CT OF SMALL-BOWEL LYMPHOMA IN IMMUNOCOMPETENT PATIENTS AND PATIENTS WITH AIDS - COMPARISON OF FINDINGS

OBJECTIVE. The purpose of this study was to describe and analyze the C T features of small-bowel lymphoma, compare those features with the ra diographic presentation in immunocompetent patients and patients with AIDS, and discuss the role of CT in the initial detection and evaluati on of this disease. MATERIALS AND METHODS. Abdominal CT examinations o f 42 consecutive patients with proven small-bowel lymphoma were retros pectively reviewed. In 19 patients, small-bowel examinations were also available for review. The 42-patient study group was divided into two subgroups: 22 patients with AIDS and 20 immunocompetent patients. RES ULTS. Primary small-bowel lymphoma was present in 37% of patients and was equally distributed between the two subgroups. The histologic type s included non-Hodgkin's lymphoma in 33 patients, Burkitt's lymphoma i n seven patients, Hodgkin's lymphoma in one patient, and mucosa-associ ated lymphoid tissue-type lymphoma in one patient. Solid organ involve ment (liver, spleen, kidney, or adrenal glands) was detected in 22% of patients with AIDS and in 10% of the immunocompetent patients. We saw two main patterns of CT appearance. In the first pattern, single or m ultiple segments had circumferential wall thickening, homogeneous in a ttenuation, that ranged from 1.5 cm to 7 cm (mean, 2.6 cm) in 33 patie nts. In the second pattern, single or multiple cavitary lesions were r evealed as nodular and grossly enlarged intestinal lumen with bowel wa ll thickening in 13 patients. A polypoid mass that was entirely intral uminal was seen in one patient. Heterogeneous areas of low attenuation were revealed in two intestinal tumors of HIV-positive patients. Mese nteric or retroperitoneal lymphadenopathy was seen in 45% of patients with AIDS and 60% of the immunocompetent patients. The gross morpholog ic features, distribution, pattern of CT presentation, degree of wall thickening, and length of involvement were all similar in the two subg roups. CONCLUSION. More than half (52%) of the individuals with small- bowel lymphoma diagnosed at our institution in the last 4 years were p atients with AIDS. The features revealed by CT scans were characterist ic or highly suggestive of small-bowel lymphoma. We saw no significant differences in the radiographic features of patients with AIDS and im munocompetent patients.