Beyond moulage sign and TTG levels: the role of cross-sectional imaging in celiac sprue

Abstract

Celiac disease is an autoimmune disorder that causes inflammation and destruction in the small intestine of genetically susceptible individuals following ingestion of gluten. Awareness of the disease has increased; however, it remains a challenge to diagnose. This review summarizes the intestinal and extraintestinal cross-sectional imaging findings of celiac disease. Small intestine fold abnormalities are the most specific imaging findings for celiac disease, whereas most other imaging findings reflect a more generalized pattern seen with malabsorptive processes. Familiarity with the imaging pattern may allow the radiologist to suggest the diagnosis in patients with atypical presentations in whom it is not clinically suspected. Earlier detection allows earlier treatment initiation and may prevent significant morbidity and mortality that can occur with delayed diagnosis. Refractory celiac disease carries the greatest risk of mortality due to associated complications, including cavitating mesenteric lymph node syndrome, ulcerative jejunoileitis, enteropathy-associated T cell lymphoma, and adenocarcinoma, all of which are described and illustrated. Radiologic and endoscopic investigations are complimentary modalities in the setting of complicated celiac disease.

Non-invasive prediction of persistent villous atrophy in celiac disease

“…The strengths of our study include a complex analysis of many non-invasive parameters for detection of persistent VA in patients with CD on a long-term GFD combining serology tests, clinical parameters, and bowel ultrasound. Many radiologic studies regarding CD are limited to some specific findings on cross-sectional imaging[ 23 ]. The role of bowel ultrasound is firmly established in the diagnosis and management of Crohn’s disease[ 24 ].…”

Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders

“…Intestinal involvement is the leading cause of morbidity, mainly secondary to malabsorption as well as an increased risk for mucosa-associated lymphoid tissue (MALT) lymphoma [ 25 ]. Small bowel follow-through under fluoroscopy shows jejunal dilation, fold thickening, decreased jejunal fold with increased ileal fold (so-called “reversal of fold pattern”), hypomotility, and transient intussusceptions ( Figure 4 B) [ 32 , 33 ]. CT and MRI are more sensitive and can better delineate bowel wall thickening, mesenteric lymphadenopathy, duodenojejunal fatty proliferation, hypervascular mesentery, and hyposplenism.…”

“…CT and MRI are more sensitive and can better delineate bowel wall thickening, mesenteric lymphadenopathy, duodenojejunal fatty proliferation, hypervascular mesentery, and hyposplenism. CT enterography (CTE) with intravenous and oral contrast can show ulcers, strictures, mucosal enhancement, increased splanchnic circulation, dilated vasa recta, reversed jejunoileal fold pattern, and ileal fold thickening ( Figure 4 C) [ 32 , 33 , 34 ]. MR enterography (MRE) has shown comparable sensitivity to CTE for the diagnosis of intestinal inflammation and has been used for the diagnosis of CD and its complications, particularly malignancy [ 31 , 33 ].…”