AJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Soyer, P.
Right arrow Articles by Rymer, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Soyer, P.
Right arrow Articles by Rymer, R.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?

Celiac Disease in Adults: Evaluation with MDCT Enteroclysis

Philippe Soyer1, Mourad Boudiaf1, Yann Fargeaudou1, Xavier Dray2, Lounis Hamzi1, Kouroche Vahedi2, Anne Lavergne-Slove3 and Roland Rymer1

1 Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP-GHU Nord and University Diderot-Paris 7, 2, rue Ambroise Paré, 75475 Paris Cedex 10, France.
2 Department of Digestive Diseases, Hôpital Lariboisière-AP-HP-GHU Nord and University Diderot-Paris, Paris, France.
3 Department of Pathology, Hôpital Lariboisière-AP-HP-GHU Nord and University Diderot-Paris, Paris, France.


Figure 1
View larger version (175K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 1 —39-year-old woman with celiac disease. Photograph of histologic specimen obtained during duodenal biopsy reveals Marsh type 1 lesions consisting of numerous intraepithelial lymphocytes (infiltrative inflammatory lesions) (arrowheads) in absence of atrophic lesions. V = villi of normal size and absence of atrophy, C = crypts, which are free of hyperplasia. (H and E, x100)

 

Figure 2
View larger version (193K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 2 —42-year-old woman with celiac disease. Photograph of histologic specimen obtained during duodenal biopsy shows Marsh type 2 lesions, which are cryptic and hyperplastic (arrows) and have increased number of mitoses (arrowheads) (up to three per crypt). (H and E, x100)

 

Figure 3
View larger version (141K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 3 —53-year-old man with celiac disease. Photograph of histologic specimen obtained during duodenal biopsy shows Marsh type 3C lesions, which are characterized by total absence of villi (total villous atrophy), and numerous intraepithelial lymphocytes that have hyperplastic granular components (arrows) and distorted profile. (H and E, x100)

 

Figure 4
View larger version (163K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 4A —47-year-old man with unknown celiac disease. Coronal CT reformation of MDCT enteroclysis scan shows reversed jejunoileal fold pattern consisting of rarity of jejunal folds (arrows) associated with greater number of ileal folds (arrowheads). Appearance suggests celiac disease.

 

Figure 5
View larger version (114K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 4B —47-year-old man with unknown celiac disease. Endoscopic image corroborating MDCT enteroclysis findings shows atrophic jejunal mucosa.

 

Figure 6
View larger version (122K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 5 —58-year-old man with celiac disease. Axial MDCT enteroclysis scan shows engorged mesenteric vessels (arrowheads) frequently found in adult patients with celiac disease.

 

Figure 7
View larger version (135K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 6 —57-year-old man with celiac disease. Push enteroscopic image shows nodular pattern (arrowheads) of jejunal mucosa consistent with celiac disease. Diagnosis was confirmed at histopathologic analysis of biopsy specimen.

 

Figure 8
View larger version (124K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 7 —37-year-old woman with celiac disease. Wireless capsule endoscopic image shows atrophic jejunal mucosa (arrowheads), which suggests presence of celiac disease. Diagnosis was confirmed at histopathologic analysis.

 

Figure 9
View larger version (172K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 8 —70-year-old man with transient small-bowel intussusception in association with celiac disease. Axial MDCT enteroclysis scan shows target sign (arrowheads) corresponding to transient small-bowel intussusception. No tumor is present.

 

Figure 10
View larger version (149K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 9A —82-year-old woman with ileal lymphoma-associated celiac disease. Axial MDCT enteroclysis scan shows target sign (arrows) corresponding to small-bowel intussusception secondary to lymphoma (arrowhead). Tumor was located in ileum.

 

Figure 11
View larger version (142K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 9B —82-year-old woman with ileal lymphoma-associated celiac disease. Axial MDCT enteroclysis scan at lower level than A shows typical bowel-within-bowel feature (arrows) and intussusception longer than 3 cm.

 

Figure 12
View larger version (143K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 9C —82-year-old woman with ileal lymphoma-associated celiac disease. Endoscopic findings confirm diagnosis of intussusception secondary to small-bowel tumor (arrowheads).

 

Figure 13
View larger version (124K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 10A —48-year-old man with ulcerative jejunoileitis associated with refractory celiac disease. Axial MDCT enteroclysis scan depicts circumferential thickening (arrows) of ileal wall that exhibits stratification with bilaminar appearance. Hyperenhancing internal layer is present in association with soft-tissue-attenuation external layer. There is no evidence of malignancy. (Reprinted with permission from Boudiaf M, Jaff A, Soyer P, Bouhnik Y, Hamzi L, Rymer R. Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients. Radiology 2004; 233:338–344 [18])

 

Figure 14
View larger version (133K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 10B —48-year-old man with ulcerative jejunoileitis associated with refractory celiac disease. Wireless capsule endoscopic image shows ulceration (arrow) that suggests diagnosis.

 

Figure 15
View larger version (125K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 10C —48-year-old man with ulcerative jejunoileitis associated with refractory celiac disease. Photograph of gross specimen shows ulceration (arrow). Diagnosis was confirmed after surgery.

 

Figure 16
View larger version (145K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 10D —48-year-old man with ulcerative jejunoileitis associated with refractory celiac disease. Axial MDCT enteroclysis scan obtained after partial resection of ileum shows findings (arrowheads) similar to those observed preoperatively (i.e., stratification with bilaminar appearance) and that are highly suggestive of recurrence at site of anastomosis. Diagnosis of recurrence was confirmed histologically.

 

Figure 17
View larger version (126K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 11A —77-year-old woman with jejunal T-cell lymphoma associated with refractory celiac disease. Axial MDCT enteroclysis scan shows proximal jejunal mass (arrowheads) with pseudoaneurysmal pattern suggesting malignant tumor.

 

Figure 18
View larger version (137K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 11B —77-year-old woman with jejunal T-cell lymphoma associated with refractory celiac disease. Coronal CT reformation of MDCT enteroclysis scan clarifies presence of tumor (arrowheads) with irregular margins.

 

Figure 19
View larger version (113K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 11C —77-year-old woman with jejunal T-cell lymphoma associated with refractory celiac disease. Wireless capsule endoscopic image shows irregular mass (arrows) in proximal jejunum.

 

Figure 20
View larger version (136K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 12 —40-year-old man with enteropathy-associated T-cell lymphoma associated with celiac disease. Axial MDCT enteroclysis scan obtained without small-bowel distention shows multiple enlarged mesenteric lymph nodes (arrowheads), which correspond to T-cell lymphomatous involvement. Histopathologic analysis after small-bowel biopsy showed total villous atrophy and major intraepithelial infiltration by aberrant (CD3 positive, CD8 negative) clonal intraepithelial proliferation of T cells.

 

Figure 21
View larger version (168K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 13A —55-year-old woman with jejunal adenocarcinoma associated with celiac disease. Axial MDCT enteroclysis scan shows large jejunal mass (arrowheads) displaying aneurysmal pattern suggestive of malignant small-bowel tumor. Tip of nasojejunal tube (arrow) is evident.

 

Figure 22
View larger version (116K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 13B —55-year-old woman with jejunal adenocarcinoma associated with celiac disease. Push enteroscopic image confirms presence of jejunal tumor (arrowheads).

 

Figure 23
View larger version (178K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 14A —37-year-old man with cavitating mesenteric lymphadenopathy syndrome and splenic atrophy associated with celiac disease. Cavitating lymphadenopathy is most often mesenteric, but other locations are possible. Axial MDCT enteroclysis scan shows mesenteric lymph node with markedly hypoattenuating center (arrowhead).

 

Figure 24
View larger version (168K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 14B —37-year-old man with cavitating mesenteric lymphadenopathy syndrome and splenic atrophy associated with celiac disease. Cavitating lymphadenopathy is most often mesenteric, but other locations are possible. Axial MDCT enteroclysis scan shows associated small spleen (arrowhead).

 

Figure 25
View larger version (123K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 14C —37-year-old man with cavitating mesenteric lymphadenopathy syndrome and splenic atrophy associated with celiac disease. Cavitating lymphadenopathy is most often mesenteric, but other locations are possible. Histologic photograph shows lymph node with central acidophilic necrosis in association with peripheral rim (arrowheads). (H and E, x25)

 

Figure 26
View larger version (111K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 15 —33-year-old woman with celiac disease. Axial MDCT scan obtained without small-bowel distention shows gas (arrowheads) in bowel wall that resolved spontaneously. Patient was treated conservatively in absence of clinical symptoms.

 

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by the American Roentgen Ray Society.