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Del Toro C, Cabrera-Aguirre A, Casillas J, Ivanovic A, Scortegagna E, Estanga I, Alessandrino F. Imaging spectrum of non-neoplastic and neoplastic conditions of the duodenum: a pictorial review. Abdom Radiol (NY) 2023; 48:2237-2257. [PMID: 37099183 DOI: 10.1007/s00261-023-03909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/27/2023]
Abstract
Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide spectrum of abnormalities. Computed tomography and magnetic resonance imaging, in conjunction with endoscopy, are often performed to evaluate these conditions, and several duodenal pathologies can be identified on fluoroscopic studies. Since many conditions affecting this organ are asymptomatic, the role of imaging cannot be overemphasized. In this article we will review the imaging features of many conditions affecting the duodenum, focusing on cross-sectional imaging studies, including congenital malformations, such as annular pancreas and intestinal malrotation; vascular pathologies, such as superior mesenteric artery syndrome; inflammatory and infectious conditions; trauma; neoplasms and iatrogenic complications. Because of the complexity of the duodenum, familiarity with the duodenal anatomy and physiology as well as the imaging features of the plethora of conditions affecting this organ is crucial to differentiate those conditions that could be managed medically from the ones that require intervention.
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Affiliation(s)
| | | | - Javier Casillas
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA
| | - Aleksandar Ivanovic
- Department of Diagnostic Imaging, Faculty of Medicine, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Indira Estanga
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA
| | - Francesco Alessandrino
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA.
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Gong JW, Zhang Z, Luo TY, Huang XT, Huo JW, He XQ, Li Q. Development and validation of a CT algorithm for the identification of nonperforated duodenal bulb ulcer. Eur J Radiol 2023; 162:110761. [PMID: 36917926 DOI: 10.1016/j.ejrad.2023.110761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/18/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To assess the value of multiplanar computed tomography (CT) in the diagnosis of nonperforated duodenal bulb ulcer (NPDBU). METHOD We retrospectively analyzed data from 135 patients with NPDBU (ulcer group) and 150 patients with a normal duodenal bulb (control group) who underwent contrast-enhanced abdominal CT and were diagnosed via upper endoscopy from January 2018 to February 2022. The clinical and CT features were compared between the two groups. Independent prognostic factors for diagnosing NPDBU were determined using binary logistic regression analysis. An external validation cohort to determine the model's efficiency comprised 80 patients from another center. RESULTS Gastrointestinal bleeding was more frequent in patients with NPDBU than in those without (p < 0.001). No significant differences in age and sex were observed between the groups (all p > 0.05). The duodenal bulbar wall was significantly thicker in the ulcer group than in the control group, as determined using CT (p < 0.001). Irregular mucosal surface, layered enhancement, and blurred fat space around the duodenal bulb were more common in the ulcer group than in the control group (all p < 0.001). Binary logistic regression analysis revealed that gastrointestinal bleeding, wall thickness of ≥ 4.85 mm, irregular mucosal surface, and blurred peripheral fat space were the most significant variations associated with NPDBU, with an area under the curve (AUC) of 0.974. The external validation cohort had an AUC of 0.916. CONCLUSIONS Careful multiplanar CT interpretation suggests the underlying presence of NPDBU and allows timely endoscopic verification and appropriate treatment.
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Affiliation(s)
- Jun-Wei Gong
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Zhu Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Tian-You Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Xing-Tao Huang
- Department of Radiology, The Fifth People's Hospital of Chongqing, Chongqing 400062, China.
| | - Ji-Wen Huo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Xiao-Qun He
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy. Gastroenterol Res Pract 2022; 2022:1381299. [PMID: 35935715 PMCID: PMC9348967 DOI: 10.1155/2022/1381299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Using conventional esophagogastroduodenoscopy (EGD) to evaluate the infrapapillary area is not feasible. The use of sedative EGD may enable endoscopists to investigate the infrapapillary condition of the duodenum. In this study, we aimed to evaluate lesions in the infrapapillary regions by using sedative EGD. Methods In this retrospective observational study, we used the data of patients who underwent sedative EGD examinations at a tertiary hospital in southern Taiwan. The endoscopists evaluated the esophagus, stomach, and proximal duodenum and then attempted to explore the infrapapillary portion of the duodenum as deeply as possible. We assessed the success rate for the exploration of infrapapillary areas. Furthermore, we analyzed specific clinical findings of sedative EGD examination. Results In total, 2973 patients underwent sedative EGD between November 1, 2010, and December 31, 2011. For 2632 of these patients, it was their first sedative EGD examination. In 2511 patients (95.4%), the exploration of the infrapapillary areas was successful. In approximately 10% of the patients, specific findings were detected over the infrapapillary region, and 7 of these patients exhibited clinically significant findings (i.e., gallbladder cancer with metastasis, periampullary Vater adenoma, natural killer cell enteropathy, villous adenoma with moderate dysplasia, infrapapillary duodenal adenoma with dysplasia, duodenal perforation with tumor-like formation, and follicular lymphoma). No patient experienced minor or major adverse reactions during the sedative EGD procedure. Conclusions The current study provided evidence that sedative EGD examination enables a safe, comfortable, and effective endoscopic examination of deeper sections of the duodenum to evaluate the papillary and infrapapillary regions.
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Duanmu J, Liang Y, Huang Z, Tan Y, Li T, Lei X. Cavernous haemangioma of the duodenum with acute massive bleeding in the ascending portion: a case report. J Int Med Res 2021; 49:3000605211010091. [PMID: 34590919 PMCID: PMC8489767 DOI: 10.1177/03000605211010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a 50-year-old male patient who presented with severe, ongoing haematochezia. A peripheral blood smear at the time of admission showed significant anaemia, and haemoglobin level was 52 g/l (normal range, 120–175 g/l). Albumin level was also low at 28 g/l (normal range, 40–55 g/l). Standard computed tomography (CT) showed mural thickening and relative lumen stenosis in the ascending (fourth) portion of the duodenum. Contrast-enhanced CT using hypotonic solution revealed the lesions to be hypervascular haemangiomas. Laparotomy and segmental duodenum resection were performed, and the first jejunal limb was anastomosed using a side-to-end technique. Histopathological examination confirmed the diagnosis of cavernous haemangioma. The patient showed marked improvement during follow-up. The present case findings emphasize that duodenal haemangioma is possible without a history of chronic anaemia, and should remain a consideration in differential diagnosis for patients presenting with massive GI bleeding. CT is useful for preoperative diagnosis of massive bleeding, and surgery with segmental resection is usually curative.
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Affiliation(s)
- Jinzhong Duanmu
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yahang Liang
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhixiang Huang
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yongming Tan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Taiyuan Li
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Gastrointestinal Surgery Institute, Nanchang University, Nanchang, Jiangxi, China
| | - Xiong Lei
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Gastrointestinal Surgery Institute, Nanchang University, Nanchang, Jiangxi, China
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Gosangi B, Rocha TC, Duran-Mendicuti A. Imaging Spectrum of Duodenal Emergencies. Radiographics 2021; 40:1441-1457. [PMID: 32870765 DOI: 10.1148/rg.2020200045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The duodenum, the first portion of the small bowel, is divided into four segments and extends to both retro- and intraperitoneal spaces. Some conditions arise primarily from the duodenum, but it can be secondarily affected by processes that involve neighboring structures. When duodenal emergencies are not identified and treated promptly, they may result in high morbidity and mortality. Imaging plays an important role in the diagnosis of duodenal conditions in the acute setting. However, the radiologic findings can be subtle, and awareness of relevant patient history and clinical presentation is important as it may increase the index of suspicion and one's ability to diagnose these conditions. Duodenal peptic disease is common and can be complicated by bleeding and perforation. The duodenum can be secondarily involved by pancreatitis and gallbladder pathologic conditions and may be affected by iatrogenic complications following endoscopic procedures. Traumatic injuries to the duodenum are generally uncommon, with penetrating traumatic injury being the most frequent mechanism of injury. Duodenal vascular pathologic conditions such as aortoduodenal fistula are uncommon but can be life threatening. The knowledge of which pathologic condition can involve which duodenal segment can help the radiologist establish a differential diagnosis and achieve a more targeted imaging approach. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Babina Gosangi
- From the Department of Radiology, Divison of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Tatiana C Rocha
- From the Department of Radiology, Divison of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Alejandra Duran-Mendicuti
- From the Department of Radiology, Divison of Emergency Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Domenech-Ximenos B, Juanpere S, Serra I, Codina J, Maroto A. Duodenal tumors on cross-sectional imaging with emphasis on multidetector computed tomography: a pictorial review. ACTA ACUST UNITED AC 2021; 26:193-199. [PMID: 32209505 DOI: 10.5152/dir.2019.19241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Duodenal tumours are uncommon, but they can cause significant morbidity and mortality. As stomach and colon are a more common site of gastrointestinal malignancies, radiologists sometimes neglect the duodenum. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can accurately locate and characterize mass-forming duodenal lesions, making them invaluable for the differential diagnosis and determining management strategies such as biopsy or surgery. Although conventional endoscopy continues to play an important role in the diagnosis of duodenal tumors, MDCT and MRI are very useful for evaluating the duodenal wall, extraduodenal space, and surrounding viscera, as well as the intraluminal content seen on endoscopy. This pictorial review aims to illustrate the most common benign and malignant mass-forming duodenal lesions and to focus on the imaging features that are most helpful in reaching the correct diagnosis.
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Affiliation(s)
- Blanca Domenech-Ximenos
- Department of Diagnostic Imaging Institute and Girona Biomedical Research Institute, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Sergi Juanpere
- Department of Diagnostic Imaging Institute and Girona Biomedical Research Institute, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Isabel Serra
- Department of Gastroenterology. Dr. Josep Trueta University Hospital, Girona, Spain
| | - Jaume Codina
- Department of Diagnostic Imaging Institute and Girona Biomedical Research Institute, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Albert Maroto
- Department of Diagnostic Imaging Institute and Girona Biomedical Research Institute, Dr. Josep Trueta University Hospital, Girona, Spain
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Juanpere S, Valls L, Serra I, Osorio M, Gelabert A, Maroto A, Pedraza S. Imaging of non-neoplastic duodenal diseases. A pictorial review with emphasis on MDCT. Insights Imaging 2018; 9:121-135. [PMID: 29388052 PMCID: PMC5893489 DOI: 10.1007/s13244-018-0593-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/23/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022] Open
Abstract
Abstract A wide spectrum of abnormalities can affect the duodenum, ranging from congenital anomalies to traumatic and inflammatory entities. The location of the duodenum and its close relationship with other organs make it easy to miss or misinterpret duodenal abnormalities on cross-sectional imaging. Endoscopy has largely supplanted fluoroscopy for the assessment of the duodenal lumen. Cross-sectional imaging modalities, especially multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), enable comprehensive assessment of the duodenum and surrounding viscera. Although overlapping imaging findings can make it difficult to differentiate between some lesions, characteristic features may suggest a specific diagnosis in some cases. Familiarity with pathologic conditions that can affect the duodenum and with the optimal MDCT and MRI techniques for studying them can help ensure diagnostic accuracy in duodenal diseases. The goal of this pictorial review is to illustrate the most common non-malignant duodenal processes. Special emphasis is placed on MDCT features and their endoscopic correlation as well as on avoiding the most common pitfalls in the evaluation of the duodenum. Teaching points • Cross-sectional imaging modalities enable comprehensive assessment of duodenum diseases. • Causes of duodenal obstruction include intraluminal masses, inflammation and hematomas. • Distinguishing between tumour and groove pancreatitis can be challenging by cross-sectional imaging. • Infectious diseases of the duodenum are difficult to diagnose, as the findings are not specific. • The most common cause of nonvariceal upper gastrointestinal bleeding is peptic ulcer disease.
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Affiliation(s)
- Sergi Juanpere
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain.
| | - Laia Valls
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Isabel Serra
- Department of Gastroenterology, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Margarita Osorio
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Arantxa Gelabert
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Albert Maroto
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Salvador Pedraza
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
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8
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Barat M, Dohan A, Dautry R, Barral M, Boudiaf M, Hoeffel C, Soyer P. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98:663-675. [PMID: 28185840 DOI: 10.1016/j.diii.2017.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.
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Affiliation(s)
- M Barat
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Dohan
- Department of Radiology, McGill University Health Centre, Montreal General and Royal Victoria Hospitals, Montreal, Canada.
| | - R Dautry
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Barral
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Boudiaf
- Pôle santé du plateau, 3/5, avenue de Villacoublay, 92360 Meudon-La-Forêt, France.
| | - C Hoeffel
- Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France.
| | - P Soyer
- Medicine department, Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
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Tonolini M, Ierardi AM, Bracchi E, Magistrelli P, Vella A, Carrafiello G. Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis. Insights Imaging 2017; 8:455-469. [PMID: 28677101 PMCID: PMC5621988 DOI: 10.1007/s13244-017-0562-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022] Open
Abstract
Abstract Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. Albeit endoscopy definitely represents the mainstay diagnostic technique, patients presenting to emergency departments with unexplained abdominal pain generally undergo multidetector CT as an initial investigation. Although superficial ulcers generally remain inconspicuous, careful multiplanar CT interpretation may allow to detect deep ulcers, secondary mural and extraluminal signs of peptic gastroduodenitis, thereby allowing timely endoscopic verification and appropriate treatment. This pictorial essay aims to provide radiologists with an increased familiarity with CT diagnosis of non-perforated PUD, with emphasis on differential diagnosis. Following an overview of current disease epidemiology and complications, it explains the appropriate CT acquisition and interpretation techniques, and reviews with several examples the cross-sectional findings of uncomplicated PUD. Afterwards, the CT features of PUD complications such as ulcer haemorrhage, gastric outlet obstruction, biliary and pancreatic fistulisation are presented. Teaching points • Gastric and duodenal peptic ulcers are increasingly caused by nonsteroidal anti-inflammatory drugs • Multiplanar CT interpretation allows detecting deep ulcers and secondary signs of gastroduodenitis • CT diagnosis of uncomplicated peptic disease relies on direct and indirect signs • Currently the commonest complication, haemorrhage may be treated with transarterial embolisation • Other uncommon complications include gastric outlet obstruction and biliopancreatic fistulisation
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Elena Bracchi
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Paolo Magistrelli
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Adriana Vella
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
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