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Gaballah AH, Algazzar M, Kazi IA, Badawy M, Guys NP, Mohamed EAS, Sammon J, Elsayes KM, Liu PS, Heller M. The Peritoneum: Anatomy, Pathologic Findings, and Patterns of Disease Spread. Radiographics 2024; 44:e230216. [PMID: 39088361 DOI: 10.1148/rg.230216] [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: 08/03/2024]
Abstract
Disease spread in the abdomen and pelvis generally occurs in a predictable pattern in relation to anatomic landmarks and fascial planes. Anatomically, the abdominopelvic cavity is subdivided into several smaller spaces or compartments by key ligaments and fascial planes. The abdominal cavity has been traditionally divided into peritoneal, retroperitoneal, and pelvic extraperitoneal spaces. Recently, more clinically relevant classifications have evolved. Many pathologic conditions affect the abdominal cavity, including traumatic, inflammatory, infectious, and neoplastic processes. These abnormalities can extend beyond their sites of origin through various pathways. Identifying the origin of a disease process is the first step in formulating a differential diagnosis and ultimately reaching a final diagnosis. Pathologic conditions differ in terms of pathways of disease spread. For example, simple fluid tracks along fascial planes, respecting anatomic boundaries, while fluid from acute necrotizing pancreatitis can destroy fascial planes, resulting in transfascial spread without regard for anatomic landmarks. Furthermore, neoplastic processes can spread through multiple pathways, with a propensity for spread to noncontiguous sites. When the origin of a disease process is not readily apparent, recognizing the spread pattern can allow the radiologist to work backward and ultimately arrive at the site or source of pathogenesis. As such, a cohesive understanding of the peritoneal anatomy, the typical organ or site of origin for a disease process, and the corresponding pattern of disease spread is critical not only for initial diagnosis but also for establishing a road map for staging, anticipating further disease spread, guiding search patterns and report checklists, determining prognosis, and tailoring appropriate follow-up imaging studies. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Ayman H Gaballah
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Maged Algazzar
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Irfan A Kazi
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Mohamed Badawy
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Nicholas Philip Guys
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Eslam Adel Shehata Mohamed
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Jennifer Sammon
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Peter S Liu
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Matthew Heller
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
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Boekestijn B, Wasser MNJM, Mieog JSD, DeRuiter MC. Retroperitoneum revisited: a review of radiological literature and updated concept of retroperitoneal fascial anatomy with imaging features and correlating anatomy. Surg Radiol Anat 2024; 46:1165-1175. [PMID: 38963431 PMCID: PMC11246311 DOI: 10.1007/s00276-024-03432-8] [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] [Received: 12/19/2023] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Spread of disease in the retroperitoneum is dictated by the complex anatomy of retroperitoneal fasciae and is still incompletely understood. Conflicting reports have led to insufficient and incorrect anatomical concepts in radiological literature. METHODS This review will discuss previous concepts prevalent in radiological literature and their shortcomings will be highlighted. New insights from recent anatomical and embryological research, together with imaging examples, will be used to clarify patterns of disease spread in the retroperitoneum that remain unexplained by these concepts. RESULTS The fusion fascia and the renal fascia in particular give rise to planes and spaces that act as vectors for spread of disease in the retroperitoneum. Some of these planes and structures, such as the caudal extension of the renal fascia, have previously not been described in radiological literature. CONCLUSION New insights, including the various fasciae, potential spaces and planes, are incorporated into an updated combined retroperitoneal fascial concept.
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Affiliation(s)
- B Boekestijn
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
| | - M N J M Wasser
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Polamraju P, Oliphant M, Aribindi S, Ponnatapura J. Navigating the labyrinth of peritoneal and extraperitoneal anatomy: abdominal spread made easy with a case based review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04429-y. [PMID: 38904709 DOI: 10.1007/s00261-024-04429-y] [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: 03/28/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
Essential to understanding disease spread in abdomen is to separate the peritoneum from the extraperitoneum. These areas have distinct anatomy with well-define separate pathways. The peritoneum is comprised of connected recesses that are potential spaces, normally not imaged except when containing excess fluid or air. Peritoneal recesses are formed by the opposing peritoneal surfaces and subdivided by the attachments of the ligaments and mesenteries to the parietal peritoneum. Disease flows within the recesses by changes in abdominal pressure. This forms a distinct spread pattern. The extraperitoneum is traditionally stratified by the renal fascia into the anterior and posterior pararenal spaces and the perirenal space. The fascia contains and directs spread from the contained organs with the compartments. Each space has a unique spread pattern defined by the containing fascia. The extraperitoneum is connected to the mesenteries and ligaments forming the subperitoneal space. This space interconnects the extraperitoneum with the mesenteries allowing for the normal continuum of blood vessels, lymphatics, and nerves but also forms the pathways for bidirectional spread of disease.
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Affiliation(s)
- Praveen Polamraju
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Michael Oliphant
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Swetha Aribindi
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Janardhana Ponnatapura
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA.
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Pathak P, Abandeh L, Aboughalia H, Pooyan A, Mansoori B. Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts. Abdom Radiol (NY) 2024; 49:1677-1698. [PMID: 38652126 DOI: 10.1007/s00261-023-04139-x] [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] [Received: 09/03/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging. CONCLUSION Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases.
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Affiliation(s)
- Priya Pathak
- Abdominal Imaging and Nuclear Medicine Divisions, Department of Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hassan Aboughalia
- Department of Radiology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Atefe Pooyan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Bahar Mansoori
- Abdominal Imaging Division, Department of Radiology, University of Washington, Seattle, WA, USA
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Montanarella M, Gonzalez Baerga CI, Menendez Santos MJ, Elsherif S, Boldig K, Kumar S, Virarkar M, Gopireddy DR. Retroperitoneal anatomy with the aid of pathologic fluid: An imaging pictorial review. J Clin Imaging Sci 2023; 13:36. [PMID: 38205277 PMCID: PMC10778072 DOI: 10.25259/jcis_79_2023] [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: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024] Open
Abstract
The retroperitoneum, a complex anatomical space within the abdominopelvic region, encompasses various vital abdominal organs. It is compartmentalized by fascial planes and contains potential spaces critical in multiple disease processes, including inflammatory effusions, hematomas, and neoplastic conditions. A comprehensive understanding of the retroperitoneum and its potential spaces is essential for radiologists in identifying and accurately describing the extent of abdominopelvic disease. This pictorial review aims to describe the anatomy of the retroperitoneum while discussing commonly encountered pathologies within this region. Through a collection of illustrative images, this review will provide radiologists with valuable insights into the retroperitoneum, facilitating their diagnostic proficiency to aid in appropriate patient clinical management.
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Affiliation(s)
- Matthew Montanarella
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | | | | | - Sherif Elsherif
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Kimberly Boldig
- Department of Internal Medicine, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Sidhu Kumar
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Mayur Virarkar
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
| | - Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, Florida, United States
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Pandey A, Kumar D, Gupta P, Khosla D, Periasamy K, Kapoor R. Primary retroperitoneal squamous cell carcinoma: a literature review. J Cancer Res Clin Oncol 2023; 149:12507-12512. [PMID: 37353604 DOI: 10.1007/s00432-023-04969-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Retroperitoneal squamous cell carcinoma is an extremely rare histological variant of retroperitoneal tumors. The exact etiology and origin of the same is still unknown. To date, only a few case reports have been published in the literature. Due to rarity, standard treatment protocol is not available. The article aims to review the literature and treatment options available for this uncommon entity, based on available data. METHODS We searched the databases like PubMed, PubMed Central, Scopus, and Google Scholar with the keywords "Squamous cell carcinoma" and "retroperitoneal tumors". Peer-reviewed and recent articles were screened. RESULTS Seven relevant articles comprising 14 cases were found. Due to the small number of reports, tabulation of treatment details and outcome was done. Like the sarcoma variant, these tumors also present with a large mass in the abdomen and abdominal discomfort. Association with human papillomavirus appears to be the most common factor that gives rise to squamous histology. CONCLUSION Retroperitoneal SCC is an uncommonly diagnosed entity. Although no specific treatment guidelines exist for this uncommon malignancy; surgery followed by adjuvant or definitive radiotherapy with concurrent chemotherapy (in inoperable cases) seems a feasible option. Multicentre trials should be conducted for establishing definitive treatment strategies for this ailment.
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Affiliation(s)
- Ankita Pandey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divyesh Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Veron Sanchez A, Bennouna I, Coquelet N, Cabo Bolado J, Pinilla Fernandez I, Mullor Delgado LA, Pezzullo M, Liberale G, Gomez Galdon M, Bali MA. Unravelling Peritoneal Carcinomatosis Using Cross-Sectional Imaging Modalities. Diagnostics (Basel) 2023; 13:2253. [PMID: 37443647 DOI: 10.3390/diagnostics13132253] [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: 05/07/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Peritoneal carcinomatosis (PC) refers to malignant epithelial cells that spread to the peritoneum, principally from abdominal malignancies. Until recently, PC prognosis has been considered ill-fated, with palliative therapies serving as the only treatment option. New locoregional treatments are changing the outcome of PC, and imaging modalities have a critical role in early diagnosis and disease staging, determining treatment decision making strategies. The aim of this review is to provide a practical approach for detecting and characterizing peritoneal deposits in cross-sectional imaging modalities, taking into account their appearances, including the secondary complications, the anatomical characteristics of the peritoneal cavity, together with the differential diagnosis with other benign and malignant peritoneal conditions. Among the cross-sectional imaging modalities, computed tomography (CT) is widely available and fast; however, magnetic resonance (MR) performs better in terms of sensitivity (92% vs. 68%), due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR mainly depends on the primary tumour histology; in case of unknown primary tumour (3-5% of cases), their behaviour at imaging may provide insights into the tumour origin. The timepoint of tumour evolution, previous or ongoing treatments, and the peritoneal spaces in which they occur also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is essential in the detection and characterisation of peritoneal deposits. Several benign and malignant conditions show similar imaging features that overlap those of PC, making differential diagnosis challenging. Knowledge of peritoneal anatomy and primary tumour histology is crucial, but one must also consider clinical history, laboratory findings, and previous imaging examinations to achieve a correct diagnosis. In conclusion, to correctly diagnose PC in cross-sectional imaging modalities, knowledge of peritoneal anatomy and peritoneal fluid flow characteristics are mandatory. Peritoneal deposit features reflect the primary tumour characteristics, and this specificity may be helpful in its identification when it is unknown. Moreover, several benign and malignant peritoneal conditions may mimic PC, which need to be considered even in oncologic patients.
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Affiliation(s)
- Ana Veron Sanchez
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Ilias Bennouna
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Nicolas Coquelet
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | | | | | | | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Gabriel Liberale
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Maria Gomez Galdon
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
| | - Maria A Bali
- Hospital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium
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Montanarella M, Boldig K, Virarkar M, Kumar S, Elsherif S, Lall C, Gopireddy DR. Intraperitoneal anatomy with the aid of pathologic fluid and gas: An imaging pictorial review. J Clin Imaging Sci 2023; 13:13. [PMID: 37292244 PMCID: PMC10246409 DOI: 10.25259/jcis_29_2023] [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: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 06/10/2023] Open
Abstract
The peritoneum is a large serosal membrane enveloping the abdomen and pelvic organs and forming the peritoneal cavity. This complex relationship forms many named abdominopelvic spaces, which are frequently involved in infectious, inflammatory, neoplastic, and traumatic pathologies. The knowledge of this anatomy is essential to the radiologist to localize and describe the extent of the disease accurately. This manuscript provides a comprehensive pictorial review of the peritoneal anatomy to describe pathologic fluid and gas.
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Affiliation(s)
- Matthew Montanarella
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Kimberly Boldig
- Department of Internal Medicine, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Sherif Elsherif
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Chandana Lall
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
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Wozniak S, Quondamatteo F, Paulsen F. "Flexures and bends of the large intestine: Current terminology and a suggestion to simplify it". J Anat 2023; 242:695-700. [PMID: 36449406 PMCID: PMC10008289 DOI: 10.1111/joa.13800] [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: 07/04/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
There are a number of inconsistencies in the description of the bends of the colon down to the anus. This is historically based on the fact that anatomists saw the colon in its position in the abdominal cavity down to the pelvis and thus from the "outside" and also described it in this way. This view is still useful in clinical practice today (e.g. for the abdominal surgeons). For the greater part of clinicians, however, the view has shifted due to modern endoscopy. This allows examiners to see the terminal section of the intestine and the colon from the "inside". To accommodate both "ways of looking" in terms of modern medicine, we have been guided by today's clinical needs, and here we attempt to reconcile these with the historically evolved anatomical terms to create a nomenclature that meets all the needs of students, anatomists and clinicians looking at the large intestine from the inside and outside. With this in mind, we propose to speak of colic flexures (right colic flexure = RCF = hepatic flexure, flexura coli sinistra; left colic flexure = LCF = splenic flexure, flexura coli dextra; descending-sigmoid flexure = DSF; sigmoid-rectum flexure = SRF) for the colon (colon). For the rectum (rectum), we suggest the term bend (superior, intermediate and inferior) when viewed in the frontal plane, the term curvature (sacral curvature; anorectal curvature = perineal curvature) when viewed in the sagittal plane.
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Affiliation(s)
- Slawomir Wozniak
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Wroclaw, Poland
| | - Fabio Quondamatteo
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Friedrich Paulsen
- Friedrich Alexander University Erlangen-Nürnberg (FAU), Institute of Functional and Clinical Anatomy, Erlangen, Germany
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Tervo L, Outinen T, Kiekara T, Tietäväinen J, Paakkala A, Pörsti I, Huhtala H, Mäkelä S, Mustonen J. The presence of intraperitoneal, retroperitoneal and pleural fluid in acute Puumala hantavirus infection. Infect Dis (Lond) 2023; 55:207-215. [PMID: 36562294 DOI: 10.1080/23744235.2022.2160010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Puumala hantavirus (PUUV) causes most cases of haemorrhagic fever with renal syndrome (HFRS) in Europe. PUUV infection is characterised by acute kidney injury, thrombocytopenia and increased capillary leakage. Typical symptoms are fever, headache, nausea, abdominal and back pain. This study aimed to evaluate the amount and distribution of intraperitoneal, retroperitoneal and pleural fluid and the association of fluid collections to the symptoms and clinical findings in patients with acute PUUV infection. METHODS Abdominal magnetic resonance imaging (MRI) was performed on 27 hospitalised patients with acute PUUV infection. The clinical and laboratory findings and patients' symptoms were analysed in relation to the imaging findings. The thickness of the fluid collections was measured in millimetres (mm) from axial images. RESULTS Fluid collections were found in all patients. The amount of intraperitoneal fluid correlated positively with plasma C-reactive protein (CRP) level (r = 0.586, p = .001), while it had an inverse correlation with serum creatinine concentration (r = -0.418, p = .030). Retroperitoneal fluid also correlated inversely with serum creatinine and cystatin C concentrations (r = -0.501, p = .008 and r = -0.383, p = .048, respectively). The amount of fluid was not greater in patients with abdominal or back pain. Patients with back pain had higher serum creatinine compared with patients without back pain, 452 µmol/L (range 88-1071) vs. 83 µmol/L (range 60-679), p = .004. CONCLUSIONS Fluid collections were found in all patients. A greater amount of intraperitoneal fluid associates with higher CRP concentrations but not with higher serum creatinine levels. Back pain associates with higher creatinine level but not with the presence of fluids.
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Affiliation(s)
- L Tervo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - T Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - T Kiekara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - J Tietäväinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - A Paakkala
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - I Pörsti
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - S Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - J Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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11
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Caruso MJ, Bidani K, Singh AK. Wandering liver, spleen, and kidney: what the radiologist needs to know. Abdom Radiol (NY) 2023; 48:1854-1861. [PMID: 36752858 DOI: 10.1007/s00261-022-03789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
The wandering spleen, wandering liver, and wandering kidney are rare diagnoses that can be asymptomatic or are associated with nonspecific symptoms, making the clinical diagnosis elusive. In addition, given the small number of cases, these conditions are not well understood. Major complications of wandering spleen result from torsion of the vascular pedicle with resultant ischemia, physiologic dysfunction, and/or infarction. Wandering liver is commonly associated with bowel obstruction, particularly colonic volvulus, with very rare reports of hepatic ischemia or infarct. Wandering kidneys are not commonly associated with serious complications. In many cases, the wandering spleen, liver or kidney can be found in their anatomic position on static imaging and are only diagnosed during ultrasound or with serial radiographic or cross-sectional imaging with different patient positioning, or with prior studies demonstrating different locations of the involved organ. Treatment approaches for uncomplicated wandering spleen, liver, or kidney include watchful waiting and splenopexy, hepatopexy, or nephropexy, respectively. Complicated wandering spleens are treated with splenectomy. Given the variable clinical presentation of these conditions, imaging plays a pivotal role in diagnosing these rare and often incidentally discovered phenomena.
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Affiliation(s)
- Michael J Caruso
- Department of Radiology, UMass Memorial Medical Center, Worcester, USA
| | - Khyati Bidani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ajay Kumar Singh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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12
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Kaur G, Kaur T, Das CJ. Morrison's Pouch: Anatomy and Radiological Appearance of Pathological Processes. Indian J Radiol Imaging 2022; 33:80-88. [PMID: 36855710 PMCID: PMC9968550 DOI: 10.1055/s-0042-1758874] [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: 12/13/2022] Open
Abstract
Morrison's pouch is the intraperitoneal space in the supramesocolic compartment located between the right liver lobe and right kidney. Pathological conditions that can involve this peritoneal space include fluid collections, infectious or inflammatory processes, and neoplasms. Frequent involvement by disease entities can be attributed to its dependent location, communication with the inframesocolic compartment, close proximity to the adjacent organs and peritoneal fluid dynamics. Knowledge of the appearance of pathological entities on various imaging modalities helps the radiologist in making the correct diagnosis.
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Affiliation(s)
- Gurkawal Kaur
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tejinder Kaur
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J. Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence Chandan J. Das, MD, DNB, MAMS, FICR, FRCP (Edin) Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical SciencesAnsari Nagar, New Delhi 110029India
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13
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Is MDCT an accurate tool to differentiate between benign and malignant etiology in diffuse peritoneal disease? ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3921-3929. [PMID: 35978185 DOI: 10.1007/s00261-022-03641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE There is often considerable overlap of imaging findings in benign and malignant peritoneal diseases. We evaluated patients with diffuse peritoneal disease, to assess the diagnostic value of MDCT in predicting benign or malignant etiology in patients with unknown etiology, by analyzing the various patterns of involvement, particularly tuberculosis (TB) vs malignancy. METHODS One hundred and thirty-six patients with diffuse peritoneal disease who had abdominal CT and subsequently underwent omental biopsies were included in the study. Peritoneal, mesenteric and omental involvement by disease was evaluated on CT using specific parameters. The presence of lymphadenopathy, ascites, scalloping of organs, involvement of liver and spleen, were also compared between benign and malignant conditions using histopathology as the gold standard. RESULTS In 136 patients, 72 benign and 64 malignant pathologies were classified as per histopathology. Higher age (p < 0.001), increasing omental thickness (mean 25.2 mm, p = 0.004), omental caking (p < 0.001), > 10 mm mesenteric/peritoneal nodules (p < 0.03), visceral scalloping (p = 0.001), free ascites (p = 0.003), serosal involvement (p = 0.004) and bilateral pleural effusion (p = 0.02) were associated with malignant etiology. Mesenteric thickening/stranding (p = 0.02), mesenteric adenopathy (p < 0.001), necrotic nodes (p = 0.02), splenomegaly (p = < 0.001) and higher attenuation (> 20HU) of ascitic fluid (p < 0.001) were associated with benign etiology. The presence of mesenteric thickening or stranding (p = 0.01), splenomegaly (p = 0.02), higher ascitic fluid attenuation > 20HU (p = < 0.01), mesenteric adenopathy (p < 0.01), necrotic nodes (p = 0.03) favored tuberculosis. CT had diagnostic accuracy (79.3, 86.7%), sensitivity (79.2, 74.6%) and specificity (79.4, 97%) for observers 1 and 2, respectively (Kappa 0.713). CONCLUSION Contrast-enhanced MDCT has good sensitivity, specificity and accuracy in differentiating benign and malignant etiologies of diffuse peritoneal disease. Multiple common parameters can be used to differentiate between tuberculous peritonitis and peritoneal carcinomatosis.
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Jang S, Lee S, Choi J. CT imaging features of fat stranding in cats and dogs with abdominal disorder. J Vet Sci 2022; 23:e70. [PMID: 36038190 PMCID: PMC9715384 DOI: 10.4142/jvs.22059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/24/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fat stranding is a non-specific finding of an increased fat attenuation on computed tomography (CT) images. Fat stranding is used for detecting the underlying lesion in humans. OBJECTIVES To assess the clinical significance of fat stranding on CT images for identifying the underlying cause in dogs and cats. METHODS In this retrospective study, the incidence, location, extent, distribution, and pattern of fat stranding were assessed on CT studies obtained from 134 cases. RESULTS Fat stranding was found in 38% (51/134) of all cases and in 35% (37/107) of tumors, which was significantly higher in malignant tumors (44%) than benign tumors (12%). Moreover, fat stranding was found in more than two areas in malignant tumors (16/33) and in a single area in benign tumors (4/4). In inflammation, fat stranding was demonstrated in 54% (7/13) in a single area (7/7) as a focal distribution (6/7). In trauma, fat stranding was revealed in 50% (7/14) and most were in multiple areas (6/7). Regardless of the etiologies, fat stranding was always around the underlying lesion and a reticular pattern was the most common presentation. Logistic regression analysis revealed that multiple areas (p = 0.040) of fat stranding and a reticulonodular pattern (p = 0.022) are the significant predictors of malignant tumor. CONCLUSIONS These findings indicated that CT fat stranding can be used as a clue for identifying the underlying lesion and can be useful for narrowing the differential list based on the extent and pattern.
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Affiliation(s)
- Seolyn Jang
- Department of Veterinary Medical Imaging, College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Suhyun Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
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15
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A huge preperitoneal collection following acute necrotizing pancreatitis: A case report and the management approach. Ann Med Surg (Lond) 2022; 78:103843. [PMID: 35734743 PMCID: PMC9207096 DOI: 10.1016/j.amsu.2022.103843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
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16
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Shinagare AB, Sadowski EA, Park H, Brook OR, Forstner R, Wallace SK, Horowitz JM, Horowitz N, Javitt M, Jha P, Kido A, Lakhman Y, Lee SI, Manganaro L, Maturen KE, Nougaret S, Poder L, Rauch GM, Reinhold C, Sala E, Thomassin-Naggara I, Vargas HA, Venkatesan A, Nikolic O, Rockall AG. Ovarian cancer reporting lexicon for computed tomography (CT) and magnetic resonance (MR) imaging developed by the SAR Uterine and Ovarian Cancer Disease-Focused Panel and the ESUR Female Pelvic Imaging Working Group. Eur Radiol 2022; 32:3220-3235. [PMID: 34846566 PMCID: PMC9516633 DOI: 10.1007/s00330-021-08390-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Imaging evaluation is an essential part of treatment planning for patients with ovarian cancer. Variation in the terminology used for describing ovarian cancer on computed tomography (CT) and magnetic resonance (MR) imaging can lead to ambiguity and inconsistency in clinical radiology reports. The aim of this collaborative project between Society of Abdominal Radiology (SAR) Uterine and Ovarian Cancer (UOC) Disease-focused Panel (DFP) and the European Society of Uroradiology (ESUR) Female Pelvic Imaging (FPI) Working Group was to develop an ovarian cancer reporting lexicon for CT and MR imaging. METHODS Twenty-one members of the SAR UOC DFP and ESUR FPI working group, one radiology clinical fellow, and two gynecologic oncology surgeons formed the Ovarian Cancer Reporting Lexicon Committee. Two attending radiologist members of the committee prepared a preliminary list of imaging terms that was sent as an online survey to 173 radiologists and gynecologic oncologic physicians, of whom 67 responded to the survey. The committee reviewed these responses to create a final consensus list of lexicon terms. RESULTS An ovarian cancer reporting lexicon was created for CT and MR Imaging. This consensus-based lexicon has 6 major categories of terms: general, adnexal lesion-specific, peritoneal carcinomatosis-specific, lymph node-specific, metastatic disease -specific, and fluid-specific. CONCLUSIONS This lexicon for CT and MR imaging evaluation of ovarian cancer patients has the capacity to improve the clarity and consistency of reporting disease sites seen on imaging. KEY POINTS • This reporting lexicon for CT and MR imaging provides a list of consensus-based, standardized terms and definitions for reporting sites of ovarian cancer on imaging at initial diagnosis or follow-up. • Use of standardized terms and morphologic imaging descriptors can help improve interdisciplinary communication of disease extent and facilitate optimal patient management. • The radiologists should identify and communicate areas of disease, including difficult to resect or potentially unresectable disease that may limit the ability to achieve optimal resection.
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Affiliation(s)
- Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA
| | - Hyesun Park
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Sumer K Wallace
- Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave. H4/664A, Madison, WI, 53792, USA
| | - Jeanne M Horowitz
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Chicago, IL, 60611, USA
| | - Neil Horowitz
- Division of Gynecologic Oncology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Marcia Javitt
- Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | - Priyanka Jha
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Aki Kido
- Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 6068507, Japan
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
| | - Susanna I Lee
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, V.le Regina Elena, 324 00161, Rome, Italy
| | - Katherine E Maturen
- Department of Radiology and Obstetrics and Gynecology, University of Michigan Hospitals, 1500 E Med Ctr Dr, Ann Arbor, MI, 48109, USA
| | | | - Liina Poder
- Department of Radiology and Biomedical Imaging, Obstetrics, Gynecology and Reproductive Sciences, UCSF, 505 Parnassus Ave, L-374, San Francisco, CA, 94143-0628, USA
| | - Gaiane M Rauch
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Centre, McGill University, Montreal, Canada, 1001 Decarie boul., Montreal, Quebec, H4A 3J1, Canada
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Service d'Imagerie, 4 rue de la Chine, 75020, Paris, France
| | - Herbert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
| | - Aradhana Venkatesan
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., FCT 15.6074, MSC 1182, Houston, TX, 77030, USA
| | - Olivera Nikolic
- Clinical Center of Vojvodina, Center of Radiology, Faculty of Medicine, University of Novi Sad, 1-9 Hajduk Veljkova str. 21000, Novi Sad, Serbia
| | - Andrea G Rockall
- Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, ICTEM Building, Du Cane Rd, London, W12 0NN, UK
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17
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Abdominal CT findings in Puumala hantavirus-infected patients. Abdom Radiol (NY) 2022; 47:2552-2559. [PMID: 35441863 DOI: 10.1007/s00261-022-03467-8] [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: 01/03/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Previous clinical studies have reported abdominal findings on ultrasonography or MRI in Puumala hantavirus-infected patients. PURPOSE To determine if abdominal computed tomography (CT) can lead to a diagnosis of Puumala virus infection in the presence of a suggestive clinical picture. MATERIAL AND METHODS CT findings were studied retrospectively in 30 patients who presented to the emergency department of two (Belgian) hospitals with serologically confirmed Puumala hantavirus infection. RESULTS The most frequent finding was perirenal fascial thickening (90%), followed by perirenal fat stranding (87%). Retroperitoneal fat stranding was found in 19 patients (64%) in the perivesical spaces along the fascia of the external iliac vessels with or without involvement of the presacral fat. Half of the patients had pelvic ascites, and pleural fluid was found in 7 of them. The right and left mean pole-to-pole kidney's lengths were respectively 125.7 mm and 127.8 mm in 28 patients. CONCLUSION Retroperitoneal fat stranding, perirenal fascial thickening and/or perirenal fat stranding were found in most patients with acute Puumala virus infection who have undergone CT. Although nonspecific, these findings may help to suggest Puumala hantavirus infection in the right clinical settings.
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18
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Retroperitoneal Sarcoma Care in 2021. Cancers (Basel) 2022; 14:cancers14051293. [PMID: 35267600 PMCID: PMC8909774 DOI: 10.3390/cancers14051293] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 12/16/2022] Open
Abstract
Soft-tissue sarcomas are biologically heterogenous tumors arising from connective tissues with over 100 subtypes. Although sarcomas account for <1% of all adult malignancies, retroperitoneal sarcomas are a distinct subgroup accounting for <10% of all sarcomatous tumors. There have been considerable advancements in the understanding and treatment of retroperitoneal sarcoma in the last decade, with standard treatment consisting of upfront primary surgical resection. The evidence surrounding the addition of radiation therapy remains controversial. There remains no standard with regards to systemic therapy, including immunotherapy. Adjunctive therapy remains largely dictated by expert consensus and preferences at individual centers or participation in clinical trials. In this 2021 review, we detail the anatomical boundaries of the retroperitoneum, clinical characteristics, contemporary standard of care and well as recent advancements in retroperitoneal sarcoma care. Ongoing international collaborations are encouraged to advance our understanding of this complex disease.
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Magnetic resonance imaging glossary of findings of pediatric pancreatitis and the revised Atlanta classification. Pediatr Radiol 2022; 52:189-199. [PMID: 33978804 DOI: 10.1007/s00247-021-05017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/23/2020] [Accepted: 02/11/2021] [Indexed: 02/07/2023]
Abstract
While still uncommon, the incidence of acute pancreatitis in children has been increasing over the last two decades. The Atlanta classification for acute pancreatitis, developed for adults, stratifies cases of acute pancreatitis based on imaging and clinical criteria. This classification scheme allows for standardized use of terminology to facilitate treatment and prognostication. Although US and CT should be used in critical or unstable patients, MRI is an ideal imaging modality in pediatric patients with acute pancreatitis because of its ability to characterize tissue without ionizing radiation. We review MRI examples specific to Atlanta classification terminology in pediatric patients. Chronic pancreatitis has also been increasingly diagnosed in children, and imaging plays a key role in the diagnosis and management of this insidious disease. MRI with magnetic resonance cholangiopancreatography is the optimal modality for assessing the pancreas in a child with known or suspected chronic pancreatitis because it provides tissue characterization and high-contrast imaging of the pancreatic duct without the use of invasive instrumentation or ionizing radiation. We also review and demonstrate accepted MRI findings of chronic pancreatitis.
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20
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Campos NMF, Almeida V, Curvo Semedo L. Peritoneal disease: key imaging findings that help in the differential diagnosis. Br J Radiol 2022; 95:20210346. [PMID: 34767464 PMCID: PMC8822557 DOI: 10.1259/bjr.20210346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The peritoneum is a unique serosal membrane, which can be the site of primary tumors and, more commonly, secondary pathologic processes. Peritoneal carcinomatosis is the most common malignant condition to affect the peritoneal cavity, and the radiologist plays an important role in making the diagnosis and assessing the extent of disease, especially in sites that may hinder surgery. In this review, we address the role of the radiologist in the setting of peritoneal pathology, focusing on peritoneal carcinomatosis as this is the predominant malignant process, followed by revising typical imaging findings that can guide the differential diagnosis.We review the most frequent primary and secondary peritoneal tumor and tumor-like lesions, proposing a systemic approach based on clinical history and morphological appearance, namely distinguishing predominantly cystic from solid lesions, both solitary and multiple.
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Affiliation(s)
- Nuno M F Campos
- Department of Medical Imaging, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Vânia Almeida
- Department of Pathology, Coimbra Hospital and University Centre, Coimbra, Portugal
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Han C, Tang X, Yang M, Zhang K, Liu J, Lin R, Ding Z. How Useful Is Endoscopic Ultrasound in Differentiating T3/T4a T Stage of Colorectal Cancer: A Prospective Study. Front Oncol 2022; 11:618512. [PMID: 35127462 PMCID: PMC8813747 DOI: 10.3389/fonc.2021.618512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Endoscopic ultrasound (EUS) is an established method for staging of colorectal cancer. Nevertheless, prior assessments of its T stage accuracy have been limited, particularly ambiguity in assessed T3 and T4a stage. This study was to characterize the EUS image features and pay attention to distinguish T3 from T4a T stage. Methods A total of 638 patients who prospectively underwent colorectal EUS were recorded. The final diagnoses were compared with the concurrent or follow-up histopathology. Univariate and multivariate logistic regressions were used to assess variation in diagnostic performance with case attributes. Results The accuracies of EUS in classifying colorectal cancer for overall, T1, T2, T3, and T4a stages are 73.04, 62.32, 67.46, 71.26, and 83.52%, respectively. With attention to EUS image features, the lesion penetrates the entire wall and locates below the seminal vesicles or cervix is T3 stage. If the lesion locates above clearly-defined space between the anterior rectal wall and the posterior surface of the seminal vesicles or cervix, we identify as T4a stage; However, when located above seminal vesicles or cervix but on the posterior wall of the rectum, the lesion still considers as T3 stage. The tumor location and histological type are associated with inaccuracy T stage. Conclusions EUS provides reliable diagnostic accuracy in the colorectal cancer stage. The seminal vesicles and cervix are the important markers to predict infiltration depth for T3/T4a stage. Furthermore, the tumor location, histological type, and EUS image features for each tumor T stage should warrant attention.
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Affiliation(s)
- Chaoqun Han
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuelian Tang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Yang
- Division of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Lin
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Rong Lin, ; Zhen Ding,
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Rong Lin, ; Zhen Ding,
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22
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Kataria N, Hacking S, Abdelwahed M, Burke A, Karam P, Gimenez C, Das K, Khutti S. The role of cytology as an effective tool in management of omental and peritoneal lesions: Experience of a large health care system. Diagn Cytopathol 2021; 50:57-63. [PMID: 34870898 DOI: 10.1002/dc.24911] [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: 03/10/2021] [Revised: 09/25/2021] [Accepted: 11/26/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study is to assess the efficacy of cytology in omental or peritoneal lesions. METHODS A retrospective review of the pathology database for cytology cases of peritoneal or omental nodules over a 3-year period (2016-2018) was conducted. The cases consisted of either FNA only (FO); FNA and Core biopsy (FCB) or Touch prep and core biopsy (TCB). Cases were further divided based on the prior history of carcinoma. Concordance rates of cytologic diagnosis with histologic diagnosis were studied. RESULTS Out of 104 cytology cases reviewed, 60 (57.7%) had prior history of cancer (PHC) and 44 (42.3%) had no prior history of cancer (NPHC). Of the cases with PHC, 43(71.66%) were recurrence, 10 (16.66%) were second cancer, and 7 (11.66%) were non-neoplastic lesions. Of the cases with NPHC, 38 (86.4%) had a second cancer diagnosis, while 6 (13.6%) were non-neoplastic. For FO only cases, 11 of 35 (31.4%) had follow up and 9 of 11 (81.8%) were concordant. For FCB cases, 6 out of 39 (15.4%) had follow up and 6 (100%) were concordant. For TCB cases, 9 out of 30 (30%) had follow up and 9 (100%) were concordant. A definite diagnosis was reached in 30/35, 39/39, and 29/30 cases in FO, FCB, and TCB, respectively. CONCLUSION In summary, cytologic evaluation of omental lesions is an effective tool in providing accurate diagnosis and guiding further management. Also, the results based on our study show that the combined techniques are superior at reaching a definitive diagnosis.
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Affiliation(s)
- Nidhi Kataria
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Sean Hacking
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Mohammed Abdelwahed
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Alexander Burke
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Priyanka Karam
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Seema Khutti
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
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Comment on "SARS-CoV-2 is Present in Peritoneal Fluid in COVID-19 Patients". Ann Surg 2021; 274:e794-e795. [PMID: 33065649 DOI: 10.1097/sla.0000000000004540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu G, Li H, Zhong P, Chen D, Zhang Z, Guo Z, Zhuo Y, Xue L, Lai C. Initial Experience with the Comprehensive Modified Laparoscopic Pyeloplasty Technique Based on Membrane Anatomy for Treating Ureteropelvic Junction Obstruction. Urol Int 2021; 106:487-494. [PMID: 34844250 DOI: 10.1159/000519929] [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: 04/17/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the objective was to present our initial experience and evaluate the feasibility of the novel comprehensive modified laparoscopic pyeloplasty (CMLP) technique based on membrane anatomy. MATERIALS AND METHODS Forty-eight patients underwent CMLP from February 2016 to October 2020. CMLP involves the following: dissection of the ureter was based on the fascia or fusion fascia formed by embryonic development. The ureter was separated from the ureteral sheath, and the pelvis and ureter were incised with incomplete amputation. The first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis to ensure correct orientation of the anastomosis; anastomosis of the renal pelvis and ureter was performed using the touchless technique. RESULTS All CMLPs were completed successfully without conversion. The mean overall operating time was 230.96 min. The median estimated blood loss was 50.00 (interquartile range 20.00-57.50) mL. The average postoperative hospital stay was 9.31 days. The average follow-up time was 24.73 months. No major complications occurred. In 1 case, revision laparoscopic pyeloplasty was performed, but the obstruction persisted after double J stent removal, so ultimately, the double J stent required regular replacement. Another asymptomatic patient with hydronephrosis experienced failed treatment and is still under follow-up. The overall success rate was 95.83% (46/48). The success rate in patients with recurrent ureteropelvic junction obstruction (UPJO) was 87.5% (7/8). CONCLUSIONS CMLP is a practical and effective treatment option for UPJO with a high success rate. An advantage of CMLP is the clear surgical field.
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Affiliation(s)
- Guohao Wu
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China,
| | - Haomin Li
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Peifeng Zhong
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dongjiang Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhihua Zhang
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zexiong Guo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yumin Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lianfang Xue
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Caiyong Lai
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China.,Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Multidisciplinary Management of Retroperitoneal Sarcoma: Diagnosis, Prognostic Factors and Treatment. Cancers (Basel) 2021; 13:cancers13164016. [PMID: 34439171 PMCID: PMC8392612 DOI: 10.3390/cancers13164016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary The management of retroperitoneal sarcomas can be challenging due to the variety of their presentation, histopathological types, and behaviours. This literature review provides a comprehensive and practical overview of the management of retroperitoneal sarcomas, focusing on diagnostic challenges, prognostic factors, multidisciplinary aspects of treatment and new research perspectives. Abstract Retroperitoneal sarcomas (RPS) are rare cancers whose management can be challenging due to various presentation patterns, multiple organ involvement, and a high local and distant recurrence rate. Histopathology and prognostic factors analysis are essential to predict the behaviour of the disease and plan the best therapeutic strategy. To date, surgery is still the main therapeutic option that guarantees a chance of cure from the primary disease. While chemotherapy and radiotherapy seem to be good options for controlling metastatic and recurrent irresectable disease, their role in the treatment of primary RPS remains unclear. This literature review aims to provide a comprehensive overview of the multidisciplinary aspects of RPS management in high-volume centres, summarising the diagnostic path, the prognostic factors, and the most suitable therapeutic options.
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Son IW, Kim S, Hong SB, Lee NK, Jeong MR, Han SY, Woo HY. Puncture needle with a hard plastic sheath and plastic wings minimizes repuncture attempts in ultrasound-guided paracentesis. Yeungnam Univ J Med 2021; 39:18-23. [PMID: 34247458 PMCID: PMC8895958 DOI: 10.12701/yujm.2021.01109] [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: 05/08/2021] [Accepted: 06/16/2021] [Indexed: 11/09/2022] Open
Abstract
Background This study was performed to evaluate periprocedural factors, complications, and repuncture rate of the newly developed puncture needle and compare it with the routinely used puncture needle for ultrasound (US)-guided paracentesis. Methods We retrospectively identified 137 patients who underwent US-guided paracentesis between July 2018 and March 2019. Among them, 82 patients underwent US-guided paracentesis with a newly developed puncture needle. The other 55 patients underwent US-guided paracentesis with a routinely used puncture needle. The periprocedural factors, complications, and repuncture rate were compared between the two groups using the Mann-Whitney U test and Fisher exact test. The repuncture-associated factors were assessed using logistic regression analysis. Results There were no major or minor complications in either group. The rate of repuncture was significantly lower in the group using the newly developed puncture needle compared with the group using the routinely used puncture needle (p=0.01). The duration of the procedure was significantly shorter with the newly developed puncture needle compared with the routinely used puncture needle (p=0.01). In univariate analysis, the thickness of the abdominal wall (p=0.04) and the use of the newly developed puncture needle (p=0.01) were significantly associated with the rate of repuncture. In multivariate analysis, only the use of the newly developed puncture needle was significantly associated with the rate of repuncture. Conclusion Using this novel puncture needle with a hard plastic sheath and plastic wings, the rate of repuncture and the duration of the procedure were decreased without complications of US-guided paracentesis.
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Affiliation(s)
- Il Wan Son
- Department of Radiology, Dongnam Institution of Radiological & Medical Sciences, Busan, Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Mi Ri Jeong
- Department of Radiology, Busan Medical Center, Busan, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyun Young Woo
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Al-Dasuqi K, Irshaid L, Mathur M. Radiologic-Pathologic Correlation of Primary Retroperitoneal Neoplasms. Radiographics 2021; 40:1631-1657. [PMID: 33001785 DOI: 10.1148/rg.2020200015] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An earlier incorrect version of this article appeared in print. The online version is correct.
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Affiliation(s)
- Khalid Al-Dasuqi
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Lina Irshaid
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Radiology and Biomedical Imaging (K.A.D., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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Update on the Role of Imaging in Clinical Staging and Restaging of Renal Cell Carcinoma Based on the AJCC 8th Edition, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:541-555. [PMID: 33759558 DOI: 10.2214/ajr.21.25493] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This article reviews the essential role of imaging in clinical staging and restaging of renal cell carcinoma (RCC). To completely characterize and stage an indeterminate renal mass, renal CT or MRI without and with IV contrast administration is recommended. The critical items for initial clinical staging of an indeterminate renal mass or of a known RCC according to the TNM staging system are tumor size, renal sinus fat invasion, urinary collecting system invasion, perinephric fat invasion, venous invasion, adrenal gland invasion, invasion of the perirenal (Gerota) fascia, invasion into other adjacent organs, the presence of enlarged or pathologic regional (retroperitoneal) lymph nodes, and the presence of distant metastatic disease. Larger tumor size is associated with higher stage disease and invasiveness, lymph node spread, and distant metastatic disease. Imaging practice guidelines for clinical staging of RCC, as well as the role of renal mass biopsy, are highlighted. Specific findings associated with response of advanced cancer to antiangiogenic therapy and immunotherapy are discussed, as well as limitations of changes in tumor size after targeted therapy. The accurate clinical staging and restaging of RCC using renal CT or MRI provides important prognostic information and helps guide the optimal management of patients with RCC.
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29
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Overview of spontaneous intraabdominal tumor hemorrhage: etiologies, imaging findings, and management. Abdom Radiol (NY) 2021; 46:427-440. [PMID: 32691111 DOI: 10.1007/s00261-020-02663-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Hemorrhage is a potential complication of benign and malignant tumors and tumor-like conditions in the abdomen. Patients often have non-specific presentations, although they may present critically ill and hemodynamically unstable. Imaging plays an important role not only in the diagnosis of hemorrhage but also in the detection and characterization of an underlying mass. Ultrasound, computed tomography, and magnetic resonance imaging are utilized in evaluating these patients, with each having particular strengths and limitations. Spontaneous tumor hemorrhage is most commonly seen in hepatic and renal lesions, although it can arise from nearly every abdominal organ. In this article, we will review principles of tumor hemorrhage, illustrate common and uncommon imaging features, and highlight different options for management.
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Dvorak P, Hoffmann P, Balik M, Hoffmannova M, Kopecky J, Dvorakova R, Nova M. Percutaneous biopsy of retroperitoneal lesions - 10 year experience of a single centre. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:435-443. [DOI: 10.5507/bp.2019.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
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31
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Mul J, van de Ven CP, Seravalli E, Littooij AS, Wijnen MHWA, van Grotel M, van den Heuvel-Eibrink MM, Janssens GO. The contribution of surgical clips for optimizing highly-conformal image-guided flank irradiation in pediatric renal tumors: A single center experience. Radiother Oncol 2020; 156:62-68. [PMID: 33310005 DOI: 10.1016/j.radonc.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Two-opposing photon beams are considered standard of care for flank irradiation in pediatric patients with renal tumors. Nowadays, Image-Guided Radiotherapy (IGRT) techniques allow high-precision dose delivery to complex flank target volumes taking into account postoperative organ shifts and tumor bed motion. This study examines the contribution of a lateral and superior surgical clip on flank target volume delineation intended for IGRT. METHODS Between 01-2015 and 09-2019, 30/162 newly-diagnosed pediatric patients with renal tumors, lateral/superior surgical clips (n = 30/30) and available 4D-CT-scans (n = 27/30), underwent postoperative flank irradiation. The lateral and superior clip, as respective markers for the lateral tumor extension and intrafraction motion, were analyzed. The positive and negative values depict the lateral/dorsal/cranial or the medial/ventral/caudal direction, respectively. Planning target volumes (PTV) were generated based on lateral clips (PTVlatclip), superior clips with 4D-CT technology (PTVsupclip), and both clips combined (PTVcombined), and compared to an approach without clips (PTVnoclip). RESULTS Indicated by clips, the mean lateral tumor bed extension along the posterior wall was 74° (range: 50°-93°), while mean intrafraction motion was +1.2 mm (range: -1.8/+4.8 mm), +0.6 mm (range: +0.6/+4.9 mm), -0.3 mm (range: -3.8/+0.7 mm) in craniocaudal, ventrodorsal, mediolateral direction, respectively. The median PTVnoclip (556 mL) was statistically different from the median PTVlatclip (454 mL, p = <0.01), median PTVsupclip (373 mL, p = <0.01) and median PTVcombined (348 mL p = <0.01). CONCLUSION In pediatric patients with renal tumors, surgical clips at the lateral and superior border of the tumor bed can optimize flank target volume delineation and, consequently, reduce the normal tissue volume receiving high-dose irradiation when IGRT techniques are applied.
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Affiliation(s)
- Joeri Mul
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemieke S Littooij
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Bonnin A, Durot C, Djelouah M, Dohan A, Arrivé L, Rousset P, Hoeffel C. MR Imaging of the Perihepatic Space. Korean J Radiol 2020; 22:547-558. [PMID: 33236541 PMCID: PMC8005346 DOI: 10.3348/kjr.2019.0774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/02/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
The perihepatic space is frequently involved in a spectrum of diseases, including intrahepatic lesions extending to the liver capsule and disease conditions involving adjacent organs extending to the perihepatic space or spreading thanks to the communication from intraperitoneal or extraperitoneal sites through the hepatic ligaments. Lesions resulting from the dissemination of peritoneal processes may also affect the perihepatic space. Here we discuss how to assess the perihepatic origin of a lesion and describe the magnetic resonance imaging (MRI) features of normal structures and fluids that may be abnormally located in the perihepatic space. We then review and illustrate the MRI findings present in cases of perihepatic infectious, tumor-related, and miscellaneous conditions. Finally, we highlight the value of MRI over computed tomography.
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Affiliation(s)
- Angèle Bonnin
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France.
| | - Carole Durot
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Manel Djelouah
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Paris, France.,Paris Descartes University, Sorbonne Paris-Cité-Paris V, Paris, France
| | - Lionel Arrivé
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Lyon 1 Claude Bernard University, Lyon, France
| | - Christine Hoeffel
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims, France.,CRESTIC, Reims Champagne-Ardenne University, Reims, France
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Liu LH, Zhou GF, Zhou JJ, Rao SX, Zeng MS. Impact of visceral adipose tissue on the accuracy of T-staging by CT in colon cancer. Eur J Radiol 2020; 134:109400. [PMID: 33254063 DOI: 10.1016/j.ejrad.2020.109400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Accuracy of preoperative T-staging for colon cancer remains disappointing and may potentially influenced by patients' individual characteristics including visceral adipose tissue (VAT). We sought to clarify the impact of VAT on the accuracy of T-staging by CT. METHODS This study of 216 consecutive patients who underwent elective surgery was conducted in a single cancer center, to control other potentially confounding factors. Patients were divided into accurate- and mis-staging groups according to the comparison between preoperative CT-defined (cT) and postoperative pathologic T-stages (pT). Patients' individual characteristics, including CT-based VAT at L2/L3 level, age, sex, body mass index (BMI), tumor location, present of bowel obstruction and pathologic subtype, were compared between the two groups. Association between VAT and mis-staging was assessed using multivariate logistic regression to adjust for confounders. RESULTS Of the 216 patients, 84 (39%) were mis-staged by CT. The mean VAT in accurate-staging group was significantly higher than that in mis-staging group (146.8 ± 66.1 cm2 vs 98.1 ± 44.7 cm2, P < 0.001), with an optimal cutoff point of 122 cm2 for predicting mis-staging. After partial adjustment, a lower VAT (< 122 cm2, P < 0.001) and proximal location of tumor (P = 0.004) were independent factors associated with higher probability of mis-staging. Compared to VAT ≥ 122 cm2 as the reference, VAT < 122 cm2 exhibited an odds ratio of 2.701 (95% confidence intervals [CI], 1.618-3.907) for the probability of mis-staging. CONCLUSION A lower-VAT is associated with an increased probability of inaccurate clinical T-staging in colon cancer.
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Affiliation(s)
- Li-Heng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Multi-Disciplinary Team of Colorectal Cancer, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Feng Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Multi-Disciplinary Team of Colorectal Cancer, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Jun Zhou
- Department of Radiology, Xianmen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Multi-Disciplinary Team of Colorectal Cancer, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Multi-Disciplinary Team of Colorectal Cancer, Zhongshan Hospital, Fudan University, Shanghai, China.
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Hargrove D, Liang B, Kashfi-Sadabad R, Joshi GN, Gonzalez-Fajardo L, Glass S, Jay M, Salner A, Lu X. Tumor-mesoporous silica nanoparticle interactions following intraperitoneal delivery for targeting peritoneal metastasis. J Control Release 2020; 328:846-858. [PMID: 33166606 DOI: 10.1016/j.jconrel.2020.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022]
Abstract
The use of intraperitoneal administration of nanoparticles has been reported to facilitate higher concentrations of nanoparticles in metastatic peritoneal tumors. While this strategy is appealing for limiting systemic exposure of nanocarrier delivered toxic cargoes and increasing nanoparticle concentrations in avascular peritoneal tumors, little is known about the mechanism of nanoparticle accumulation on tumor tissues and currently, no nanoparticle-based product has been approved for intraperitoneal delivery. Here, we investigated the nanoparticle-specific characteristics that led to increased peritoneal tumor accumulation using MCM-41 type mesoporous silica nanoparticles as our model system. We also investigated the components of the peritoneal tumor stroma that facilitated nanoparticle-tumor interaction. The tumor extracellular matrix is the main factor driving these interactions, specifically the interaction of nanoparticles with collagen. Upon disruption of the collagen matrix, nanoparticle accumulation was reduced by 50%. It is also notable that the incorporation of targeting ligands did not increase overall tumor accumulation in vivo while it significantly increased nanoparticle accumulation in vitro. The use of other particle chemistries did not grossly affect the tumor targetability, but additional concerns arose when those tested particles exhibited significant systemic exposure. Mesoporous silica nanoparticles are advantageous for intraperitoneal administration for the treatment of peritoneal metastasis due to their physical stability, tumor targetability, strong interaction with the collagen matrix, and extended peritoneal residence time. Maximizing nanoparticle interaction with the tumor extracellular matrix is critical for developing strategies to deliver emerging therapeutics for peritoneal cancer treatment using nanocarriers.
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Affiliation(s)
- Derek Hargrove
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, USA
| | - Brian Liang
- School of Medicine, University of Connecticut, Storrs, CT, USA
| | | | - Gaurav N Joshi
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, USA
| | | | - Sterling Glass
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, USA
| | - Michael Jay
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew Salner
- Helen and Harrry Gray Cancer Center, Hartford Hospital Department of Radiation Oncology, Hartford, CT, USA
| | - Xiuling Lu
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, USA.
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Mesentery - a 'New' organ. Emerg Top Life Sci 2020; 4:191-206. [PMID: 32539112 DOI: 10.1042/etls20200006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022]
Abstract
The mesentery is the organ in which all abdominal digestive organs develop, and which maintains these in systemic continuity in adulthood. Interest in the mesentery was rekindled by advancements of Heald and Hohenberger in colorectal surgery. Conventional descriptions hold there are multiple mesenteries centrally connected to the posterior midline. Recent advances first demonstrated that, distal to the duodenojejunal flexure, the mesentery is a continuous collection of tissues. This observation explained how the small and large intestines are centrally connected, and the anatomy of the associated peritoneal landscape. In turn it prompted recategorisation of the mesentery as an organ. Subsequent work demonstrated the mesentery remains continuous throughout development, and that abdominal digestive organs (i.e. liver, spleen, intestine and pancreas) develop either on, or in it. This relationship is retained into adulthood when abdominal digestive organs are directly connected to the mesentery (i.e. they are 'mesenteric' in embryological origin and anatomical position). Recognition of mesenteric continuity identified the mesenteric model of abdominal anatomy according to which all abdominal abdomino-pelvic organs are organised into either a mesenteric or a non-mesenteric domain. This model explains the positional anatomy of all abdominal digestive organs, and associated vasculature. Moreover, it explains the peritoneal landscape and enables differentiation of peritoneum from the mesentery. Increased scientific focus on the mesentery has identified multiple vital or specialised functions. These vary across time and in anatomical location. The following review demonstrates how recent advances related to the mesentery are re-orientating the study of human biology in general and, by extension, clinical practice.
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Nguyen K, Siegelman ES, Tu W, Schieda N. Update on MR Imaging of cystic retroperitoneal masses. Abdom Radiol (NY) 2020; 45:3172-3183. [PMID: 31501965 DOI: 10.1007/s00261-019-02196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article reviews the MRI appearance of cystic retroperitoneal (RP) masses. CONCLUSION Lymphangiomas are the most common RP cystic masses and typically appear simple; microscopic fat is a specific but insensitive finding. Location, internal complexity, and enhancement pattern suggest alternative diagnoses which range from normal anatomic variants to congenital abnormalities and importantly include benign, neurogenic, and malignant neoplasms. An approach to the MR imaging of cystic RP masses is presented.
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Affiliation(s)
- Kathleen Nguyen
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Evan S Siegelman
- Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Wendy Tu
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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Bermo MS, Koppula B, Kumar M, Leblond A, Matesan MC. The Peritoneum: What Nuclear Radiologists Need to Know. Semin Nucl Med 2020; 50:405-418. [PMID: 32768005 DOI: 10.1053/j.semnuclmed.2020.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The peritoneum is the largest and most complex serous membrane in the human body. The peritoneal membrane is composed of a layer of mesothelium supported by a thin layer of connective tissue. The peritoneum is one continuous sheet, forming two layers and a potential space between them - the peritoneal cavity- which is subdivided into multiple communicating spaces containing small amount of serous fluid that facilitates frictionless movement of mobile intraabdominal viscera. Peritoneum also contributes to fluid exchange mechanism and plays a role in immune response. The peritoneum is subject to many neoplastic and non-neoplastic processes including infections, trauma, developmental and inflammatory processes. Different Nuclear Medicine imaging techniques can be used to diagnose peritoneal diseases, most of these techniques can be customized depending on the clinical scenario and expected findings. Peritoneal scintigraphy can detect abnormal peritoneal communication or compartmentalization. Several nuclear medicine techniques can help characterize intraperitoneal fluid collections and differentiate sterile from infected fluid. PET imaging plays an important role in imaging of different neoplastic and non-neoplastic peritoneal pathologies. Nuclear radiologists need to be familiar with peritoneal anatomy and pathology to interpret peritoneal findings in dedicated peritoneal nuclear medicine imaging studies, as part of more general nuclear medicine scans, or on CT or MRI component of hybrid imaging studies. The purpose of this article is to review the normal peritoneal anatomy, various pathologic processes involving the peritoneum, and different nuclear medicine and hybrid imaging techniques that can help detect, characterize, and follow up peritoneal pathology.
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Affiliation(s)
- Mohammed S Bermo
- Department of Radiology, Texas Tech University Health Science Center, El Paso, TX.
| | - Bhasker Koppula
- Department of Radiology, University of Utah, Salt Lake City, UT
| | - Meena Kumar
- Diagnostic Imaging Service, VA Puget Sound Health Care System, Seattle, WA
| | - Antoine Leblond
- Department of Radiology, University of Montreal, Montreal, Quebec, Canada
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Leturia Etxeberria M, Biurrun Mancisidor MC, Ugarte Nuño A, Arenaza Choperena G, Mendoza Alonso M, Esnaola Albizu M, Serdio Mier A, Gredilla Sáenz M, Gomez Usabiaga V. Imaging Assessment of Ectopic Gas Collections. Radiographics 2020; 40:1318-1338. [DOI: 10.1148/rg.2020200028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Leturia Etxeberria
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Maria Carmen Biurrun Mancisidor
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Ane Ugarte Nuño
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Gorka Arenaza Choperena
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Miguel Mendoza Alonso
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Maite Esnaola Albizu
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Alberto Serdio Mier
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - María Gredilla Sáenz
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Virginia Gomez Usabiaga
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
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Bakshi S. Pancreatic abscess within hepato-gastric ligament: case report of an extremely rare disease. BMC Surg 2020; 20:20. [PMID: 32000756 PMCID: PMC6993323 DOI: 10.1186/s12893-020-0688-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5–15% of patients with peri-pancreatic fluid collection following acute pancreatitis. Collection usually occurs within the lesser sac of the omentum (near the pancreatic head and body region). But in 20–22% cases, that may be extra-pancreatic like in the mediastinum, pleura, in the peritoneal cavity including the pelvis. The pancreatic pseudocyst typically contains brownish fluid with necrotic tissue sludge which may get infected giving rise to infected pseudocyst or pancreatic abscess. The present case is an unusual condition of a young alcoholic subject who was finally diagnosed as a case of a pancreatic abscess within hepato-gastric ligament and was managed with operative intervention. To the best of the author’s knowledge, it is the first-ever reported case of a pancreatic abscess within the hepato-gastric ligament in the world. Literature was reviewed to explore potential etiopathogenesis and therapeutic strategies of this extremely rare condition. Case presentation A 38 years old gentleman, chronic alcoholic, having a previous history of acute pancreatitis 3 months back, presented with fever (102 degrees Fahrenheit) and a huge [20 cm (horizontal) X 15 cm (vertical)] severely painful swelling in the epigastric region. The swelling was round-shaped, intra-abdominal, fixed to deeper tissue, tense-cystic, poorly trans-illuminant, non-pulsatile and irreducible. Routine blood tests showed leucocytosis (14,500/mm3) with neutrophilia and elevated plasma pancreatic amylase and lipase levels. USG and MDCT scan of the whole abdomen revealed a thick-walled echogenic cystic swelling of size 18 cm × 12 cm in the epigastric region. USG guided aspiration of the cyst revealed mixed purulent brownish fluid. The cyst fluid was negative for mucin stain and contained high amylase level with low CEA level, suggesting infected pancreatic pseudocyst. An open drainage procedure was considered through an upper midline laparotomy. Aspiration of the pus mixed cyst fluid along with tissue debris was done. Through irrigation of the cyst was done with normal saline. The cyst wall was de-roofed leaving a small part adherent to the inferior surface of the left lobe of the liver. Later the cyst fluid culture showed significant growth of Escherichia coli. He was put on IV antibiotics. The patient was discharged in a stable condition after 5 days. The histopathological examination confirmed pancreatic abscess. Six months after the operation, the patient is doing well, remaining asymptomatic and there is no sign of recurrence. Conclusions Due to extreme rarity, pancreatic abscess formation within hepato-gastric ligament may be a diagnostic dilemma and requires a high index of suspicion. Surgeons should be aware of this rare clinical entity for prompt management of potential morbidity.
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Affiliation(s)
- Sabyasachi Bakshi
- Department of General surgery, BSMCH, Bankura, West Bengal, PIN-722102, India. .,, Kathghara Lane, Sonatuli, Hooghly, West Bengal, PIN-712103, India.
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Lan J, Liao B, Ai J, Zhou L, Wang K. Direct Puncture Tunnel Method for Establishing the Retroperitoneal Cavity: Anatomic Confirmation and Clinical Experience. J Endourol 2020; 34:298-303. [PMID: 31973586 DOI: 10.1089/end.2019.0699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose: The feasibility and safety of the direct puncture tunnel method to establish the retroperitoneal cavity was assessed by CT and clinical experience. Materials and Methods: Ten patients who underwent retroperitoneoscopic procedure were scanned by CT in the lateral decubitus position. The distance between the lumbar fascia and psoas major muscle (L-P distance) on the puncture line was measured. The angle between the puncture line and the posterior colon margin (P-C angle) was also measured. In total, 292 patients who underwent retroperitoneoscopic procedure were used to establish the retroperitoneal cavity using the direct puncture tunnel method, and complications in these patients were evaluated. Results: The average L-P distance was 25.0 mm (left side) and 25.5 mm (right side) in the lateral decubitus position. The average P-C angle was 26.8° (left side) and 29.7° (right side). The retroperitoneal cavity was well established in all 292 patients, and no visceral or blood vessel injury occurred. Conclusions: CT scans in the lateral recumbent position indicate that there are no visceral and large blood vessels on the puncture path. The scans also provide a window for inserting the first trocar blindly into the retroperitoneum. A high success rate and low complication rate were observed clinically for the direct puncture tunnel method. We consider the direct puncture tunnel method to be a simple, effective, and safe way to establish the retroperitoneal cavity.
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Affiliation(s)
- Jianhua Lan
- Department and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, People's Hospital of Guang'an City, Guang'an, China
| | - Banghua Liao
- Department and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianzhong Ai
- Department and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Zhou
- Department and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Kunjie Wang
- Department and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Byrnes KG, Walsh D, Dockery P, McDermott K, Coffey JC. Anatomy of the mesentery: Current understanding and mechanisms of attachment. Semin Cell Dev Biol 2019; 92:12-17. [DOI: 10.1016/j.semcdb.2018.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/10/2018] [Indexed: 01/10/2023]
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42
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Kastelein AW, Vos LM, de Jong KH, van Baal JO, Nieuwland R, van Noorden CJ, Roovers JPW, Lok CA. Embryology, anatomy, physiology and pathophysiology of the peritoneum and the peritoneal vasculature. Semin Cell Dev Biol 2019; 92:27-36. [DOI: 10.1016/j.semcdb.2018.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 01/25/2023]
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Abstract
We reported the preoperative radio-guided localization of 4 peritoneal metastatic nodules in the case of a 45-year-old woman with uterine leiomyosarcoma. Three lines of chemotherapy were tried, but cardiotoxicity occurred. Within the context of so-called GOSTT (guided intraoperative scintigraphic tumor targeting), preoperative radio-guided localization of peritoneal metastases enabled their subsequent radio-guided excisional biopsy. SPECT/CT allowed for anatomical localization of the hot lesions and generated a 3-dimensional volume-rendering roadmap, facilitating a surgical approach.
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Sharma M, Patil A, Kumar A, Pathak A, Somani P, Sreesh SS, Rameshbabu CS. Imaging of infracolic and pelvic compartment by linear EUS. Endosc Ultrasound 2019; 8:161-171. [PMID: 31134898 PMCID: PMC6590000 DOI: 10.4103/eus.eus_25_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The peritoneal cavity is subdivided into supracolic and infracolic compartments by transverse mesocolon, which attaches the colon to the posterior abdominal wall. Infracolic compartment is subdivided into right and left compartment by small bowel mesentery. Left infracolic space freely communicates with pelvic compartment. The infracolic compartment contains the coils of small bowel which is separated from paracolic gutter on either side by ascending and descending colon. Pelvic compartment mainly contains bladder, rectum and genital organ (prostate, seminal vesicle in male and uterus in female). The evaluation of different compartments of peritoneum is gaining importance in multimodality imaging. It has become essential that clinicians and endosonographers thoroughly understand the peritoneal spaces and the ligaments and mesenteries that form their boundaries in order to localize disease to a particular peritoneal/subperitoneal space and formulate a differential diagnosis on the basis of that location. In this article we describe the applied EUS anatomy of peritoneal ligaments, infracolic and pelvic compartments of peritoneum and there technique of imaging from stomach, duodenum, sigmoid colon and rectum. Imaging from stomach images the infracolic compartment through transverse mesocolon, imaging from duodenum images the infracolic compartment through the mesentery and imaging from rectum and sigmoid images the infracolic and pelvic compartments through the sigmoid mesocolon and pelvic peritoneum.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Amol Patil
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Avinash Kumar
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Srijaya S Sreesh
- Department of Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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Ghadimi M, Bruns CJ. [Systematic surgery of retroperitoneal sarcomas : Imaging-guided planning of surgical strategy]. Chirurg 2019; 90:447-456. [PMID: 31001643 DOI: 10.1007/s00104-019-0952-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abdominal and retroperitoneal sarcomas (RPS) represent approximately 25-30% of all soft tissue sarcomas, if besides typical retroperitoneal tumors gastrointestinal stromal tumors (GIST) are also included. The surgical R0 en bloc resection with histopathologically free margins is basically the only potentially curative treatment procedure. When planning the surgical strategy, the histopathological subtype and tumor localization are pivotal. The extent of resection should be guided by the goal to reach an en bloc resection with histopathologically negative margins. Due to the frequently found vast dimensions of RPS and ultimately topographic proximity to vital structures at primary diagnosis, R0 resections are not always achievable. Despite the introduction of multimodal treatment regimens and the development of standardized extended surgical procedures, such as systematic retroperitoneal compartmental resection (SRCR), local recurrences remain the most common cause of tumor-associated death. Finally, the results of the transatlantic RPS working group (TARPSWG) could show that treatment of RPS in specialized high-volume centers contributes to better long-term survival. Particularly in Germany there is an urgent demand for centralization of sarcoma patient treatment.
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Affiliation(s)
- M Ghadimi
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Uniklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - C J Bruns
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Uniklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
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The hepatoduodenal ligament revisited: cross-sectional imaging spectrum of non-neoplastic conditions. Abdom Radiol (NY) 2019; 44:1269-1294. [PMID: 30448917 DOI: 10.1007/s00261-018-1829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The hepatoduodenal ligament is frequently involved by conditions affecting the portal triad and surrounding structures, including a vast array of non-neoplastic conditions. Due its unique location between the retroperitoneum and the peritoneal space, the hepatoduodenal ligament is also targeted by inflammatory conditions involving the retroperitoneum and the liver. Finally, the presence of lymphatics and of the biliary tracts makes the hepatoduodenal ligament a route of spread for a variety of infections. The purpose of this pictorial essay is twofold: to review the cross-sectional radiological anatomy and variants of the structures within the hepatoduodenal ligament, and to illustrate the non-neoplastic conditions that may arise within the hepatoduodenal ligament. CONCLUSION Familiarity with these specific entities and their cross-sectional imaging findings is fundamental for a more accurate diagnosis.
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Tokunaga K, Furuta A, Arizono S, Teramoto Y, Negoro H, Kido A, Isoda H, Togashi K. Duodenal obstruction induced by retroperitoneal progression of bladder cancer: a report of two cases. Abdom Radiol (NY) 2019; 44:1223-1229. [PMID: 30600382 DOI: 10.1007/s00261-018-1874-8] [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: 11/25/2022]
Abstract
Bladder cancer usually forms a papillary structure. Progression along the cavity or membranous structures surrounding the bladder, rectum, or retroperitoneum without formation of a discrete mass is rare. We here present two patients with duodenal obstruction caused by retroperitoneal progression of bladder cancer, in both of whom computed tomography revealed bladder and rectal wall thickening with a malignant target sign, thickened mesorectal fascia with abnormal tissue stranding, and increased perirectal fat density. Both cancers progressed despite treatment, as indicated by faint abnormal tissue stranding and increased retroperitoneal fat density along the retromesenteric plane from the pelvis to the duodenum. Subsequently, both patients developed obstruction in the horizontal portion of the duodenum, still without formation of a mass lesion. These two patients highlight the challenges associated with retroperitoneal invasion by bladder cancer in the absence of a mass lesion and underscore the importance of considering cancer progression in patients with bowel obstruction, even when there is no obvious mass lesion and/or only minor retroperitoneal findings. Progression along the retromesenteric plane may be the key pathway via which progressive bladder cancer results in duodenal obstruction without or with a minor mass lesion.
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Affiliation(s)
- Koji Tokunaga
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeki Arizono
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuki Teramoto
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiromitsu Negoro
- Department of Urology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Quadrelli S, Lloyd T, Medoro L, Coucher J. Unusual case of extraperitoneal gas in the abdomen. J Med Imaging Radiat Oncol 2018; 63:79-81. [PMID: 30353980 DOI: 10.1111/1754-9485.12820] [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: 06/30/2018] [Accepted: 09/04/2018] [Indexed: 12/01/2022]
Abstract
The retroperitoneal space is made up of multiple communicating compartments. Here we detail an unusual case of ectopic gas almost exclusively isolated to the properitoneal space, a space in communication with the retroperitoneum. This case is a reminder that when extraperitoneal gas is identified, the retroperitoneal structures should be interrogated carefully to identify a cause.
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Affiliation(s)
- Scott Quadrelli
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Thomas Lloyd
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Lora Medoro
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - John Coucher
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Byrnes KG, Walsh D, Lewton-Brain P, McDermott K, Coffey JC. Anatomy of the mesentery: Historical development and recent advances. Semin Cell Dev Biol 2018; 92:4-11. [PMID: 30316830 DOI: 10.1016/j.semcdb.2018.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
Recent appraisals of mesenteric anatomy clarify its structure and show a continuous and helical-shaped organ. This new model signifies a departure from the conventional model which described multiple, separate "mesenteries". Renaissance anatomists depicted the mesentery as a continuous structure. Events that led to replacement of a continuous with a fragmented model span several centuries. In effect, the scientific and clinical community has come full circle and back to the Renaissance model. Here we review the historical development of our understanding of the mesentery. We discuss how the fragmented model replaced the continuous model. Additionally, we examine factors that contributed to recent advances in mesenteric anatomy as these present new opportunities for systematic investigation.
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Affiliation(s)
- Kevin Gerard Byrnes
- Department of Surgery, University Hospital Limerick, Limerick, Ireland; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Dara Walsh
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | | | - Kieran McDermott
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - John Calvin Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland; Graduate Entry Medical School, University of Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland.
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Preoperative CT-based predictive factors for resectability and medium-term overall survival in patients with peritoneal carcinomatosis from colorectal cancer. Clin Radiol 2018; 73:756.e11-756.e16. [DOI: 10.1016/j.crad.2018.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
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