Malignant tumours of the small intestine: a review of histopathology, multidetector CT and MRI aspects.

Small bowel neoplasms, including adenocarcinoma, carcinoid tumour, lymphoma and gastrointestinal stromal tumours, represent a small percentage of gastrointestinal cancers, yet are among those with the poorest prognosis compared with other gastrointestinal malignancies. Unclear clinical scenarios and difficult radiological diagnosis often delay treatment with negative effects on patient survival. Recently, multidetector CT (MDCT) and MRI have been introduced as feasible and accurate diagnostic techniques for the identification and staging of small bowel neoplasms. These techniques are gradually replacing conventional barium radiography as the tool of choice. However, the inherent technical and physiological challenges of small bowel imaging require a familiarity with patient preparation and scan protocols. Adequate knowledge of the histopathology and natural evolution of small bowel neoplasms is also important for differential diagnosis. The aim of this article is to review MDCT and MRI protocols for the evaluation of small bowel tumours and to provide a concise yet comprehensive guide to the most relevant imaging features relative to histopathology.

[1]  K. Ouriel,et al.  Adenocarcinoma of the small intestine. , 1984, American journal of surgery.

[2]  North Jh,et al.  Malignant tumors of the small intestine : A review of 144 cases , 2000 .

[3]  A. Laghi,et al.  Oral Contrast Agents for Magnetic Resonance Imaging of the Bowel , 2002, Topics in magnetic resonance imaging : TMRI.

[4]  E. Keeffe,et al.  Isolated metastasis to small bowel from anaplastic thyroid carcinoma. With a review of extra-abdominal malignancies that spread to the bowel. , 1987, Journal of Clinical Gastroenterology.

[5]  Swanson Jm Cancer of the small intestine. , 1946 .

[6]  K. Horton,et al.  Computed Tomography Imaging of Gastrointestinal Stromal Tumors With Pathology Correlation , 2004, Journal of computer assisted tomography.

[7]  M. Lens,et al.  Melanoma of the small intestine. , 2009, The Lancet. Oncology.

[8]  W. Schima,et al.  MDCT of small bowel tumours , 2007, Cancer imaging : the official publication of the International Cancer Imaging Society.

[9]  F. Regan,et al.  Fast MR imaging and the detection of small-bowel obstruction. , 1998, AJR. American journal of roentgenology.

[10]  T. Asselah,et al.  Breath-hold fast spin-echo MR imaging of Crohn's disease. , 1998, AJR. American journal of roentgenology.

[11]  Z. Traill,et al.  The current role of the barium examination of the small intestine. , 1997, Clinical radiology.

[12]  P. Prassopoulos,et al.  Abdominal helical CT: milk as a low-attenuation oral contrast agent. , 1999, Radiology.

[13]  F. Maccioni Double-contrast magnetic resonance imaging of the small and large bowel: effectiveness in the evaluation of inflammatory bowel disease , 2010, Abdominal Imaging.

[14]  A. Grossman,et al.  Fibrosis and carcinoid syndrome: from causation to future therapy , 2009, Nature Reviews Endocrinology.

[15]  N. Sata,et al.  A new 3-D diagnosis strategy for duodenal malignant lesions using multidetector row CT, CT virtual duodenoscopy, duodenography, and 3-D multicholangiography , 2006, Abdominal Imaging.

[16]  H. Nava,et al.  Adenocarcinoma of the small intestine: 21-Year review of diagnosis, treatment, and prognosis , 1994, Annals of Surgical Oncology.

[17]  C. Kim,et al.  Gastrointestinal metastasis of lung cancer with special emphasis on a long-term survivor after operation , 2009, Journal of Cancer Research and Clinical Oncology.

[18]  Elliot K Fishman,et al.  Multidetector-Row Computed Tomography and 3-Dimensional Computed Tomography Imaging of Small Bowel Neoplasms: Current Concept in Diagnosis , 2004, Journal of computer assisted tomography.

[19]  J. Fletcher,et al.  Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy--feasibility study. , 2003, Radiology.

[20]  F. Kelvin,et al.  The role of the physician in the late diagnosis of primary malignant tumors of the small intestine. , 1991, The American journal of gastroenterology.

[21]  K. Hunt,et al.  Gastrointestinal stromal tumors: overview of pathologic features, molecular biology, and therapy with imatinib mesylate. , 2004, Histology and histopathology.

[22]  K. Horton,et al.  Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[23]  N. Gourtsoyiannis,et al.  MR Imaging of the Small Bowel with a True-FISP Sequence After Enteroclysis with Water Solution , 2000, Investigative radiology.

[24]  A. Wotherspoon Extragastric MALT lymphoma , 2002, Gut.

[25]  R. Martin,et al.  Malignant tumors of the small intestine. , 1986, The Surgical clinics of North America.

[26]  L. Bonomo,et al.  Multidetector CT in small-bowel neoplasms , 2007, La radiologia medica.

[27]  A. Gabelmann,et al.  [Quantifying the inflammatory activity in Crohn's disease using CE dynamic MRI]. , 2003, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[28]  E. Kazerooni,et al.  Duodenal neoplasms: predictive value of CT for determining malignancy and tumor resectability. , 1992, AJR. American journal of roentgenology.

[29]  A. Aschoff,et al.  MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis , 2000, European Radiology.

[30]  A. D. Van den Abbeele,et al.  NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. , 2007, Journal of the National Comprehensive Cancer Network : JNCCN.

[31]  C. Charnsangavej,et al.  Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. , 2006, Radiographics : a review publication of the Radiological Society of North America, Inc.

[32]  E. Fishman,et al.  Small bowel cancer. Imaging features and staging. , 1997, Radiologic clinics of North America.

[33]  G. Masselli,et al.  Small-bowel neoplasms: prospective evaluation of MR enteroclysis. , 2009, Radiology.

[34]  A. B. Lowenfels,et al.  Distribution of small bowel tumors. , 1977, Cancer letters.

[35]  J. Berlin,et al.  Diagnosis and staging of small bowel tumours , 2006, Cancer imaging : the official publication of the International Cancer Imaging Society.

[36]  B. Coulier,et al.  Carcinoid tumor of the small intestine: MDCT findings with pathologic correlation. , 2007, JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie.

[37]  J. Fletcher,et al.  Biology of gastrointestinal stromal tumors. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[38]  Jian-Rong Xu,et al.  Updating magnetic resonance imaging of small bowel: imaging protocols and clinical indications. , 2008, World journal of gastroenterology.

[39]  R. Semelka,et al.  MR imaging of the small bowel using the HASTE sequence. , 1998, AJR. American journal of roentgenology.

[40]  L. Sobin,et al.  Benign Fibrous Tumors and Tumorlike Lesions of the Mesentery: Radiologic-Pathologic Correlation , 2006 .

[41]  E. Hecht,et al.  Evaluation of bowel distention and bowel wall appearance by using neutral oral contrast agent for multi-detector row CT. , 2006, Radiology.

[42]  R. Herrmann,et al.  Gastrointestinal involvement in non‐Hodgkin's lymphoma , 1980, Cancer.

[43]  J. Marshall,et al.  Carcinoid Tumors of the Gut: Our Experience Over Three Decades and Review of the Literature , 1993, Journal of clinical gastroenterology.

[44]  C. Catalano,et al.  Polyethylene glycol solution as an oral contrast agent for MR imaging of the small bowel. , 2001, AJR. American journal of roentgenology.

[45]  S. Pauls,et al.  EKG-getriggerte Mehrzeilen-Spiral-CT des Thorax zur Erkennung intrapulmonaler Metastasen , 2003 .

[46]  U. Tateishi,et al.  CT and MRI findings in KIT-weak or KIT-negative atypical gastrointestinal stromal tumors , 2006, European Radiology.

[47]  C. Bartolozzi,et al.  Crohn Disease of the Small Bowel: Spiral CT Evaluation After Oral Hyperhydration with Isotonic Solution , 2001, Journal of computer assisted tomography.

[48]  C. Desch Can You Recommend a Doctor for My Brother's Secretary's Sister? , 2007 .

[49]  R. Caprilli,et al.  MR imaging in patients with Crohn disease: value of T2- versus T1-weighted gadolinium-enhanced MR sequences with use of an oral superparamagnetic contrast agent. , 2006, Radiology.

[50]  Thomas G. Maris,et al.  MR enteroclysis protocol optimization: comparison between 3D FLASH with fat saturation after intravenous gadolinium injection and true FISP sequences , 2001, European Radiology.

[51]  T. Winter,et al.  Upper gastrointestinal tract and abdomen: water as an orally administered contrast agent for helical CT. , 1996, Radiology.

[52]  J. Parfitt,et al.  Gastrointestinal Kaposi’s sarcoma: CD117 expression and the potential for misdiagnosis as gastrointestinal stromal tumour , 2008, Histopathology.

[53]  K. Tominaga,et al.  Usefulness of double-balloon endoscopy in the diagnosis of malignant small-bowel tumors. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[54]  C. Catalano,et al.  MR imaging of the small bowel using polyethylene glycol solution as an oral contrast agent in adults and children with celiac disease: preliminary observations. , 2003, AJR. American journal of roentgenology.

[55]  K. Herrmann,et al.  Morphologisches Erscheinungsbild neuroendokriner Tumoren des Dünndarms im MR-Enteroklysma , 2009, Der Radiologe.