Beyond moulage sign and TTG levels: the role of cross-sectional imaging in celiac sprue

Shannon P. Sheedy, John M. Barlow, Joel Garland Fletcher, Thomas Christopher Smyrk, Francis J. Scholz, Don C. Codipilly, Badr F. Al Bawardy, Jeff L. Fidler

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Celiac disease is an autoimmune disorder that causes inflammation and destruction in the small intestine of genetically susceptible individuals following ingestion of gluten. Awareness of the disease has increased; however, it remains a challenge to diagnose. This review summarizes the intestinal and extraintestinal cross-sectional imaging findings of celiac disease. Small intestine fold abnormalities are the most specific imaging findings for celiac disease, whereas most other imaging findings reflect a more generalized pattern seen with malabsorptive processes. Familiarity with the imaging pattern may allow the radiologist to suggest the diagnosis in patients with atypical presentations in whom it is not clinically suspected. Earlier detection allows earlier treatment initiation and may prevent significant morbidity and mortality that can occur with delayed diagnosis. Refractory celiac disease carries the greatest risk of mortality due to associated complications, including cavitating mesenteric lymph node syndrome, ulcerative jejunoileitis, enteropathy-associated T cell lymphoma, and adenocarcinoma, all of which are described and illustrated. Radiologic and endoscopic investigations are complimentary modalities in the setting of complicated celiac disease.

Original languageEnglish (US)
Pages (from-to)361-388
Number of pages28
JournalAbdominal Radiology
Issue number2
StatePublished - Feb 1 2017


  • Celiac disease
  • Celiac sprue
  • Refractory celiac disease
  • Refractory sprue
  • Small bowel disease
  • Small bowel enterography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology


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