Showing papers in "Abdominal Imaging in 2010"
TL;DR: The results indicate that DE dual-source CT permits for the accurate in vivo differentiation between UA-containing and non-UA-containing urinary stones.
Abstract: To prospectively investigate the in vivo diagnostic performance of dual-energy (DE) computed tomography (CT) for the differentiation between uric acid (UA)-containing and non-UA-containing urinary stones. DE CT scans were performed in 180 patients with suspected urinary stone disease using a dual-source CT scanner in the DE mode (tube voltages 80 and 140 kV). Urinary stones were classified as UA-containing or non-UA-containing based on CT number measurements and DE software results. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) for the detection of UA-containing urinary stones were calculated using the crystallographic stone analysis as the reference standard. DE CT detected 110/180 patients (61%) with urinary stone disease. In 53 patients, stones were sampled. Forty-four out of 53 stones (83%) were non-UA-containing; and nine stones (17%) were UA-containing. The software automatically mapped 52/53 (98%) stones. One non-UA-containing stone (UA, 2 mm) was missed; one UA-containing stone (3 mm) was misclassified by software analysis. The sensitivity, specificity, PPV, and NPV for the detection of UA-containing stones was 89% (8/9, 95% CI: 52–100%), 98% (43/44, 95% CI: 88–100%), 89% (8/9, 95% CI: 52–100%), and 98% (43/44, 95% CI: 88–100%). Our results indicate that DE dual-source CT permits for the accurate in vivo differentiation between UA-containing and non-UA-containing urinary stones.
106 citations
TL;DR: MR accurately diagnoses deep infiltrating endometriosis; 3DUS accurately diagnosesDeep infiltration of endometrial cysts in specific locations is accurately diagnosed.
Abstract: To compare two different imaging modalities, magnetic resonance (MR), and three-dimensional sonography (3DUS), in order to evaluate the specific role in preoperative work-up of deep infiltrating endometriosis. 33 women with endometriosis underwent 3DUS and MR followed by surgical and histopathological investigations. Investigators described the disease extension in the following sites: torus uterinus and uterosacral ligaments (USL), vagina, rectovaginal-septum, rectosigmoid, bladder, ovaries. Results were compared with surgical and histopathological findings. Ovarian and deep pelvic endometriosis were found by surgery and histology in, respectively, 24 (72.7%) and 22 (66.6%) of the 33 patients. Sensitivity and specificity values of 3DUS for the diagnosis of endometrial cysts were 87.5% and 100%, respectively; those of MRI were 96.8% and 91.1%, respectively. Sensitivity and specificity of 3DUS for the diagnosis of deep infiltrating endometriosis in specific sites were: USL 50% and 94.7%; vagina 84% and 80%; rectovaginal-septum 76.9% and 100%; rectosigmoid 33.3% and 100%; bladder 25% and 100%. Those of MR were: USL 69.2% and 94.3%; vagina 83.3% and 88.8%; rectovaginal-septum 76.4% and 100%; restosigmoid 75% and 100%; bladder 83.3% and 100%. MR accurately diagnoses deep infiltrating endometriosis; 3DUS accurately diagnoses deep infiltrating endometriosis in specific locations.
99 citations
TL;DR: Gd- and SPIO-enhanced MRI seem to be the most accurate modality in the identification of liver metastases from colo-rectal carcinoma, and PET/CT shows a trend to perform better than the other modalities.
Abstract: To compare contrast-enhanced US (CE-US), multidetector-CT (MDCT), 1.5 Tesla MR with extra-cellular (Gd-enhanced) and intracellular (SPIO-enhanced) contrast agents and PET/CT, in the detection of hepatic metastases from colorectal cancer. A total of 34 patients with colo-rectal adenocarcinoma underwent preoperatively CE-US, MDCT, Gd- and SPIO-enhanced MR imaging (MRI), and PET/CT. Each set of images was reviewed independently by two blinded observers. The ROC method was used to analyze the results, which were correlated with surgical findings, intraoperative US, histopathology, and MDCT follow-up. A total of 57 hepatic lesions were identified: 11 hemangiomas, 29 cysts, 1 focal fatty liver, 16 metastases (dimensional distribution: 5/16 < 5 mm; 3/16 between 5 mm and <10 mm; 8/16 ≥ 10 mm). Six of 34 patients were classified as positive for the presence of at least one metastasis. Considering all the metastases and those ≥10 mm, ROC areas showed no significant differences between Gd- and SPIO-enhanced MRI, which performed significantly better than the other modalities (P < 0.05). Considering the lesions <10 mm, ROC areas showed no significant differences between all modalities; however MRI presented a trend to perform better than the other techniques. Considering the patients, ROC areas showed no significant differences between all the modalities; however PET/CT seemed to perform better than the others. Gd- and SPIO-enhanced MRI seem to be the most accurate modality in the identification of liver metastases from colo-rectal carcinoma. PET/CT shows a trend to perform better than the other modalities in the identification of patients with liver metastases.
96 citations
TL;DR: The preliminary results suggest that theUse of either DWI or DCEI is superior to the use of T2WI for predicting locally recurrent prostate cancer after radiation therapy, and the sensitivity and specificity of DWI, D CEI, and combined DCEi and DWI were higher than those for T2-weighted imaging.
Abstract: The purpose of this study was to retrospectively assess the diagnostic performance of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCEI) at 3T in predicting locally recurrent prostate cancer after radiation therapy. Twenty-four patients with a rising prostate-specific antigen level after treatment with radiation therapy underwent prostate MR imaging at 3T, followed by transrectal ultrasound-guided biopsy. MRI findings and biopsy results were correlated in six prostate sectors of both peripheral zones. Two radiologists in consensus reviewed the MR images and rated the likelihood of recurrent cancer on a 5-point scale. Out of the 144 prostate sectors, 37 (26%) sectors were positive for cancer in ten patients. For predicting locally recurrent cancer, the sensitivity and specificity of DWI, DCEI, and combined DCEI and DWI were higher than those for T2-weighted imaging (T2WI). The accuracy of DWI, DCEI and combined DCEI and DWI was greater than that of T2WI. A significantly greater Az was determined for combined DCEI and DWI (Az = 0.863, P < 0.05) as compared with T2WI, DCEI, and DWI. For predicting locally recurrent prostate cancer after radiation therapy, our preliminary results suggest that the use of either DWI or DCEI is superior to the use of T2WI.
77 citations
TL;DR: 64-Section CT with the addition of isotropic reformatted coronal and sagittal images is a very effective technique in the detection of peritoneal metastases of 0.5 cm in diameter or larger, although sensitivity decreases remarkably for lesions <0.5" diameter.
Abstract: To prospectively investigate the diagnostic accuracy of a 64-section multi-detector row computed tomography (CT) for the detection of peritoneal metastases, with the use of surgery and histopathological findings as the reference standard. The study cohort comprised 18 patients with peritoneal carcinomatosis who underwent multiphasic CT with a 64-section CT, 0–119 days before cytoreductive surgery. Transverse CT images along with isotropic reformatted coronal and sagittal images were prospectively and independently evaluated by one of the five staff radiologists in an unblinded fashion. The overall sensitivity, specificity, positive, and negative predictive values of CT for the detection of peritoneal metastases were, respectively, 75% (93 of 124 lesions; confidence interval [CI] 68–84), 92% (118 of 128; CI 85–96), 90% (93 of 103; CI 83–95), and 79% (118 of 149; CI 72–86). For lesions 0.5 cm in diameter or larger, CT yielded a mean sensitivity of 89% (77 of 87; CI 75–97), although sensitivity decreased to only 43% (16 of 37; CI 28–56) for lesions <0.5 cm in diameter. 64-Section CT with the addition of isotropic reformatted coronal and sagittal images is a very effective technique in the detection of peritoneal metastases of 0.5 cm in diameter or larger, although sensitivity decreases remarkably for lesions <0.5 cm in diameter.
76 citations
TL;DR: Dynamic contrast-enhanced multislice spiral CT was performed prospectively in 73 cases with histologically proven RCC to observe the perfusion CT findings of renal cell carcinoma and prospectively correlate perfusionCT parameters with tumor MVD and VEGF expression.
Abstract: Objective
To observe the perfusion CT findings of renal cell carcinoma (RCC) and prospectively correlate perfusion CT parameters with tumor MVD and VEGF expression.
74 citations
TL;DR: Hyper- or iso-enhancement during the cortical phase, subsequent washout in late phase, inhomogeneous enhancement, and perilesional rim-like enhancement are clues for R CCs, which might be useful for characterization of RCCs.
Abstract: Objective
To investigate the findings of renal cell carcinomas (RCCs) on contrast-enhanced ultrasound (CEUS)
72 citations
TL;DR: The results indicate that time attenuation curves obtained from triple-phase helical CT in protocol B provide useful information in differentiating chronic pancreatitis from pancreatic adenocarcinoma.
Abstract: Background
Chronic pancreatitis and pancreatic adenocarcinoma often show similar clinical and imaging appearances. This study aims to differentiate chronic pancreatitis from pancreatic adenocarcinoma by defining enhancement patterns in both pathologic conditions during triple-phase helical CT.
71 citations
TL;DR: It is concluded that MDCT is the technique of choice in the diagnosis of peritoneal seeding, while [18F]FDG-PET/CT, though showing similar accuracy, remains the most accurate technique for monitoring therapeutic response and disease recurrence.
Abstract: The diagnosis of peritoneal carcinomatosis secondary to ovarian cancer is a real challenge in the cancer imaging field. In this retrospective study, we evaluate the accuracy of Single Detector Computed Tomography (SDCT), Multi Detector Computed Tomography (MDCT), and Positron Emission Tomography–Computed Tomography with F18-fluorodeoxyglucose ([18F]FDG-PET/CT) in the diagnosis of peritoneal seeding and we evaluate the possible applications of MDCT to predict the complete surgical removal of the peritoneal deposits. A total of 228 scans (91 SDCT, 89 MDCT, and 48 [18F]FDG-PET/CT) of patients with peritoneal carcinomatosis secondary to ovarian cancer proved at laparoscopy and confirmed by histopathology were retrospectively reviewed by two independent groups of Radiologists and Nuclear Medicine Physicians for the evaluation of ascites, peritoneal nodules, and omental cake signs. MDCT showed 81% of true positives, SDCT 72.5%, and [18F]FDG-PET/CT 77%. False negatives were 19% for MDCT, 27.5% for SDCT, and 23% for [18F]FDG-PET/CT. From our results, we concluded that MDCT is the technique of choice in the diagnosis of peritoneal seeding, while [18F]FDG-PET/CT, though showing similar accuracy, remains the most accurate technique for monitoring therapeutic response and disease recurrence. MDCT could play an important role due to its ability to predict the possibility of complete surgical removal of disease thus influencing the treatment plan aimed to improve quality of life.
69 citations
TL;DR: MRE has demonstrated a good sensitivity in detection of CD activity, particularly in depiction of mural thickening, mural enhancement, and vascular engorgement and may be considered an alternative to CTE in assessing degree of CD and evaluating therapeutic effectiveness.
Abstract: Background
To compare magnetic resonance enterography (MRE) and computed tomography enterography (CTE) in detecting inflammatory bowel disease activity (IBD) in patients with Crohn’s disease (CD).
67 citations
TL;DR: The ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation and transcatheter arterial chemoembolization treatments of hepatocellular carcinoma (HCC) is evaluated.
Abstract: We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.
TL;DR: In the experience CEUS shows complete concordance with CT and MRI in the characterization of all 24 pseudotumors considered dubious at conventional and power Doppler US, which can reduce the need for contrast-enhanced CT or dynamic MRI in this item.
Abstract: Background: Within the term “pseudotumors” are grouped some renal anatomic variations that may simulate a focal renal lesion at ultrasonography. Our purpose was to assess the accuracy of contrast-enhanced ultrasonography (CEUS) using a second-generation contrast agent in the diagnosis of renal pseudotumors. Methods: We retrospectively retrieved CEUS examinations performed in 24 patients for characterization of suspected renal pseudotumor, in which conventional and power Doppler US study had been unable to confidently exclude a neoplasm. The considered criterion to define the diagnosis of renal pseudotumor was the demonstration of the same perfusion and reperfusion after microbubble breakage in both pseudotumor and surrounding parenchyma during early and late corticomedullary phase. In all patients, multiphase CT or dynamic MRI was available, representing a standard of reference for this study. In cases of CT or MRI diagnosis of renal lesion, final diagnoses were obtained with percutaneous renal biopsy or with surgery. Results: Contrast-enhanced ultrasonography diagnosis was concordant with MR or CT images in all cases. Conclusion: In our experience CEUS shows complete concordance with CT and MRI in the characterization of all 24 pseudotumors considered dubious at conventional and power Doppler US. The appropriate use of CEUS can reduce the need for contrast-enhanced CT or dynamic MRI in this item.
TL;DR: The “mushroom cap” sign on T2-weighted MR imaging may be a characteristic sign for diagnosing deep rectosigmoid endometriosis.
Abstract: The purpose of this study is to evaluate the “mushroom cap” sign on T2-weighted MR imaging in patients with submucosal tumors in the rectosigmoid colon. From January 2001 to August 2009, 12 patients with four different diseases presenting or mimicking submucosal tumors in the rectosigmoid colon underwent colonic resection. All patients with deep endometriosis (n = 6), gastrointestinal stromal tumor (n = 4), metastasis from ovary cancer (n = 1), and carcinoid tumor (n = 1) had either an MRI of the rectum or pelvis before surgery. We evaluated the MRI findings and compared them with the macroscopic and microscopic observations in the resected specimens. In all six cases of deep endometriosis, a characteristic “mushroom cap” shaped appearance was found on T2-weighted MR imaging. Heterogeneous low signal intensity of the hypertrophic muscularis propria, covered with high signal intensity of the mucosa and submucosa on T2-weighted MR images, looked like a “mushroom cap” with the pattern of intraluminal endophytic growth. In histological findings, deep endometriosis involved the submucosa (n = 4) or mucosa (n = 2). The “mushroom cap” sign was not present in any of the six other tumors. The “mushroom cap” sign on T2-weighted MR imaging may be a characteristic sign for diagnosing deep rectosigmoid endometriosis.
TL;DR: DCBE is more accurate than unenhanced MRI in the diagnosis of bowel endometriosis, and should be preferred in the preoperative management of this disease, since it usually enables a proper surgical planning.
Abstract: The purpose of the study was to compare the accuracy of double-contrast barium enema (DCBE) and magnetic resonance imaging (MRI) in the diagnosis of intestinal endometriosis using the histological examination on resected specimen as comparative standard. Eighty-three consecutive patients with suspected intestinal endometriosis, resected between 2005 and 2007, were prospectively evaluated. All of the women underwent preoperative DCBE and MRI on the same day. We evaluated number, site (rectum, sigmoid, cecum), and size of the lesions. The imaging findings were correlated with those resulting at pathology. Among the 65 women who underwent surgery, 50/65 (76.9%) were found to have bowel endometriosis, with 9/50 (18%) patients presenting two lesions; DCBE allowed to detect 50/59 (84.7%) lesions. MRI allowed to detect 42/59 (71.1%) lesions. DCBE showed sensibility, specificity, PPV, NPV, and accuracy of respectively 84.7, 93.7, 98.0, 62.5, and 86.6%, MRI of 71.1, 83.3, 93.3, 46.8, and 74.6%. DCBE is more accurate than unenhanced MRI in the diagnosis of bowel endometriosis, and should be preferred in the preoperative management of this disease, since it usually enables a proper surgical planning.
TL;DR: Sclerosing nodular transformation of the spleen shows increased tracer accumulation on positron emission tomography, and a central scar-like appearance with an enhancing capsule and radiating septae on CT and MR studies that reflects the gross and histopathological features of the lesion may be visible.
Abstract: Sclerosing angiomatoid nodular transformation (SANT) is a benign, proliferative vascular lesion affecting the spleen. Few reports detailing the cross sectional and PET appearance of this lesion are available, and the lesion’s behavior with 99mTc-sulfur colloid scintigraphy is previously unreported. Sclerosing nodular transformation of the spleen shows increased tracer accumulation on positron emission tomography, and a central scar-like appearance with an enhancing capsule and radiating septae on CT and MR studies that reflects the gross and histopathological features of the lesion may be visible. An understanding of this pathological finding may allow prospective recognition of the sclerosing nodular transformation of the spleen on cross sectional imaging studies.
TL;DR: Qualitative and quantitative analysis of time–signal intensity curves obtained with dynamic contrast-enhanced MRI allow reliable noninvasive differentiation between active and inactive CD.
Abstract: To assess Crohn’s disease (CD) activity through analysis of time–signal intensity curves and quantitative contrast-enhancement parameters on dynamic contrast-enhanced MRI. 70 patients (male:female = 44:26, age 15–45 years, mean 27.8 years) with biopsy-proven clinically active or inactive CD, underwent dynamic contrast-enhanced MRI after oral administration of iso-osmotic solution. Time–signal intensity curves were classified according to their shape as type I (early upslope with late plateau) and type II (slow contrast material wash-in with late wash-out). Curve parameters such as maximum enhancement (ME), the ratio between late and ME (LE/ME), and UpSlope (US) were compared between patients with active and inactive CD (two-tailed Mann–Whitney test). Sensitivity, specificity, and cut-off for each parameter were calculated by means of receiver operating characteristic curve (ROC) analysis. 53/53 patients with active CD and 17/17 with inactive CD showed type I and type II curves, respectively. ME, LE/ME, and US were significantly higher in active than in inactive CD. ME, LE/ME, and US had sensitivity and specificity of 100%:100%:100% and 100%:83%:100% with cut-offs of 135.5:0.8909:2, respectively. Qualitative and quantitative analysis of time–signal intensity curves obtained with dynamic contrast-enhanced MRI allow reliable noninvasive differentiation between active and inactive CD.
TL;DR: RWC-TVS is a new, simple technique for a single-step and accurate preoperative assessment of rectosigmoid endometriosis and was equally efficient as BE in the detection of a significant intestinal lumen stenosis.
Abstract: To evaluate the accuracy of Transrectal Sonography (TRS) and a new technique, Transvaginal Sonography with Water-Contrast in the Rectum (RWC-TVS), in the diagnosis of rectosigmoid endometriosis, and the accuracy of Barium Enema (BE) and RWC-TVS in the detection of intestinal stenosis due to endometriosis. In a prospective study, we compared the findings of TRS and RWC-TVS performed before surgery with the operative and pathologic findings in 61 consecutive patients who underwent laparoscopy or laparotomy for suspected rectosigmoid endometriosis. The accuracy of BE and RWC-TVS in the detection of intestinal stenosis was evaluated comparing the radiologic and ultrasonographic results with the macroscopic findings at surgery and pathology. RWC-TVS diagnosed rectosigmoid endometriosis with the same accuracy of TRS and was equally efficient as BE in the detection of a significant intestinal lumen stenosis. For the diagnosis of rectosigmoid endometriosis the sensitivity, specificity, positive and negative predictive values of TRS and RWC-TVS were 88.2% and 96%, 80%, and 90%, 95.7%, and 98%, and 57.1% and 81.8%, respectively. For the detection of intestinal stenosis the sensitivity, specificity, positive and negative predictive values of BE and RWC-TVS were 93.7% and 87.5%, 94.2% and 91.4%, 88.2% and 82.3%, and 97% and 94.1%, respectively. RWC-TVS is a new, simple technique for a single-step and accurate preoperative assessment of rectosigmoid endometriosis.
TL;DR: It is suggested that CTC is the radiological imaging technique of the large bowel with the lowest risk of stochastic radiation effects, suggesting that the radiation dose associated with a low-dose CT colonography protocol for colorectal cancer screening is substantially lower than that from DCBE.
Abstract: Our aim is to compare the radiation dose associated with a low-dose CT colonography (CTC) protocol for colorectal cancer screening with that delivered by double-contrast barium enema (DCBE). CTC of twenty asymptomatic individuals (M:F = 10:10) participating to a colorectal cancer screening program and DCBE of fifteen patients (M:F = 6:9) were evaluated. For CTC, absorbed dose was determined by calculating the dose-length product for each CTC examination from measurements on a CT dose phantom equipped with a CT ion chamber. For DCBE, the free-in-air Kerma at the patient’s X-ray entry surface and the Kerma-area product during fluoroscopy and fluorography were measured with a Barracuda system, with fluoroscopy times being recorded blinded to the performing operator. Effective dose at CTC was 2.17 ± 0.12 mSv, with good and excellent image quality in 14/20 (70%) and 6/20 cases (30%), respectively. With DCBE, effective patient dose was 4.12 ± 0.17 mSv, 1.9 times greater than CTC (P < 0.0001). Our results show that effective dose from screening CTC is substantially lower than that from DCBE, suggesting that CTC is the radiological imaging technique of the large bowel with the lowest risk of stochastic radiation effects.
TL;DR: Computed tomography is the most widely available and best validated modality for imaging patients with pancreatic adenocarcinoma and it is crucial that radiologists have an understanding of the implications of findings that are relevant to the determination of resectability.
Abstract: Imaging studies play an important role in the diagnosis and management of patients with pancreatic adenocarcinoma. Computed tomography (CT) is the most widely available and best validated modality for imaging these patients. Meticulous technique following a well-designed pancreas protocol is essential for maximizing the diagnostic efficacy of CT. After the diagnosis of pancreatic adenocarcinoma is made, the key to management is staging to determine resectability. In practice, staging often entails predicting the presence or absence of vascular invasion by tumor, for which several radiologic grading systems exist. With advances in surgical techniques, the definition of resectability is in evolution, and it is crucial that radiologists have an understanding of the implications of findings that are relevant to the determination of resectability.
TL;DR: In this article, the distribution of venous thrombi associated with primary or secondary abdominal malignancies on magnetic resonance (MR) imaging with respect to thrombus type (bland vs. tumor), tumor sites, tumor types, and veins involved in a large oncologic patient population was examined.
Abstract: The purpose of this study was to examine the distribution of venous thrombi associated with primary or secondary abdominal malignancies on magnetic resonance (MR) imaging with respect to thrombus type (bland vs. tumor), tumor sites, tumor types, and veins involved in a large oncologic patient population. In a retrospective review of 10,908 oncologic patients, MR imaging studies identified 142 (1.3%) showing venous thrombi, of which 55 (0.5%) were bland and 87 (0.79%) were tumor thrombus. Bland thrombi were most commonly seen in liver (35%; 19/55) and retroperitoneal malignancies (24%; 13/55) and were most often located in the inferior vena cava (45%; 25/55) and the portal vein (22%; 12/55). Tumor thrombi were most commonly seen in renal (55%; 48/87) and liver (32%; 28/87) malignancies. The prevalence of tumor thrombi was 8.8% (48/545) in primary renal, 4.7% (6/126) in primary retroperitoneal, 2.9% (19/634) in primary liver, and 1.8% (9/479) in secondary liver malignancies. Tumor thrombi were most commonly located in the inferior vena cava (57%; 50/87), the renal vein (48%; 42/87), and the portal vein (29%; 25/87).
TL;DR: MR imaging permits the diagnosis of NCE as well as the evaluation of exact extension of the disease.
Abstract: Objective
The purpose of this study was to describe the MR imaging findings of Nuck canal endometriosis (NCE).
TL;DR: The imaging appearances of small bowel tumors on MRI and the usefulness of MR enteroclysis in the diagnosis and categorization of these tumors are illustrated, also discussing the role of MRE in comparison with other diagnostic modalities.
Abstract: Magnetic resonance imaging (MRI) of the small bowel has become widely accepted at centers dedicated to the diagnosis and treatment of inflammatory bowel disease, due to the method’s diagnostic efficacy. MR enteroclysis is an imaging modality that combines the advantages of enteroclysis and multiplanar MR and allows the detection and the manifestations of small bowel diseases wherever they are located (intraluminal, intramural, or extramural). Magnetic resonance enteroclysis (MRE) is an emerging technique used for the detection and evaluation of small bowel neoplasms. This article illustrates the imaging appearances of small bowel tumors on MRI and the usefulness of MR enteroclysis in the diagnosis and categorization of these tumors, also discussing the role of MRE in comparison with other diagnostic modalities.
TL;DR: This work reviewed 226 selective abdominal angiography and CT scans during selective arteriography of common hepatic artery, superior mesenteric artery, splenic artery, or peripancreatic arteries including posterior superior pancreaticoduodenal arteries, to clarify the cross-sectional anatomy of the pancreatic arterial territory.
Abstract: The pancreas has complex arterial supplies. Therefore, special attention should be paid in pancreatic arterial intervention for patients with acute pancreatitis and pancreatic carcinomas. Knowledge of pancreatic arterial anatomy and arterial territory is important not only to perform pancreatic arterial intervention, but to read the pancreatic angiography and cross-sectional image. We reviewed 226 selective abdominal angiography and CT scans during selective arteriography (CTA) of common hepatic artery, superior mesenteric artery, splenic artery, or peripancreatic arteries including posterior superior pancreaticoduodenal artery, anterior superior pancreaticoduodenal artery, inferior pancreaticoduodenal artery, and dorsal pancreatic artery. CTA images were evaluated to clarify the cross-sectional anatomy of the pancreatic arterial territory. Variations of the peripancreatic arteries were also investigated. In this exhibit, schemes and illustrative cases demonstrate pancreatic arterial territory and variations.
TL;DR: The purpose of this review is to describe the current terminology and new concepts in the pathophysiology, to outline the long existing and newly developed radiological scoring systems in prediction of severity and outcome with their respective advantages and limitations, and to define the role of radiological prognostic scored systems in the new environment of perception of the last decade.
Abstract: Acute pancreatitis (AP) is a common inflammatory disease which can be mild and self-limiting without complications or severe with prolonged hospitalization, high morbidity, and high mortality. Different radiological scoring systems to predict severity and outcome in AP have been developed since the early 1990s. In the meantime, new insights in the pathophysiology of AP and consequently, therapeutic management of these patients have been introduced. The purpose of this review is therefore (1) to describe the current terminology and new concepts in the pathophysiology, (2) to outline the long existing and newly developed radiological scoring systems in prediction of severity and outcome with their respective advantages and limitations, and (3) to define the role of radiological prognostic scoring systems in the new environment of perception of the last decade. Risk stratification in AP requires scoring systems that can be calculated early in the course of disease which allows time for intervention. For that reason, scoring systems based on necrosis are not useful in severity prediction. The recent developed radiological scoring systems based on signs of systemic inflammatory response syndrome and organ dysfunction are promising in prediction of severity early after onset of AP.
TL;DR: CT colonography should replace colonoscopy for preoperative staging of colorectal cancer and has better performance in the identification of colonic masses, in the completion of Colonic evaluation and in the segmental localization of tumor.
Abstract: Once presence of a colorectal cancer has been diagnosed, a key factor for patient's prognosis in view of surgical intervention is the correct segmental localization and resection of the tumor. The aim of this work was to compare the accuracy of the current gold standard technique, conventional colonoscopy (CC), to computed tomography colonography (CTC) in the segmental localization of tumor. Sixty-five patients (mean age 64; 45 female and 19 male) with colorectal cancer diagnosed at colonoscopy underwent CTC before surgery. In 45 out of 65 cases (69%), patients were referred to CTC after incomplete CC. Reasons were patient intolerance to CC or presence of stenosing cancer, with consistent difficulties in crossing the tract of the colon involved by the lesion. CTC allowed the complete colonic examination in 63/65 cases, since in 2 patients with an obstructing lesion of the sigmoid colon, pneumocolon could not be obtained. However, per patient and per lesion sensitivity of CTC was 100%. Difference from colonoscopy was statistically significant (P 3 cm), in the completion of colonic evaluation and in the segmental localization of tumor. CTC should replace colonoscopy for preoperative staging of colorectal cancer.
TL;DR: It is concluded that DW-EPI is more sensitive than T2-weighted MR imaging and at least as accurate as superparamagnetic iron oxide-enhanced or gadolinium-enhancing MR imaging for the detection of hepatic metastases.
Abstract: Diffusion-weighted MR imaging is increasingly applied to detect and characterize focal hepatic lesions. In this update article, technical aspects regarding diffusion-weighted echo-planar imaging (DW-EPI) of the liver will be addressed, and concepts for image interpretation will be provided. The value of DW-EPI for the detection of hepatic metastases is illustrated on the basis of a review of the literature and our personal experience. In this respect, special emphasis is given to the comparison of DW-EPI with well-established MR imaging techniques such as T2-weighted and contrast-enhanced MR imaging, and advantages and limitations of DW-EPI will be described. Based on the review, it is concluded that DW-EPI is more sensitive than T2-weighted MR imaging and at least as accurate as superparamagnetic iron oxide-enhanced or gadolinium-enhanced MR imaging for the detection of hepatic metastases. Although difficulties occasionally arise in further characterizing small lesions detected with DW-EPI, substantial improvements in the preoperative evaluation of liver metastases in candidates for hepatic resection may be expected.
TL;DR: Functional cine MRI is suitable for follow-up studies in patients after hernia repair to detect and evaluate the implanted meshes and typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed as well.
Abstract: To non-invasively identify incisional hernia repair implanted synthetic meshes with MRI, and also focusing on the evaluation of postsurgical complications such as adhesions. A total of 43 patients underwent either laparoscopic intraperitoneal onlay-mesh or open abdominal wall repair using preperitoneal layers. The patients were examined using a true-fast-imaging-with-steady-state-precession (trueFISP)-sequence in transverse/sagittal orientation with a section-by-section dynamic depiction of induced visceral slide. A 9-segment-abdominal-map was used to document the adhesion location/type. The MR-images were analysed regarding hernia relapse, layer-morphology, rectus-abdominis muscle-condition, and abdominal wall mobility. In 12 patients pre- and postsurgery-MRI was performed. Time range between surgery and examination was 6–36 months. In all laparoscopy-patients the meshes were identified. For open surgery the mesh was not visualized in 20, but was seen in 6 cases. A total of 11 cases showed a recurrent hernia. Seventy intraabdominal adhesions were detected. Fifteen patients had restricted mobility. 20 patients showed an rectus-abdominis-muscle-asymmetry. Comparing pre- and post-op-MRI, 6 out of 8 patients with open repair showed thick scar-plaques. Three patients with open repair had new adhesion-formations postoperatively. Functional cine MRI is suitable for follow-up studies in patients after hernia repair to detect and evaluate the implanted meshes. Typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed as well.
TL;DR: CTC with limited bowel preparation performed in an FOBT positive screening population has high diagnostic accuracy for the detection of adenomas and carcinomas and a sensitivity similar to that of colonoscopy for relevant lesions.
Abstract: Purpose
Aim was to evaluate the accuracy of computed tomography colonography (CTC) for detection of colorectal neoplasia in a Fecal Occult Blood Test (FOBT) positive screening population.
TL;DR: The utility and performances of high-quality computed tomography multiplanar reconstructions combined with vascular volume rendering analysis for the diagnosis of internal hernia are enlightened.
Abstract: We report a rare case of small bowel obstruction of a 45-year-old female which was caused by internal hernia of the terminal ileum and cecum through the foramen of Winslow. The patient presented to the emergency department with acute abdominal pain, distention, and nausea, suggesting an intestinal obstruction. The complete unambiguous preoperative diagnosis was achieved by a 64-row multi-detector computed tomography. This report enlightens the utility and performances of high-quality computed tomography multiplanar reconstructions combined with vascular volume rendering analysis for the diagnosis of internal hernia.
TL;DR: Available evidence indicates that MR colonography (MRC) can be a useful tool as an alternative or complementary to endoscopy for the detection of activity and assessment of severity in colonic CD.
Abstract: Conventional colonoscopy combined by histological examination, represents the standard for the evaluation of colorectal pathologies and usually is the first examination for the evaluation of patients with suspected or established diagnosis of Crohn’s disease (CD). However, information provided by colonoscopy is limited to mucosal alterations since the technique is unable to evaluate transmural changes or presence of extraluminal complications such as abscesses or fistula. Technological advances in magnetic resonance (MR) raised expectations on the potential role of this imaging modality for evaluation of the gastrointestinal tract based on the high spatial and tissue resolution as well as lack of ionizing radiation. Available evidence indicates that MR colonography (MRC) can be a useful tool as an alternative or complementary to endoscopy for the detection of activity and assessment of severity in colonic CD. In this article, we review the technical aspects of MRC and the spectrum of findings that provide valuable information for the evaluation of colonic CD. Potential applications and limitations of MRC are also discussed.