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MR Enteroclysis in Solitary Ileal Metastasis from Renal Cell Carcinoma

Agostino Gemelli Hospital Rome 00168, Italy

A 75-year-old woman came to our institution for observation in March 2002 with a history of nausea, melena, and loose stools. She had undergone left radical nephrectomy and splenectomy for renal cell carcinoma in January 2000, with resultant renal insufficiency. Rectal examination showed bloody stool. Esophagogastroduodenoscopy and colonoscopy showed normal findings. The referring surgeon proposed small-bowel examination; MR enteroclysis was performed.

Nasojejunal intubation was performed under fluoroscopy guidance using a 13-French catheter–guidewire device. After intubation, the patient was transferred to the MRI suite and placed on the MR device table in the prone position to distend the loops and to avoid gastric reflux and vomiting.

MR enteroclysis was performed with a torso phased array coil on a 1.5-T magnet. The images revealed a 5-cm oval soft-tissue mass involving a distal ileal loop, slightly hyperintense on T2-weighted images with a strong enhancement in the arterial phase of contrast administration (Fig. 3A, 3B, 3C, 3D). The mass was multilobulated with smooth borders and no extraserosal invasion, suggesting a hypervascular submucosal lesion. No evidence of other lesions or lymphadenopathy was observed.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —75-year-old woman with solitary ileal metastasis from renal cell carcinoma. Axial (A) and coronal (B) single-shot fast spin-echo T2-weighted images show well-defined lesion (arrows) with narrowing of lumen of distal ileal loop with no evidence of extravisceral spread and mesenteric lymphadenopathy.

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —75-year-old woman with solitary ileal metastasis from renal cell carcinoma. Axial (A) and coronal (B) single-shot fast spin-echo T2-weighted images show well-defined lesion (arrows) with narrowing of lumen of distal ileal loop with no evidence of extravisceral spread and mesenteric lymphadenopathy.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C. —75-year-old woman with solitary ileal metastasis from renal cell carcinoma. MR fluoroscopy image confirms organic stenotic tract (arrow) of distal ileum without prestenotic dilatation.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D. —75-year-old woman with solitary ileal metastasis from renal cell carcinoma. Corresponding gadolinium-enhanced 3D T1-weighted coronal image shows strong inhomogeneous enhancement of lesion (arrows) in arterial phase.

At surgery, a 5-cm endoluminal mass was found in a distal ileal loop without serosal infiltration; no other abdominal lesions were detected. Diagnosis of ileal metastasis from renal cell carcinoma was established. Small-bowel secondary lesions are usually multiple; solitary metastases from renal carcinoma are rare [1].

MR enteroclysis was only recently introduced in clinical practice; it offers adequate image quality coupled with the benefits of volume challenge [2]. MR enteroclysis allowed the identification and local staging of the ileal lesion, combining the advantages of cross-sectional MRI to evaluate the local neoplastic staging [3] with those of conventional enteroclysis for intraluminal evaluation.

MRI examination of the small intestine includes T1- and T2-weighted sequences in the axial and coronal planes. We use single-shot fast spin-echo heavily T2-weighted sequences (slab thickness, 7–10 cm; TR/TE, infinite/950) to monitor the infusion process and the functional assessment, followed by single-shot fast spin-echo T2-weighted sequences (TE, 90 msec) to visualize the lumen, bowel walls, and mesenteries. T1-weighted sequences are acquired with fast-spoiled gradient-echo sequences, fat saturation, and IV administration of gadolinium chelates 3D acquisition. This technique allowed our surgeons to assess the small-bowel lesion before potential surgery with high-quality images while avoiding the use of multiple radiation examinations.

References

1. Hession PR, Campbell RS. Late presentation of solitary jejunal metastasis from renal cell carcinoma. Int J Clin Pract1997; 51:334 –335[Medline]
2. Gourtsoyannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P. MR enteroclysis: technical considerations and clinical applications. Eur Radiol2002; 12:2651 –2658[Medline]
3. Semelka RC, John G, Kelekis NL, Burdeny DA, Ascher SM. Small bowel neoplastic disease: demonstration by MRI. J Magn Reson Imaging 1996;6:855 –860[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Masselli, G. Articles by Vecchioli, A. Search for Related Content PubMed PubMed Citation Articles by Masselli, G. Articles by Vecchioli, A. Social Bookmarking                      What's this?