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MR Enterography of Small-Bowel Lymphoma: Potential for Suggestion of Histologic Subtype and the Presence of Underlying Celiac Disease

¹ Department of Radiology, University College Hospital, Newcastle Rd., Galway, Ireland.
² Present address: Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 10945 Le Conte Ave., Peter V. Ueberroth Bldg., Ste. 3371, Los Angeles, CA 90095-7206.

OBJECTIVE. The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma using MR enterography to identify key morphologic traits capable of providing an association between imaging manifestations and likely histologic diagnosis.

MATERIALS AND METHODS. Over a 54-month period, 10 patients with subsequently confirmed small-bowel lymphoma were imaged using a standardized MR enterography technique. Retrospective chart review was performed to detect associated disease processes, such as celiac disease. The morphologic characteristics of each segment with lymphomatous involvement were evaluated with respect to tumor location, tumor size, mural characteristics, fold features, loop dilatation, luminal stricturing, mesenteric or antimesenteric distribution, mesenteric involvement, and signal intensity.

RESULTS. Nineteen distinct segments of lymphomatous involvement were identified in 10 patients, and underlying celiac disease was confirmed in six of the 10 patients. This patient group comprised 10 patients with non-Hodgkin's lymphoma (NHL) of various subtypes. No cases of Hodgkin's lymphoma were encountered. Analysis revealed celiac NHL enteropathy to have a tendency toward localization to a single, long (> 10 cm), smooth continuous bowel segment, often with aneurysmal loop dilatation, in the absence of a distinct mesenteric or antimesenteric distribution. Luminal stricturing was encountered in cases of low-grade lymphoma, whereas mesenteric fat infiltration represented a characteristic of high-grade disease.

CONCLUSION. We describe the characteristics of small-bowel lymphoma on MR enterography, identifying a number of key features that may help the interpreting radiologist in suggesting the underlying histologic subtype and whether the presence of underlying celiac disease is likely.

Keywords: celiac disease • imaging–histology correlation • lymphoma • MR enterography • MRI • small bowel