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Prathapan L, Rama Krishnan KK, Bala P, T P. Pixel to Pathology: A Prospective Cross-Sectional Study on the Role of Multidetector Computed Tomography in the Evaluation of Malignant Large Bowel Lesions With Histopathological Correlation. Cureus 2024; 16:e71200. [PMID: 39525180 PMCID: PMC11549844 DOI: 10.7759/cureus.71200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Colorectal lesions can present as a mass or as focal or diffuse thickening of the colon wall and may also be associated with abnormalities in the perienteric region. Multidetector computed tomography (MDCT) enables simultaneous imaging of both extracolonic structures and the gut wall. It is instrumental in assessing tumor extent, detecting pericolic dissemination, including lymph node involvement, and identifying metastases. This study aims to evaluate the role of MDCT in diagnosing large bowel lesions in patients referred from the surgery department with suspected large bowel pathology and to correlate MDCT findings with histopathological results. MATERIALS AND METHODS In the Department of Radiodiagnosis at Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, this study was carried out from February 2023 to January 2024 over a one-year span. CT imaging was carried out utilizing a GE Optima 128 Slice MDCT scanner for instances of clinically suspected large bowel pathology. IV contrast, rectal, oral (positive), and plain CT were the imaging protocols that were used. RESULTS Thirty of the 45 patients were female, and 15 were male; most of the patients were in the 46-60 age range. Twenty-three of the 24 instances with a CT diagnosis of malignancy had a histological confirmation. On CT, all 21 benign lesions were correctly detected. Benign lesions showed homogenous attenuation, mild symmetric wall thickening, and diffuse bowel involvement. Heterogeneous attenuation, pronounced asymmetric wall thickening, and localized bowel involvement were observed in malignant lesions. CONCLUSION For the diagnosis and differentiation of benign from malignant colon and rectum lesions, MDCT has shown itself to be an excellent technique. MDCT provides additional information about related pericolic abnormalities, lymph node presence, neighboring organ infiltration, and distant metastases in addition to identifying the lesions.
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Affiliation(s)
- Lonika Prathapan
- Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Pondicherry, IND
| | | | - Priyadharshini Bala
- Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Pondicherry, IND
| | - Prabakaran T
- Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Pondicherry, IND
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Gulinac M, Kiprin G, Tsranchev I, Graklanov V, Chervenkov L, Velikova T. Clinical issues and challenges in imaging of gastrointestinal diseases: A minireview and our experience. World J Clin Cases 2024; 12:3304-3313. [PMID: 38983422 PMCID: PMC11229912 DOI: 10.12998/wjcc.v12.i18.3304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
Imaging techniques play a crucial role in the modern era of medicine, particularly in gastroenterology. Nowadays, various non-invasive and invasive imaging modalities are being routinely employed to evaluate different gastrointestinal (GI) diseases. However, many instrumental as well as clinical issues are arising in the area of modern GI imaging. This minireview article aims to briefly overview the clinical issues and challenges encountered in imaging GI diseases while highlighting our experience in the field. We also summarize the advances in clinically available diagnostic methods for evaluating different diseases of the GI tract and demonstrate our experience in the area. In conclusion, almost all imaging techniques used in imaging GI diseases can also raise many challenges that necessitate careful consideration and profound expertise in this field.
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Affiliation(s)
- Milena Gulinac
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Georgi Kiprin
- Department of Gastroenterology, MHAT Eurohospital, Plovdiv 4000, Bulgaria
| | - Ivan Tsranchev
- Department of Forensic Medicine and Deontology, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
| | - Vasko Graklanov
- First Department of Internal Diseases, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Plovdiv 4000, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
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3
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Che X, Yang C, Pan L, Gu D, Dai G, Shu J, Yang L. Achieving safe and high-performance gastrointestinal tract spectral CT imaging with small-molecule lanthanide complex. Biomater Res 2023; 27:119. [PMID: 37990349 PMCID: PMC10664581 DOI: 10.1186/s40824-023-00463-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Non-intrusive imaging of gastrointestinal (GI) tract using computed tomography (CT) contrast agents is of the most significant issues in the diagnosis and treatment of GI diseases. Moreover, spectral CT, which can generate monochromatic images to display the X-ray attenuation characteristics of contrast agents, provides a better imaging sensitivity for diagnose inflammatory bowel disease (IBD) than convention CT imaging. METHODS Herein, a convenient and one-pot synthesis method is provided for the fabrication of small-molecule lanthanide complex Holmium-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (Ho-DOTA) as a biosafe and high-performance spectral CT contrast agent for GI imaging with IBD. In vivo CT imaging was administered with both healthy mice and colitis mice induced by dextran sodium sulfate. RESULTS We found that Ho-DOTA accumulated in inflammation sites of large intestines and produced high CT contrast compared with healthy mice. Both in vitro and in vivo experimental results also showed that Ho-DOTA provided much more diagnostic sensitivity and accuracy due to the excellent X-ray attenuation characteristics of Ho-DOTA compared with clinical iodinate agent. Furthermore, the proposed contrast media could be timely excreted from the body via the urinary and digestive system, keeping away from the potential side effects due to long-term retention in vivo. CONCLUSION Accordingly, Ho-DOTA with excellent biocompatibility can be useful as a potential high-performance spectral CT contrast agent for further clinical imaging of gastrointestinal tract and diagnosis of intestinal system diseases.
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Affiliation(s)
- Xiaoling Che
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Chunmei Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Liping Pan
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Didi Gu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Guidong Dai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China.
| | - Lu Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China.
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Lee HW, Jung JW, Park S, Lee K, Lee SK. Computed tomographic features of focal lipogranulomatous lymphangitis for differentiating from malignant intestinal lesions in a dog. J Vet Sci 2023; 24:e25. [PMID: 37012033 PMCID: PMC10071275 DOI: 10.4142/jvs.22301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
An eight-year-old Maltese dog presented with diarrhea and anorexia. Ultrasonography revealed marked focal wall thickening with loss of layering in the distal ileum. Contrast-enhanced computed tomography (CT) revealed a preserved wall layer with hypoattenuating middle wall thickening. In some segments of the lesion, small nodules protruding toward the mesentery from the outer layer were observed. Histopathology revealed focal lipogranulomatous lymphangitis (FLL) with lymphangiectasia. This is the first report to describe the CT features of FLL in a dog. CT features of preserved wall layers with hypoattenuating middle wall thickening and small nodules can assist in diagnosing FLL in dogs.
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Affiliation(s)
- Hye-Won Lee
- Department of Diagnostic Veterinary Imaging, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Jin-Woo Jung
- Noah Animal Medical Center, Gwangju 61426, Korea
| | - Seungjo Park
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Kija Lee
- Department of Diagnostic Veterinary Imaging, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Sang-Kwon Lee
- Department of Diagnostic Veterinary Imaging, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
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Siow JW, Chau J, Podadera JM, Makara M. Investigation of scan delays for CT evaluation of inner wall layering and peak enhancement of the canine stomach and small intestine using a 20 second fixed-injection-duration and bolus tracking technique. Vet Radiol Ultrasound 2023; 64:42-52. [PMID: 35959974 PMCID: PMC10087455 DOI: 10.1111/vru.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023] Open
Abstract
Many gastrointestinal diseases affect the mucosal layer, suggesting that on computed tomography (CT) examination, detection of consistent inner wall layering of the gastrointestinal tract may aid in detection of disease. Changes in wall enhancement can also characterise specific diseases and provide prognostic information. The objectives of this mixed retrospective and prospective analytical study were therefore to identify the scan delays for peak detection of canine stomach and small intestinal inner wall layering and enhancement when using a 20 s fixed-injection-duration and bolus tracking technique. For each patient, 700 mg I/kg iohexol was administered intravenously. Bolus tracking was used to determine aortic arrival. Diagnostic scans were performed after a post-aortic arrival scan delay. Postcontrast CT series were grouped according to post-aortic arrival scan delay: 5 s (n = 17), 10 s (n = 18), 15 s (n = 23), 20 s (n = 10), 25 s (n = 6), 30 s (n = 14), 35 s (n = 17), 40 s (n = 24), and 180 s (n = 60). The stomach and small intestine were assessed for the presence of a contrast-enhancing inner wall layer and wall enhancement. Statistical modeling showed that the scan delays for peak inner wall layering and enhancement were 10 and 15 s for the small intestine, respectively, and 40 s for the stomach. For the injection protocol used in this study, assessment of the canine gastrointestinal tract may use scan delays of 10-15 s and 40 s.
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Affiliation(s)
- Jia Wen Siow
- University Veterinary Teaching Hospital, School of Veterinary Science, University of Sydney, Camperdown, New South Wales, Australia
| | - Jennifer Chau
- University Veterinary Teaching Hospital, School of Veterinary Science, University of Sydney, Camperdown, New South Wales, Australia
| | - Juan M Podadera
- University Veterinary Teaching Hospital, School of Veterinary Science, University of Sydney, Camperdown, New South Wales, Australia
| | - Mariano Makara
- Northside Veterinary Specialists, 335 Mona Vale Road, Terrey Hills, New South Wales, Australia
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Ding SS, Liu C, Zhang YF, Sun LP, Xiang LH, Liu H, Fang Y, Ren WW, Zhao H, Sun XM, Zhang K, Zhang CB, Xu XR, Xu HX. Contrast-enhanced ultrasound in the assessment of Crohn's disease activity: comparison with computed tomography enterography. LA RADIOLOGIA MEDICA 2022; 127:1068-1078. [PMID: 35943658 DOI: 10.1007/s11547-022-01535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/25/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Continuous assessment of disease activity remains a huge challenge during the follow-ups of patients with Crohn's disease (CD). In this paper, we aimed to evaluate the performance of contrast-enhanced ultrasound (CEUS) by comparing with computed tomography enterography (CTE) in the assessment of disease activity in CD. MATERIALS AND METHODS Fifty-two patients diagnosed with CD were included in this study, using the CEUS and CTE as imaging methods for comparison. The selected parameters included the location and thickness of the thickest part of the intestinal wall, mesenteric fat proliferation, mesenteric vessels change, enhancement pattern and the presence of complications. Patients were clinically assessed using the Crohn's disease activity index (CDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Simple endoscopic score for Crohn's disease (SES-CD) was regarded as the reference standard. RESULTS The location of the thickest part of the intestinal wall (κ = 0.653), bowel wall thickness (ICC = 0.795), mesenteric vessels change (κ = 0.692) and complications (κ = 0.796) displayed substantial agreement (0.61-0.80) between CEUS and CTE, while the detection of mesenteric fat proliferation (κ = 0.395) and enhancement pattern (κ = 0.288) showed fair consistency (0.21-0.40) for comparison. In CEUS, bowel wall thickness, mesenteric fat proliferation, enhancement pattern and mesenteric vessels change were statistically significant in assessing CD activity, while bowel wall thickness, mesenteric fat proliferation and mesenteric vessels change in CTE. Bowel wall thickness showed the best diagnostic performance in the assessment of CD activity at CEUS and CTE. CONCLUSION CEUS provides a radiation-free and effective way to assess the CD activity in comparison with CTE, which also avoids frequent colonoscopy examinations, improves tolerance of patients, and reduces the cost of medical care, thereby serving as a useful tool for CD follow-up.
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Affiliation(s)
- Shi-Si Ding
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chang Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yan Fang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui Zhao
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao-Min Sun
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Kun Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chang-Bao Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Xiao-Rong Xu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China.
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Mazza S, Laurenza C, Elvo B, Tanzi G, Ungari M, Soro S, Verga MC, Drago A, Grassia R. Rectal linitis plastica as the first presentation of metastatic lobular breast cancer: an endoscopic ultrasound diagnosis. Clin J Gastroenterol 2022; 15:1072-1077. [DOI: 10.1007/s12328-022-01690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
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Murakami M, Heng HG, Sola M. CT features of confirmed and presumed gastric wall edema in dogs. Vet Radiol Ultrasound 2022; 63:711-718. [PMID: 35674240 PMCID: PMC9796106 DOI: 10.1111/vru.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
Postcontrast computed tomographic (CT) characteristics of gastrointestinal (GI) wall edema in humans have been described as GI wall thickening with a thickened submucosal layer and thin enhanced inner and outer layers. Published studies describing CT features of gastric wall edema in dogs are currently lacking. The aim of this retrospective, case series was to describe CT features of gastric wall edema in a group of dogs. Medical records were searched for dogs with postcontrast abdominal CT scans and a diagnosis of gastric wall edema based on histopathology (group I) or CT characteristics consistent with those reported in humans (group II). Clinical diagnosis, mean serum albumin concentration, and histopathological diagnosis were recorded. The following CT characteristics were recorded: numbers of wall layers, attenuation and contrast enhancement, presence of blood vessels, locations, distribution, and thickness. Twelve dogs (3 in group I and 9 in group II) were included. The most common clinical finding was hypoalbuminemia. In group I, a well-defined three-layer appearance with a non-enhancing fluid-attenuating middle layer was observed in three dogs and thin blood vessels in the middle layer in two dogs. In group II, nine dogs had a three-layer appearance with a non-enhancing fluid-attenuating middle layer. Locations of gastric wall thickening were diffuse in two, focal concentric in six, and focal asymmetric in four dogs. Findings supported including gastric wall edema as a differential diagnosis for dogs with hypoalbuminemia and CT characteristics of a three-layer appearance in the gastric wall, with a non-enhancing fluid-attenuating middle layer and thin blood vessels.
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Affiliation(s)
- Masahiro Murakami
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Purdue UniversityWest LafayetteIndianaUSA
| | - Hock Gan Heng
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Purdue UniversityWest LafayetteIndianaUSA
| | - Mario Sola
- Department of Comparative PathobiologyCollege of Veterinary Medicine, Purdue UniversityWest LafayetteIndianaUSA
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9
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Zhuang P, Xiang K, Meng X, Wang G, Li Z, Lu Y, Kan D, Zhang X, Sun SK. Gram-scale synthesis of a neodymium chelate as a spectral CT and second near-infrared window imaging agent for visualizing the gastrointestinal tract in vivo. J Mater Chem B 2021; 9:2285-2294. [PMID: 33616148 DOI: 10.1039/d0tb02276d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The diagnosis of gastrointestinal (GI) tract diseases is frequently performed in the clinic, so it is crucial to develop high-performance contrast agents for real-time and non-invasive imaging examination of the GI tract. Herein, we show a novel method to synthesize a neodymium (Nd) chelate, Nd-diethylenetriaminepentaacetic acid (Nd-DTPA), on a large scale without byproducts for spectral computed tomography (CT) and second near-infrared window imaging of the GI tract in vivo. The Nd-DTPA was simply generated by heating the mixture of Nd2O3 and DTPA in water at 85 °C for 2 h. This dual-modal imaging agent has the advantages of a simple and green synthesis route, no need of purification process, high yield (86.24%), large-scale production capability (>10 g in lab synthesis), good chemical stability and excellent water solubility (≈2 g mL-1). Moreover, the Nd-DTPA emitted strong near-infrared fluorescence at 1308 nm, and exhibited superior X-ray attenuation ability compared to clinical iohexol. The proposed Nd-DTPA can integrate the complementary merits of dual-modal imaging to realize spatial-temporal and highly sensitive imaging of the GI tract in vivo, and accurate diagnosis of the location of intestinal obstruction and monitor its recovery after surgery. The developed highly efficient method for the gram-scale synthesis of Nd-DTPA and the proposed spectral CT and second near-infrared window dual-modal imaging strategy provide a promising route for accurate visualization of the GI tract in vivo.
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Affiliation(s)
- Pengrui Zhuang
- Department of Medical imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Ke Xiang
- Department of Medical imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Xiangxi Meng
- Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Guohe Wang
- Department of Medical imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Ziyuan Li
- Department of Biomedical Engineering, Peking University, Beijing 100871, China
| | - Yanye Lu
- Department of Biomedical Engineering, Peking University, Beijing 100871, China
| | - Di Kan
- Department of Medical imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Xuejun Zhang
- Department of Medical imaging, Tianjin Medical University, Tianjin 300203, China.
| | - Shao-Kai Sun
- Department of Medical imaging, Tianjin Medical University, Tianjin 300203, China.
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Abstract
Dual-energy CT (DECT) overcomes several limitations of conventional single-energy CT (SECT) for the evaluation of gastrointestinal diseases. This article provides an overview of practical aspects of the DECT technology and acquisition protocols, reviews existing clinical applications, discusses current challenges, and describes future directions, with a focus on gastrointestinal imaging. A head-to-head comparison of technical specifications among DECT scanner implementations is provided. Energy- and material-specific DECT image reconstructions enable retrospective (i.e., after examination acquisition) image quality adjustments that are not possible using SECT. Such adjustments may, for example, correct insufficient contrast bolus or metal artifacts, thereby potentially avoiding patient recalls. A combination of low-energy monochromatic images, iodine maps, and virtual unenhanced images can be included in protocols to improve lesion detection and disease characterization. Relevant literature is reviewed regarding use of DECT for evaluation of the liver, gallbladder, pancreas, and bowel. Challenges involving cost, workflow, body habitus, and variability in DECT measurements are considered. Artificial intelligence and machine-learning image reconstruction algorithms, PACS integration, photon-counting hardware, and novel contrast agents are expected to expand the multienergy capability of DECT and further augment its value.
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11
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Trabzonlu TA, Mozaffary A, Kim D, Yaghmai V. Dual-energy CT evaluation of gastrointestinal bleeding. Abdom Radiol (NY) 2020; 45:1-14. [PMID: 31728614 DOI: 10.1007/s00261-019-02226-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gastrointestinal bleeding is a common cause for hospital admissions and is an important cause of morbidity and mortality. Although endoscopy is accepted as the standard initial diagnostic modality for the evaluation of gastrointestinal bleeding, multiphasic computed tomography (CT) imaging has become an alternative diagnostic tool. Dual-energy CT with post-processing techniques may have additional advantages over single-energy computed tomography in evaluation of gastrointestinal bleeding. In this article, we discuss the role of dual-energy CT in the evaluation of gastrointestinal bleeding with potential advantages over conventional CT and limitations.
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12
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Mang T, Scharitzer M. [Imaging of gastrointestinal inflammation : Characteristic patterns and signs]. Radiologe 2019; 58:281-291. [PMID: 29572712 DOI: 10.1007/s00117-018-0376-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CLINICAL PROBLEM Pathological conditions of the gastrointestinal tract can result from various disorders, including inflammatory, infectious, neoplastic, and ischemic diseases. RADIOLOGICAL STANDARD PROCEDURES Cross-sectional imaging techniques have largely replaced many of the conventional fluoroscopic examinations, such as small bowel follow-through and double-contrast barium enema. The former allow for time-efficient, accurate, and minimally invasive diagnostics. Therefore, they have become important diagnostic tools for the evaluation of inflammatory diseases of the gastrointestinal tract. The distension of the intestinal lumen with orally administered neutral contrast media improves not only the evaluation of the intraluminal aspect, but also of the cross-sectional appearance. Furthermore, with cross-sectional imaging techniques, the additional assessment of the extraintestinal structures and organs is also possible. METHODICAL INNOVATIONS AND ASSESSMENT With the ongoing development of scanner and software technology, pathologic conditions of the gastrointestinal wall can be characterized in more detail by both computed tomography and magnetic resonance imaging. A structured approach, based on the analysis of typical radiological signs and patterns, combined with the evaluation of extraintestinal findings may help to assign the observed imaging findings to specific disease groups. RECOMMENDATIONS This article summarizes common signs and typical patterns frequently seen in inflammatory conditions of the gastrointestinal tract. A systematic approach for structured analysis of specific and nonspecific imaging features and common pitfalls may aid in the interpretation and help to narrow the spectrum of potential differential diagnoses.
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Affiliation(s)
- T Mang
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - M Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Norton JC, Slawinski PR, Lay HS, Martin JW, Cox BF, Cummins G, Desmulliez MP, Clutton RE, Obstein KL, Cochran S, Valdastri P. Intelligent magnetic manipulation for gastrointestinal ultrasound. Sci Robot 2019; 4:eaav7725. [PMID: 31380501 PMCID: PMC6677276 DOI: 10.1126/scirobotics.aav7725] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diagnostic endoscopy in the gastrointestinal tract has remained largely unchanged for decades and is limited to the visualization of the tissue surface, the collection of biopsy samples for diagnoses, and minor interventions such as clipping or tissue removal. In this work, we present the autonomous servoing of a magnetic capsule robot for in-situ, subsurface diagnostics of microanatomy. We investigated and showed the feasibility of closed-loop magnetic control using digitized microultrasound (μUS) feedback; this is crucial for obtaining robust imaging in an unknown and unconstrained environment. We demonstrated the functionality of an autonomous servoing algorithm that uses μUS feedback, both on benchtop trials as well as in-vivo in a porcine model. We have validated this magnetic-μUS servoing in instances of autonomous linear probe motion and were able to locate markers in an agar phantom with 1.0 ± 0.9 mm position accuracy using a fusion of robot localization and μUS image information. This work demonstrates the feasibility of closed-loop robotic μUS imaging in the bowel without the need for either a rigid physical link between the transducer and extracorporeal tools or complex manual manipulation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Keith L. Obstein
- STORM Lab USA, Vanderbilt University, Nashville, USA
- Vanderbilt University Medical Center, Nashville, USA
| | - Sandy Cochran
- University of Glasgow, School of Mechanical Engineering, Glasgow, UK
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Agarwala R, Singh AK, Shah J, Mandavdhare HS, Sharma V. Ileocecal thickening: Clinical approach to a common problem. JGH OPEN 2019; 3:456-463. [PMID: 31832544 PMCID: PMC6891021 DOI: 10.1002/jgh3.12186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 12/22/2022]
Abstract
Ileocecal thickening (ICT) is a common finding on radiological imaging. It can be caused by a variety of inflammatory, infectious, or neoplastic conditions, and evaluating a patient of ICT can be a challenging task. Intestinal tuberculosis (ITB), Crohn's disease (CD), and adenocarcinoma are the most common causes. Enteric bacterial infections, cytomegalovirus, histoplasmosis, amebiasis, systemic vasculitis, lymphoma, etc. should be suspected in appropriate clinical settings. However, it could often be a spurious or nonspecific finding. A thickness of more than 3 mm in a normally distended small bowel is usually considered abnormal. Detailed evaluation of imaging of the site and extent of thickening; the degree and pattern of thickening; and the associated findings, such as degree of fat stranding, fibrofatty proliferation, adjacent lymph nodes, and solid organ involvement, should be performed. Ileocolonoscopy is an important tool for diagnosing and obtaining samples for tissue diagnosis. Histopathology is usually the gold standard for diagnosis, although—not uncommonly—findings could be nonspecific, and reaching a definitive diagnosis is difficult. As such, a systematic approach with the integration of clinical, biochemical, radiological, endoscopic, histological, and other laboratory tests is the key to reaching a diagnosis. In this article, we review the causes of ICT and present a clinical approach for the management of ICT.
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Affiliation(s)
- Roshan Agarwala
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Abhi K Singh
- Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Jimil Shah
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Harshal S Mandavdhare
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vishal Sharma
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
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15
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Deshpande SS, Joshi AR, Deshpande SS, Phajlani SA. Computed tomographic features of abdominal tuberculosis: unmask the impersonator! Abdom Radiol (NY) 2019; 44:11-21. [PMID: 30027495 DOI: 10.1007/s00261-018-1700-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality. METHODS We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed. RESULTS Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB. CONCLUSION ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.
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Affiliation(s)
- Sneha Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.
| | - Anagha Rajeev Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Saurabh Satish Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Soyaf A Phajlani
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
- Department of Radiology, Government Medical College, Nagpur, 440009, India
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Abstract
Since the introduction of CT colonography (CTC) in the mid-1990s, there have been continuous advancements in the examination technique and advanced visualization software for interpretation. This review will cover the origins of CTC as a natural extension of abdominal CT imaging, and discuss the evolution of CTC through the subsequent clinical phases of feasibility, validation, and implementation.
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17
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Cvejić S, Filipović S, Pavićević P, Vukadinović V. Ultrasound and magnetic resonance enterography in diagnosis of Crohn's disease in children. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Gong XH, Zhuang ZG, Zhu J, Feng Q, Xu JR, Qian LJ. Differentiation of cancerous and inflammatory colorectal perforations using multi-detector computed tomography. Abdom Radiol (NY) 2017; 42:2233-2242. [PMID: 28401282 DOI: 10.1007/s00261-017-1134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine reliable CT features to distinguish cancerous from inflammatory colorectal perforations. MATERIALS AND METHODS A total of 43 patients with surgically and pathologically confirmed colorectal perforation caused by either colorectal cancer (n =27) or an inflammatory conditions (n = 16) were identified. Two radiologists independently assessed the contrast-enhanced CT features for locations of perforation, mural configurations, soft-tissue alterations, lymphadenopathy, and metastases. Intergroup comparisons for univariate analysis were performed using Fisher's exact test or chi-square test for categorical data and Mann-Whitney test for numeric data. Stepwise logistic regression analysis was conducted with features that were found significant under the univariate analysis. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and kappa test. RESULTS Maximal mural thickness >1.39 cm (sensitivity, 100%; specificity, 68.75%), luminal mass or shoulder formation (sensitivity, 88.89%; specificity, 68.75%), absence of diverticula (sensitivity, 96.30%; specificity, 50.00%), irregular mural thickening (sensitivity, 92.59%; specificity, 81.25%), lymphadenopathy (sensitivity, 40.74%; specificity, 93.75%), and metastases (sensitivity, 25.93%; specificity, 100%) were significantly frequent in cancerous perforations. The maximal mural thickness (P = 0.0493, odds ratio = 439.83) and irregular mural thickening (P = 0.0343, odds ratio = 4.69) were identified as the highly distinguished identifiers. CONCLUSIONS The CT manifestations of cancerous and inflammatory colorectal perforations overlap. Definitive diagnosis is not always possible with imaging alone. The maximal mural thickness >1.39 cm and irregular configuration of the thickened bowel wall were the two highly statistically significant CT features that may help order the difference between the two entities.
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Affiliation(s)
- Xu Hua Gong
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Zhi Guo Zhuang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Jiong Zhu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Qi Feng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Jian Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Li Jun Qian
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China.
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Computed tomographic precision rate-of-passage assay without a fasting period in broilers: More precise foundation for targeting the releasing time of encapsulated products. Livest Sci 2017. [DOI: 10.1016/j.livsci.2017.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Isik A, Soyturk M, Süleyman S, Firat D, Peker K, Yilmaz İ, Celebi F. Correlation of Bowel Wall Thickening Seen Using Computerized Tomography With Colonoscopies: A Preliminary Study. Surg Laparosc Endosc Percutan Tech 2017; 27:154-157. [PMID: 28291060 DOI: 10.1097/sle.0000000000000389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Bowel wall thickening (BWT) is a common finding in abdominal computerized tomography imaging (CTi). The purpose of the present study was a prospective assessment and management of patients who have BWT in abdominal CTi. MATERIALS AND METHODS This study was conducted between January 2012 and July 2014 at Erzincan University Hospital, Turkey, with 64 patients who were admitted to the emergency and general surgery department. All of the patients had received colonoscopies due to BWT seen in abdominal CTi. RESULTS Twenty-three (36%) female and 41 (64%) male patients were included in the study. The mean age was 56.2 years (range, 14 to 84 y). The positive predictive value of CTi for BWT was 87.5%. The positive predictive value of a CTi diagnosis of the disease according to a radiologist's report was 78.1%. Common pathologies detected by colonoscopy included neoplasia and inflammatory bowel disease. CONCLUSIONS Diagnosis of BWT by abdominal CTi reveals pathologies in many cases. Colonoscopies will be helpful in the differential diagnosis.
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Affiliation(s)
- Arda Isik
- *General Surgery Department †Radiology Department, School of Medicine, Erzincan University, Erzincan ‡Radiology Department, School of Medicine, Karadeniz Technical University Trabzon, Turkey
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Ramanathan S, Ojili V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes. J Clin Imaging Sci 2017; 7:15. [PMID: 28480123 PMCID: PMC5404618 DOI: 10.4103/jcis.jcis_6_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/01/2017] [Indexed: 12/18/2022] Open
Abstract
Although large bowel obstruction (LBO) is less common than small bowel obstruction, it is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. Plain radiographs are sufficient to diagnose LBO in a majority of patients. However, further evaluation with multidetector computed tomography (MDCT) has become the standard of care to identify the site, severity, and etiology of obstruction. In this comprehensive review, we illustrate the various causes of LBO emphasizing the role of MDCT in the initial diagnosis and detection of complications along with the tips to differentiate from disease which can mimic LBO.
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Affiliation(s)
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Ravi Vassa
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Arpit Nagar
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA
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Abstract
RATIONALE Less than 1% of breast carcinomas metastasize to the gastrointestinal tract. The diagnosis is frequently not recognized especially when the history of breast carcinoma is remote. PATIENT CONCERNS A 61-year-old female with a remote history of breast carcinoma presented with a 3-month history of change in bowel habits. Colonoscopy showed a circumferential rectal mass with initial impression of primary rectal cancer. MRI of the rectum showed findings that are atypical for primary rectal cancer. DIAGNOSES Deep biopsy of the rectal mass confirmed lobular breast carcinoma metastasis to the rectum. INTERVENTION AND OUTCOMES The patient was treated with radiotherapy and hormonal therapy. She is symptomatically well 2 years after presentation and remains on hormonal therapy. LESSONS Lobular breast cancer which metastasizes to the rectum can mimic primary rectal cancer clinically. The unique MRI features described in our case when present with a concordant history of lobular breast carcinoma should alert the radiologist to the possibility of this diagnosis which has important treatment implications.
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Affiliation(s)
| | | | - Shi Wang
- Department of Pathology, National University Hospital, Singapore, Singapore
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Fitzgerald E, Lam R, Drees R. IMPROVING CONSPICUITY OF THE CANINE GASTROINTESTINAL WALL USING DUAL PHASE CONTRAST-ENHANCED COMPUTED TOMOGRAPHY: A RETROSPECTIVE CROSS-SECTIONAL STUDY. Vet Radiol Ultrasound 2017; 58:151-162. [DOI: 10.1111/vru.12467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ella Fitzgerald
- Department of Clinical Sciences and Services, Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| | - Richard Lam
- Department of Clinical Sciences and Services, Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| | - Randi Drees
- Department of Clinical Sciences and Services, Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
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Singla SC, Kaushal D, Sagoo HS, Calton N. Comparative analysis of colorectal carcinoma staging using operative, histopathology and computed tomography findings. Int J Appl Basic Med Res 2017; 7:10-14. [PMID: 28251101 PMCID: PMC5327599 DOI: 10.4103/2229-516x.198501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: The staging of colorectal carcinoma using 3 modalities viz operative, histopathology and CT scan has been subject of interest in accurately defining the extent of disease. This retrospective as well as prospective study was carried out at CMC, Ludhiana, Punjab from November 2011 to May 2014. Aim: The objective of this study was to assess the usefulness and accuracy of CT scan findings to state the extent and spread of colorectal malignancy and to correlate these findings with histopathological diagnosis. Method: A total of 31 biopsy proven patients showing variable bowel wall thickening involving the colon /rectum on CECT (Contrast Enhanced Computed Tomography) were included in the study. The tumours were staged based on the CT scan findings and were compared with the operative and histopathological findings. Observations: Rectum was the most common site of involvement followed by the recto-sigmoid involvement. Metastasis was observed in 5 cases out of the 31 malignant cases. Five of the 7 cases were correctly staged as T1 & T2 lesions on CT having a sensitivity of 83.3%, specificity of 92%, and positive predictive value of 71.4% and a negative predictive value of 95.8% in the diagnosis of T1 and T2 lesions. 15 of the 16 cases were correctly staged as T3 lesions. CT had a sensitivity of 88.2%, specificity of 93.8%, and positive predictive value of 93.8% and a negative predictive value of 86.7% in the diagnosis of T3 lesions. All the 8 cases were correctly staged as T4 lesions. CT had a sensitivity of 100%, specificity of 100%, and positive predictive value of 100% and a negative predictive value of 100% in the diagnosis of T4 lesions. Conclusion: We conclude that CT scan is an excellent modality in diagnosing malignant lesions of the colon and rectum.
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Affiliation(s)
- Subhash Chander Singla
- Department of Radiodiagnosis, Physiology and Pathology, CMC and H, Ludhiana, Punjab, India
| | - Dhawal Kaushal
- Department of Radiodiagnosis, Physiology and Pathology, CMC and H, Ludhiana, Punjab, India
| | - Harinder Singh Sagoo
- Department of Radiodiagnosis, Physiology and Pathology, CMC and H, Ludhiana, Punjab, India
| | - Nalini Calton
- Department of Radiodiagnosis, Physiology and Pathology, CMC and H, Ludhiana, Punjab, India
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Chen M, Remer EM, Liu X, Lopez R, Shen B. Identification of the distinguishing features of Crohn's disease and ischemic colitis using computed tomographic enterography. Gastroenterol Rep (Oxf) 2016; 5:219-225. [PMID: 28852526 PMCID: PMC5554382 DOI: 10.1093/gastro/gow037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/25/2016] [Accepted: 10/04/2016] [Indexed: 01/27/2023] Open
Abstract
Background and aims: The differential diagnosis between Crohn’s disease (CD) and ischemic colitis (ISC) is important as their clinical management is different. ISC can easily be misdiagnosed as CD, especially in elderly populations. The distinctive radiographic features of the two disease entities have not been investigated. The aim of this study is to assess the utility of computed tomographic enterography (CTE) in the differential diagnosis between CD and ISC. Methods: Patients with confirmed CD and ISC were identified through an electronic medical record search of the Cleveland Clinic Foundation. Patients who had undergone CTE, with or without concurrent colonoscopy and histopathological specimens, were included in this study. CTE images were blindly re-reviewed by an expert gastrointestinal radiologist. The sensitivities, specificities, accuracies and positive and negative predictive values for each of the CTE findings in differentiating CD from ISC were estimated. Kappa coefficients (κ) were calculated to measure diagnosis agreement between CTE and the reference standard. Results: A total of 34 eligible patients were included in this study with 17 having CD and 17 having ISC. In differentiating CD from ISC, the presence of mucosal hyperenhancement and absence of the “target sign” on CTE showed a sensitivity of 100% each for CD, while the two radiographic features yielded a low specificity of 35.3% and 76.5%, respectively. The presence of stricture had a lower sensitivity of 64.7% for the detection of CD but had a high specificity of 100%. In distinguishing CD from ISC, the accuracy of presence of mucosal hyperenhancement, stricture and absence of target sign were 67.7%, 82.4% and 88.2%, respectively. The combination of the presence of mucosal hyperenhancement and the absence of the target sign achieved an accuracy of 100% for distinguishing CD from ISC. There was a good correlation between CTE and the reference standard for distinguishing CD from ISC (κ = 0.882). Conclusions: CTE appeared to be clinically useful in distinguishing CD from ISC.
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Affiliation(s)
- Min Chen
- Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA.,Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Erick M Remer
- Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA.,Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Xiuli Liu
- Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Shen
- Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Shin Y, Kim Y, Lee K, Lee Y, Park J. CT findings of post-polypectomy coagulation syndrome and colonic perforation in patients who underwent colonoscopic polypectomy. Clin Radiol 2016; 71:1030-1036. [DOI: 10.1016/j.crad.2016.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/29/2016] [Accepted: 03/15/2016] [Indexed: 12/27/2022]
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27
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Liu Z, Ran X, Liu J, Du Y, Ren J, Qu X. Non-toxic lead sulfide nanodots as efficient contrast agents for visualizing gastrointestinal tract. Biomaterials 2016; 100:17-26. [DOI: 10.1016/j.biomaterials.2016.05.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/18/2016] [Accepted: 05/17/2016] [Indexed: 01/15/2023]
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28
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Shimamoto Y, Harima Y. A Case of Eosinophilic Gastroenteritis Forming a Rigid Chamber Mimicking Giant Duodenal Ulcer on Computed Tomography Imaging. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:259-63. [PMID: 27086704 PMCID: PMC4839256 DOI: 10.12659/ajcr.897403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Patient: Female, 67 Final Diagnosis: Eosinophilic gastroenteritis Symptoms: Abdominal distension • abdominal pain • chronic diarrhea Medication: — Clinical Procedure: CT Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Yoko Shimamoto
- Department of Internal Medicine, Ubekosan Central Hospital Corporation, Ube-city, Yamaguchi, Japan
| | - Yohei Harima
- Department of Internal Medicine, Ubekosan Central Hospital Corporation, Ube-city, Yamaguchi, Japan
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29
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Minordi LM, Scaldaferri F, Marra RS, Pecere S, Larosa L, Poscia A, Gasbarrini A, Vecchioli A, Bonomo L. Enterography CT without and with water enema in patients with Crohn’s disease: Results from a comparative observational study in comparison with endoscopy. Eur J Radiol 2016; 85:404-13. [DOI: 10.1016/j.ejrad.2015.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/12/2015] [Accepted: 11/22/2015] [Indexed: 12/31/2022]
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30
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Rashidi A, Lin MF, Cashen AF. Early post-transplant contrast-enhanced abdominopelvic CT scan predicts the risk of subsequent acute GvHD. Bone Marrow Transplant 2015; 51:150-2. [PMID: 26437071 DOI: 10.1038/bmt.2015.232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- A Rashidi
- Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - M F Lin
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - A F Cashen
- Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
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Boustani J, Kim S, Lescut N, Lakkis Z, de Billy M, Arbez-Gindre F, Jary M, Borg C, Bosset JF. Primary Linitis Plastica of the Rectum: Focus on Magnetic Resonance Imaging Patterns and Treatment Options. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:581-5. [PMID: 26322720 PMCID: PMC4559009 DOI: 10.12659/ajcr.893830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Case series Patient: Male, 59 • Male, 85 • Male, 27 Final Diagnosis: refractory metastatic rectal cancer Symptoms: — Medication: — Clinical Procedure: Chemotherapy Specialty: Oncology
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Affiliation(s)
- Jihane Boustani
- Department of Radiotherapy, University Hospital of Besançon, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Nicolas Lescut
- Department of Radiotherapy, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | | | | | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
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Naqvi J, Hosmane S, Lapsia S. Revisiting the potential signs of colorectal cancer on contrast-enhanced computed tomography without bowel preparation. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s00261-015-0505-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Acute colitis: differential diagnosis using multidetector CT. Clin Radiol 2015; 70:262-9. [PMID: 25522900 DOI: 10.1016/j.crad.2014.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 10/10/2014] [Accepted: 11/10/2014] [Indexed: 12/26/2022]
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Barral M, Hoeffel C, Boudiaf M, Dohan A, Marteau P, Laurent V, Soyer P. Rectal cancer in inflammatory bowel diseases: MR imaging findings. ACTA ACUST UNITED AC 2015; 39:443-51. [PMID: 24570133 DOI: 10.1007/s00261-014-0103-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To retrospectively analyze the MR imaging features of rectal cancer in patients with inflammatory bowel diseases (IBD). MATERIALS AND METHODS The MR imaging examinations of 13 patients with IBD-related rectal cancer were retrospectively reviewed. MR imaging included T2-weighted, diffusion-weighted (DW), and gadolinium chelate-enhanced MR imaging. MR imaging findings were analyzed and compared with endoscopic and histopathological findings. RESULTS Eight patients (8/13; 62%) had active IBD and five (5/13; 38%) had quiescent IBD on MR imaging. Two different tumor patterns were individualized including clearly visible soft-tissue mass (4/13; 31%) (Type 1 tumor) and marked circumferential rectal wall thickening (9/13; 69%) (Type 2 tumor). Twelve tumors (12/13; 92%) showed high signal intensity on T2-weighted MR images. All six tumors studied with DW-MR imaging (6/6; 100%) showed high signal on DW-MR imaging with restricted diffusion on apparent diffusion coefficient (ADC) map. On gadolinium chelate-enhanced MR imaging, heterogeneous enhancement was observed in one tumor (1/13; 8%), whereas 12 tumors (12/13; 92%) showed homogeneous enhancement. MR imaging showed pelvic fistula and intrapelvic abscess in association with four (4/13; 31%) and two tumors (2/13; 15%), respectively. CONCLUSION Our limited retrospective study demonstrates that rectal cancer in IBD patients can present as a circumferential wall thickening resembling inflammation and can occur in the absence of fistula or abscess. The use of T2-weighted and DW-MR imaging is recommended to improve rectal cancer detection in patients with long-standing IBD.
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Affiliation(s)
- Matthias Barral
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France,
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Barral M, Boudiaf M, Dohan A, Hoeffel C, Camus M, Pautrat K, Fishman E, Cohen S, Soyer P. MDCT of acute colitis in adults: An update in current imaging features. Diagn Interv Imaging 2015; 96:133-49. [DOI: 10.1016/j.diii.2014.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
In 1924, mesenteric panniculitis was first described in the medical literature by Jura et al. as 'retractile mesenteritis.' It represents a spectrum of disease processes characterized by degeneration, inflammation and scarring of the adipose tissue of the mesentery. The clinical presentations vary according to the stage of the disease and they include abdominal pain, weight loss, nausea and vomiting. Computed tomography findings are usually diagnostic. The gross findings include thickening of the mesentery, mass lesions and adhesion to the surrounding organs. Histologically, there is a chronic inflammatory process involving the adipose tissue with fat necrosis, inflammation and fibrosis. Herein, the authors address the clinicopathological features, course, treatment and pathogenetic mechanisms of mesenteric panniculitis.
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Kishi T, Shimizu K, Hashimoto S, Onoda H, Washida Y, Sakaida I, Matsunaga N. CT enteroclysis/enterography findings in drug-induced small-bowel damage. Br J Radiol 2014; 87:20140367. [PMID: 25348282 DOI: 10.1259/bjr.20140367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate the CT enteroclysis (CTE)/enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings. METHODS CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE). RESULTS Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE. CONCLUSION On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage. ADVANCES IN KNOWLEDGE Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE.
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Affiliation(s)
- T Kishi
- 1 Department of Radiology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Diagnostic imaging in Crohn's disease: what is the new gold standard? Best Pract Res Clin Gastroenterol 2014; 28:421-36. [PMID: 24913382 DOI: 10.1016/j.bpg.2014.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/06/2014] [Accepted: 04/13/2014] [Indexed: 01/31/2023]
Abstract
Historically Barium and isotope studies been used for imaging of inflammatory bowel disease (IBD) but carry risk of radiation exposure. Use of Barium is declining resulting in fewer radiologists that have the necessary expertise. Isotopes studies lack anatomical definition but 18F - fludeoxyglucose (FDG) positron emission tomography (PET) shows promise in accurate assessment of disease compared to endoscopy. Computerised tomography (CT) is particularly useful in assessment of complications of Crohn's disease (CD) but radiation exposure is high. CT enterography (CTE) has improved visualisation of small bowel mucosal disease and allows assessment of disease activity. Ultrasound is increasingly used for preliminary assessment of patients with potential IBD. Although widely available and economically attractive, the expertise required is not widespread. Finally magnetic resonance imaging (MRI) is proving to be the most accurate tool for assessment of disease extent and distribution. MRI of the pelvis has superseded other techniques in assessment of peri-anal fistulation.
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Dhir V, Pinto B, Anakutti HP, Yadav MK, Sharma S, Sharma A. Henoch-Schönlein purpura: hitting the 'target' on CT. Arab J Gastroenterol 2014; 15:42-3. [PMID: 24630516 DOI: 10.1016/j.ajg.2014.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/21/2013] [Accepted: 01/10/2014] [Indexed: 11/26/2022]
Abstract
This image highlights the common findings on CT in Henoch-Schonelin Purpura, namely 'target sign' and comb sign. We discuss the common CT findings in this disease.
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Affiliation(s)
- Varun Dhir
- Department of Internal Medicine (Rheumatology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Benzeeta Pinto
- Department of Internal Medicine (Rheumatology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hari Prasad Anakutti
- Department of Internal Medicine (Rheumatology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Kumar Yadav
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shefali Sharma
- Department of Internal Medicine (Rheumatology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine (Rheumatology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Colorectal cancer in inflammatory bowel diseases: CT features with pathological correlation. ACTA ACUST UNITED AC 2014; 38:421-35. [PMID: 22878887 DOI: 10.1007/s00261-012-9947-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To describe CT features of inflammatory bowel disease (IBD)-related colorectal cancer and correlate the imaging findings with histopathological findings. MATERIALS AND METHODS CT imaging findings in 17 patients with IBD-related colorectal cancer were retrospectively evaluated. Imaging findings were correlated with surgical and histopathological findings. Univariate and multivariate analyses explored the relationships between CT and histopathological variables. RESULTS Two different CT patterns were individualized including clearly visible soft tissue mass (8/17; 47%) (Type 1 tumor) or stenosis with marked circumferential thickening resembling inflammation (9/17; 53%) (Type 2 tumor). At univariate analysis, thickness of tumor-free colorectal wall at CT was greater in Crohn disease (median, 13 mm) than in ulcerative colitis (median, 7 mm) (P = 0.011). Significant association was found between presence of signet ring cells and Type 2 tumor at CT (6/9, 67% P = 0.009) and colonic dilatation proximal to tumor (5/6, 83%; P = 0.035). At multivariate analysis, free-fluid effusion was the single independent CT variable predictive for the presence of signet ring cells (odds ratio = 50; 95% CI 2.56-977.02; P = 0.01). CONCLUSION Colorectal cancer in IBD displays two main features on CT. Type 2 tumors and free-fluid effusion correlate with presence of signet ring cells. Knowledge of these findings is critical to help suggest the diagnosis.
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Fernandes T, Oliveira MI, Castro R, Araújo B, Viamonte B, Cunha R. Bowel wall thickening at CT: simplifying the diagnosis. Insights Imaging 2014; 5:195-208. [PMID: 24407923 PMCID: PMC3999365 DOI: 10.1007/s13244-013-0308-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 02/07/2023] Open
Abstract
Objective In this article we present a simplified algorithm-based approach to the thickening of the small and large bowel wall detected on routine computed tomography (CT) of the abdomen. Background Thickening of the small or large bowel wall may be caused by neoplastic, inflammatory, infectious, or ischaemic conditions. First, distinction should be made between focal and segmental or diffuse wall thickening. In cases of focal thickening further analysis of the wall symmetry and perienteric anomalies allows distinguishing between neoplasms and inflammatory conditions. In cases of segmental or diffuse thickening, the pattern of attenuation in light of clinical findings helps narrowing the differential diagnosis. Conclusion Focal bowel wall thickening may be caused by tumours or inflammatory conditions. Bowel tumours may appear as either regular and symmetric or irregular or asymmetric thickening. When fat stranding is disproportionately more severe than the degree of wall thickening, inflammatory conditions are more likely. With the exception of lymphoma, segmental or diffuse wall thickening is usually caused by benign conditions, such as ischaemic, infectious and inflammatory diseases. Key points • Thickening of the bowel wall may be focal (<5 cm) and segmental or diffuse (6-40 cm or >40 cm) in extension. • Focal, irregular and asymmetrical thickening of the bowel wall suggests a malignancy. • Perienteric fat stranding disproportionally more severe than the degree of wall thickening suggests an inflammatory condition. • Regular, symmetric and homogeneous wall thickening is more frequently due to benign conditions, but can also be caused by neoplasms such as well-differentiated adenocarcinoma and lymphoma. • Segmental or diffuse bowel wall thickening is usually caused by ischaemic, inflammatory or infectious conditions and the attenuation pattern is helpful in narrowing the differential diagnosis.
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Affiliation(s)
- Teresa Fernandes
- Department of Radiology, Hospital de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal,
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Ma X, Kang F, Xu F, Feng A, Zhao Y, Lu T, Yang W, Wang Z, Lin M, Wang J. Enhancement of Cerenkov luminescence imaging by dual excitation of Er(3+),Yb(3+)-doped rare-earth microparticles. PLoS One 2013; 8:e77926. [PMID: 24205030 PMCID: PMC3808356 DOI: 10.1371/journal.pone.0077926] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 09/06/2013] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED Cerenkov luminescence imaging (CLI) has been successfully utilized in various fields of preclinical studies; however, CLI is challenging due to its weak luminescent intensity and insufficient penetration capability. Here, we report the design and synthesis of a type of rare-earth microparticles (REMPs), which can be dually excited by Cerenkov luminescence (CL) resulting from the decay of radionuclides to enhance CLI in terms of intensity and penetration. METHODS Yb(3+)- and Er(3+)- codoped hexagonal NaYF4 hollow microtubes were synthesized via a hydrothermal route. The phase, morphology, and emission spectrum were confirmed for these REMPs by power X-ray diffraction (XRD), scanning electron microscopy (SEM), and spectrophotometry, respectively. A commercial CCD camera equipped with a series of optical filters was employed to quantify the intensity and spectrum of CLI from radionuclides. The enhancement of penetration was investigated by imaging studies of nylon phantoms and nude mouse pseudotumor models. RESULTS the REMPs could be dually excited by CL at the wavelengths of 520 and 980 nm, and the emission peaks overlaid at 660 nm. This strategy approximately doubled the overall detectable intensity of CLI and extended its maximum penetration in nylon phantoms from 5 to 15 mm. The penetration study in living animals yielded similar results. CONCLUSIONS this study demonstrated that CL can dually excite REMPs and that the overlaid emissions in the range of 660 nm could significantly enhance the penetration and intensity of CL. The proposed enhanced CLI strategy may have promising applications in the future.
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Affiliation(s)
- Xiaowei Ma
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, PR China
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, PR China
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an, PR China
| | - Ailing Feng
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an, PR China
| | - Ying Zhao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an, PR China
| | - Tianjian Lu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an, PR China
| | - Weidong Yang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, PR China
| | - Zhe Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, PR China
| | - Min Lin
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center, Xi'an Jiaotong University, Xi'an, PR China
- * E-mail: (JW); (ML)
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, PR China
- * E-mail: (JW); (ML)
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Etiology of small bowel thickening on computed tomography. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 26:897-901. [PMID: 23248791 DOI: 10.1155/2012/282603] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Abdominal pain is often evaluated using imaging, most often with computed tomography (CT). While CT is sensitive and specific for certain diagnoses, small bowel thickening is a nonspecific finding on CT with a broad differential diagnosis including infection, inflammation, ischemia and neoplasm. METHOD A review of medical records of patients who underwent CT scans of the abdomen and pelvis over a one-year period and exhibited small bowel thickening were retrospectively evaluated to determine the final diagnosis. RESULTS The etiologies of small bowel thickening on CT were as follows: infection (113 of 446 [25.34%]); reactive inflammation (69 of 446 [15.47%]); primary inflammation (62 of 446 [13.90%]); small bowel obstruction (38 of 446 [8.52%]); iatrogenic (33 of 446 [7.40%]); neoplastic (32 of 446 [7.17%]); ascites (30 of 446 [6.73%]); unknown (28 of 446 [6.28%]); ischemic (24 of 446 [5.38%]); and miscellaneous (17 of 446 [3.81%]). CONCLUSION Infectious and inflammatory (primary or reactive) conditions were the most common cause of small bowel thickening in the present series; these data can be used to formulate a more specific differential diagnosis.
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Katz DS, Scheirey CD, Bordia R, Hines JJ, Javors BR, Scholz FJ. Computed Tomography of Miscellaneous Regional and Diffuse Small Bowel Disorders. Radiol Clin North Am 2013. [DOI: 10.1016/j.rcl.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lee JS, Cho JH, Kim KO, Lee SH, Jang BI. [Clinical significance of the large intestinal wall thickening detected by abdominal computed tomography]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:300-5. [PMID: 23172278 DOI: 10.4166/kjg.2012.60.5.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Bowel wall thickening on CT has been reported to reflect colorectal carcinoma and colitis. The aim of this study was to evaluate the clinical significance of the large intestinal wall thickening on CT. METHODS Between January 2006 and August 2010, medical records of 815 patients who underwent endoscopy after CT scans within 1 month were reviewed retrospectively. RESULTS A total of 233 patients were included. The wall thickening was actually associated with abnormal endoscopic findings in 81.1% of the cases. The accuracy rate on diagnosis between CT and endoscopy was 63.5%. The discrepancy in diagnosis was higher in cases with left colon abnormality and short segment lesion. Abdominal pain was significantly more common in cases suspected malignancy on CT compared with colitis (p=0.047). Most of the malignancy diagnosed on CT involved the left side colon and most of the colitis involved the entire colon (p<0.001). The length of lesion was below 5 cm in 86.5% of the malignancy. Malignancy was more common in patients aged over 50 years with hemoglobin below 12 g/dL. The CT findings significantly suggestive of malignancy were lymph node enlargement and length of lesion below 5 cm (p=0.027 and p<0.001). CONCLUSIONS The large intestinal wall thickening on CT was limited in the differential diagnosis of malignancy and colitis. Additional endoscopic evaluation is needed in patients with bowel wall thickening associated with lymph node enlargement and short segment lesion on CT in order to exclude malignancy.
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Affiliation(s)
- Jung Soo Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea
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Ahn JY, Jung HY, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH, Hwang HS. Diagnosis of an accessory spleen mimicking a gastric submucosal tumor using endoscopic ultrasonography-guided fine-needle aspiration. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:433-6. [PMID: 22735877 DOI: 10.4166/kjg.2012.59.6.433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Accessory spleen can be mistaken as a gastric subepithelial mass, and may not be differentiated in CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 39-year old woman with history of splenectomy. In subsequent CT and EUS, the subepithelial mass was located on the fourth layer of the stomach. To make a definite diagnosis, EUS-guided fine needle aspiration (FNA) was performed, and a splenic tissue was demonstrated in histologic examination. EUS-guided FNA can be beneficial in the diagnosis of accessory spleen which mimics a gastric subepithelial mass.
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Affiliation(s)
- Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea
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Kim KH, Jung DS, Kim SY, Kim B, Han SH, Jung EH, Kim DM, Lee H. Severe Scrub Typhus with Enterocolitis by the Ikeda Strain of Orientia tsutsugamushi. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung Han Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dong Sik Jung
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Su Young Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Bosung Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Seung-Hee Han
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Eui Han Jung
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dong-Min Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Hyuck Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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