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El Adioui G, Imrani K, Ettouhami B, Moatassim Billah N, Nassar I. [Jejuno-ileal fold pattern reversal]. Rev Med Interne 2024; 45:48-49. [PMID: 37891045 DOI: 10.1016/j.revmed.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/24/2023] [Indexed: 10/29/2023]
Affiliation(s)
- G El Adioui
- Service de radiologie centrale, CHU Ibn Sina, Rabat, Maroc.
| | - K Imrani
- Service de radiologie centrale, CHU Ibn Sina, Rabat, Maroc
| | - B Ettouhami
- Service de réanimation centrale, CHU Ibn Sina, Rabat, Maroc
| | | | - I Nassar
- Service de radiologie centrale, CHU Ibn Sina, Rabat, Maroc
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Does contrast-enhanced computed tomography raise awareness in the diagnosis of the invisible side of celiac disease in adults? Abdom Radiol (NY) 2022; 47:1750-1761. [PMID: 35279730 DOI: 10.1007/s00261-022-03480-x] [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: 01/18/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE This study aimed to evaluate the diagnosis and determine major and minor criteria of celiac disease (CD) with the malabsorption patterns (MABP) in the small intestine and colon on computed tomography (CT) and additional CT findings. METHODS This retrospective study was conducted with 116 patients diagnosed with CD, 14 CD patients recovering with treatment, and 35 control patients with non-CD. All patients had CT examinations and histopathological diagnoses. The sensitivity, specificity, PPV, NPV, and accuracy values of each CT finding defined in the literature were statistically evaluated. According to the patient and control groups, the numerical values of the findings and the sensitivity and specificity values were measured according to this cut-off value. The distribution of CT findings according to pathological Marsh data was evaluated in CD patients. RESULTS Sensitivity and specificity were found to be higher in small bowel MABP findings, mesenteric hypervascularity, and increased SMV/aorta diameter. There was a numerically significant difference in MDCT findings between the control and pathological Marsh groups. In the ROC analysis performed in terms of the total numerical values of each MDCT finding observed between the groups, it was found that there were more than 7 MDCT findings, 100% sensitivity, and 92% specificity. The presence of four major and three minor criteria or three major and four minor criteria were considered significant. CONCLUSIONS Being aware of CT findings below the iceberg that may suggest CD in abdominal CT examinations performed in patients with atypical clinical and malabsorption findings or other nonspecific findings may prevent diagnostic delay and unnecessary procedures.
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Giambelluca D, Cannizzaro F, Midiri M. Jejunoileal fold pattern reversal in celiac disease. Abdom Radiol (NY) 2019; 44:3494-3495. [PMID: 31399788 DOI: 10.1007/s00261-019-02178-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dario Giambelluca
- Section of Radiological Sciences, Bi.N.D., University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Fabio Cannizzaro
- Section of Radiological Sciences, Bi.N.D., University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Bi.N.D., University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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Abstract
Computed tomography (CT) enterography is a noninvasive imaging modality with superb spatial and temporal resolution, specifically tailored to evaluate the small bowel. It has several advantages over other radiologic and optical imaging modalities, all of which serve as complementary investigations to one another. This article describes CTE technique, including dose reduction techniques, special considerations for the pediatric population, common technical and interpretive pitfalls, and reviews some of the more common small bowel entities seen with CTE.
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Affiliation(s)
- Shannon P Sheedy
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Amy B Kolbe
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Radmard AR, Hashemi Taheri AP, Salehian Nik E, Kooraki S, Kolahdoozan S, Mirminachi B, Sotoudeh M, Ekhlasi G, Malekzadeh R, Shahbazkhani B. MR enterography in nonresponsive adult celiac disease: Correlation with endoscopic, pathologic, serologic, and genetic features. J Magn Reson Imaging 2017; 46:1096-1106. [DOI: 10.1002/jmri.25646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/10/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Amir Reza Radmard
- Department of Radiology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | | | - Elham Salehian Nik
- Department of Radiology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Soheil Kooraki
- Department of Radiology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Shadi Kolahdoozan
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Babak Mirminachi
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Masoud Sotoudeh
- Department of Pathology, Shariati Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Golnaz Ekhlasi
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Reza Malekzadeh
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
| | - Bijan Shahbazkhani
- Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute; Tehran University of Medical Sciences; Tehran Iran
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Beyond moulage sign and TTG levels: the role of cross-sectional imaging in celiac sprue. Abdom Radiol (NY) 2017; 42:361-388. [PMID: 28154909 DOI: 10.1007/s00261-016-1006-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Celiac disease is an autoimmune disorder that causes inflammation and destruction in the small intestine of genetically susceptible individuals following ingestion of gluten. Awareness of the disease has increased; however, it remains a challenge to diagnose. This review summarizes the intestinal and extraintestinal cross-sectional imaging findings of celiac disease. Small intestine fold abnormalities are the most specific imaging findings for celiac disease, whereas most other imaging findings reflect a more generalized pattern seen with malabsorptive processes. Familiarity with the imaging pattern may allow the radiologist to suggest the diagnosis in patients with atypical presentations in whom it is not clinically suspected. Earlier detection allows earlier treatment initiation and may prevent significant morbidity and mortality that can occur with delayed diagnosis. Refractory celiac disease carries the greatest risk of mortality due to associated complications, including cavitating mesenteric lymph node syndrome, ulcerative jejunoileitis, enteropathy-associated T cell lymphoma, and adenocarcinoma, all of which are described and illustrated. Radiologic and endoscopic investigations are complimentary modalities in the setting of complicated celiac disease.
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Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013; 108:656-76; quiz 677. [PMID: 23609613 PMCID: PMC3706994 DOI: 10.1038/ajg.2013.79] [Citation(s) in RCA: 1086] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This guideline presents recommendations for the diagnosis and management of patients with celiac disease. Celiac disease is an immune-based reaction to dietary gluten (storage protein for wheat, barley, and rye) that primarily affects the small intestine in those with a genetic predisposition and resolves with exclusion of gluten from the diet. There has been a substantial increase in the prevalence of celiac disease over the last 50 years and an increase in the rate of diagnosis in the last 10 years. Celiac disease can present with many symptoms, including typical gastrointestinal symptoms (e.g., diarrhea, steatorrhea, weight loss, bloating, flatulence, abdominal pain) and also non-gastrointestinal abnormalities (e.g., abnormal liver function tests, iron deficiency anemia, bone disease, skin disorders, and many other protean manifestations). Indeed, many individuals with celiac disease may have no symptoms at all. Celiac disease is usually detected by serologic testing of celiac-specific antibodies. The diagnosis is confirmed by duodenal mucosal biopsies. Both serology and biopsy should be performed on a gluten-containing diet. The treatment for celiac disease is primarily a gluten-free diet (GFD), which requires significant patient education, motivation, and follow-up. Non-responsive celiac disease occurs frequently, particularly in those diagnosed in adulthood. Persistent or recurring symptoms should lead to a review of the patient's original diagnosis to exclude alternative diagnoses, a review of the GFD to ensure there is no obvious gluten contamination, and serologic testing to confirm adherence with the GFD. In addition, evaluation for disorders associated with celiac disease that could cause persistent symptoms, such as microscopic colitis, pancreatic exocrine dysfunction, and complications of celiac disease, such as enteropathy-associated lymphoma or refractory celiac disease, should be entertained. Newer therapeutic modalities are being studied in clinical trials, but are not yet approved for use in practice. Given the incomplete response of many patients to a GFD-free diet as well as the difficulty of adherence to the GFD over the long term, development of new effective therapies for symptom control and reversal of inflammation and organ damage are needed. The prevalence of celiac disease is increasing worldwide and many patients with celiac disease remain undiagnosed, highlighting the need for improved strategies in the future for the optimal detection of patients.
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Affiliation(s)
- Alberto Rubio-Tapia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ivor D Hill
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ciarán P Kelly
- Celiac Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - Audrey H Calderwood
- Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Tomei E, Diacinti D, Stagnitti A, Marini M, Laghi A, Passariello R, Semelka RC. MR enterography: Relationship between intestinal fold pattern and the clinical presentation of adult celiac disease. J Magn Reson Imaging 2012; 36:183-7. [DOI: 10.1002/jmri.23625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 01/23/2012] [Indexed: 01/28/2023] Open
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Soyer P, Boudiaf M, Dray X, Fargeaudou Y, Vahedi K, Aout M, Vicaut E, Hamzi L, Rymer R. CT enteroclysis features of uncomplicated celiac disease: retrospective analysis of 44 patients. Radiology 2009; 253:416-24. [PMID: 19864528 DOI: 10.1148/radiol.2532090533] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To describe the computed tomographic (CT) enteroclysis features of uncomplicated celiac disease (CD) and to determine the most indicative appearance of this condition by using a retrospective case-control study. MATERIALS AND METHODS This study had institutional review board approval. The CT enteroclysis examinations of 44 consecutive patients with proved uncomplicated CD (21 men, 23 women; mean age, 44.45 years) were reviewed by two blinded readers and compared with those obtained in 44 control subjects (21 men, 23 women; mean age, 44.48 years), who were matched for sex and age. Comparisons were calculated by using univariate analysis. RESULTS Reversed jejunoileal fold pattern had the highest specificity (100%; 44 of 44; 95% confidence interval [CI]: 91.96%, 100%) and was the most discriminating independent variable for the diagnosis of uncomplicated CD (odds ratio, 39.9; P < .0001) but had a sensitivity of 63.64% (28 of 44; 95% CI: 47.77%, 77.59%). Ileal fold thickening, vascular engorgement, and splenic atrophy were other variables that strongly correlated with the presence of uncomplicated CD. CONCLUSION CT enteroclysis may help establish a diagnosis of uncomplicated CD and may clarify the cause of nonspecific gastrointestinal symptoms in patients with unknown CD. However, future prospective trials are needed to determine the actual value of CT enteroclysis in patients with CD and validate the clinical usefulness of CT enteroclysis in the detection of unknown uncomplicated CD.
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Affiliation(s)
- Philippe Soyer
- Department of Abdominal Imaging, and Clinical Research Unit, Hôpital Lariboisière-AP-HP-GHU Nord and Diderot-Paris 7 University, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
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Rubesin SE, Herlinger H, Furth EE. "Bubbly" duodenal bulb in clinically unsuspected or refractory adult celiac disease. ABDOMINAL IMAGING 1998; 23:449-52. [PMID: 9663286 DOI: 10.1007/s002619900378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- S E Rubesin
- Hospital of the University of Pennsylvania, Philadelphia, USA
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