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European Radiology

, Volume 23, Issue 7, pp 1901–1910 | Cite as

Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours

  • Elisa Amzallag-BellengerEmail author
  • Philippe Soyer
  • Coralie Barbe
  • Marie-Danièle Diebold
  • Guillaume Cadiot
  • Christine Hoeffel
Gastrointestinal

Abstract

Purpose

To prospectively evaluate magnetic resonance (MR) enterography for detecting mesenteric small-bowel tumours (MSBTs) and assess the added value of gadolinium-chelate injection.

Material and methods

Over a 2-year period MR enterography examinations of 75 patients (33 men, 42 women; mean age, 53.8 years; range, 19–85) with suspected MSBT were blindly analysed by two readers for the presence of MSBT. Sensitivities, specificities, predictive positive values (PPVs), negative predictive values (NPVs) and accuracies of MR enterography for the detection of MSBT were calculated on per-patient and per-lesion bases. The McNemar test was used to compare sensitivities and specificities of the unenhanced and gadolinium-enhanced sets of MR enterographies.

Results

Thirty-seven MSBTs were pathologically confirmed in 26 patients. The mean tolerance score of the examinations was 0.7. On a per-patient basis, sensitivity, specificity, PPV, NPV and accuracy for detection of MSBT were 96 % [95 % CI, 89–100 %], 96 % [90–100 %], 93 % [83–100 %], 98 % [94–100 %] and 96 % [92–100 %], respectively. On a per-lesion basis, sensitivity and PPV were 70 % [56–85 %] and 93 % [83–100 %], respectively. Gadolinium injection yielded higher sensitivities on both bases (P = 0.008).

Conclusion

MR enterography is an accurate and well-tolerated imaging modality for detecting MSBT. Intravenous administration of gadolinium-chelate improves sensitivity for MSBT detection.

Key Points

• MR enterography accurately detects mesenteric small bowel tumours.

• MR enterography is a well-tolerated imaging technique.

• Intravenous administration of gadolinium chelate improves sensitivity for detecting small-bowel tumours.

Keywords

MR imaging MR enterography Small-bowel tumours Tumour Gadolinium 

Abbreviations

MSBT

Mesenteric small-bowel tumour

VCE

Videocapsule endoscopy

PEG

Polyethylene glycol

HASTE

Half-Fourier single-shot spin echo

TrueFISP

True free-induction with steady state free precession

VIBE

Volumetric interpolated breath-hold

GIST

Gastrointestinal stromal tumour

PJS

Peutz-Jeghers syndrome

Notes

Disclosure

The authors did not receive any support for this article.

G. Cadiot is a board member of Mayoli Spindler and is a consultant for Novartis and Kéocyt; he has received payments for lectures, including service on speakers bureaus, from Ipsen, Novartis, Biocodex, Abbott and Mayoli Spindler, for manuscript preparation from Novartis and for the development of educational presentations from Pfizer and Ipsen; he has also received travel, accommodation and meeting expenses from Ferring.

References

  1. 1.
    Maglinte DT (2005) Capsule imaging and the role of radiology in the investigation of diseases of the small bowel. Radiology 236:763–767PubMedCrossRefGoogle Scholar
  2. 2.
    Soyer P, Boudiaf M, Fishman EK et al (2011) Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives. Crit Rev Oncol Hematol 80:10–30PubMedCrossRefGoogle Scholar
  3. 3.
    Soyer P (2012) Obscure gastrointestinal bleeding: difficulties in comparing CT enterography and video capsule endoscopy. Eur Radiol 22:1167–1171PubMedCrossRefGoogle Scholar
  4. 4.
    Pennazio M, Rondonotti E, De Franchis R (2008) Capsule endoscopy in neoplastic diseases. World J Gastroenterol 14:5245–5253PubMedCrossRefGoogle Scholar
  5. 5.
    Pilleul F, Penigaud M, Milot L, Saurin JC, Chayvialle JA, Valette PJ (2006) Possible small bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis. Radiology 241:796–801PubMedCrossRefGoogle Scholar
  6. 6.
    Kamaoui I, De-Luca V, Ficarelli S, Mennesson N, Lombard-Bohas C, Pilleul F (2010) Value of CT enteroclysis in suspected small-bowel carcinoid tumors. AJR Am J Roentgenol 194:629–633PubMedCrossRefGoogle Scholar
  7. 7.
    Soyer P, Aout M, Hoeffel C, Vicaut E, Placé V, Boudiaf M (2013) Helical CT-enteroclysis in the detection of small-bowel tumours: a meta-analysis. Eur Radiol 23:388-399Google Scholar
  8. 8.
    Masselli G, Polettini E, Casciani E, Bertini L, Vecchioli A, Gualdi G (2009) Small bowel neoplasms: prospective evaluation of MR enteroclysis. Radiology 251:743–750PubMedCrossRefGoogle Scholar
  9. 9.
    Masselli G, Gualdi G (2010) Evaluation of small bowel tumors: MR enteroclysis. Abdom Imaging 35:23–30PubMedCrossRefGoogle Scholar
  10. 10.
    Van Weyenberg SJ, Meijerink MR, Jacobs MA et al (2010) MR enteroclysis in the diagnosis of the small-bowel neoplasms. Radiology 254:765–773PubMedCrossRefGoogle Scholar
  11. 11.
    Amzallag-Bellenger E, Oudjit A, Ruiz A, Cadiot G, Soyer P, Hoeffel C (2012) Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease. Radiographics 32:1423–1444PubMedCrossRefGoogle Scholar
  12. 12.
    Sinha R, Verma R, Verma S, Rajesh A (2011) MR Enterography of Crohn disease: part 1, rationale, technique, and pitfalls. AJR Am J Roentgenol 197:76–79PubMedCrossRefGoogle Scholar
  13. 13.
    Sinha R, Verma R, Verma S, Rajesh A (2011) MR Enterography of Crohn disease: part 2, imaging and pathologic findings. AJR Am J Roentgenol 197:80–85PubMedCrossRefGoogle Scholar
  14. 14.
    Negaard A, Paulsen V, Sandvik L et al (2007) A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis. Eur Radiol 17:2294–2301PubMedCrossRefGoogle Scholar
  15. 15.
    Gupta A, Postgate AJ, Burling D et al (2010) A prospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome. AJR Am J Roentgenol 195:108–116PubMedCrossRefGoogle Scholar
  16. 16.
    Caspari R, Von Falkenhausen M, Krautmacher C, Schild H, Heller J, Sauerbruch T (2004) Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers syndrome. Endoscopy 36:1054–1059PubMedCrossRefGoogle Scholar
  17. 17.
    Masselli G, Casciani E, Polettini E, Gualdi G (2008) Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol 18:438–447PubMedCrossRefGoogle Scholar
  18. 18.
    Masselli G, Gualdi G (2012) MR imaging of the small bowel. Radiology 264:333–348PubMedCrossRefGoogle Scholar
  19. 19.
    Cronin CG, Delappe E, Lohan DG, Roche C, Murphy JM (2010) Normal small bowel wall characteristics on MR enterography. Eur J Radiol 75:207–211PubMedCrossRefGoogle Scholar
  20. 20.
    Lohan DG, Alhajeri AN, Cronin CG, Roche CJ, Murphy JM (2008) MR Enterography of small-bowel lymphoma: potential for suggestion of histologic subtype and the presence of underlying celiac disease. AJR Am J Roentgenol 190:287–293PubMedCrossRefGoogle Scholar
  21. 21.
    Cohen J (1968) Weighted Kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–230PubMedCrossRefGoogle Scholar
  22. 22.
    Pappalardo G, Gualdi G, Nunziale A, Masselli G, Floriani I, Casciani E (2012) The impact of magnetic resonance in the preoperative staging and the surgical planning for treating small bowel neoplasms. Surg Today. doi: 10.1007/s00595-012-0270-1
  23. 23.
    Cronin CG, Lohan DG, Mhuircheartaigh JN et al (2008) MRI small-bowel follow-through: prone versus supine patient positioning for best small-bowel distention and lesion detection. AJR Am J Roentgenol 191:502–506PubMedCrossRefGoogle Scholar
  24. 24.
    Boudiaf M, Jaff A, Soyer P, Bouhnik Y, Hamzi L, Rymer R (2004) Small bowel diseases: prospective evaluation of multidetector row helical CT enteroclysis in 107 consecutive patients. Radiology 233:338–344PubMedCrossRefGoogle Scholar
  25. 25.
    Minordi LM, Vecchioli A, Guidi L, Mirk P, Fiorentini L, Bonomo L (2006) Multidetector CT enteroclysis versus barium enteroclysis with methylcellulose in patients with suspected small bowel disease. Eur Radiol 16:1527–1536PubMedCrossRefGoogle Scholar
  26. 26.
    Minordi LM, Vecchioli A, Mirk P, Bonomo L (2011) CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease. Br J Radiol 84:112–119PubMedCrossRefGoogle Scholar
  27. 27.
    Khalife S, Soyer P, Alatawi A et al (2011) Obscure gastrointestinal bleeding: preliminary comparison of 64-section CT enteroclysis with video capsule endoscopy. Eur Radiol 21:79–86PubMedCrossRefGoogle Scholar
  28. 28.
    Maccioni F, Al Ansari N, Mazzamurro F, Barchetti F, Marini M (2012) Surveillance of patients affected by Peutz-Jeghers syndrome: diagnostic value of MR enterography in prone and supine position. Abdom Imaging 37:279–287PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Elisa Amzallag-Bellenger
    • 1
    Email author
  • Philippe Soyer
    • 2
    • 3
  • Coralie Barbe
    • 4
  • Marie-Danièle Diebold
    • 5
  • Guillaume Cadiot
    • 6
  • Christine Hoeffel
    • 1
  1. 1.Department of RadiologyHôpital Robert DebréReims CedexFrance
  2. 2.Department of RadiologyHôpital Lariboisière, Assistance Publique-Hôpitaux de ParisParisFrance
  3. 3.Université Paris-Diderot, Sorbonne Paris CitéParisFrance
  4. 4.Department of StatisticsHôpital Robert DebréReims CedexFrance
  5. 5.Department of PathologyHôpital Robert DebréReims CedexFrance
  6. 6.Department of GastroenterologyHôpital Robert DebréReims CedexFrance

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