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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

Dilated duodenum secondary to superior mesenteric artery (SMA) syndrome.On axial (A) T2-weighted MR image, 2nd portion of duodenum is dilated and measures 4 cm (arrow). On sagittal image (B), it is detected that angle between aorta and SMA is narrowed (SMA syndrome). SMA syndrome can be diagnosed in clinically suspected cases on MRI by showing that aortomesenteric angle and distance are less than normal in reconstructed images and by dilatation proximal to obstruction. In barium studies, dilatation in duodenum, barium retention and vertical vascular external impression in 3rd segment are positive signs for SMA syndrome. However, these radiographic symptoms are non-specific, and they may also be seen in diseases such as scleroderma, diabetes, pancreatitis, and peptic ulcer.
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Figure 11: Dilated duodenum secondary to superior mesenteric artery (SMA) syndrome.On axial (A) T2-weighted MR image, 2nd portion of duodenum is dilated and measures 4 cm (arrow). On sagittal image (B), it is detected that angle between aorta and SMA is narrowed (SMA syndrome). SMA syndrome can be diagnosed in clinically suspected cases on MRI by showing that aortomesenteric angle and distance are less than normal in reconstructed images and by dilatation proximal to obstruction. In barium studies, dilatation in duodenum, barium retention and vertical vascular external impression in 3rd segment are positive signs for SMA syndrome. However, these radiographic symptoms are non-specific, and they may also be seen in diseases such as scleroderma, diabetes, pancreatitis, and peptic ulcer.

Mentions: Also known as Wilkie's syndrome, SMA syndrome is a rare pathology that arises from the compression of the 3rd segment of the duodenum intermittently between the aorta and the SMA, causing obstruction in the duodenum and proximal gastroduodenal dilatation (2627282930). It is more frequent in young adults and in women (28). Typical symptoms are epigastric pain, postprandial dyspepsia, nausea, vomiting of bile-stained material, early satiety and weight loss (262829). The most frequently encountered factor in etiopathogenesis is the decrease of superior mesenteric fatty tissue between the aorta and the SMA caused by extreme loss of weight. More rare reasons include short or abnormally inserted ligament of Treitz and hyperlordosis (282930). Normally, the fat pad between the aorta and the SMA increases the distance and angle between these two vascular structures and prevents the development of obstruction in the duodenum (30). It is stated in previous studies that the angle between the aorta and the SMA is 6-22° in those who have SMA syndrome and 25-60° in those who do not. Moreover, it is also found that the distance between the aorta and the SMA is shorter than normal in the duodenal crossing point in SMA syndrome (2-8 mm in SMA syndrome but 10-28 mm in normal cases) (Fig. 11) (2627).


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)

Dilated duodenum secondary to superior mesenteric artery (SMA) syndrome.On axial (A) T2-weighted MR image, 2nd portion of duodenum is dilated and measures 4 cm (arrow). On sagittal image (B), it is detected that angle between aorta and SMA is narrowed (SMA syndrome). SMA syndrome can be diagnosed in clinically suspected cases on MRI by showing that aortomesenteric angle and distance are less than normal in reconstructed images and by dilatation proximal to obstruction. In barium studies, dilatation in duodenum, barium retention and vertical vascular external impression in 3rd segment are positive signs for SMA syndrome. However, these radiographic symptoms are non-specific, and they may also be seen in diseases such as scleroderma, diabetes, pancreatitis, and peptic ulcer.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 11: Dilated duodenum secondary to superior mesenteric artery (SMA) syndrome.On axial (A) T2-weighted MR image, 2nd portion of duodenum is dilated and measures 4 cm (arrow). On sagittal image (B), it is detected that angle between aorta and SMA is narrowed (SMA syndrome). SMA syndrome can be diagnosed in clinically suspected cases on MRI by showing that aortomesenteric angle and distance are less than normal in reconstructed images and by dilatation proximal to obstruction. In barium studies, dilatation in duodenum, barium retention and vertical vascular external impression in 3rd segment are positive signs for SMA syndrome. However, these radiographic symptoms are non-specific, and they may also be seen in diseases such as scleroderma, diabetes, pancreatitis, and peptic ulcer.
Mentions: Also known as Wilkie's syndrome, SMA syndrome is a rare pathology that arises from the compression of the 3rd segment of the duodenum intermittently between the aorta and the SMA, causing obstruction in the duodenum and proximal gastroduodenal dilatation (2627282930). It is more frequent in young adults and in women (28). Typical symptoms are epigastric pain, postprandial dyspepsia, nausea, vomiting of bile-stained material, early satiety and weight loss (262829). The most frequently encountered factor in etiopathogenesis is the decrease of superior mesenteric fatty tissue between the aorta and the SMA caused by extreme loss of weight. More rare reasons include short or abnormally inserted ligament of Treitz and hyperlordosis (282930). Normally, the fat pad between the aorta and the SMA increases the distance and angle between these two vascular structures and prevents the development of obstruction in the duodenum (30). It is stated in previous studies that the angle between the aorta and the SMA is 6-22° in those who have SMA syndrome and 25-60° in those who do not. Moreover, it is also found that the distance between the aorta and the SMA is shorter than normal in the duodenal crossing point in SMA syndrome (2-8 mm in SMA syndrome but 10-28 mm in normal cases) (Fig. 11) (2627).

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