The Imaging Features of Small Bowel Tumours
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The Imaging Features of Small Bowel Tumours Katherine van Ree & Peter Thurley & Rajeev Singh & Nicholas Hurst & Dominic Clark
Published online: 26 June 2012 # Springer Science+Business Media, LLC 2012
Abstract Objective Small bowel tumours account for only 2–5 % of gastrointestinal neoplasms but are an important source of morbidity and mortality. This article presents the features demonstrated by a wide range of small bowel tumours across different imaging modalities. Conclusion Early and accurate diagnosis via radiological means is an important factor in overall survival for malignant tumours and a thorough understanding of the common features is essential for all radiologists. Keywords Small bowel tumours . Neuroendocrine . Gastrointestinal stromal . Neurogenic . Adenocarcinoma . Lymphoma . Metastases
Introduction Tumours of the small bowel are rare, accounting for 2–5 % of gastrointestinal (GI) tract tumours [1–3]. Despite this, they may cause significant morbidity and mortality as they often present late in the course of the disease. K. van Ree (*) 110 Salisbury Road, London W13 9TT, UK e-mail: [email protected] P. Thurley : R. Singh : D. Clark Main X-ray, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK N. Hurst Department of Surgery, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK
The identification of tumours whilst they remain completely surgically resectable has been shown to be a major factor in improving outcome in terms of survival [4] and the radiologist plays a key role in aiding diagnosis in the earliest stages of disease. In the past, an accurate diagnosis has proven difficult. However, newer techniques with improved sensitivities are now frequently used. These include multidetector computed tomography (MDCT) with multiplanar reformats, computed tomography enteroclysis/enterography (CTE), magnetic resonance entercolysis/enterography (MRE) and multiplanar magnetic resonance (MR) imaging [5–9]. Small bowel tumours encompass a diverse range of pathologies arising from many cell types. They can be both benign and malignant, with several benign tumours demonstrating clear malignant potential. Malignant tumours of the small bowel are more common (Table 1), accounting for over 60 % [1, 2, 10]. This pictorial review focuses on the malignant group and those with malignant potential.
Small Bowel Imaging Techniques There is a wide range of options available to the clinician when considering how to image the small bowel: endoscopic techniques, capsule enteroscopy, conventional fluoroscopic contrast studies, fluoroscopic enteroclysis, MDCT, multiplanar MR and CT and MR enteroclysis studies. The radiological approach historically has been via fluoroscopic studies using either orally administered contrast (the small bowel meal or “follow through”) or contrast introduced via a nasojejunal tube placed by the radiologist at the time of examination (a technique known as enteroclysis but often referred to as a small bowel enema). The conventional small bowel meal has limitatio
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