Imaging

Lymphoma of the small intestine

Preliminary Diagnosis: Lymphoma of the Small Intestine

I. What imaging technique is first-line for this diagnosis?

CT imaging of the abdomen and pelvis with IV and PO contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of lymphoma of the small intestine.

Advantages

  • Gold standard in detecting and characterizing pathology of the bowel

  • Highly sensitive and specific in characterizing the primary pathology affecting the bowel; helps characterize any secondary complications

  • May help guide treatment and therapy

  • Offers exquisite detail of the surrounding soft tissues, vascular structures, and osseous structures

Disadvantages

  • Exposes patients to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • Fluoroscopic-guided contrasted small bowel series

  • MR of the abdomen and pelvis with PO contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of lymphoma of the small intestine.

Fluoroscopic-guided contrasted small bowel series

Advantages

  • More portable than CT

Disadvantages

  • May expose patients to a large amount of ionizing radiation

  • Less sensitive and specific in detecting and characterizing a primary abnormality or localizing any secondary complications

  • Less adept in characterizing the surrounding soft tissues, vascular structures, and osseous structures

  • Highly operator dependent

MR of the abdomen and pelvis with PO contrast

Advantages

  • Does not expose patients to any ionizing radiation

  • PO contrasted MR imaging may allow detailed evaluation of the bowel mucosa

Disadvantages

  • Expensive

  • Time-consuming

  • May be subject to motion and susceptibility weighted artifact secondary to length of imaging and surrounding metallic artifact degrading image quality

  • Offers limited evaluation of osseous structures and air filled structures

VI. What are the contraindications for the alternative imaging techniques?

Fluoroscopic-guided contrasted small bowel series

  • May be contraindicated in pregnant patients

MR of the abdomen and pelvis with PO contrast

  • May be contraindicated in patients with non-MR compatible hardware

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