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Feinggumloon S, Panpikoon T, Piyajaroenkij T, Prasertchai T, Treesit T. Successful transarterial embolization of hemorrhage following percutaneous liver biopsy in hepatic amyloidosis. Clin Case Rep 2024; 12:e9223. [PMID: 39386349 PMCID: PMC11461566 DOI: 10.1002/ccr3.9223] [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: 03/31/2024] [Revised: 06/19/2024] [Accepted: 07/13/2024] [Indexed: 10/12/2024] Open
Abstract
Percutaneous liver biopsy is essential for diagnosing hepatic amyloidosis. Post biopsy hemorrhage is unusual but can occur. The potential for bleeding can result from various factors, such as the deposition of amyloid in the hepatic parenchyma or vessel wall, deficiencies in coagulation factors, hyperfibrinolysis, and platelet dysfunction. Transarterial embolization can be a safe and effective method for achieving hemostasis.
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Affiliation(s)
- Sasikorn Feinggumloon
- Department of Diagnostic and Therapeutic Radiology, Faculty of MedicineRamathibodi Hospital, Mahidol UniversityBangkokThailand
| | - Tanapong Panpikoon
- Department of Diagnostic and Therapeutic Radiology, Faculty of MedicineRamathibodi Hospital, Mahidol UniversityBangkokThailand
| | - Thanakrit Piyajaroenkij
- Division of Hematology, Department of Medicine, Faculty of MedicineRamathibodi Hospital, Mahidol UniversityBangkokThailand
| | - Tanatip Prasertchai
- Department of Pathology, Faculty of MedicineRamathibodi Hospital, Mahidol UniversityBangkokThailand
| | - Tharintorn Treesit
- Department of Diagnostic and Therapeutic Radiology, Faculty of MedicineRamathibodi Hospital, Mahidol UniversityBangkokThailand
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Dhillon P, Naidu M, Olson MC, VanBuren WM, Sheedy SP, Wells ML, Fidler JL, Heiken JP, Venkatesh SK, Kelm ZS. Diffusely Infiltrative Small Bowel Disease. Radiographics 2024; 44:e230148. [PMID: 39207924 DOI: 10.1148/rg.230148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Multiple infiltrative disorders can affect the small bowel, often resulting in diffuse small bowel wall thickening. These infiltrative disorders can manifest owing to various factors such as an influx of immunologic or neoplastic cells or the accumulation of substances within one or more layers of the intestinal wall. Although there can be considerable overlap in the appearances of infiltrative diseases on cross-sectional images, a comprehensive understanding of more specific ancillary imaging features and clinicopathologic correlation can substantially narrow the differential diagnosis. The radiologist can be instrumental in synthesizing the clinical and imaging information and guiding subsequent workup. The authors present a comprehensive review of the infiltrative disorders that commonly involve the small bowel. These disorders are organized on the basis of their pathophysiologic features, with multiple illustrative case examples to enhance understanding of these entities. CT and MRI are currently the most commonly used imaging modalities for evaluating small bowel disorders, and this review is focused on these two modalities. Detailed information regarding the pathologic features, clinical presentation, and imaging findings of these infiltrative disorders is provided to aid radiologists in recognizing and differentiating these conditions. ©RSNA, 2024.
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Affiliation(s)
- Preet Dhillon
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Madeline Naidu
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Michael C Olson
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Wendaline M VanBuren
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Shannon P Sheedy
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Michael L Wells
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Jeff L Fidler
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Jay P Heiken
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Sudhakar K Venkatesh
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
| | - Zachary S Kelm
- From the Department of Radiology (P.D., M.C.O., W.M.V., S.P.S., M.L.W., J.L.F., J.P.H., S.K.V., Z.S.K.), Mayo Clinic (M.N.), 200 First St SW, Rochester, MN 55905
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Rajiah PS, Suman G, Vijay K, Venugopal N, Mansoori B, Chalian M, Agarwal AK. Multisystem Imaging Manifestations of Kidney Failure. Radiographics 2024; 44:e230124. [PMID: 39052499 DOI: 10.1148/rg.230124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Kidney failure (KF) refers to a progressive decline in glomerular filtration rate to below 15 ml/min per 1.73 m2, necessitating renal replacement therapy with dialysis or renal transplant. The hemodynamic and metabolic alterations in KF combined with a proinflammatory and coagulopathic state leads to complex multisystemic complications. The imaging hallmark of systemic manifestations of KF is bone resorption caused by secondary hyperparathyroidism. Other musculoskeletal complications include brown tumor, osteosclerosis, calcinosis, soft-tissue calcification, and amyloid arthropathy. Cardiovascular complications and infections are the leading causes of death in KF. Cardiovascular complications include accelerated atherosclerosis, cardiomyopathy, pericarditis, myocardial calcinosis, and venous thromboembolism. Neurologic complications such as encephalopathy, osmotic demyelination, cerebrovascular disease, and opportunistic infections are also frequently encountered. Pulmonary complications include edema and calcifications. Radiography and CT are used in assessing musculoskeletal and thoracic complications, while MRI plays a key role in assessing neurologic and cardiovascular complications. CT iodinated contrast material is generally avoided in patients with KF except in situations where the benefit of contrast-enhanced CT outweighs the risks and in patients already undergoing maintenance dialysis. At MRI, group II gadolinium-based contrast material can be safely administered in patients with KF. The authors discuss the extrarenal systemic manifestations of KF, the choice of imaging modality in their assessment, and imaging findings of complications. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., G.S.); UT Southwestern Medical Center, Dallas, Tex (K.V.); University of Washington, Seattle, Wash (N.V., B.M., M.C.); and Mayo Clinic, Jacksonville, Fla (A.K.A.)
| | - Garima Suman
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., G.S.); UT Southwestern Medical Center, Dallas, Tex (K.V.); University of Washington, Seattle, Wash (N.V., B.M., M.C.); and Mayo Clinic, Jacksonville, Fla (A.K.A.)
| | - Kanupriya Vijay
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., G.S.); UT Southwestern Medical Center, Dallas, Tex (K.V.); University of Washington, Seattle, Wash (N.V., B.M., M.C.); and Mayo Clinic, Jacksonville, Fla (A.K.A.)
| | - Nitin Venugopal
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., G.S.); UT Southwestern Medical Center, Dallas, Tex (K.V.); University of Washington, Seattle, Wash (N.V., B.M., M.C.); and Mayo Clinic, Jacksonville, Fla (A.K.A.)
| | - Bahar Mansoori
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., G.S.); UT Southwestern Medical Center, Dallas, Tex (K.V.); University of Washington, Seattle, Wash (N.V., B.M., M.C.); and Mayo Clinic, Jacksonville, Fla (A.K.A.)
| | - Majid Chalian
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., G.S.); UT Southwestern Medical Center, Dallas, Tex (K.V.); University of Washington, Seattle, Wash (N.V., B.M., M.C.); and Mayo Clinic, Jacksonville, Fla (A.K.A.)
| | - Amit Kumar Agarwal
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., G.S.); UT Southwestern Medical Center, Dallas, Tex (K.V.); University of Washington, Seattle, Wash (N.V., B.M., M.C.); and Mayo Clinic, Jacksonville, Fla (A.K.A.)
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Norisyam Y, Zairul Anuar KB, Ohn KM, Moharzudi M. Rare vertebral pathological fracture in primary amyloidosis. BMJ Case Rep 2024; 17:e258973. [PMID: 38388204 PMCID: PMC10884212 DOI: 10.1136/bcr-2023-258973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Spinal involvement in primary amyloidosis is an exceedingly rare condition, presenting with typical pathological fracture symptoms that are often indistinguishable from other pathologies such as bone metastasis, metabolic disorders and infections. Histopathological studies for tissue diagnosis are the cornerstone of a definitive diagnosis, leading to successful treatment. Early diagnosis and intervention play a pivotal role in the care of patients with amyloidosis. Here, we present a unique case of a pathological fracture in the L4 vertebra following minor trauma. This fracture manifested with pain, instability and limitations in daily activities in a patient who had already been diagnosed with systemic amyloidosis and was undergoing chemotherapy. This case represents a distinct instance of vertebral involvement in amyloidosis and was managed with both chemotherapy and surgical intervention to address the spinal pathology, resulting in favourable outcomes.
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Affiliation(s)
- Yusoff Norisyam
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | | | - Khin Maung Ohn
- Orthopaedic Surgery, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Mohamed Moharzudi
- Department of Pathology, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
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Gozzi L, Cozzi D, Cavigli E, Moroni C, Giannessi C, Zantonelli G, Smorchkova O, Ruzga R, Danti G, Bertelli E, Luzzi V, Pasini V, Miele V. Primary Lymphoproliferative Lung Diseases: Imaging and Multidisciplinary Approach. Diagnostics (Basel) 2023; 13:diagnostics13071360. [PMID: 37046580 PMCID: PMC10093093 DOI: 10.3390/diagnostics13071360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Lymphoproliferative lung diseases are a heterogeneous group of disorders characterized by primary or secondary involvement of the lung. Primary pulmonary lymphomas are the most common type, representing 0.5–1% of all primary malignancies of the lung. The radiological presentation is often heterogeneous and non-specific: consolidations, masses, and nodules are the most common findings, followed by ground-glass opacities and interstitial involvement, more common in secondary lung lymphomas. These findings usually show a prevalent perilymphatic spread along bronchovascular bundles, without a prevalence in the upper or lower lung lobes. An ancillary sign, such as a “halo sign”, “reverse halo sign”, air bronchogram, or CT angiogram sign, may be present and can help rule out a differential diagnosis. Since a wide spectrum of pulmonary parenchymal diseases may mimic lymphoma, a correct clinical evaluation and a multidisciplinary approach are mandatory. In this sense, despite High-Resolution Computer Tomography (HRCT) representing the gold standard, a tissue sample is needed for a certain and definitive diagnosis. Cryobiopsy is a relatively new technique that permits the obtaining of a larger amount of tissue without significant artifacts, and is less invasive and more precise than surgical biopsy.
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Affiliation(s)
- Luca Gozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Edoardo Cavigli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | | | - Giulia Zantonelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Olga Smorchkova
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ron Ruzga
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ginevra Danti
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Valentina Luzzi
- Interventional Pneumology, Careggi University Hospital, 50134 Florence, Italy
| | - Valeria Pasini
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, 50133 Florence, Italy
| | - Vittorio Miele
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
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Nehra AK, Sheedy SP, Johnson CD, Flicek KT, Venkatesh SK, Heiken JP, Wells ML, Ehman EC, Barlow JM, Fletcher JG, Olson MC, Bharucha AE, Katzka DA, Fidler JL. Imaging Review of Gastrointestinal Motility Disorders. Radiographics 2022; 42:2014-2036. [PMID: 36206184 DOI: 10.1148/rg.220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The motor function of the gastrointestinal tract relies on the enteric nervous system, which includes neurons spanning from the esophagus to the internal anal sphincter. Disorders of gastrointestinal motility arise as a result of disease within the affected portion of the enteric nervous system and may be caused by a wide array of underlying diseases. The etiology of motility disorders may be primary or due to secondary causes related to infection or inflammation, congenital abnormalities, metabolic disturbances, systemic illness, or medication-related side effects. The symptoms of gastrointestinal dysmotility tend to be nonspecific and may cause diagnostic difficulty. Therefore, evaluation of motility disorders requires a combination of clinical, radiologic, and endoscopic or manometric testing. Radiologic studies including fluoroscopy, CT, MRI, and nuclear scintigraphy allow exclusion of alternative pathologic conditions and serve as adjuncts to endoscopy and manometry to determine the appropriate diagnosis. Additionally, radiologist understanding of clinical evaluation of motility disorders is necessary for guiding referring clinicians and appropriately imaging patients. New developments and advances in imaging techniques have allowed improved assessment and diagnosis of motility disorders, which will continue to improve patient treatment options. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Avinash K Nehra
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Shannon P Sheedy
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - C Daniel Johnson
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Kristina T Flicek
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Jay P Heiken
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Michael L Wells
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Eric C Ehman
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - John M Barlow
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Joel G Fletcher
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Michael C Olson
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Adil E Bharucha
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - David A Katzka
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
| | - Jeff L Fidler
- From the Department of Radiology (A.K.N., S.P.S., K.T.F., S.K.V., J.P.H., M.L.W., E.C.E., J.M.B., J.G.F., M.C.O., J.L.F.) and Division of Gastroenterology and Hepatology (A.E.B., D.A.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.D.J.)
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