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Gastrointestinal Imaging

E2856. Imaging Evaluation of Gastrointestinal Schistosomiasis: A Multimodality Review of Imaging Findings

Nepal P1,  Ojili V2,  Baxi A2,  Kaur N2,  Nagar A.3 1. Hamad Medical Corporation , Doha, Qatar; 2. The University of Texas Health Science Center at San Antonio, San Antonio, TX; 3. The Ohio State University Wexner Medical Center, Columbus, OH

Address correspondence to P. Nepal (pankaj-123@live.com)

Background Information: Schistosomiasis is a common tropical and subtropical disease affecting over 200 million people around the world, with the majority (85%) in Africa. Diagnosis of the disease is primarily by parasitology, serology, or molecular methods; however, each method has specific limitations. The role of radiology modalities like ultrasound, CT, and MRI is not only to complement diagnosis but also to evaluate severity of the disease process and its complications. Hence, radiologists should be familiar with common and uncommon imaging features of schistosomiasis for accurate diagnosis and timely intervention.

Educational Goals/Teaching Points: The goal of this exhibit is to understand basic pathophysiology of Schistosomiasis (caused by trematode parasite of genus Schistosoma affecting the liver and gastrointestinal tract) and illustrate common and uncommon imaging features associated with the disease. We will demonstrate role of radiology with radiography, ultrasound, CT and MRI with cases of systemic involvement apart from the gastrointestinal tract, like the CNS, genitourinary tract, lungs, and pulmonary artery.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Ultrasound is an initial imaging modality for evaluating liver parenchymal disease that has the benefits of ease of performance, low cost, and free from radiation; however, colorectal, cerebral, pulmonary, and genitourinary involvement are better evaluated with CT, especially for demonstrating the extent of calcification associated with urogenital schistosomiasis. MRI is invaluable in diagnosing cerebral and spinal schistosomiasis and differentiating periportal fibrosis and edema. Hyperintense signal on T2-weighted MRI may be helpful for differentiating periportal fibrosis from inflammation and may provide precise information on the abdominal venous system, including the portal vein.

Conclusion: The role of imaging modalities such as ultrasound, CT, and MRI are invaluable in diagnosing and assessing severity and complications of schistosomiasis. Radiologists must be familiar with common as well as uncommon presentation of the disease.