Frye Judson M, Hansel Stephanie L, Dolan Steven G, Fidler Jeff L, Song Louis M Wong Kee, Barlow John M, Smyrk Tom C, Flicek Kristina T, Hara Amy K, Bruining David H, Fletcher Joel G
Department of Radiology, Mayo Clinic Health System, La Crosse, WI, USA.
Abdom Imaging. 2015 Jun;40(5):1011-25. doi: 10.1007/s00261-015-0367-2.
CT and MR enterography and capsule endoscopy are increasingly used as routine diagnostic tests for patients with potential small bowel disorders and obscure gastrointestinal bleeding. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used drugs that disrupt prostaglandin synthesis and result in a variety of localized complications within the small bowel ranging from ulcer formation to characteristic circumferential strictures, or diaphragms. NSAID enteropathy encompasses this spectrum of acute and chronic inflammatory sequelae, and is associated with typical findings at capsule endoscopy and surgery. Herein we review the typical clinical presentation of NSAID enteropathy, in addition to its endoscopic appearances, focusing on imaging findings at cross-sectional enterography. Multiple, short-segment strictures are the hallmarks of imaging diagnosis. Strictures may have minimal hyperenhancement or wall thickening, but these findings are typically symmetric and circumferential with respect to the bowel lumen. Multifocal Crohn's strictures, and occasionally radiation-induced strictures or adhesions, will mimic NSAID diaphragms. Multi-phase or multi-sequence imaging at CT and MR enterography increase diagnostic confidence in stricture presence. Strategies for subsequent workup and therapy after enterography are also discussed. Given the frequent use of NSAIDs and typical appearance of these strictures, knowledge of characteristic imaging findings can be particularly useful when evaluating patients with anemia and recurrent small bowel obstruction.
CT小肠造影、磁共振小肠造影和胶囊内镜越来越多地被用作潜在小肠疾病和不明原因胃肠道出血患者的常规诊断检查。非甾体抗炎药（NSAIDs）是常用药物，可破坏前列腺素合成，导致小肠内出现各种局部并发症，从溃疡形成到特征性的环形狭窄或隔膜。NSAID小肠病包括这一系列急性和慢性炎症后遗症，并与胶囊内镜检查和手术中的典型表现相关。在此，我们除了回顾NSAID小肠病的内镜表现外，还将重点介绍横断面小肠造影的影像学表现，回顾其典型的临床表现。多发、短节段狭窄是影像学诊断的标志。狭窄可能仅有轻微强化或肠壁增厚，但这些表现通常相对于肠腔是对称且环形的。多灶性克罗恩病狭窄，偶尔还有放射性狭窄或粘连，可能会模仿NSAID隔膜。CT小肠造影和磁共振小肠造影的多期或多序列成像可提高对狭窄存在的诊断信心。本文还讨论了小肠造影后后续检查和治疗的策略。鉴于NSAIDs的频繁使用以及这些狭窄的典型表现，在评估贫血和复发性小肠梗阻患者时，了解其特征性影像学表现可能特别有用。
