HYPOTONIC DUODENOGRAPHY: IMAGING TECHNIQUE AND INTERPRETATION

Abstract

Hypotonic duodenography is an x-ray-based radiological imaging technique that uses an anticholinergic agent to suppress duodenal peristalsis. It is used not only for the qualitative and quantitative diagnosis of neoplastic lesions but also to clearly understand the overall image of a wide range of duodenal lesions, identify the exact wall location of the lesions, and assess the relationship of the lesions with the surrounding organs. An advantage of hypotonic duodenography is that it can provide detailed information to supplement endoscopic diagnoses. There are two variants of the test: tube-based methods that use a dedicated duodenal sonde for specialized examinations, and tubeless methods that involve the ingestion of a contrast agent. Generally, a barium preparation is used as the contrast agent and double-contrast imaging is performed. However, in patients who are at risk for severe constipation or intestinal obstruction, a water-soluble gastrointestinal contrast agent is used instead. The actual examination and interpretation should be performed after fully understanding the radiographic view of the normal duodenum. The normal duodenal mucosa is accompanied by a fine pattern of intestinal villi and Kerckringʼs folds. Moreover, it is important to be aware of the position and shape of the major duodenal papilla. During imaging, it is important to identify the wall of the target lesion and introduce barium onto it to acquire an image with good contrast.