Small-Bowel Neoplasms: Role of MRI Enteroclysis

Abstract

Small-bowel neoplasms are the 3%–6% of all gastrointestinal tract neoplasms. Due to the rarity of these lesions, the low index of clinical suspicion, and the inadequate radiologic examinations or incorrect interpretation of radiologic findings, a delay in diagnosis of 6–8 months from the first symptoms often occurs. Even if conventional enteroclysis and capsule endoscopy are the most common procedures used to accurately depict the bowel lumen and mucosal surface, their use in evaluating the mural and extramural extents of small-bowel tumors is limited. Instead multidetector computed tomographic enteroclysis and magnetic resonance enteroclysis have the potential to simultaneously depict intraluminal, mural, and extraintestinal abnormalities. In particular MR enteroclysis has an excellent soft tissue contrast resolution and multiplanar imaging capability. It can provide anatomic, functional, and real time information without the need of ionizing radiation. MR findings, appearances of the lesions, combined with the contrast-enhancement behavior and characteristic of the stenosis are important to differentiate small-bowel neoplasm from other nonneoplastic diseases.

Detecting a rare composite small bowel lymphoma by Magnetic Resonance Imaging coincidentally: A case report with radiological, surgical and histopathological features

“…The literature reports about 21 cases of GI diffuse large B cell lymphoma with CHL [6] , but we didn’t find previous cases of small-bowel lymphoma with FL and CHL.Many tools are available to diagnose lymphoma [13] , [14] , [15] , [16] , [17] , [18] , including MRI that, in our case, helped us to diagnose this malignancy. This feature highlighted the crucial importance of radiological techniques in the investigation and work up of intestinal tumors [13] , [15] , [16] , [17] , [18] , [19] . Five different patterns CT/MRI of GI lymphomas have been reported in the literature: polypoid/nodular pattern, infiltrative pattern, aneurismal pattern, exotic mass and stenosing mass [16] , [17] , [18] .…”

“…This feature highlighted the crucial importance of radiological techniques in the investigation and work up of intestinal tumors [13] , [15] , [16] , [17] , [18] , [19] . Five different patterns CT/MRI of GI lymphomas have been reported in the literature: polypoid/nodular pattern, infiltrative pattern, aneurismal pattern, exotic mass and stenosing mass [16] , [17] , [18] . The polypoid pattern usually causes bowel intussusceptions and shows solid nodules with homogeneous signal density/intensity developing as polypoid mass.…”

Neuroendocrine neoplasms of the small intestine and the appendix — update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)]

“…1) [35][36][37][38]. Follow-up examinations of small intestinal tumours should be performed using CT or MRI enterography, while MRI enteroclysis should be performed in patients with clinical suspicion of a tumour of the small intestine and negative MRI/CT enterography [6,35,[39][40][41][42][43][44].…”

“…Endoscopic diagnostics of the small intestine is usually undertaken in search of a primary tumour in the presence of metastases with an unknown primary site (often much larger than the primary lesion), uncharacteristic symptoms from the abdominal cavity, or when looking for the cause of gastrointestinal bleeding [39,46]. The widespread use of colonoscopy, including screening colonoscopy, gives hope for early detection of small intestine lesions.…”

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

“…For the follow-up concerning small intestine diseases, CT or MRI enterography should be applied. MRI enteroclysis should be performed in patients with a clinically suspected pathology of the small intestine and with negative MRI/CT enterography results [3,5,44,45]. Ultrasonography (US) is of limited use in detecting the primary tumour site.…”