Umberto I Hospital, University La Sapienza, Viale del Policlinico, Rome, 155-00161, Italy.
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21
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Abstract
Until recently, diagnosis and management of small-bowel tumors were delayed by the difficulty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques. An array of new methods has recently been developed, increasing the possibility of detecting these tumors at an earlier stage. Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ, since it is non-invasive and enables the entire small bowel to be visualized. High-quality images of the small-bowel mucosa may be captured and small and flat lesions recognized, without exposure to radiation. Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range, 1.6%-2.4%) and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding. The majority of tumors identified by CE are malignant; many were unsuspected and not found by other methods. However, it remains difficult to identify pathology and tumor type based on the lesion’s endoscopic appearance. Despite its limitations, CE provides crucial information leading in most cases to changes in subsequent patient management. Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push-and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms, ultimately resulting in a survival advantage and in cost savings, remains to be determined through carefully-designed studies.
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Zhu J, Xu JR, Gong HX, Zhou Y. Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications. World J Gastroenterol 2008; 14:3403-9. [PMID: 18528938 PMCID: PMC2716595 DOI: 10.3748/wjg.14.3403] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
High soft tissue contrast resolution, acquisition of multi-planar images and the possibility to obtain functional information make magnetic resonance an interesting imaging technique to evaluate the small bowel disease. The absence of ionizing radiation is an important feature of magnetic resonance imaging (MRI) examinations because inflammatory diseases such as Crohn’s disease (CD) are studied most frequently, which are prevalent among children and young adults. MRI, using modern equipment and a rigorous technical approach, can offer detailed morphologic information and functional data on the small bowel. This article discusses the MRI protocols for small bowel and the MR imaging findings of small bowel diseases, such as CD and small bowel neoplasms.
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Matsuki M, Inada Y, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Nishimura H, Iwamoto M, Hiramatsu M, Tanigawa N, Kurisu Y, Tsuji M. CT and MR features of sclerosing mesenteritis mimicking a mesenteric metastasis from the carcinoid tumor. RADIATION MEDICINE 2006; 24:220-3. [PMID: 16875311 DOI: 10.1007/s11604-005-1405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sclerosing mesenteritis is a rare and benign inflammatory entity characterized by fibrofatty thickening of the mesentery. To our knowledge, there are only a few reports on the features of sclerosing mesenteritis on magnetic resonance (MR) imaging and computed tomography (CT). In this present case, MR imaging demonstrated tissue characterization of fibrosis, and partial maximum intensity projection (MIP) and three-dimensional angiography images obtained using multislice CT clearly revealed the extent of the tumor and the vascular appearance affected by the mass. However, a mesenteric metastasis from the carcinoid tumor may show such imaging features. Therefore, when encountering such a case, we suggest that a tentative diagnosis of sclerosing mesenteritis be made, followed by a biopsy for intraoperative histopathologic analysis to avoid aggressive surgery.
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Affiliation(s)
- Mitsuru Matsuki
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
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Abstract
MR imaging, using modern equipment and a rigorous technical approach, can offer detailed morphologic information and functional data on the small bowel. The optimal study technique is debatable, although the oral administration of contrast material as a first-line approach is less expensive, faster, easier to perform, and better tolerated by patients. MR enteroclysis might be reserved for selected cases as a second-line study. The major clinical indication is the evaluation of patients who have suspected or known Crohn's disease. The absence of ionizing radiation, considering the young age of most of the patients and the frequency of the examinations, is an important advantage over other techniques (radiograph and CT enteroclysis).
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Affiliation(s)
- Andrea Laghi
- Department of Radiological Sciences, University of Rome La Sapienza, Polo Didattico Pontino - I.C.O.T., Latina, Via Franco Faggiana 34, 04100 Latina, Italy.
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Abstract
MR enteroclysis (MRE) is an emerging technique for the evaluation of small intestinal diseases. Administration of an iso-osmotic water solution through a nasojejunal catheter can guarantee adequate luminal distention, and in combination with ultrafast sequences, such as single shot TSE, true FISP, HASTE and 3D FLASH, results in excellent anatomic demonstration of the small intestine. MR fluoroscopy can be performed during MRE examination to monitor the filling process and might be useful in studying low-grade stenosis or motility related disorders. MRE is a very promising technique for the detection and characterization of involved small bowel segments in patients with Crohn's disease while its diagnostic performance in disclosing lumen narrowing and extramural manifestations and complications of the disease is outstanding. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction.
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Affiliation(s)
- Nicholas C Gourtsoyiannis
- Department of Radiology, University Hospital of Iraklion, University of Crete Medical School, P.O. Box 1352, 711 10 Iraklion Crete, Greece.
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Abstract
Neuroendocrine tumors (NETs) constitute a heterogeneous group of neoplasms that originate from endocrine glands such as the pituitary, the parathyroids, and the (neuroendocrine) adrenal, as well as endocrine islets within glandular tissue (thyroid or pancreatic) and cells dispersed between exocrine cells, such as endocrine cells of the digestive (gastroenteropancreatic) and respiratory tracts. Conventionally, NETs may present with a wide variety of functional or nonfunctional endocrine syndromes and may be familial and have other associated tumors. Assessment of specific or general tumor markers offers high sensitivity in establishing the diagnosis and can also have prognostic significance. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogs and metaiodobenzylguanidine. Successful treatment of disseminated NETs requires a multimodal approach; radical tumor surgery may be curative but is rarely possible. Well-differentiated and slow-growing gastroenteropancreatic tumors should be treated with somatostatin analogs or alpha-interferon, with chemotherapy being reserved for poorly differentiated and progressive tumors. Therapy with radionuclides may be used for tumors exhibiting uptake to a diagnostic scan, either after surgery to eradicate microscopic residual disease or later if conventional treatment or biotherapy fails. Maintenance of the quality of life should be a priority, particularly because patients with disseminated disease may experience prolonged survival.
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Affiliation(s)
- Gregory A Kaltsas
- Department of Endocrinology, St Bartholomew's Hospital, London EC1A 7BE, United Kingdom
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Abstract
The role of radiologic studies has been well established in the diagnosis and management of patients with small bowel diseases. While small bowel follow-through examination or enteroclysis is widely accepted as the primary imaging method for small bowel investigation, additional cross-sectional imaging studies are often required for an accurate diagnosis and the precise evaluation of the extraluminal disease. Since fast magnetic resonance imaging (MRI) sequences have become available, there is increasing interest in the use of MRI for small bowel evaluation, attributed to its inherent advantages such as the lack of radiation exposure, excellent soft tissue contrast, and direct multiplanar capabilities. In this article, we review the current techniques, clinical applications, and limitations of MRI for the evaluation of patients with small bowel diseases.
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Affiliation(s)
- Kyoung Won Kim
- Department of Radiology, University of Ulsan-Asan Medical Center, 388-1, Pungnap-dong, Songpa-ku, Seoul 138-736, Korea
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Masselli G, Brizi MG, Restaino G, Vecchioli A. MR Enteroclysis in Solitary Ileal Metastasis from Renal Cell Carcinoma. AJR Am J Roentgenol 2004; 182:828-9. [PMID: 14976000 DOI: 10.2214/ajr.182.3.1820828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G Masselli
- Agostino Gemelli Hospital, Rome 00168, Italy
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31
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Maccioni F, Almberger M, Bruni A, Parlanti S, Marini M. Magnetic resonance imaging of an ileal carcinoid tumor. Clin Imaging 2003; 27:403-7. [PMID: 14585569 DOI: 10.1016/s0899-7071(03)00004-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The authors report the case of an advanced carcinoid tumor located in the distal ileum studied with CT, US and MRI. The lesion was deeply invasive and associated with liver metastases and peritoneal spreading. Imaging findings obtained with the different modalities have been reported, compared and discussed. MRI may play a role in the diagnosis and staging of carcinoid tumors, although CT still remains the investigation of choice.
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Affiliation(s)
- Francesca Maccioni
- Department of Radiology, University La Sapienza Rome, Viale Regina Elena 324, 00161 Rome, Italy.
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32
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Abstract
MR enteroclysis provides adequate image quality and sufficient distention of the entire small bowel. The functional information provided by MR enteroclysis equals that provided by conventional enteroclysis, which implies the ability reliably to depict even low-grade SBO. The inherent advantages of enteroclysis over conventional enteroclysis are the potential to detect extraluminal pathologic conditions and the ability to provide detailed information about the wall of the small bowel and the entire abdomen. Unlike conventional enteroclysis, MR enteroclysis does not have problems with overlapping bowel loops. MR enteroclysis has the potential to be an excellent diagnostic method for examinations of small bowel disease because of the functional information, the soft tissue contrast, and multiplanar imaging capabilities.
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Affiliation(s)
- Heinz Werner Umschaden
- Department of Radiology, General Hospital Wolfsberg, Paul Hackhoferstrasse 9, 9400 Wolfsberg, Austria.
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Papanikolaou N, Prassopoulos P, Grammatikakis I, Maris T, Gourtsoyiannis NC. Technical challenges and clinical applications of magnetic resonance enteroclysis. Top Magn Reson Imaging 2002; 13:397-408. [PMID: 12478020 DOI: 10.1097/00002142-200212000-00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
With the advent of gradient systems the image quality of ultrafast pulse sequences, i.e., half Fourier acquisition single shot turbo spin echo (HASTE), true fast imaging with steady-state processing and fast low angle shot (FLASH), improved substantially and clinical applications including small bowel imaging became feasible. Within this context, magnetic resonance enteroclysis was developed as a comprehensive examination of the small bowel, providing luminal, transmural, and exoenteric diagnostic information of small bowel abnormalities. Clinical applications of magnetic resonance enteroclysis include diagnostic evaluation and follow-up of patients with inflammatory or neoplastic diseases and small bowel obstruction.
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Affiliation(s)
- Nickolas Papanikolaou
- Department of Radiology, University Hospital of Iraklion, University of Crete Medical School, Greece.
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Bader TR, Semelka RC, Chiu VC, Armao DM, Woosley JT. MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver. J Magn Reson Imaging 2001; 14:261-9. [PMID: 11536403 DOI: 10.1002/jmri.1182] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate the spectrum of appearances of gastrointestinal carcinoid tumors at magnetic resonance imaging (MRI) and to elucidate patterns of appearances of carcinoid liver metastases on precontrast and postgadolinium images. The MR examinations of 29 patients (11 men, 18 women; age range, 33-87 years) with histologically confirmed gastrointestinal carcinoid tumors, representing our complete 9.5 years of experience with this entity, were retrospectively reviewed. Twelve patients had MR examinations prior to resection or biopsy of the primary tumor (preoperative group); 17 patients were imaged postsurgically (postoperative group). All MR studies were performed at 1.5 T and comprised T1-weighted spoiled gradient echo (SGE), T2-weighted fat-suppressed turbo spin echo, HASTE, and serial postgadolinium T1-weighted SGE sequences without and with fat suppression. Morphology, signal intensity, and contrast enhancement of primary tumors and of metastases to the mesentery, peritoneum, and liver were evaluated. Primary tumors were visualized in 8 of 12 patients and best demonstrated on postgadolinium T1-weighted fat-suppressed images. The appearance of primary tumors was a nodular mass originating from the bowel wall (4 of 12 patients) or regional uniform bowel wall thickening (4 of 12 patients) with moderate intense enhancement on postgadolinium images. In 4 of 12 patients the primary tumor was prospectively not seen. Mesenteric metastases, seen in eight patients, presented as nodular masses and were associated with mesenteric stranding in seven patients. A total of 156 liver metastases were evaluated in 16 patients. On precontrast T1- and T2-weighted images, 117 metastases (75%) were hypointense and hyperintense, respectively. A total of 146 metastases (94%) were hypervascular, showing moderate intense enhancement during the hepatic arterial phase, and 9 metastases (6%) were hypovascular. Twenty-three metastases (15%) were visible only on immediate postgadolinium images. MRI is able to demonstrate findings in carcinoid tumors, including the primary tumor, mesenteric metastases, and liver metastases. Liver metastases are commonly hypervascular and may be demonstrable only on immediate postgadolinium images.
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Affiliation(s)
- T R Bader
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7510, USA
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Ricke J, Klose KJ, Mignon M, Oberg K, Wiedenmann B. Standardisation of imaging in neuroendocrine tumours: results of a European delphi process. Eur J Radiol 2001; 37:8-17. [PMID: 11274833 DOI: 10.1016/s0720-048x(00)00187-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In 1998 and 1999, a delphi consensus procedure was performed to establish guidelines for standardised diagnostic imaging of neuroendocrine tumours. The procedure included four consecutive workshops of a European group of experts in neuroendocrine tumours as well as feedback given by specialists from the departments of radiology, nuclear medicine, surgery and internal medicine of the according home institutions. Diverging approaches among the centres, which became apparent during the discussion, reflect a lack of controlled studies specifically for rare subgroups of neuroendocrine tumours. This paper summarises the standards for diagnostic imaging as developed during the delphi process. In particular, the diagnostic workflows as well as the technical properties of different imaging modalities are described in detail.
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Affiliation(s)
- J Ricke
- Department of Radiology, Charité Campus Virchow-Klinikum, Medical Faculty, Humboldt University, Berlin, Germany.
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Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Maris T, Prassopoulos P. MR imaging of the small bowel with a true-FISP sequence after enteroclysis with water solution. Invest Radiol 2000; 35:707-11. [PMID: 11204796 DOI: 10.1097/00004424-200012000-00003] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate a novel MR enteroclysis technique for small-bowel imaging. METHODS Twenty-one patients with suspected small-bowel disease underwent both MR and conventional enteroclysis. MR enteroclysis was performed by injecting an iso-osmotic water solution through a nasojejunal catheter with a flow rate of 80 to 150 mL/min. A maximum of 2 L of water solution was administered. A dynamic heavily T2-weighted single-shot turbo spin-echo sequence was applied in coronal orientation to monitor the bowel filling and adequate distention. Twelve 4-mm-thick slices were acquired by using a true fast imaging with steady-state precession (true-FISP) sequence during an 18-second breath-hold interval. Small-bowel distention, wall conspicuity, homogeneity of opacification, and the presence of artifacts were subjectively evaluated by two reviewers using five-point scales. RESULTS Chemical shift artifacts were low and ghost artifacts were absent. Susceptibility artifacts were more prominent in the ileum; motion artifacts were low in the jejunum, ileum, and ileocecal area. Homogeneity of opacification was very good in the jejunum, good to very good in the ileum, and good in the ileocecal area. Distention was very good to excellent in the jejunum and ileum and very good in the ileocecal area. Wall conspicuity was very good to excellent in the jejunum and ileum. CONCLUSIONS MR enteroclysis with the true-FISP sequence produced high-quality images of the small bowel. Further clinical studies are required to determine the clinical efficacy of the new technique compared with conventional enteroclysis.
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Affiliation(s)
- N Gourtsoyiannis
- Department of Radiology, University Hospital of Heraklion, Crete, Greece.
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Chung JJ, Semelka RC, Martin DR, Marcos HB. Colon diseases: MR evaluation using combined T2-weighted single-shot echo train spin-echo and gadolinium-enhanced spoiled gradient-echo sequences. J Magn Reson Imaging 2000; 12:297-305. [PMID: 10931593 DOI: 10.1002/1522-2586(200008)12:2<297::aid-jmri12>3.0.co;2-q] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study demonstrates the appearance of large bowel diseases on magnetic resonance (MR) images using breath-hold T2-weighted half-Fourier acquisition snapshot turbo spin-echo (HASTE), breath-hold T1-weighted spoiled gradient-echo (SGE), and breath-hold gadolinium-enhanced T1-weighted SGE with and without fat-suppression sequences. The study represents a collective experience using a generalized combined abdominal-pelvic imaging protocol. Of 29 patients, 27 had surgical, endoscopic, microbiological, and/or histopathological correlation, and 2 had a diagnosis based on characteristic imaging findings. Fifteen patients had neoplastic disease including colon adenocarcinoma (n = 11), rectosigmoid carcinoid (n = 1), familial adenomatous polyposis (n = 2), and cecal lipoma (n = 1). Fourteen patients had non-neoplastic disease including diverticulosis (n = 6), ischemic colitis (n = 2), pseudomembranous colitis (n = 2), acute appendicitis with periappendiceal abscess (n = 2), Mycobacterium avium intracellulare (MAI) colitis (n = 1), and Crohn's proctocolitis (n = 1). In all 15 patients with neoplastic diseases, MR imaging depicted the primary lesions and demonstrated local extent. Mass lesions were best shown on T2-weighted HASTE and gadolinium-enhanced fat-suppressed SGE images. Of 14 patients with non-neoplastic diseases, inflammatory changes were best shown on gadolinium-enhanced fat-suppressed T1-weighted SGE images in all cases. MR imaging with fast scanning breath-hold techniques and intravenous gadolinium enhancement provided good depiction and characterization of large bowel diseases.
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Affiliation(s)
- J J Chung
- Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA
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Umschaden HW, Szolar D, Gasser J, Umschaden M, Haselbach H. Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology 2000; 215:717-25. [PMID: 10831690 DOI: 10.1148/radiology.215.3.r00jn12717] [Citation(s) in RCA: 220] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate if magnetic resonance (MR) enteroclysis can be performed routinely and to compare MR enteroclysis findings with those of conventional enteroclysis or surgery. MATERIALS AND METHODS MR enteroclysis was prospectively performed in 30 patients with symptoms of inflammatory bowel disease or small-bowel obstruction (SBO). A methylcellulose-water solution was used to distend the small bowel. To monitor dynamic changes in the small bowel, a single-shot fast spin-echo T2-weighted sequence was applied. For morphologic assessment, breath-hold T2-weighted fast spin-echo and coronal T1-weighted gradient-recalled-echo MR images were obtained without and with gadolinium enhancement. Image quality and degree of small-bowel distention were graded. MR imaging findings and degree of SBO were compared with findings at conventional enteroclysis (n = 25) or surgery (n = 5). RESULTS MR enteroclysis was well tolerated and provided adequate image quality and sufficient small-bowel distention. SBO grade based on MR enteroclysis images (n = 10) was identical to that based on conventional enteroclysis images (n = 6) or surgical findings (n = 4). There was exact agreement between MR enteroclysis and retrospective findings in all five patients who underwent surgery, and MR findings were identical to those at enteroclysis in 18 patients, superior in six patients, and inferior in one patient. CONCLUSION MR enteroclysis can be performed routinely with adequate image quality and sufficient small-bowel distention. The functional information provided by MR enteroclysis is identical to that provided at conventional enteroclysis.
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Affiliation(s)
- H W Umschaden
- Department of Radiology, General Hospital Klagenfurt, Austria.
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Boudghène F. [Magnetic resonance imaging in abdominal pathology]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1999; 124:187-200. [PMID: 10349758 DOI: 10.1016/s0001-4001(99)80064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Boudghène
- Service de radiologie, hôpital Tenon, Paris, France
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Abstract
Carcinoid tumours are often indolent asymptomatic tumours. However, a small but significant proportion are malignant and difficult to manage. Multiple endocrine neoplasia type 1 (MEN-1) may be associated with carcinoid tumours and should therefore be considered in the investigation of these patients. This review puts into context the use of newer imaging modalities, including octreotide scintigraphy. The therapeutic treatment options are discussed, including the use of octreotide, the role of receptor-targeted therapy, hepatic-artery embolisation, and the arguments against chemotherapy. We review the need for careful patient selection when considering curative and palliative surgery, including liver transplantation. We conclude that there are now better diagnostic tools and therapeutic options available for those patients with malignant carcinoid tumours, and that these patients are best managed by a multidisciplinary approach. Earlier detection and treatment of these tumours should lead to improved quality of life and survival, which, ideally, should be assessed in formal trials.
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Affiliation(s)
- M E Caplin
- Neuroendocrine Tumour Group and Clinic, Royal Free Hospital, London, UK.
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Ha HK, Lee EH, Lim CH, Shin YM, Jeong YK, Yoon KH, Lee MG, Min YI, Auh YH. Application of MRI for small intestinal diseases. J Magn Reson Imaging 1998; 8:375-83. [PMID: 9562064 DOI: 10.1002/jmri.1880080217] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Until recently, MRI has not been considered to be suitable for the evaluation of the small intestine due to artifacts associated with bowel peristalsis or respiration. However, recent advances of MR techniques enable the acquisition of clear images of the small intestine. Therefore, the purpose of this article is to review the details for the application of MRI in patients with small intestinal diseases. This article discusses bowel preparation and oral contrast agents as well as MR techniques and pulse sequences. Thereafter, the usefulness of MRI for the lesions in the peritoneal cavity or in the gastrointestinal tract are discussed. Small intestinal lesions are categorized into inflammatory, neoplastic, ischemic, and obstructive bowel diseases. In conclusion, MRI can be used as an alternate modality of choice for imaging various diseases of the small intestine.
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Affiliation(s)
- H K Ha
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Marcos HB, Semelka RC, Worawattanakul S. Adult intussusception: demonstration by current MR techniques. Magn Reson Imaging 1997; 15:1095-8. [PMID: 9364957 DOI: 10.1016/s0730-725x(97)00157-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe magnetic resonance findings in three patients with small bowel intussusception from different etiologies including idiopathic, adenomatous polyps, and hamartomatous polyps. Magnetic resonance findings showed a bowel-within-bowel appearance in two patients and a coiled-spring appearance in one patient. These findings were best shown on T2-weighted images, and clear definition was present on breathing independent T2-weighted images using half fourier acquisition snap shot turbo spin echo T2-weighted images.
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Affiliation(s)
- H B Marcos
- Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA
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