SPOTS

Post gadolinium T1-weighted MR image with fat saturation Figure 34.3  Peritoneal tuberculosis. CT demonstrates marked thickening and enhancement of the parietal peritoneum (arrows). Note high-attenuation ascites (cursor). Figure 34.4  Peritoneal tuberculosis. Post gadolinium T1-weighted MR image with fat saturation depicting enhancement of the peritoneal lining (small arrows). There is involvement of the caecum characterized by homogeneous enhancement of the bowel wall (large arrow). Post gadolinium T1-weighted MR image with fat saturation

Figure 34. 5 Sclerosing peritonitis Figure 34.5  Sclerosing peritonitis. Enhanced CT shows loculated fluid collection and extensive peritoneal calcification

Figure 34. 8 Peritoneal mesothelioma Figure 34.8  Peritoneal mesothelioma. Enhanced CT shows a soft-tissue mass that obliterates pelvic peritoneal spaces and engulfs the sigmoid colon

Figure 34. 9 Cystic mesothelioma: CT and MRI findings Figure 34.9  Cystic mesothelioma: CT and MRI findings. (A) Enhanced CT demonstrates a well-defined, multilocular cystic mass with thin septations (arrowheads). (B) Sixteen months after resection, CT of the pelvis reveals two thin-walled cystic masses with serous contents (asterisks) representing local recurrence. (C) A corresponding T1-weighted MRI image reveals the watery nature of the fluid seen within the locules of the recurrent cystic mesothelioma (asterisks). T1-weighted MRI

Figure 34. 10 Cystic mesenteric lymphangioma Figure 34.10  Cystic mesenteric lymphangioma. Enhanced CT depicting a multilocular cystic mass with thin internal septa, occupying the small-bowel mesentery

Coronal true FISP image Figure 34.12  CT enteroclysis in a patient with active Crohn's disease. Enhanced CT, MIP reconstruction, shows extensive ileal Crohn's disease (arrows) with fibrofatty proliferation of the mesentery and segmental hyperaemia. Figure 34.13  MRI enteroclysis in a patient with Crohn's disease. Coronal true FISP image demonstrates increased mesenteric vascularity, in the form of parallel, low-intensity linear structures perpendicular to the long axis of involved, thickened-wall small-bowel segments   Coronal true FISP image

Enhanced CT (A) and true-FISP MRI (B) in a patient who presented with abdominal pain Figure 34.16  Mesenteric panniculitis. Enhanced CT (A) and true-FISP MRI (B) in a patient who presented with abdominal pain show a well-delineated fatty mass (large arrows) extending from the root of the small-bowel mesentery toward the left abdomen, engulfing mesenteric vessels without distortion. Note the perivascular halo (small arrow).

Figure 34. 17 Fibrosing mesenteritis Figure 34.17  Fibrosing mesenteritis. Enhanced CT in a patient who presented with fever of unknown origin demonstrates a fibrofatty mesenteric mass with irregular borders surrounding mesenteric vessels. Strands of soft-tissue density are seen radiating from the mass to the adjacent mesenteric fat. Figure 34.18  Fibrosing mesenteritis: CT appearances. Enhanced abdominal CT demonstrating a large, ill-defined, soft-tissue mesenteric mass with extensive calcification. Note retraction and thickening of the adjacent bowel loops.

Figure 34. 19 Mesenteric ischaemia Figure 34.19  Mesenteric ischaemia. Unenhanced CT shows diffuse haziness of the affected small-bowel mesentery with effacement of the vascular markings, reflecting oedema, haemorrhage and venous congestion. Note also the thickened high-attenuation bowel wall due to intramural haemorrhage. Unenhanced CT

Figure 34. 20 Embolic occlusion of superior mesenteric artery Figure 34.20  Embolic occlusion of superior mesenteric artery. Enhanced CT shows occlusion of jejunal branches (black arrow) that is responsible for acute small-bowel ischaemia, manifested as mural thickening (large white arrow). Note also the associated localized haziness in adjacent mesentery (small white arrows). Enhanced CT

(A) Enhanced (B) T1-weighted spin-echo Figure 34.23  Liposarcoma: CT-MR-pathological correlation. (A) Enhanced CT of the abdomen demonstrates a large mesenteric mass (arrows) with both fat and soft-tissue densities, encasing large peripheral vessels (arrowheads). (B) T1-weighted spin-echo image demonstrating the multiple fibrous strands seen in this liposarcoma, as well as two components, one brighter centrally (corresponding to a fatty element) and a lower intensity peripheral component (corresponding to an undifferentiated sarcomatous element). (A) Enhanced (B) T1-weighted spin-echo

Figure 34.25  Carcinoid. Enhanced CT shows a mesenteric mass with radiating strands toward adjacent bowel loops. An area of dystropic calcification is also evident (arrow).

Figure 33.24  Acute diverticulitis with thickening of the wall of the sigmoid and marked inflammatory changes in the surrounding mesenteric fat. Gas is seen in several diverticula.

Figure 33. 26 CT of a bladder fistula secondary to diverticulitis Figure 33.26  CT of a bladder fistula secondary to diverticulitis. Note the gas in the bladder indicating a fistulous communication to the bowel, the presence of sigmoid diverticular disease with inflammatory thickening of the base of the bladder at the site of the fistula.

Figure 33.29  DCBE in an acute attack of UC with collar stud ulcers (arrow) protruding through the mucosal line (arrowhead).

Figure 33.30  Aphthoid ulcers (arrows) in CD.

Figure 33.35  Chronic UC with mesorectal lipohyperplasia causing widening of the post-rectal space. There is increased submucosal fat (arrow) creating a target sign in this unenhanced CT. unenhanced CT.

Figure 33.39  Pseudomembranous colitis with marked thickening of the colonic wall (arrows) and prominent submucosal oedema creating the accordion sign.

Figure 33.41  Pneumatosis coli with numerous gas cysts in the wall of the colon.

Figure 33.43  Contrast enema showing the twisted occluded distal end (arrow) in a sigmoid volvulus.

Figure 32. 6 Lymphoid hyperplasia Figure 32.6  Lymphoid hyperplasia. Multiple small filling defects characteristic of lymphoid hyperplasia are shown on a double-contrast view of the duodenal cap

Figure 32.8  Lipoma. (A) A large intraluminal filling defect is seen occupying and distending the second part of the duodenum on a barium examination. (B) CT shows the lesion to be a well-defined, round mass with low attenuation values, characteristic of fat.

Figure 32. 10 Carcinoma of the pancreas Figure 32.10  Carcinoma of the pancreas. Barium examination of the duodenum shows the characteristic reversed ‘3’ sign of Frostberg with effacement and distortion of the mucosal pattern on the medial wall of the second portion of the duodenum in a patient with carcinoma of the head of the pancreas.

Figure 32.13  Crohn's disease. Marked irregular narrowing of the antrum and first portion of the duodenum, giving the ‘pseudo post-Billroth I’ appearance

Figure 32. 14 Intramural haematoma Figure 32.14  Intramural haematoma. CT shows a mass of mixed attenuation, characteristic of haematoma, surrounding the third portion of the duodenum (arrowheads).

Figure 32. 18 Longitudinal ulcer in Crohn's disease Figure 32.18  Longitudinal ulcer in Crohn's disease. There is a long, longitudinal ulcer involving the mesenteric border of the terminal ileum.

Figure 32.19  Cobblestoning of the terminal ileum, thickening of the wall of the terminal ileum, and an enlarged ileocaecal valve in Crohn's disease.

Figure 32.21  Crohn's disease. (A) Coronal reconstruction image of CT enterography shows thickened distal ileal loops and mural stratification resulting in a ‘target’ appearance (arrows). Prestenotic dilatation is also seen. (B) A coronal, three-dimensional projection of the same patient showing the vascular engorgement (arrows) of an involved ileal loop (comb sign).

True FISP coronal image Figure 32.22  True FISP coronal image of a patient with Crohn's disease of the terminal ileum. Moderate luminal narrowing and mural thickening is shown. Black boundary artifact (arrow) can be easily differentiated from the thickened bowel wall, exhibiting moderate signal intensity. True FISP coronal image

Coronal true FISP spot view Figure 32.23  34-year-old male patient with active Crohn's disease (Crohn's Disease Activity Index (CDAI) = 244). Coronal true FISP spot view demonstrates luminal narrowing and wall thickening in a segment of distal ileum. A fissure ulcer (arrow) penetrating the thickened wall and increased mesenteric vascularity are also disclosed   Coronal true FISP spot view

coronal true FISP image Figure 32.24  Extensive fibrofatty proliferation of the mesentery, accompanying involved ileal segments is demonstrated on a coronal true FISP image Radiological Imaging of the Small Intestine. coronal true FISP image

Coronal true FISP spot view Figure 32.25  Coronal true FISP spot view in a patient with Crohn's disease showing multiple mesenteric lymph nodes (arrows) of variable size. Bowel wall thickening of ileal loops is also present. Coronal true FISP spot view

Coronal 2D FLASH image after IV gadolinium administration Figure 32.26  27-year-old patient with active Crohn's disease (CDAI = 312). Coronal 2D FLASH image after IV gadolinium administration, showing multilayered mural enhancement of distal ileal loops (small arrow) and multiple enhancing mesenteric lymph nodes (arrowheads). Vascular engorgement is also present. Coronal 2D FLASH image after IV gadolinium administration

consecutive coronal true FISP images Figure 32.27  Four consecutive coronal true FISP images in a patient with fistulizing/perforating subtype of Crohn's disease. Multiple entero-enteric fistulae forming a ‘star’-like sign are nicely demonstrated (arrow). consecutive coronal true FISP images

Figure 32. 28 Peutz-Jeghers syndrome Figure 32.28  Peutz-Jeghers syndrome. Jejunal intussusception is seen resulting from the presence of multiple hamartomatous polyps in a patient with Peutz-Jeghers syndrome.

Figure 32. 29 Carcinoid tumour Figure 32.29  Carcinoid tumour. A round, well-defined, intraluminal filling defect (arrow) is seen in the distal ileum of a patient who presented with symptoms of intermittent obstruction but without any manifestations of the carcinoid syndrome. Figure 32.30  Carcinoid tumour. CT shows a carcinoid mass (arrow) with a characteristic stellate radiating pattern and thickening of the adjacent intestinal wall.

Figure 32.31  Lymphoma. A large mass is seen infiltrating and compressing the pelvic loops of ileum. There is also a large cavitating ulcer that has eroded a number of loops of intestine producing an ileo-ileal fistula. The patient presented with abdominal pain, weight loss, anaemia and a palpable mass.

Figure 32. 32 Patient with small intestinal lymphoma Figure 32.32  Patient with small intestinal lymphoma. The coronal true FISP image (A) shows significant mural thickening of the terminal ileum (arrow) and multiple, small and large, in size, mesenteric lymph nodes (dotted arrows). Diffusion-weighted image with a b-value of 1000 s/mm2 renders the lesions with high signal intensity, compatible with the presence of restricted water diffusion pattern due to hypercellularity. coronal true FISP image (A) Diffusion-weighted image with a b-value of 1000

Figure 32.34  Malignant GIST. CT shows a large, heterogeneous, soft tissue mass, merely hanging from an ileal segment. Absence of lymph node enlargement.

Figure 32. 38 Small bowel obstruction secondary to an adhesive band Figure 32.38  Small bowel obstruction secondary to an adhesive band. Enhanced CT, coronal reformation image of a patient with splenic lymphoma shows the transition zone (arrow) between the dilated, fluid-filled jejunal loops proximal to the site of obstruction and the collapsed loops distally. No mass or mural thickening is seen at the transition zone. Note the micronodular lymphomatous splenic involvement.