Imaging

Adenocarcinoma of the small intestine

Preliminary Diagnosis: Adenocarcinoma of the Small Intestine

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

  • CT of the Abdomen and Pelvis with intravenous (IV) and oral (PO) contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of Adenocarcinoma of the Small Intestine.

Advantages

  • Highly sensitive and specific in detecting and characterizing small bowel pathology and localizing any secondary complications.

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

  • May direct therapy and treatment.

  • Relatively quick imaging modality.

  • Offers exquisite detail of the bowel mucosa.

Disadvantages

  • Exposure 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?

  • MR of the the abdomen and pelvis with oral (PO) contrast

  • Fluoroscopic guided double contrasted small bowel series

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Adenocarcinoma of the Small Intestine.

MR of the the abdomen and pelvis with oral (PO) contrast

Advantages

  • Offers exquisite contrast detail of the bowel mucosa.

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Expensive

  • Time consuming

  • Limited in evaluation the surrounding osseous structures.

  • May be subject to motion artifact and susceptibility weighted artifact limiting evaluation of the MR imaging.

Fluoroscopic guided double contrasted small bowel series

Advantages

  • May be used in some patients who are incompatible with CT scanners or MRIs due to body habitus

Disadvantages

  • Highly operator dependent.

  • May expose patients to a large amount of radiation.

  • Less sensitive and specific in detecting a primary abnormality of the small bowel and/or characterizing any secondary complications than other imaging modalities

  • Less adept in evaluating the surrounding soft tissues, vasculature, and osseous structures.

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

MR of the the abdomen and pelvis with oral (PO) contrast

  • MR imaging may be contraindicated in patients with non MR compatible hardware.

Fluoroscopic guided double contrasted small bowel series

  • No specific contraindications to Fluoroscopic guided double contrasted small bowel series exist.

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