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Paparo F, Panvini N, Montale A, Pigati M, Marinaro E, Melani EF, Piccardo A, Molini L. Multimodality imaging features of small bowel cancers complicating Crohn's disease: a pictorial review. Abdom Radiol (NY) 2024; 49:2083-2097. [PMID: 38441632 DOI: 10.1007/s00261-024-04201-2] [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: 10/26/2023] [Revised: 01/02/2024] [Accepted: 01/12/2024] [Indexed: 06/29/2024]
Abstract
Patients with Crohn's disease (CD) are at increased risk of developing small bowel cancer, since chronic inflammation may trigger the histopathological sequence that begins from low-grade dysplasia of the intestinal epithelium and may eventually lead to malignant transformation. Owing to their location in a portion of the gastrointestinal tract which is not easily accessible to conventional endoscopic techniques, the detection of CD-related small bowel cancers is still a clinical challenge. The radiological features of CD-related small bowel adenocarcinoma (SBA) in patients with CD have been described in some previous studies, including its appearance in both CT and MRI examinations. Radiological signs of active or fibrostenotic CD may be intermixed with those suggesting the presence of CD-related SBA. In CT studies, the most relevant findings consistent with malignant transformation are the presence of a stricture with irregular asymmetric thickening of small bowel walls, loss of mural stratification, and moderate enhancement after intravenous administration of iodinated contrast media, in association with enlarged adjacent mesenteric lymph nodes. Many of the CD-related SBA features that can be observed on CT imaging are similar to those detectable by MRI. This latter modality provides the additional value of the functional characterization of small bowel strictures, thereby helping to distinguish between inflammatory, fibrotic, and malignant stenosis in the setting of active CD. Positron Emission Tomography (PET)/CT enables the metabolic assessment of enlarged mesenteric lymph nodes, and PET/MRI fusion imaging can incorporate morphological, functional and metabolic information into a single set of imaging data, thus overcoming the limitations of the separate assessment of each individual modality. Owing to the low incidence and prevalence of this long-term complication of CD, we believe that a detailed multimodality pictorial essay on this topic, also including the PET-CT and fusion imaging documentation of some cases, would be useful to the medical literature.
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Affiliation(s)
- Francesco Paparo
- Diagnostic Imaging Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Nicola Panvini
- Diagnostic Imaging Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy.
| | - Amedeo Montale
- Gastroenterology Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Maria Pigati
- Diagnostic Imaging Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Eugenio Marinaro
- Pathology Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Enrico Francesco Melani
- Diagnostic Imaging Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Arnoldo Piccardo
- Nuclear Medicine Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Lucio Molini
- Diagnostic Imaging Unit, E.O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
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Deepak P, Ludwig DR, Fidler JL, Guglielmo FF, Bruining DH. Medical and Endoscopic Management of Crohn Disease. Top Magn Reson Imaging 2021; 30:43-61. [PMID: 33528211 DOI: 10.1097/rmr.0000000000000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.
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Affiliation(s)
- Parakkal Deepak
- Washington University Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University in Saint Louis School of Medicine, St. Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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