Scleroderma

Preliminary Diagnosis: Scleroderma

I. What imaging technique is first-line for this diagnosis?

Fluoroscopic guided double contrasted upper GI examination with a small bowel follow through.

II. Describe the advantages and disadvantages of this technique for diagnosing scleroderma.

Advantages

• Details the GI system for any mucosal abnormalities secondary to scleroderma.

Disadvantages

• Limited in evaluating the surrounding soft tissues and osseous structures.
• May expose patient to large amounts of ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications exist.

IV. What alternative imaging techniques are available?

• CT imaging of the area of concern with IV and po contrast.
• MR imaging of the area of concern with IV and po contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing scleroderma.

CT imaging of the area of concern with IV and po contrast

Advantages

• Highly adept in characterizing the primary process and any secondary complications.
• Offers exquisite visualization of the surrounding soft tissues and osseous structures often affected in diffuse systemic scleroderma.
• May help guide percutaneous intervention.

Disadvantages

• Exposes patients to ionizing radiation.

MR imaging of the area of concern with IV and po contrast

Advantages

• Offers exquisite visualization of the surrounding soft tissues,
• Does not expose patients to ionizing radiation,

Disadvantages

• Less adept in detailing the surrounding osseous and vasculature.
• Less adept in guiding percutaneus intervention.
• Expensive.
• Time consuming.
• Requires significant patient cooperation to minimize motion artifact.

VI. What are the contraindications for the alternative imaging techniques?

CT imaging of the area of concern with IV and po contrast

• May be contraindicated in pregnant patients.
• IV contrast may be contraindicated in patients with renal failure or contrast allergy.

MR imaging of the area of concern with IV and po contrast

• May be contraindicated in patients with non-MR compatible hardware.

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