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Collagenous sprue cross-sectional imaging: a comparative blinded study.

Badr Al-Bawardy1, Shannon P Sheedy2, Michelle B Herberts3

  • 1Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA. albawardy.badr@mayo.edu.

Abdominal Radiology (New York)
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PubMed
Summary

Collagenous sprue (CS) is a rare enteropathy. Imaging studies reveal characteristic findings like mesenteric lymph node prominence and jejunoileal fold pattern reversal, suggesting malabsorption.

Keywords:
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Area of Science:

  • Gastroenterology
  • Radiology
  • Pathology

Background:

  • Collagenous sprue (CS) is a rare enteropathy.
  • It is characterized by villous atrophy and a thickened subepithelial collagen band.
  • Accurate diagnosis relies on histopathology, but cross-sectional imaging can provide valuable clues.

Purpose of the Study:

  • To describe the cross-sectional imaging findings of collagenous sprue.
  • To identify imaging features that differentiate CS from other enteropathies.

Main Methods:

  • A retrospective case-control study comparing 54 CS patients with 54 irritable bowel syndrome (IBS) patients.
  • Imaging studies included CT abdomen/pelvis (CT A/P), CT enterography (CTE), or magnetic resonance enterography within 6 months of small bowel (SB) biopsy.
  • Two gastrointestinal radiologists, blinded to clinical data, reviewed all imaging studies.

Main Results:

  • CS patients were older and more likely to be on angiotensin receptor blockers than IBS patients.
  • Significant differences in imaging findings included mesenteric lymph node prominence (56% vs. 15%), jejunoileal fold pattern reversal (46% vs. 6%), SB dilation (28% vs. 0%), SB conformational change (28% vs. 6%), SB wall thickening (13% vs. 2%), and ulcerative jejunoileitis (4% vs. 0%).
  • Malabsorption was suspected in 72% of CS patients versus 2% of IBS patients.

Conclusions:

  • Cross-sectional imaging findings suggestive of mucosal malabsorption are common in collagenous sprue.
  • Specific imaging features can help radiologists identify potential cases of CS, aiding in diagnosis.