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MR enterography grading of pediatric ileocolonic Crohn disease activity based on a single bowel segment. Radiol Med 2021; 126:1396-1406. [PMID: 34414550 DOI: 10.1007/s11547-021-01409-w] [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: 01/12/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ileocolonoscopy with histology has been considered the gold standard for Crohn disease (CD) diagnosis and monitoring. Over the last years, magnetic resonance enterography (MRE) has become more and more popular, representing a valid non-invasive technique. OBJECTIVE To propose a simplified MRE score, the pediatric CD magnetic resonance index (PCDMRI), based only on the most affected bowel segment, to grade active inflammation in children with CD. MATERIALS AND METHODS Two radiologists retrospectively evaluated MRE images of children with histopathology-proven CD. The PCDMRI was based on six mural and perimural variables assessed for the most affected bowel segment (chosen by visual inspection of the key bowel wall imaging findings associated with active inflammation), and five extramural per-examination features. Correlation analysis was performed between both the PCDMRI and the MRE global score (based on all the affected segments) and the pediatric clinical disease activity index (PCDAI), the simple endoscopic score for CD (SES-CD), serum C-reactive protein (CRP) and fecal calprotectin (fC). Inter-reader reproducibility of the scoring system was estimated. Agreement on disease location between MRE and ileocolonoscopy was evaluated. RESULTS The study involved 42 children for a total of 80 MRE. PCDMRI and global score positively correlated with PCDAI, SES-CD, CRP and fC. Inter-reader reproducibility was 91%. Agreement on disease location was substantial. CONCLUSION The PCDMRI and the global score resulted equally correlated with the PCDAI, suggesting a high impact of the most affected segment on symptoms. The PDCMRI may be a useful non-invasive tool for a rapid and reproducible grading of the disease activity in children with ileocolonic CD.
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Meima ‐ van Praag EM, van Rijn KL, Monraats MA, Buskens CJ, Stoker J. Magnetic resonance imaging after ligation of the intersphincteric fistula tract for high perianal fistulas in Crohn's disease: a retrospective cohort study. Colorectal Dis 2021; 23:169-177. [PMID: 32767809 PMCID: PMC7891352 DOI: 10.1111/codi.15296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022]
Abstract
AIM Ligation of the intersphincteric fistula tract (LIFT) is increasingly being used for surgical closure of high perianal fistulas in Crohn's disease. Currently, data on postoperative MRI findings are scarce, although they are considered important for assessing healing and recurrence. Our aim, therefore, was to evaluate fistula characteristics on MRI and their relationship with clinical outcomes after LIFT. METHOD Consecutive Crohn's patients treated with LIFT between 2007 and 2018 who underwent baseline and follow-up MRI were retrospectively included. MRIs were scored by two radiologists according to characteristics based on the original and modified Van Assche indices. MRI findings, with emphasis on fibrosis, and the relationship with clinical healing, re-interventions and recurrences are described. RESULTS Twelve patients were included [four men, median age 34 (interquartile range 28-39) years]. Follow-up MRI was performed at a median of 5.5 months (interquartile range 2.5-6.0) after LIFT. At baseline, all patients showed a tract with predominantly granulation tissue, which changed to predominantly fibrotic in seven (in three of whom it was completely fibrotic). All patients with a (predominantly) fibrotic tract had clinical closure and no re-interventions or recurrences during long-term follow-up. In contrast, of the five patients with persisting granulation tissue, two reached clinical healing, two needed re-intervention and one had a recurrence. CONCLUSION Markedly decreased fistula activity can be observed on MRI after LIFT. The majority of patients develop a predominantly fibrotic tract relatively soon after LIFT without clinical recurrence, suggesting a highly effective therapy. Unfavourable clinical outcomes were only present in patients with persisting granulation tissue, indicating the potential prognostic value of MRI.
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Affiliation(s)
- E. M. Meima ‐ van Praag
- Department of SurgeryAmsterdam Gastroenterology, Endocrinology and MetabolismAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - K. L. van Rijn
- Department of Radiology and Nuclear MedicineAmsterdam Gastroenterology, Endocrinology and MetabolismAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - M. A. Monraats
- Department of Radiology and Nuclear MedicineAmsterdam Gastroenterology, Endocrinology and MetabolismAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - C. J. Buskens
- Department of SurgeryAmsterdam Gastroenterology, Endocrinology and MetabolismAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - J. Stoker
- Department of Radiology and Nuclear MedicineAmsterdam Gastroenterology, Endocrinology and MetabolismAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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3
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Harrington SG, Johnson MK, Greer MLC, Gee MS. Pearls and Pitfalls in MR Enterography Interpretation for Pediatric Patients. Semin Ultrasound CT MR 2020; 41:462-471. [DOI: 10.1053/j.sult.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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4
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Cantarelli BCF, de Oliveira RS, Alves AMA, Ribeiro BJ, Velloni F, D'Ippolito G. Evaluating inflammatory activity in Crohn's disease by cross-sectional imaging techniques. Radiol Bras 2020; 53:38-46. [PMID: 32313336 PMCID: PMC7159043 DOI: 10.1590/0100-3984.2018.0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease.
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Affiliation(s)
| | | | - Aldo Maurici Araújo Alves
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Bruno Jucá Ribeiro
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Fernanda Velloni
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América S/A, Barueri, SP, Brazil
| | - Giuseppe D'Ippolito
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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5
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Lin S, Lin X, Li X, Chen M, Mao R. Making Qualitative Intestinal Stricture Quantitative: Embracing Radiomics in IBD. Inflamm Bowel Dis 2020; 26:743-745. [PMID: 31504502 DOI: 10.1093/ibd/izz197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 12/29/2022]
Abstract
Quantifying intestinal fibrosis is an important but challenging issue in stricturing CD. With the advent of radiomics, MRE and CTE are highly minable data rather than merely pictures, which will greatly facilitate precision medicine in intestinal fibrosis of CD.
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Affiliation(s)
- Sinan Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China.,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - Xiaoqin Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Xuehua Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China.,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
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6
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Gandhi NS, Dillman JR, Grand DJ, Huang C, Fletcher JG, Al-Hawary MM, Anupindi SA, Baker ME, Bruining DH, Chatterji M, Fidler JL, Gee MS, Grajo JR, Guglielmo FF, Jaffe TA, Park SH, Rimola J, Taouli B, Taylor SA, Yeh B. Computed tomography and magnetic resonance enterography protocols and techniques: survey of the Society of Abdominal Radiology Crohn's Disease Disease-Focused Panel. Abdom Radiol (NY) 2020; 45:1011-1017. [PMID: 31982931 DOI: 10.1007/s00261-020-02407-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To survey Society of Abdominal Radiology Crohn's Disease (CD) Disease-Focused Panel (DFP) members to understand state-of-the-art CT/MR enterography (CTE/MRE) protocols and variability between institutions. METHODS This study was determined by an institutional review board to be "exempt" research. The survey consisted of 70 questions about CTE/MRE patient preparation, administration of contrast materials, imaging techniques, and other protocol details. The survey was administered to DFP members using SurveyMonkey® (Surveymonkey.com). Descriptive statistical analyses were performed. RESULTS Responses were received from 16 DFP institutions (3 non-USA, 2 pediatric); 15 (94%) were academic/university-based. 10 (63%) Institutions image most CD patients with MRE; 4 (25%) use CTE and MRE equally. Hypoperistaltic medication is given for MRE at 13 (81%) institutions versus only 2 (13%) institutions for CTE. Most institutions have a technologist or nurse monitor oral contrast material drinking (n = 12 for CTE, 75%; n = 11 for MRE, 69%). 2 (13%) institutions use only dual-energy capable scanners for CTE, while 9 (56%) use either a single-energy or dual-energy scanner based on availability. Axial CTE images are reconstructed at 2-3 mm thickness at 8 (50%) institutions, > 3 mm at 5 (31%), and < 2 mm at 3 (19%) institutions. 13 (81%) institutions perform MRE on either 1.5 or 3T scanners without preference. All institutions perform MRE multiphase postcontrast imaging (median = 4 phases), ranging from 20 to 600 s after contrast material injection. CONCLUSION CTE and MRE protocol knowledge from DFP institutions can help radiology practices optimize/standardize protocols, potentially improving image quality and patient outcomes, permitting objective comparisons between examinations, and facilitating research.
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Affiliation(s)
- Namita S Gandhi
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David J Grand
- Department of Radiology, Rhode Island Hospital, Providence, RI, USA
| | - Chenchan Huang
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | | | - Mahmoud M Al-Hawary
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia & University of Pennsylvania, Philadelphia, PA, USA
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manjil Chatterji
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tracy A Jaffe
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Benjamin Yeh
- Department of Radiology, University of California, San Francisco, USA
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Supplementary Anal Imaging by Magnetic Resonance Enterography in Patients with Crohn's Disease Not Suspected of Having Perianal Fistulas. Clin Gastroenterol Hepatol 2020; 18:415-423.e4. [PMID: 31352093 DOI: 10.1016/j.cgh.2019.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few data are available to guide the use of anal imaging for patients with Crohn's disease (CD) who are not suspected of having perianal fistulas. We aimed to evaluate the role of anal imaging supplementary to magnetic resonance enterography (MRE) in these patients. METHODS In a prospective study, we added a round of anal MR imaging (MRI), collecting axial images alone, to MRE evaluation of 451 consecutive adults who were diagnosed with or suspected of having CD but not believed to have perianal fistulas. Images were examined for perianal tracts; if present, colorectal surgeons reexamined patients to identify external openings or perianal inflammation or abscess. Patients were followed and data were collected on dedicated treatment for perianal fistulas or abscess. We calculated the diagnostic yield for anal MRI, associated factors, and outcomes of MRI-detected asymptomatic perianal tracts. RESULTS A total of 440 patients (mean age, 29.6±8.9 years) met the inclusion criteria. Anal MRI revealed perianal tracts in 53 patients (12%; 95% CI, 9.3%-15.4%). Surgeons however did not identify any lesions that required treatment. The asymptomatic tracts were mostly single unbranched (83%), inter-sphincteric (72%), or had a linear dark signal at the tract margin (79%). Younger age at MRE, female sex, and CD activity index scores of 220-450 were independently associated with detection of perianal tracts. MRI detection of asymptomatic tracts was independently associated with later development of perianal fistulas or abscess that required treatment: 17.8% cumulative incidence at 37 months and an adjusted hazard ratio of 3.06 (95% CI, 1.01-9.27; P = .048). CONCLUSIONS In a prospective study of patients with CD, we found that adding anal MRI evaluation to MRE resulted in early identification of patients at risk for perianal complications.
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8
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The efficacy of new oral contrast mixture for computed tomography enterography. Pol J Radiol 2020; 84:e403-e412. [PMID: 31969958 PMCID: PMC6964335 DOI: 10.5114/pjr.2019.89684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose To show the reliabilities of the new mixture (composed of water, methylcellulose, lactulose, locust bean gum, and sorbitol) and to compare the luminal distension and radiological confidence scores of this solution with water-lactulose mixture. Material and methods Computed tomography enterography (CTE) images in a three-year period were included randomly in our institutional review board-approved and retrospective study. Ninety-one patients drank a lactulose and water mixture (Group 1), and 54 patients drank the new mixture (Group 2). Patients who drank the oral contrast agent were taken to a 64-detector row multiple detector computed tomography machine. Coronal and sagittal reformatted images were also formed. The gastrointestinal tract was divided into 11 segments for scoring. Each segment was graded for distensional and radiological confidence. CTE images were evaluated by two radiologists. Results Inter- and intra-reader reliabilities were good or excellent for all gastrointestinal segments in both groups (p < 0.001). The best κ values were obtained in sigmoid colon assessments. Lower agreement values were detected in duodenum and jejunum scores. The new mixture group (Group 2) showed better results than Group 1 for ileum and colonic segments according to distension and confidence scorings. Conclusions Inter- and intra-reader reliabilities of the new mixture were good or excellent for CTE. The new mixture seems to be more efficient and reliable for ileum and colon. The new mixture can increase bowel distention, radiological confidence, and quality in CTE evaluations.
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9
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Granat N, Gabrieli S, Alpert EA. Point-of-Care Ultrasound to Diagnose Colitis in the Emergency Department: A Case Series and Review of the Literature. J Emerg Med 2019; 58:77-84. [PMID: 31672400 DOI: 10.1016/j.jemermed.2019.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/22/2019] [Accepted: 08/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colitis refers to an inflammatory process of the colon, composed of a variety of different etiologies including inflammatory bowel disease, infectious colitis, ischemic colitis, and allergic colitis. Usually, abdominal computed tomography (CT) is the gold standard in diagnosing the various forms of colitis. However, by the use of point-of-care ultrasound (POCUS), one may occasionally be able to discern wall thickening, pericolic fluid, and adjacent hyperechoic mesenteric fat. One may also see abscesses, fistulae, or ascites. CASE SERIES This is a series of 6 patients who had findings consistent with colitis seen on POCUS performed by an emergency physician. These were confirmed by abdominal CT with contrast. Early detection by POCUS was able to lead to a rapid diagnosis and to expedite treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The ability to detect findings of colitis by POCUS can be quickly learned by the emergency physician with a strong background in basic ultrasound. For many of the different subtypes of colitis, the initial treatment in the emergency department is the same: i.v. antibiotics, i.v. fluids, and "bowel rest" by maintaining the patient in nothing-by-mouth status. For the stable patient with high clinical suspicion of an infectious etiology of colitis, ultrasound can help confirm the diagnosis and rule out other etiologies. This may be especially important in certain populations such as children and young women, where one can avoid a significant amount of radiation being directed toward the pelvic area.
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Affiliation(s)
- Nadav Granat
- Department of Emergency Medicine, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Selma Gabrieli
- Department of Diagnostic Ultrasound, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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10
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Goyal P, Shah J, Gupta S, Gupta P, Sharma V. Imaging in discriminating intestinal tuberculosis and Crohn's disease: past, present and the future. Expert Rev Gastroenterol Hepatol 2019; 13:995-1007. [PMID: 31559871 DOI: 10.1080/17474124.2019.1673730] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Intestinal tuberculosis (ITB) and Crohn's disease (CD) have similar clinical presentation, but require different treatment approaches. Despite advances in various endoscopic, imaging, microbiological, and histological techniques, the differentiation of these two entities is often difficult. Newer radiological and image acquisition modalities have now become indispensable tools for evaluation of these two diseases.Areas covered: This review summarizes the currently available literature on various radiological investigations to differentiate ITB from CD. This review also enumerates the newer modalities in image acquisition techniques and their potential role for differentiating these two diseases. At present abdominal computed tomography (CT) scan is used as a first line investigation for differentiating ITB from CD. Magnetic resonance imaging (MRI) is preferred in pediatric patients and for follow-up studies.Expert opinion: Role of newer modalities like contrast enhanced abdominal ultrasound, perfusion CT, advanced MRI and positron emission tomography (PET) is evolving and requires further exploration. Till further robust studies are available, differentiation between ITB and CD requires use of a combination of clinical, endoscopic, serological, histological, and radiological parameters rather than relying on a single test.
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Affiliation(s)
- Pradeep Goyal
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonali Gupta
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA.,Department of Medicine, The Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Pankaj Gupta
- 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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Kedia S, Sharma R, Makharia G, Ahuja V, Desai D, Kandasamy D, Eapen A, Ganesan K, Ghoshal UC, Kalra N, Karthikeyan R, Madhusudhan KS, Philip M, Puri A, Puri S, Sinha SK, Banerjee R, Bhatia S, Bhat N, Dadhich S, Dhali GK, Goswami BD, Issar SK, Jayanthi V, Misra SP, Nijhawan S, Puri P, Sarkar A, Singh SP, Srivastava A, Abraham P, Ramakrishna BS. Indian guidelines on imaging of the small intestine in Crohn's disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement. Indian J Radiol Imaging 2019; 29:111-132. [PMID: 31367083 PMCID: PMC6639863 DOI: 10.4103/ijri.ijri_153_18] [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] [Indexed: 12/05/2022] Open
Abstract
The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn's disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Radiadiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Ganesan
- Department of Radiodiagnosis, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Karthikeyan
- Department of Radiodiagnosis, SRM Institute of Medical Sciences and Research, Chennai, India
| | | | - Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, Kerala, India
| | - Amarender Puri
- Department of Gastroenterology, GB Pant Institute of Medical Education and Research, New Delhi, India
| | - Sunil Puri
- Department of Radiodiagnosis, GB Pant Institute of Medical Education and Research, New Delhi, India
| | - Saroj K Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Shobna Bhatia
- Department of Gastroenterology, KEM Hospital, Mumbai, India
| | - Naresh Bhat
- Department of Gastroenterology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sunil Dadhich
- Department of Gastroenterology, SN Medical College, Jodhpur, Rajasthan, India
| | - G K Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, West Bengal, India
| | - B D Goswami
- Department of Gastroenterology, Guwahati Medical College, Guwahati, Assam, India
| | - S K Issar
- Department of Gastroenterology, Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattishgarh, India
| | - V Jayanthi
- Department of Gastroenterology, Gleneagles Global Hospitals, Chennai, India
| | - S P Misra
- Department of Gastroenterology, MLN Medical College, Allahabad, UP, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, Gleneagles Global Hospitals, Chennai, India
| | - Pankaj Puri
- Department of Gastroenterology, Military Hospital, Jodhpur, Rajasthan, India
| | - Avik Sarkar
- Department of Radiodiagnosis, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, West Bengal, India
| | - S P Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | - B S Ramakrishna
- Department of Gastroenterology, SRM Institute of Medical Sciences and Research, Chennai, India
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12
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Acute abdominal pain in patients with Crohn's disease: What urgent imaging tests should be done? RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Camera L, Pezzullo F, Acampora A, Liuzzi R, Rispo A, Nardone OM, Luglio G, Bucci L, Castiglione F, Brunetti A. Multi-detector CT enterography in active inflammatory bowel disease: Image quality and diagnostic efficacy of a low-radiation high contrast protocol. Clin Imaging 2019; 58:27-33. [PMID: 31228828 DOI: 10.1016/j.clinimag.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/20/2019] [Accepted: 06/13/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To prospectively evaluate image quality and diagnostic efficacy of a low radiation-high contrast (LR-HC) CT Enterography (CTE) in active Inflammatory Bowel Disease (IBD). MATERIALS AND METHODS Eighty-five (36M; 49F; 17-75 yrs) patients with active IBD underwent contrast-enhanced CTE and were stratified in two groups according to age (< or ≥45 yrs): Group A (N = 45; 32 ± 9 yrs; 58 ± 10 kg) and Group B (N = 40; 58 ± 10 yrs; 61 ± 13 kg). Each group received a different amount of radiation (Noise Index, NI) and non-ionic iodinated contrast media (LOCM) as follows: Group A (NI = 15; 2.5 ml/kg) and Group B (NI = 12.5; 2 ml/kg). Thyroid functional tests were performed in all patients of group A at 4-6 wks. Signal- and contrast-to-noise ratios were calculated for liver (L) and abdominal aorta (A). Statistical analysis was performed by Student's t- or Chi-square test for continuous and categorical data, respectively. RESULTS No patient of Group A developed signs of thyrotoxicosis. SNRL, CNRL and diagnostic accuracy of CTE were 8.4 ± 1.7 vs 8.9 ± 2.1 (p = 0.256), 5.4 ± 1.5 vs 5.6 ± 1.7 (p = 0.486) and 91.1 vs 92.5% (p = 0.764) whereas the effective dose and the LOCM administered were 6.7 ± 2.2 vs 13.9 ± 6.0 mSv (p < 0.001) and 144 ± 25 vs 122 ± 25 ml (p < 0.001) for Group A and B, respectively. CONCLUSION LR-HC CTE is a dose-effective protocol in the evaluation of active IBD in young patients.
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Affiliation(s)
- Luigi Camera
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy.
| | - Filomena Pezzullo
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy
| | - Angela Acampora
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy
| | - Raffaele Liuzzi
- Institute of Biostructures and Bioimaging, National Research Council, University "Federico II", Naples, Italy
| | - Antonio Rispo
- Department of Clinical Medicine and Surgery - Sections of Gastroenterology, University "Federico II", Naples, Italy
| | - Olga Maria Nardone
- Department of Clinical Medicine and Surgery - Sections of Gastroenterology, University "Federico II", Naples, Italy
| | - Gaetano Luglio
- Colo-rectal Surgery, University "Federico II", Naples, Italy
| | - Luigi Bucci
- Colo-rectal Surgery, University "Federico II", Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery - Sections of Gastroenterology, University "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy
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14
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Saade C, Nasr L, Sharara A, Barada K, Soweid A, Murad F, Tawil A, Ghieh D, Asmar K, Tamim H, Khoury NJ. Crohn's disease: A retrospective analysis between computed tomography enterography, colonoscopy, and histopathology. Radiography (Lond) 2019; 25:349-358. [PMID: 31582244 DOI: 10.1016/j.radi.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION To investigate the spectrum of computed tomography enterography (CTE) findings of active Crohn's disease (CD) in comparison to endoscopic, histopathologic and inflammatory markers. METHODS Hospital records of 197 patients with known or suspected CD who underwent CTE over a period of 5 years were reviewed. Eighty-nine patients fulfilled the inclusion criteria. Three-point severity scores for endoscopy, pathology, and haematologic inflammatory markers were recorded. The findings on CTE were identified by three readers and correlated with endoscopic, pathologic, and haematologic severity scores. Statistical analysis was carried out employing a Pearson Chi square test and Fisher exact test. Receiver operating characteristic (ROC), visual grading characteristic (VGC) and Cohens' kappa analyses were performed. RESULTS The CTE findings which were significantly correlated with the severity of active disease on endoscopy include bowel wall thickening, mucosal hyperenhancement, bilaminar stratified wall enhancement, transmural wall enhancement, and mesenteric fluid adjacent to diseased bowel (p < 0.05). Only bowel wall thickening and bilaminar stratified wall enhancement correlated with the pathological severity of active CD. ROC and VGC analysis demonstrated significantly higher areas under the curve (p < 0.0001) together with excellent inter-reader agreement (k = 0.86). CONCLUSION CTE is a reliable tool for evaluating the severity of active disease and helps in the clinical decision pathway.
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Affiliation(s)
- C Saade
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - L Nasr
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - A Sharara
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - K Barada
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - A Soweid
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - F Murad
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - A Tawil
- Department of Pathology, American University of Beirut Medical Center, Lebanon.
| | - D Ghieh
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - K Asmar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - H Tamim
- Biostatistics Unit at the Clinical Research Institute, American University of Beirut, Lebanon.
| | - N J Khoury
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
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15
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Marazuela García P, López-Frías López-Jurado A, Vicente Bártulos A. Acute abdominal pain in patients with Crohn's disease: what urgent imaging tests should be done? RADIOLOGIA 2019; 61:333-336. [PMID: 30772003 DOI: 10.1016/j.rx.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 01/25/2023]
Abstract
Crohn's disease is an autoimmune disease that predominantly affects the gastrointestinal tract. Crohn's disease is diagnosed at a young age and runs a chronic course with acute flare-ups. When patients with Crohn's disease present with flare-ups at the emergency department, they are usually managed in a way similar to patients with acute abdomen; there is no consensus about the most appropriate imaging work-up for patients with flare-ups of Crohn's disease. Thus, we decided to review the literature about the imaging tests indicated (whether related to their diagnostic performance or to lower exposure to ionizing radiation) for acute flare-ups in patients with Crohn's disease.
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Affiliation(s)
- P Marazuela García
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - A Vicente Bártulos
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España
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16
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MR Imaging Evaluation of Inflammatory Bowel Disease in Children:: Where Are We Now in 2019. Magn Reson Imaging Clin N Am 2019; 27:291-300. [PMID: 30910099 DOI: 10.1016/j.mric.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is an important cause of abdominal pain in the pediatric population. Magnetic resonance enterography (MRE) plays a crucial role in assessment of disease severity, location, extent of disease, and assessment for associated complications. As MR imaging technology has advanced, new techniques have been brought into clinical practice. Recent research has expanded our understanding of how the inflammatory processes in IBD manifest on MRE and improved radiology's ability to accurately assess the disease and its associated complications. This article discusses up-to-date MR imaging techniques and imaging manifestations of IBD in pediatric patients.
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17
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Deepak P, Fowler KJ, Fletcher JG, Bruining DH. Novel Imaging Approaches in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2019; 25:248-260. [PMID: 30010908 DOI: 10.1093/ibd/izy239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases are chronic autoimmune conditions of the gastrointestinal tract, mainly grouped into ulcerative colitis or Crohn's disease. Traditionally, symptoms have been used to guide IBD management, but this approach is fatally flawed, as symptoms don't correlate with disease activity and often fail to predict disease complications, especially with Crohn's disease. Hence, there is increasing recognition of the need for treatment algorithms based on objective measures of bowel inflammation. In this review, we will focus on advancements in the endoscopic and radiological imaging armamentarium that allow detailed assessments from intestinal mucosa to mesentery.
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Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
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18
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Ippolito D, Lombardi S, Talei Franzesi C, Drago SG, Querques G, Casiraghi A, Pecorelli A, Riva L, Sironi S. Dynamic Contrast-Enhanced MR with Quantitative Perfusion Analysis of Small Bowel in Vascular Assessment between Inflammatory and Fibrotic Lesions in Crohn's Disease: A Feasibility Study. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:1767620. [PMID: 30863218 PMCID: PMC6378774 DOI: 10.1155/2019/1767620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/26/2018] [Accepted: 12/10/2018] [Indexed: 02/08/2023]
Abstract
AIM To assess the feasibility of dynamic contrast-enhanced perfusion-MRI in characterization of active small-bowel inflammation and chronic mural fibrosis in patients with Crohn's disease (CD). METHODS We analyzed a total of 37 (11 women; 23-69 years) patients with known biopsy proven CD, who underwent MR-enterography (MRE) study, performed on a 1.5 T MRI system (Achieva, Philips), using a phased array sense body multicoil, after oral administration of 1.5-2 L of PEG solution. MRE protocol included T1 weighted, SSh T2, sBTFE, and gadolinium-enhanced THRIVE sequences acquired on coronal and axial planes. A dedicated workstation was used to generate perfusion color maps, on which we drown ROI on normal bowel and on pathological segment, thus obtaining related perfusion parameters: relative arterial, venous, and late enhancement (RAE, RVE, and RLE), maximum enhancement (ME), and time to peak (TTP). RESULTS Quantitative perfusion analysis showed a good correlation with local degree of Crohn's inflammation activity. Twenty-nine out of 37 patients showed active inflammatory disease (reference standard of active disease: wall bowel thickness and layered enhancement) with following perfusion parameters: REA (%) = 116.1, RVE (%) = 125.3, RLE (%) = 127.1, ME (%) = 1054.7, TTP (sec) = 157. The same parameters calculated in patients with mural fibrosis were as follows: RAE (%): median = 56.4; RVE (%): 81.2; RLE (%): 85.4; ME (%):809.6; TTP (sec): 203.4. A significant difference (p < 0.001) between inflamed and fibrotic bowel wall vascularity, regarding all perfusion parameters evaluated, was found, with higher values in active CD localizations. CONCLUSION Vascular assessment of perfusion kinetics of bowel wall by dynamic contrast perfusion-MR analysis may represent a complementary diagnostic tool that enables a quantitative evaluation of local inflammation activity in CD patients.
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Affiliation(s)
- Davide Ippolito
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Sophie Lombardi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Cammillo Talei Franzesi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Silvia Girolama Drago
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Giulia Querques
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Alessandra Casiraghi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Anna Pecorelli
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Luca Riva
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 2Department of Diagnostic Radiology, San Gerardo Hospital H. S. Gerardo Monza, Via Pergolesi 33, 20900-Monza, MB, Italy
| | - Sandro Sironi
- 1School of Medicine, University of Milano-Bicocca, Milan, Italy
- 3Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital H. Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
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19
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Rapp JB, Anupindi SA, Maya CL, Biko DM. Assessment of normal jejunum with diffusion-weighted imaging on MRE in children. Pediatr Radiol 2018; 48:1763-1770. [PMID: 30066156 DOI: 10.1007/s00247-018-4200-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/14/2018] [Accepted: 06/25/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diffusion restriction has been utilized as a marker for bowel inflammation on magnetic resonance enterography (MRE). However, diffusion restriction has been seen in otherwise normal appearing small bowel in patients without active inflammation, with little published data on this subject. OBJECTIVE Assess diffusion restriction in normal loops of jejunum and to determine if there is a correlation to luminal distention, age, magnet field strength, slice thickness, and bowel segment location. MATERIALS AND METHODS A retrospective analysis of subjects with a normal MRE and clinical work-up was performed. The abdomen was divided into four quadrants. If available, two loops of jejunum were randomly chosen in each quadrant. Two radiologists evaluated the loops of jejunum for distension, wall thickness, enhancement and diffusion restriction. Disagreement was resolved by consensus. Presence of diffusion restriction was correlated with luminal distension, age, magnet field strength, slice thickness and abdominal quadrant. RESULTS One hundred ninety-seven loops of jejunum were evaluated in 39 subjects. Fifteen subjects (38.5%) had jejunal loops with diffusion restriction for a total of 28 loops. There was no correlation between diffusion restriction and luminal distension, age, magnet field strength or quadrant location (P>0.05, Pearson chi-squared test or Student's t-tests). Of the 15 subjects with a loop demonstrating diffusion restriction, additional loops with diffusion restriction were found in 40%. There was a very weak trend observed for greater slice thickness in patients with jejunal diffusion restriction (Student's t-test, P=0.10). CONCLUSION Jejunal diffusion restriction is a common finding in children with no clinical evidence of bowel pathology, irrespective of patient age, luminal distension, location of bowel loop and magnetic field strength. Further studies may be valuable in assessing the impact of slice thickness on subjective diffusion restriction in the jejunum.
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Affiliation(s)
- Jordan B Rapp
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carolina L Maya
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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20
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Park SH, Ye BD, Lee TY, Fletcher JG. Computed Tomography and Magnetic Resonance Small Bowel Enterography: Current Status and Future Trends Focusing on Crohn's Disease. Gastroenterol Clin North Am 2018; 47:475-499. [PMID: 30115433 DOI: 10.1016/j.gtc.2018.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are presently state-of-the-art radiologic tests used to examine the small bowel for various indications. This article focuses on CTE and MRE for the evaluation of Crohn disease. The article describes recent efforts to achieve more standardized interpretation of CTE and MRE, summarizes recent research studies investigating the role and impact of CTE and MRE more directly for several different clinical and research issues beyond general diagnostic accuracy, and provides an update on progress in imaging techniques. Also addressed are areas that need further exploration in the future.
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Affiliation(s)
- Seong Ho Park
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Byong Duk Ye
- Department of Gastroenterology, Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Tae Young Lee
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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21
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Dillman JR, Towbin AJ, Imbus R, Young J, Gates E, Trout AT. Comparison of Two Neutral Oral Contrast Agents in Pediatric Patients: A Prospective Randomized Study. Radiology 2018; 288:245-251. [PMID: 29737955 DOI: 10.1148/radiol.2018173039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Dillman
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH 45229
| | - Alexander J. Towbin
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH 45229
| | - Rebecca Imbus
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH 45229
| | - Julie Young
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH 45229
| | - Erica Gates
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH 45229
| | - Andrew T. Trout
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML 5031, Cincinnati, OH 45229
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22
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Abstract
PURPOSE To establish the relationship between penetrating complications and bowel luminal narrowing/stricturing disease in pediatric Crohn disease (CD). MATERIALS AND METHODS This retrospective study was IRB-approved and HIPAA compliant with waiver of informed consent. CT and MRI examinations describing intra-abdominal penetrating complications in CD patients ≤ 18 years old between January 1, 2009 and March 31, 2016 were reviewed to document: type of complication, affected bowel segment, minimum bowel luminal diameter, maximum upstream diameter, location of penetrating complication relative to luminal narrowing, length of narrowed bowel segment, and the presence of active bowel wall inflammation. Data were summarized using descriptive statistics including means, standard deviations, as well as counts and percentages. RESULTS A total of 52 penetrating complications were identified in 45 patients. Mean patient age was 15.7 ± 2.2 years (range 11-18 years) with 25/45 (56%) boys. Nearly all penetrating complications (51/52, 98%) were associated with a minimum bowel luminal diameter of ≤ 2 mm, with no visible lumen in 26/52 (50%). Mean maximum upstream diameter was 2.8 ± 0.8 cm (range 1.2-5.2 cm), and 17/52 (33%) penetrating complications were associated with > 3 cm upstream diameter. The mean ratio of maximum to minimum luminal diameter was 26.2 ± 8.8 (range 3.6-52.0). Active intestinal inflammation was associated with 100% (52/52) of penetrating complications. Nearly every penetrating complication (51/52, 98%) involved the terminal or distal ileum. CONCLUSIONS Penetrating complications in pediatric CD nearly always occur in the setting of considerable luminal narrowing or stricture and active intestinal inflammation.
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23
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Stanic Benic M, Giljaca V, Vlahovic-Palcevski V. The impact of biological interventions on health-related quality of life in adults with Crohn's disease. Hippokratia 2018. [DOI: 10.1002/14651858.cd012973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mirjana Stanic Benic
- Clinical Hospital Centre Rijeka; Department of Clinical Pharmacology; Krešimirova 42 Rijeka Croatia 51000
| | - Vanja Giljaca
- Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital; Directorate of Surgery, Department of Gastroenterology; Bordesley Green East Birmingham UK B9 5SS
| | - Vera Vlahovic-Palcevski
- Clinical Hospital Centre Rijeka; Department of Clinical Pharmacology; Krešimirova 42 Rijeka Croatia 51000
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24
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Kedia S, Sharma R, Makharia GK, Ahuja V, Desai D, Kandasamy D, Eapen A, Ganesan K, Ghoshal UC, Kalra N, Karthikeyan D, Madhusudhan KS, Philip M, Puri AS, Puri S, Sinha SK, Banerjee R, Bhatia S, Bhat N, Dadhich S, Dhali GK, Goswami BD, Issar SK, Jayanthi V, Misra SP, Nijhawan S, Puri P, Sarkar A, Singh SP, Srivastava A, Abraham P, Ramakrishna BS. Imaging of the small intestine in Crohn's disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association. Indian J Gastroenterol 2017; 36:487-508. [PMID: 29307029 DOI: 10.1007/s12664-017-0804-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 02/07/2023]
Abstract
The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients with suspected or known Crohn's disease. These 29 position statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital and Medical Research Centre, Veer Sawarkar Marg, Mumbai, 400 016, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632 004, India
| | - Karthik Ganesan
- Department of Radiodiagnosis, Sir H N Reliance Foundation Hospital and Research Centre, Prarthana Samaj, Raja Rammohan Roy Road, Mumbai, 400 004, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - D Karthikeyan
- Department of Radiodiagnosis, SRM Institutes for Medical Science, 1, Jawaharlal Nehru Salai, Vadapalani, Chennai, 600 026, India
| | | | - Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 017, India
| | - Amarender Singh Puri
- Department of Gastroenterology, GB Pant Institute of Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India
| | - Sunil Puri
- Department of Radiodiagnosis, GB Pant Institute of Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India
| | - Saroj K Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Shobna Bhatia
- Department of Gastroenterology, KEM Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India
| | - Naresh Bhat
- Department of Gastroenterology, Aster CMI Hospital, 43/2, New Airport Road, NH.7, Sahakara Nagar, Bengaluru, 560 092, India
| | - Sunil Dadhich
- Department of Gastroenterology, SN Medical College, Residency Road, Shastri Nagar, Jodhpur, 342 003, India
| | - G K Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, 700 020, India
| | - B D Goswami
- Department of Gastroenterology, Guwahati Medical College, GMC Hospital Road, Bhangagarh, Guwahati, 781 032, India
| | - S K Issar
- Department of Gastroenterology, Jawaharlal Nehru Hospital and Research Centre, Hospital Sector, Bhilai, 490 009, India
| | - V Jayanthi
- Department of Gastroenterology, Gleneagles Global Hospitals, 439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India
| | - S P Misra
- Department of Gastroenterology, MLN Medical College, Allahabad, 211 002, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College, J L N. Marg, Jaipur, 302 004, India
| | - Pankaj Puri
- Department of Gastroenterology, Military Hospital, Cantt Area, Jodhpur, 342 006, India
| | - Avik Sarkar
- Department of Radiodiagnosis, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, 700 020, India
| | - S P Singh
- Department of Gastroenterology, SCB Medical College, Dock Road, Manglabag, Cuttack, 753 007, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital and Medical Research Centre, Veer Sawarkar Marg, Mumbai, 400 016, India
| | - B S Ramakrishna
- Institute of Gastroenterology, SRM Institutes for Medical Science, 1, Jawaharlal Nehru Salai, Vadapalani, Chennai, 600 026, India
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Sánchez-Carpintero de la Vega M, García Villar C. Estudios telemandados con control fluoroscópico del tracto digestivo superior: Técnicas e indicaciones. RADIOLOGIA 2017; 59:343-354. [DOI: 10.1016/j.rx.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Imaging in Patients with Crohn's Disease: Trends in Abdominal CT/MRI Utilization and Radiation Exposure Considerations over a 10-Year Period. Inflamm Bowel Dis 2017; 23:1025-1033. [PMID: 28426472 DOI: 10.1097/mib.0000000000001088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To study the trends in utilization of computed tomography (CT) and magnetic resonance imaging (MRI) in patients with Crohn's disease and to evaluate changes in CT radiation exposure over a 10-year period. METHODS In this institutional review board-approved single-institution retrospective study, we included patients who underwent CT and MRIs for evaluation of Crohn's disease between 2006 and 2015. A total of 3196 CTs and 1924 MR scans were performed in 2156 patients (mean age: 34.8 ± 17.71 yr; range: 3-91 yr) for initial diagnosis or follow-up of Crohn's disease between 2006 and 2015. Trends in CT/MR utilization was assessed by comparing the volume of CT/MRI studies performed each year. The changes in CT radiation exposure over the study period were estimated and compared. RESULTS The annual combined CT/MR utilization demonstrated a 1.9-fold rise over the last decade (2006: n = 358, 2015: n = 681, P < 0.001, r = 0.96). It was predominantly because of a substantial growth (9.2-fold increase) in the MR scan volume (2006: n = 37, 2015: n = 341, P < 0.001, r = 0.93), whereas CT volume did not show significant change (2006: n = 321, 2015: n = 340, P = 0.6). Over this same period, there was a 59.4% reduction in mean radiation exposure (2006: CT dose indexvol 16.9 ± 7.1 mGy, 2015: CT dose indexvol 6.87 ± 4.62 mGy, P < 0.001). CONCLUSIONS A 9-fold growth in annual MR scan volume contributed to a nearly 2-fold rise in yearly cross-sectional imaging utilization in Crohn's patients between 2006 and 2015. Rising trend in imaging utilization paralleled a 60% reduction of CT radiation exposure.
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Abstract
BACKGROUND AND AIMS The prevalence and incidence of inflammatory bowel disease (IBD) in North America is among the highest in the world and imparts substantial direct and indirect medical costs. The Choosing Wisely Campaign was launched in wide variety of medical specialties and disciplines to reduce unnecessary or harmful tests or treatment interventions. METHODS The Choosing Wisely list for IBD was developed by the Canadian IBD Network for Research and Growth in Quality Improvement (CINERGI) in collaboration with Crohn's and Colitis Canada (CCC) and the Canadian Association of Gastroenterology (CAG). Using a modified Delphi process, 5 recommendations were selected from an initial list of 30 statements at a face-to-face consensus meeting. RESULTS The 5 things physicians and patients should question: (1) Don't use steroids (e.g., prednisone) for maintenance therapy in IBD; (2) Don't use opioids long-term to manage abdominal pain in inflammatory bowel disease (IBD); (3) Don't unnecessarily prolong the course of intravenous corticosteroids in patients with acute severe ulcerative colitis (UC) in the absence of clinical response; (4) Don't initiate or escalate long-term medical therapies for the treatment of IBD based only on symptoms; and (5) Don't use abdominal computed tomography (CT) scan to assess IBD in the acute setting unless there is suspicion of a complication (obstruction, perforation, abscess) or a non-IBD etiology for abdominal symptoms. CONCLUSIONS The Choosing Wisely recommendations will foster patient-physician discussions to optimize IBD therapy, reduce adverse effects from testing and treatment, and reduce medical expenditure.
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Seemann NM, Radhakrishnan S, Gazendam A, King SK, Falkiner M, Shkumat N, Greer MLC, Langer JC. The role of imaging in the preoperative assessment of children with inflammatory colitis. J Pediatr Surg 2017; 52:970-974. [PMID: 28347526 DOI: 10.1016/j.jpedsurg.2017.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/09/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Accurate diagnosis of Crohn's disease or ulcerative colitis is essential for surgical planning. This study compared the accuracy, safety, and utility of small bowel follow-through (SBFT) and magnetic resonance enterography (MRE) for detecting small bowel (SB) involvement preoperatively. METHODS A retrospective review of children who underwent colectomy for inflammatory bowel disease (2000-2014) was performed. Preoperative SBFT and MRE were independently reviewed by two radiologists blinded to clinical data. Gold standard for diagnosis was surgical pathology. RESULTS 68 patients (36 female) were included. 45 patients had SBFT prior to colectomy, 17 patients had MRE, and 6 both. Interrater reliability for radiologic interpretation was 90% (SBFT) and 91% (MRE). Mean study durations were 190min (SBFT) and 59min (MRE). Median effective dose for SBFT was 1.5mSv, while MRE involved no ionizing radiation. Specificities for diagnosing SB involvement were 87.5% (SBFT) and 94% (MRE). 54 patients underwent subtotal colectomy and ileostomy, 12 restorative proctocolectomy, and 2 colectomy with ileorectal anastomosis. Preoperative imaging correlated with surgical pathology in 83% (SBFT) and 90% (MRE). CONCLUSION MRE is at least as effective as SBFT for assessing SB disease in children with colitis prior to colectomy. MRE requires less time and does not expose children to ionizing radiation. Retrospective Case Series, Level 4 Evidence.
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Affiliation(s)
- Natashia M Seemann
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shilpa Radhakrishnan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aaron Gazendam
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sebastian K King
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Falkiner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Shkumat
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Camera L, Liccardo I, Romano F, Liuzzi R, Rispo A, Imbriaco M, Testa A, Luglio G, De Fronzo S, Castiglione F, Bucci L, Brunetti A. Diagnostic efficacy of single-pass abdominal multidetector-row CT: prospective evaluation of a low dose protocol. Br J Radiol 2016; 90:20160612. [PMID: 27826994 DOI: 10.1259/bjr.20160612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic efficacy of single-pass contrast-enhanced multidetector CT (CE-MDCT) performed with a low-radiation high-contrast (LR-HC) dose protocol in selected patients with non-traumatic acute bowel disease. METHODS 65 (32 males, 33 females; aged 20-67 years) consecutive patients with non-traumatic acute bowel disease underwent single-pass CE-MDCT performed 70-100 s after i.v. bolus injection of a non-ionic iodinated contrast medium (CM) (370 mgI ml-1). In 46 (70%) patients with a clinical and/or ultrasonographic suspicion of inflammatory bowel disease, up to 1.2-1.4 l of a 7% polyethylene-glycol solution was orally administered 45-60 mins prior to the CT examination. Patients were then divided into two groups according to age: Group A (20-44 years; n = 34) and Group B (45-70 years; n = 31). Noise index (NI) and CM dose were selected as follows: Group A (NI = 15; 2.5 ml kg-1) and Group B (NI = 12.5; 2 ml kg-1). All patients of Group A underwent thyroid functional tests at 4-6 weeks. Final diagnoses were obtained by open (n = 12) or laparoscopic surgery (n = 4), endoscopy w/without biopsy (n = 24) and clinical (n = 19) and/or instrumental (ultrasonography) (n = 6) follow-up at 11 ± 4 months (range 6-18 mo.). Statistical analysis was performed by χ2 and Student's t-test for categorical and continuous variables, respectively. RESULTS Sensitivity and specificity were 91.3 vs 95.4% (p = 0.905) and 90.9 vs 88.8% (p = 0.998) with an overall diagnostic accuracy of 91.1 vs 93.5% (p = 0.756), whereas the radiation (in millisievert) and CM dose (in millilitre) were 7.5 ± 2.8 mSv and 155 ± 30 ml for Group A and 14.1 ± 5.3 mSv and 130 ± 24 ml for Group B (p < 0.001), respectively. No patients of Group A showed laboratory signs of thyrotoxicosis at follow-up. CONCLUSION The LR-HC has proved to be a safe and a dose-effective protocol in the evaluation of selected young patients with non-traumatic acute bowel disease. Advances in knowledge: (1) As reaching the highest diagnostic benefit to risk ratio (AHARA) appears to be the current principle of MDCT imaging, an increased amount of iodinated CM (0.7-0.9 gI ml-1) can be safely administered to young patients (<40 years) with normal thyroid and renal function to compensate for the lower image quality resulting from low-dose CT protocols performed with the standard filter back-projection algorithm. Such an approach will result in a significant reduction of the radiation dose, which could be otherwise achieved only using iterative reconstruction algorithms combined with either low tube voltage and/or low tube current protocols. (2) An optimal scan delay (Tdelay) for a venous phase caudocranial acquisition can be calculated by the following formula: Tdelay = CI + 25 - TSD, where CI is the duration of the contrast injection, 25 is the average of the sum of abdominal aortic and peak hepatic arrival times and TSD is the scan duration. With such an approach, the radiation exposure resulting from bolus tracking, albeit performed with low-dose scans, can be spared in patients with normal transit times.
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Affiliation(s)
- Luigi Camera
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.,2 National Research Council (CNR), Institute of Biostructures and Bioimaging, Naples, Italy
| | - Immacolata Liccardo
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Federica Romano
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Raffaele Liuzzi
- 2 National Research Council (CNR), Institute of Biostructures and Bioimaging, Naples, Italy
| | - Antonio Rispo
- 3 Section of Gastroenterology, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Massimo Imbriaco
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Anna Testa
- 3 Section of Gastroenterology, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Gaetano Luglio
- 4 Section of Colo-rectal Surgery, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Simona De Fronzo
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Fabiana Castiglione
- 3 Section of Gastroenterology, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Luigi Bucci
- 4 Section of Colo-rectal Surgery, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Arturo Brunetti
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
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O’Malley RB, Hansen NJ, Carnell J, Afzali A, Moshiri M. Update on MR Enterography: Potentials and Pitfalls. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0172-x] [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]
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Yu HS, Gupta A, Soto JA, LeBedis C. Emergency abdominal MRI: current uses and trends. Br J Radiol 2015; 89:20150804. [PMID: 26514590 PMCID: PMC4985451 DOI: 10.1259/bjr.20150804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 12/21/2022] Open
Abstract
When evaluating the abdomen in the emergency setting, CT and ultrasound are the imaging modalities of choice, mainly because of accessibility, speed and lower relative cost. CT has the added benefit of assessing the whole abdomen for a wide spectrum of gastrointestinal disease, whereas ultrasound has the benefit of avoiding ionizing radiation. MRI is another tool that has demonstrated increasing utility in the emergency setting and also avoids the use of ionizing radiation. MRI also has the additional advantage of excellent soft-tissue contrast. However, widespread use of MRI in the emergency setting is limited by availability and relative cost. Despite such limitations, advances in MRI technology, including improved pulse sequences and coil technology and increasing clinician awareness of MRI, have led to an increased demand in abdominal MRI in the emergency setting. This is particularly true in the evaluation of acute pancreatitis; choledocholithiasis with or without cholecystitis; acute appendicitis, particularly in pregnant patients; and, in some cases, Crohn's disease. In cases of pancreatitis and Crohn's disease, MRI also plays a role in subsequent follow-up examinations.
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Affiliation(s)
- Hei S Yu
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Avneesh Gupta
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Christina LeBedis
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
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