European Journal of Radiology, 15 ( 1992) 151- 162 0 1992 Elsevier Science Publishers
157
B.V. All rights reserved. 0720-048X/92/$05.00
EURRAD 00304
Radiographic indicants of adult celiac disease assessed by double-contrast small bowel enteroclysis Francesco Departments
La Seta a, Giuseppe
Salerno ‘, Antonio
Buccellato a, Fabio Tine’ b and Grazia Furnari b
qf aRadiolog?) and bMedicine, V. Cervello Hospital and ‘Department of Radiology 2”, Civic0 e Benfratelli Hospital, Palemo, Italy (Received 6 December
1991; accepted after revision 23 March 1992)
Key words: Celiac disease, radiology; Malabsorption,
radiology; Small intestine, enteroclysis;
Small intestine, radiology
Abstract
The number of folds and lumen diameter of the proximal jejunum and distal ileum were retrospectively measured in 40 double-contrast small bowel enteroclysis studies of patients with a biopsy-proven diagnosis of adult celiac disease (ACD) and in 46 healthy control subjects. For both parameters an inverse radiographic pattern was found in celiacs compared to control subjects, in whom the number of folds and lumen calibers are physiologically greater in proximal jejunum than in the distal ileum. Mean differences in the jejuno-ileal number of folds (-7.1) and lumen calibers ( - 1.3 cm.) were in fact negative in ACD patients, in whom the values of both the parameters are less in the proximal jejunum than in the distal ileum. Particularly, the sign of “reversal of jejuno-ileal caliber” was both sensitive and specific for diagnosis of ACD in this retrospective series. Double-contrast small bowel enteroclysis can play an important role in excluding or confirming the presence of ACD, provided that an assessment of reproducibility and a prospective re-evaluation of operative characteristics of such radiographic signs are performed.
Introduction Adult celiac disease (ACD) has been correctly defined as “one of the great mimics in medicine” [ 1] because of the frequency of atypical presentations and difficulties in establishing a clinical diagnosis [ 1,2]. A definite diagnosis of ACD is generally reached by upper gastro-intestinal endoscopy [ 1,3,4] and/or intestinal biopsy. The role of radiology, however, has been greatly underestimated. More specific information than that obtainable using the small bowel “follow-through” examination has become available since the recent introduction of the double-contrast enteroclysis technique. Particularly, fold pattern modifications [5-lo] and differences in loop calibers [ 81 in the small bowel of ACD patients have been shown. In the present study such radiographic indicants were retrospectively assessed in ACD patients and Correspondence to: Francesco La Seta, M.D., Department of Radiology, Ospedale “V. Cervello”, U.S.L. 60 via Trabucco, 180 - 90146 Palermo. Italy.
healthy control subjects; the possible role of doublecontrast small bowel enteroclysis (DCSBE) in the diagnosis of ACD is discussed. Materials and Methods Between 1984 and 1990, DCSBE studies of 40 consecutive patients (age range 18-70 years; 13 males and 27 females) with biopsy-proven ACD, at the time of their first diagnosis, were retrospectively reviewed. On prone overhead films (no spot-views, no compression; tube-film distance 110 cm) the lumen diameter of the most dilated loops was measured at three sites in the most proximal jejunum and in the distal ileum. The loops were chosen after drawing a line corresponding to the mesentery root axis [6] (Fig.1). On the same loops, the number of folds occurring over lengths of 5 cm was counted and, as described by Herlinger [ 51, an average was obtained for all the measurements (i.e. caliber and number of folds both in the proximal jejunum and the distal ileum). The same parameters were measured on DCSBE
158 -5 0
-4 --
00
Z ti B = k 0
ooooo 00 00
0
00
1 --
00
g2 5
3-4 -5 CONTROLS
CELIACS
(n=46)
(k40)
Fig. 2. Distribution of data on caliber differences in ACD patients (mean = - 1.2) and controls (mean = 1.06). PJC = proximal jejunum caliber; DIC = distal ileum caliber.
T r ” B
’
0.6 P 0 * :
Fig. 1. DCSBE. Normal small intestine. The two arrows indicate the direction of the mesentery root axis. The gradual reduction of loop caliber and number of folds from the upper jejunum to distal ileum is easily visible.
studies of 46 consecutive otherwise healthy patients (age range 14-68 years; 17 males and 29 females) referred during the same period because of possible mal-
0.6
I ” =
0.4
f r : t i 0 l-a
0.2
0 0
0.2
0.4 False positive
TABLE 1 Number of folds and lumen diameters (mean values and standard deviations) of proximal jejunum and distal ileum both within and between ACD patients and healthy control subjects
Folds (No.) proximal jejunum distal ileum difference Lumen caliber (cm) proximal jejunum distal ileum difference
ACD (n = 40)
Controls (n = 46)
t test*
P
5.8 (3.9) 12.9 (2.3) - 7.1
12.2 (1.9) 7.4 (1.7) + 4.8
9.82 12.6
157
B.V. All rights reserved. 0720-048X/92/$05.00
EURRAD 00304
Radiographic indicants of adult celiac disease assessed by double-contrast small bowel enteroclysis Francesco Departments
La Seta a, Giuseppe
Salerno ‘, Antonio
Buccellato a, Fabio Tine’ b and Grazia Furnari b
qf aRadiolog?) and bMedicine, V. Cervello Hospital and ‘Department of Radiology 2”, Civic0 e Benfratelli Hospital, Palemo, Italy (Received 6 December
1991; accepted after revision 23 March 1992)
Key words: Celiac disease, radiology; Malabsorption,
radiology; Small intestine, enteroclysis;
Small intestine, radiology
Abstract
The number of folds and lumen diameter of the proximal jejunum and distal ileum were retrospectively measured in 40 double-contrast small bowel enteroclysis studies of patients with a biopsy-proven diagnosis of adult celiac disease (ACD) and in 46 healthy control subjects. For both parameters an inverse radiographic pattern was found in celiacs compared to control subjects, in whom the number of folds and lumen calibers are physiologically greater in proximal jejunum than in the distal ileum. Mean differences in the jejuno-ileal number of folds (-7.1) and lumen calibers ( - 1.3 cm.) were in fact negative in ACD patients, in whom the values of both the parameters are less in the proximal jejunum than in the distal ileum. Particularly, the sign of “reversal of jejuno-ileal caliber” was both sensitive and specific for diagnosis of ACD in this retrospective series. Double-contrast small bowel enteroclysis can play an important role in excluding or confirming the presence of ACD, provided that an assessment of reproducibility and a prospective re-evaluation of operative characteristics of such radiographic signs are performed.
Introduction Adult celiac disease (ACD) has been correctly defined as “one of the great mimics in medicine” [ 1] because of the frequency of atypical presentations and difficulties in establishing a clinical diagnosis [ 1,2]. A definite diagnosis of ACD is generally reached by upper gastro-intestinal endoscopy [ 1,3,4] and/or intestinal biopsy. The role of radiology, however, has been greatly underestimated. More specific information than that obtainable using the small bowel “follow-through” examination has become available since the recent introduction of the double-contrast enteroclysis technique. Particularly, fold pattern modifications [5-lo] and differences in loop calibers [ 81 in the small bowel of ACD patients have been shown. In the present study such radiographic indicants were retrospectively assessed in ACD patients and Correspondence to: Francesco La Seta, M.D., Department of Radiology, Ospedale “V. Cervello”, U.S.L. 60 via Trabucco, 180 - 90146 Palermo. Italy.
healthy control subjects; the possible role of doublecontrast small bowel enteroclysis (DCSBE) in the diagnosis of ACD is discussed. Materials and Methods Between 1984 and 1990, DCSBE studies of 40 consecutive patients (age range 18-70 years; 13 males and 27 females) with biopsy-proven ACD, at the time of their first diagnosis, were retrospectively reviewed. On prone overhead films (no spot-views, no compression; tube-film distance 110 cm) the lumen diameter of the most dilated loops was measured at three sites in the most proximal jejunum and in the distal ileum. The loops were chosen after drawing a line corresponding to the mesentery root axis [6] (Fig.1). On the same loops, the number of folds occurring over lengths of 5 cm was counted and, as described by Herlinger [ 51, an average was obtained for all the measurements (i.e. caliber and number of folds both in the proximal jejunum and the distal ileum). The same parameters were measured on DCSBE
158 -5 0
-4 --
00
Z ti B = k 0
ooooo 00 00
0
00
1 --
00
g2 5
3-4 -5 CONTROLS
CELIACS
(n=46)
(k40)
Fig. 2. Distribution of data on caliber differences in ACD patients (mean = - 1.2) and controls (mean = 1.06). PJC = proximal jejunum caliber; DIC = distal ileum caliber.
T r ” B
’
0.6 P 0 * :
Fig. 1. DCSBE. Normal small intestine. The two arrows indicate the direction of the mesentery root axis. The gradual reduction of loop caliber and number of folds from the upper jejunum to distal ileum is easily visible.
studies of 46 consecutive otherwise healthy patients (age range 14-68 years; 17 males and 29 females) referred during the same period because of possible mal-
0.6
I ” =
0.4
f r : t i 0 l-a
0.2
0 0
0.2
0.4 False positive
TABLE 1 Number of folds and lumen diameters (mean values and standard deviations) of proximal jejunum and distal ileum both within and between ACD patients and healthy control subjects
Folds (No.) proximal jejunum distal ileum difference Lumen caliber (cm) proximal jejunum distal ileum difference
ACD (n = 40)
Controls (n = 46)
t test*
P
5.8 (3.9) 12.9 (2.3) - 7.1
12.2 (1.9) 7.4 (1.7) + 4.8
9.82 12.6
