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MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations.

Dusunceli Atman E, Erden A, Ustuner E, Uzun C, Bektas M - Korean J Radiol (2015)

Bottom Line: This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma.MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ankara University School of Medicine, Ankara 06100, Turkey.

ABSTRACT
This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

No MeSH data available.


Related in: MedlinePlus

Diverticulum.On axial T2-weighted (A) and magnetic resonance cholangiopancreatography (B) images, 4 cm diverticulum (white arrows in A) is seen at transverse segment of duodenum. On axial section (A), air within diverticulum lumen causes signal void (arrowheads in A). In addition, choledochus (arrow in B) is larger than expected, with filling defects within its lumen related to stones and stent (B). Air-fluid level within diverticulum is important sign that allows its recognition on axial sections and also allows differentiation from other cystic lesions that may be encountered within region. D = diverticulum
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Figure 6: Diverticulum.On axial T2-weighted (A) and magnetic resonance cholangiopancreatography (B) images, 4 cm diverticulum (white arrows in A) is seen at transverse segment of duodenum. On axial section (A), air within diverticulum lumen causes signal void (arrowheads in A). In addition, choledochus (arrow in B) is larger than expected, with filling defects within its lumen related to stones and stent (B). Air-fluid level within diverticulum is important sign that allows its recognition on axial sections and also allows differentiation from other cystic lesions that may be encountered within region. D = diverticulum

Mentions: A duodenal diverticulum is the herniation of the mucosa and the muscular layer from the intestine wall. A real duodenal diverticulum is congenital and arises from luminal recanalization anomalies during embryologic development (678910), and it includes all of the layers in the intestine wall. A pseudo-diverticulum, which is more frequently encountered, includes only the mucosa and submucosa layers and is most frequently found on the medial wall of the 2nd and 3rd segments of the duodenum (67810). Diverticula are most frequently seen in the duodenum, after the colon in the gastrointestinal (GI) tract (11). They are seen relatively more frequently in women, and the prevalence increases with age (9). Most cases are asymptomatic and are detected incidentally at a rate of approximately 11% during GI barium studies or during endoscopy that is performed for other reasons (911). Diverticulitis may be complicated with perforation in the retroperitoneal space (7). The area in which diverticula are most frequently seen is in the 2 to 3 cm periphery of the ampulla of Vater and are called juxtapapillary or periampullary diverticula. Diverticula in this location may rarely cause functional disorders in the ampulla and compression of the CBD, depending on their size and configuration, and in this way, may lead to biliopancreatic symptoms such as jaundice, cholangitis, or biliary calculus (911). If the diverticulum lumen is full of air or a mixture of air-liquid, it may be easily identified with computerized tomography (CT) or MRI. However, in the event that the lumen is completely filled with liquid, the diverticulum may be confused with cystic tumors of the pancreas or with choledochus cysts on CT or MRI (69). It is important to show the continuity in the duodenum lumen of a diverticulum with multiplanar imaging on MRI to avoid misinterpretation. Moreover, the air-liquid level is beneficial for identifying diverticula in axial sections and enabling their differentiation from the cystic lesions that may be seen in this location (Figs. 4, 5, 6) (69).


MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations.

Dusunceli Atman E, Erden A, Ustuner E, Uzun C, Bektas M - Korean J Radiol (2015)

Diverticulum.On axial T2-weighted (A) and magnetic resonance cholangiopancreatography (B) images, 4 cm diverticulum (white arrows in A) is seen at transverse segment of duodenum. On axial section (A), air within diverticulum lumen causes signal void (arrowheads in A). In addition, choledochus (arrow in B) is larger than expected, with filling defects within its lumen related to stones and stent (B). Air-fluid level within diverticulum is important sign that allows its recognition on axial sections and also allows differentiation from other cystic lesions that may be encountered within region. D = diverticulum
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644744&req=5

Figure 6: Diverticulum.On axial T2-weighted (A) and magnetic resonance cholangiopancreatography (B) images, 4 cm diverticulum (white arrows in A) is seen at transverse segment of duodenum. On axial section (A), air within diverticulum lumen causes signal void (arrowheads in A). In addition, choledochus (arrow in B) is larger than expected, with filling defects within its lumen related to stones and stent (B). Air-fluid level within diverticulum is important sign that allows its recognition on axial sections and also allows differentiation from other cystic lesions that may be encountered within region. D = diverticulum
Mentions: A duodenal diverticulum is the herniation of the mucosa and the muscular layer from the intestine wall. A real duodenal diverticulum is congenital and arises from luminal recanalization anomalies during embryologic development (678910), and it includes all of the layers in the intestine wall. A pseudo-diverticulum, which is more frequently encountered, includes only the mucosa and submucosa layers and is most frequently found on the medial wall of the 2nd and 3rd segments of the duodenum (67810). Diverticula are most frequently seen in the duodenum, after the colon in the gastrointestinal (GI) tract (11). They are seen relatively more frequently in women, and the prevalence increases with age (9). Most cases are asymptomatic and are detected incidentally at a rate of approximately 11% during GI barium studies or during endoscopy that is performed for other reasons (911). Diverticulitis may be complicated with perforation in the retroperitoneal space (7). The area in which diverticula are most frequently seen is in the 2 to 3 cm periphery of the ampulla of Vater and are called juxtapapillary or periampullary diverticula. Diverticula in this location may rarely cause functional disorders in the ampulla and compression of the CBD, depending on their size and configuration, and in this way, may lead to biliopancreatic symptoms such as jaundice, cholangitis, or biliary calculus (911). If the diverticulum lumen is full of air or a mixture of air-liquid, it may be easily identified with computerized tomography (CT) or MRI. However, in the event that the lumen is completely filled with liquid, the diverticulum may be confused with cystic tumors of the pancreas or with choledochus cysts on CT or MRI (69). It is important to show the continuity in the duodenum lumen of a diverticulum with multiplanar imaging on MRI to avoid misinterpretation. Moreover, the air-liquid level is beneficial for identifying diverticula in axial sections and enabling their differentiation from the cystic lesions that may be seen in this location (Figs. 4, 5, 6) (69).

Bottom Line: This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma.MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ankara University School of Medicine, Ankara 06100, Turkey.

ABSTRACT
This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

No MeSH data available.


Related in: MedlinePlus