CT evaluation of small bowel neoplasms: spectrum of disease.

Buckley, Julie A.; Fishman, Elliot K.

doi:10.1148/radiographics.18.2.9536485

Cited by 193 publications

(117 citation statements)

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“…Irregular short asymmetric lesions with abrupt margins are the hallmark of adenocarcinomas and metastatic diseases [4]. In our study 89% of inflammatory lesion had symmetrical thickening and 96.4%of malignancy had asymmetrical thickening, considered to be specific for malignant lesions (Table 3).…”

Section: Type Of Wall Thickeningsupporting

confidence: 48%

Multidetector Computed Tomography in Large Bowel Lesions—A Study of 100 Cases

et al. 2011

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This study aims to evaluate the role of multidetector computed tomography (MDCT) in detecting and classifying the large bowel lesions. A prospective study of 100 adult patients was conducted from June 2007 to October 2009. Rectal and IV contrast were used for three dimensional reconstruction. Angiography was performed in cases of suspected ischemic pathology. CT colongraphy was done to evaluate adenomas. CT findings were correlated and confirmed by either colonoscopy, biopsy, postoperative findings or follow-up CT. The pathologies were common in 50-70 yrs (44%). M: F ratio was 2:1. Malignant lesions were seen in (55%) followed by inflammatory lesions in 26%, diverticulitis and ischemic colitis in 6% each. Miscellaneous conditions like polyps, volvulus and intussusceptions were seen in 7%. Adenocarcinoma was the common malignancy (81.2%). Present study showed that adenocarcinomas were associated with marked thickening of bowel wall (>1.5 cm) in 85.4% of patients, asymmetrical wall thickening (96.4%), focal involvement (length <10 cm) in 85.5% with heterogeneous post contrast enhancement (96.3%). Inflammatory lesions showed mild thickening (69%),segmental or diffuse involvement (77%), symmetrical wall thickening (89%) and homogenous post contrast enhancement (81%). Ischemic lesions showed marked thickening (83.4%), symmetrical thickening (100%) and homogenous enhancement (100%). Diverticulitis showed marked thickening (100%), asymmetrical wall thickening (66.7%) with heterogeneous post contrast enhancement (100%), with pericolic fluid. Arterial/venous thrombosis was diagnosed in 66.66%. Three per cent had benign adenomatous polyps on CT colonographic studies. MDCT was accurate in 98.2% cases for differentiating between benign and malignant etiology and is the modality of choice.

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Section: Type Of Wall Thickeningsupporting

confidence: 48%

Multidetector Computed Tomography in Large Bowel Lesions—A Study of 100 Cases

et al. 2011

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“…Metastases may be distinguished from the patient's history and visualization of the primary mass. 14,22,[30][31][32] Recurrent/metastatic disease developed in half the patients in this study. Peritoneal and hepatic metastases were the most common sites of metastatic disease.…”

Section: Discussionmentioning

confidence: 65%

MDCT and clinicopathological features of small bowel gastrointestinal stromal tumours in 102 patients: a single institute experience

Baheti

Shinagare

O’Neill

et al. 2015

BJR

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Objective: Small bowel (SB) is the second most common site of gastrointestinal stromal tumours (GISTs). We evaluated clinical presentation, pathology, imaging features and metastatic pattern of SB GIST. Methods: Imaging and clinicopathological data of 102 patients with jejunal/ileal GIST treated at Dana-Farber Cancer Institute and Brigham and Women's Hospital (Boston, MA) between 2002 and 2013 were evaluated. Imaging of treatment-naive primary tumour (41 patients) and follow-up imaging in all patients was reviewed. Results: 90/102 patients were symptomatic at presentation, abdominal pain and lower gastrointestinal blood loss being the most common symptoms. On pathology, 21 GISTs were low risk, 17 were intermediate and 64 were high risk. The mean tumour size was 8.5 cm. On baseline CT (n 5 41), tumours were predominantly well circumscribed, exophytic and smooth/mildly lobulated in contour. Of 41 tumours, 16 (39%) were homogeneous, whereas 25 (61%) were heterogeneous. Of the 41 tumours, cystic/necrotic areas (Hounsfield units ,20) were seen in 16 (39%) and calcifications in 9 (22%). CT demonstrated complications in 13/41 (32%) patients in the form of tumour-bowel fistula (TBF) (7/41), bowel obstruction (4/41) and intraperitoneal rupture (2/41). Amongst 102 total patients, metastases developed in 51 (50%) patients (27 at presentation), predominantly involving peritoneum (40/102) and liver (32/102). 7/8 (87%) patients having intraperitoneal rupture at presentation developed metastases. Metastases elsewhere were always associated with hepatic/peritoneal metastases. At last follow-up, 28 patients were deceased (median survival, 65 months). Conclusion: SB GISTs were predominantly large, wellcircumscribed, exophytic tumours with or without cystic/ necrotic areas. Complications such as TBF, bowel obstruction and intraperitoneal perforation were visualized at presentation, with patients with perforation demonstrating a high risk of metastatic disease. Exophytic eccentric bowel wall involvement and lack of associated adenopathy are useful indicators to help differentiate GISTs from other SB neoplasms. Advances in knowledge: SB GISTs are predominantly large, well-circumscribed, exophytic tumours, and may present with complications. They often are symptomatic at presentation, are high risk on pathology and metastasize to the peritoneum more commonly than the liver.

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“…Tables 3-5 summarise mural thickening [16,22,30,31,[39][40][41], symmetry of small bowel thickening [16,31,42] and sites of abnormality in the small bowel [16,41], respectively. Identification of the layer of the small bowel wall that is predominantly affected also helps in reaching a diagnosis ( Table 6).…”

Section: Mural Thickening and Symmetrymentioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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ABSTRACT. CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation. Until recently, diagnosis of small bowel pathology had relied primarily on radiological techniques, in part due to the relative inaccessibility of the small bowel to conventional endoscopy. However, new endoscopic developments-notably the recent introduction of capsule endoscopy and double balloon enteroscopy-are challenging this position. Capsule endoscopy, for example, is now generally accepted as first-line investigation for occult gastrointestinal haemorrhage, and increasingly advocated for diagnosis of early Crohn's disease. However, the radiological community has not stood still. In parallel with the development of new endoscopic techniques, rapid progress has been made in crosssectional imaging technologies, harnessing the power of multidetector row CT (MDCT), MRI and ultrasound, facilitating rapid, accurate and minimally invasive investigation of the small bowel and adjacent tissues.CT enterography was first introduced by Raptopoulos et al [1] in 1997 as a modification to ''standard'' abdomino-pelvic CT examination to specifically examine the small bowel in detail, notably to assess the extent and severity of Crohn's disease [1,2]. They combined neutral (low-density) oral contrast with ''enteric phase'' CT to optimise contrast resolution between mucosa and lumen, thereby maximising conspicuity of abnormalities arising from the small bowel wall. Several authors have subsequently described similar techniques, which are broadly categorised into CT enterography (where patients drink oral contrast) and CT enteroclysis (luminal contrast is introduced via a nasojejunal tube placed fluoroscopically prior to CT examination). Although superior jejunal distension is attained using enteroclysis, the convenience, efficiency and superior patient experience achieved with CT enterography make it the preferred technique at the authors' institutions, and therefore the focus of this review. This paper will critically review the CT enterography technique and provide practical tips on interpretation to assist radiologists and help them avoid common interpretative pitfalls. We will also examine its role relative to other complementary non-ionising radiation radiological tests. TechniqueThe technique of CT enterography combines small bowel distension with a neutral or low-density oral contrast mixture and abdomino-pelvic CT examination during the enteric phase following administration of intravenous contrast. Patients drink approximately 1.5-2 l of oral contrast over 45-60 min. Patient comp...

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CT evaluation of small bowel neoplasms: spectrum of disease.

Cited by 193 publications

References 0 publications

Multidetector Computed Tomography in Large Bowel Lesions—A Study of 100 Cases

Multidetector Computed Tomography in Large Bowel Lesions—A Study of 100 Cases

MDCT and clinicopathological features of small bowel gastrointestinal stromal tumours in 102 patients: a single institute experience

CT enterography: review of technique and practical tips

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