1
|
Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, D'Hooghe T, Bourne T, D'Hoore A, Wolthuis A, Van Cleynenbreughel B, Meuleman C, Timmerman D. IDEAL study: magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. Ultrasound Obstet Gynecol 2020; 56:255-266. [PMID: 31503381 DOI: 10.1002/uog.21868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the value of using one-stop magnetic resonance imaging (MRI) vs standard radiological imaging as a supplement to transvaginal ultrasonography (TVS) for the preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center. METHODS This prospective observational study compared the diagnostic value of the standard preoperative imaging practice of our center, which involves expert TVS complemented by intravenous urography (IVU) for the evaluation of the ureters and double-contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and cecum, with that of expert TVS complemented by a 'one-stop' MRI examination evaluating the upper abdomen, pelvis, kidneys and ureters as well as rectum and sigmoid on the same day, for the preoperative triaging of 74 women with clinically suspected deep endometriosis. The findings at laparoscopy were considered the reference standard. Patients were stratified according to their need for monodisciplinary surgical approach, carried out by gynecologists only, or multidisciplinary surgical approach, involving abdominal surgeons and/or urologists, based on the extent to which endometriosis affected the reproductive organs, bowel, ureters, bladder or other abdominal organs. RESULTS Our standard preoperative imaging approach and the combined findings of TVS and MRI had similar diagnostic performance, resulting in correct stratification for a monodisciplinary or a multidisciplinary surgical approach of 67/74 (90.5%) patients. However, there were differences between the estimation of the severity of disease by DCBE and MRI. The severity of rectal involvement was underestimated in 2.7% of the patients by both TVS and DCBE, whereas it was overestimated in 6.8% of the patients by TVS and/or DCBE. CONCLUSIONS Complementary to expert TVS, 'one-stop' MRI can predict intraoperative findings equally well as standard radiological imaging (IVU and DCBE) in patients referred for endometriosis surgery in a tertiary care academic center. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- D Bielen
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - C Tomassetti
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - D Vanbeckevoort
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - L De Wever
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - T D'Hooghe
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Darmstadt, Germany
| | - T Bourne
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Gynecology and Obstetrics, Imperial College Healthcare NHS Trust, London, UK
| | - A D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | | | - C Meuleman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
- Leuven University Endometriosis Center, KU Leuven University Hospitals, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| |
Collapse
|
2
|
de Buck van Overstraeten A, Vermeire S, Vanbeckevoort D, Rimola J, Ferrante M, Van Assche G, Wolthuis A, D’Hoore A. Modified Side-To-Side Isoperistaltic Strictureplasty over the Ileocaecal Valve: An Alternative to Ileocaecal Resection in Extensive Terminal Ileal Crohn's Disease. J Crohns Colitis 2016; 10:437-42. [PMID: 26674959 PMCID: PMC4946765 DOI: 10.1093/ecco-jcc/jjv230] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative to ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn's disease [CD]. METHODS This type of strictureplasty was proposed to all patients with an extensive strictured [neo-] terminal ileal segment [> 20 cm]. Short- and long-term outcome data were retrieved from a prospectively maintained database. Safety and medium-term efficacy were studied, using both postoperative magnetic resonance enterography [MRE] and ileocolonoscopy at 6 months. RESULTS Between June 2009 and September 2014, 29 CD patients had a modified strictureplasty [male 9/29, median age 38 [range: 16-64] years]. The median length of strictureplasty was 50 [27-110] cm. Twelve patients underwent a total of 30 additional procedures during surgery, mainly additional short strictureplasties, but also segmental resections. The majority had a laparoscopic-assisted procedure. Median length of hospital stay was 9 [6-17] days. Two patients had an early rescue procedure to oversew a small anastomotic leak. MRE and ileocolonoscopy at follow-up showed a remarkable regression of inflammation and bowel wall thickness. Clinical recurrence, necessitating initiation or modification of medical therapy, and surgical recurrence were reported in 11 and 1 patient after a median follow-up of 21 [1-54] months, respectively. CONCLUSION A modified long Michelassi strictureplasty appears to be safe in patients with extensive stricturing Crohn's ileitis. Significant mucosal and bowel wall healing is observed and suggests that clearance of microbial stasis may play a role in this process.
Collapse
Affiliation(s)
| | - S. Vermeire
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - D. Vanbeckevoort
- University Hospitals Leuven, Department of Radiology, KU Leuven, Belgium
| | - J. Rimola
- Hospital Clinic de Barcelona, Department of Radiology, Barcelona, Spain
| | - M. Ferrante
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - G. Van Assche
- University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium
| | - A. Wolthuis
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| | - A. D’Hoore
- University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium
| |
Collapse
|
3
|
Affiliation(s)
| | | | - D. Vanbeckevoort
- Department of Radiology,University Hospital Gasthuisberg, Leuven, Belgium
| | | | - S. Fieuws
- I-Biostat, Katholieke Universiteit Leuven and Universiteit Hasselt, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery, Belgium
| |
Collapse
|
4
|
Jochmans I, Topal B, D’Hoore A, Aerts R, Vanbeckevoort D, Bielen D, Haustermans K, Van Cutsem E, Penninckx F. Yield of Routine Imaging after Curative Colorectal Cancer Treatment. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2008.11680182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- I. Jochmans
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | - B. Topal
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | - A. D’Hoore
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | - R. Aerts
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | | | - D. Bielen
- Radiology, University Clinic Gasthuisberg, Leuven, Belgium
| | - K. Haustermans
- Radiotherapy, University Clinic Gasthuisberg, Leuven, Belgium
| | - E. Van Cutsem
- Digestive Oncology, University Clinic Gasthuisberg, Leuven, Belgium
| | - F. Penninckx
- Departments of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| |
Collapse
|
5
|
Vancauwenberghe T, Snoeckx A, Vanbeckevoort D, Dymarkowski S, Vanhoenacker FM. Imaging of the spleen: what the clinician needs to know. Singapore Med J 2016; 56:133-44. [PMID: 25820845 DOI: 10.11622/smedj.2015040] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The spleen is considered 'the forgotten organ' among radiologists and clinicians, although it is well visualised on abdominal computed tomography and magnetic resonance imaging. Moreover, the spleen is commonly involved in a wide range of pathologic disorders. These include congenital anomalies, infectious and inflammatory diseases, vascular disorders, benign and malignant tumours, and systemic disorders. In this review, we focus on the key imaging findings of the normal spleen, its variants, as well as relevant congenital and acquired abnormalities. It is of utmost importance to recognise and correctly interpret the variable spectrum of abnormalities that may involve the spleen, in order to avoid unnecessary invasive procedures and to guide adequate treatment.
Collapse
Affiliation(s)
- T Vancauwenberghe
- Department of Radiology, Leuven University Hospital, Herestraat 49, 3000 Leuven, Belgium.
| | | | | | | | | |
Collapse
|
6
|
Coimbra AJF, Rimola J, O'Byrne S, Lu TT, Bengtsson T, de Crespigny A, Luca D, Rutgeerts P, Bruining DH, Fidler JL, Sandborn WJ, Santillan CS, Higgins PDR, Al-Hawary MM, Vermeire S, Vanbeckevoort D, Vanslembrouck R, Peyrin-Biroulet L, Laurent V, Herrmann KA, Panes J. Magnetic resonance enterography is feasible and reliable in multicenter clinical trials in patients with Crohn's disease, and may help select subjects with active inflammation. Aliment Pharmacol Ther 2016; 43:61-72. [PMID: 26548868 DOI: 10.1111/apt.13453] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/23/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reliable tools for patient selection are critical for clinical drug trials. AIM To evaluate a consensus-based, standardised magnetic resonance enterography (MRE) protocol for selecting patients for inclusion in Crohn's disease (CD) multicenter clinical trials. METHODS This study recruited 20 patients [Crohn's Disease Activity Index (CDAI) scores: <150 (n = 8); 150-220 (n = 4); 220-450 (n = 8)], to undergo ileocolonoscopy and two MREs (with and without colonic contrast) within a 14-day period. Procedures were scored centrally using, Magnetic Resonance Index of Activity (MaRIA), and both Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic Score (SES-CD). RESULTS 37 MREs were acquired. Both MREs were evaluable in 16 patients for calculation of test-retest and inter-reader reliability scores. The MaRIA scores for the terminal ileum had excellent test-retest and inter-reader reliability, with correlations >0.9. The proximal ileum showed strong within-reader agreement (0.90-0.96), and fair between-reader agreement (0.59-0.72). MRE procedures were tolerable. MaRIA scores correlated with CDEIS and SES-CD (0.63 and 0.71), but not with CDAI (0.34). MRE identified 3 patients with intra-abdominal complications, who would otherwise have been included in clinical trials. Furthermore, both MRE and ileocolonoscopy identified active bowel wall inflammation in 2 patients with CDAI <150, and none in 1 patient with CDAI > 220. Data quality was good/excellent in 85% of scans, and fair or better in 96%. CONCLUSIONS Magnetic resonance enterography of high-quality and reproducibility was feasible in a global multi- centre setting, with evidence for improved selectivity over CDAI and ileocolonoscopy in identifying appropriate CD patients for inclusion in therapeutic intervention trials.
Collapse
Affiliation(s)
| | - J Rimola
- Hospital Clínic de Barcelona, Catalonia, Spain
| | - S O'Byrne
- Genentech, Inc., South San Francisco, CA, USA
| | - T T Lu
- Genentech, Inc., South San Francisco, CA, USA
| | - T Bengtsson
- Genentech, Inc., South San Francisco, CA, USA
| | | | - D Luca
- Genentech, Inc., South San Francisco, CA, USA
| | - P Rutgeerts
- University Hospitals Leuven, Leuven, Belgium
| | | | | | - W J Sandborn
- University of California San Diego, La Jolla, CA, USA
| | - C S Santillan
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | - L Peyrin-Biroulet
- University Hospital of Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - V Laurent
- Adults University, Nancy University, Vandoeuvre-lès-Nancy, France
| | - K A Herrmann
- University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - J Panes
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| |
Collapse
|
7
|
Meylemans D, Penninckx F, Vanbeckevoort D, Wolthuis AM, Fieuws S, D'Hoore A. Endoscopic versus radiology-based location of rectal cancer. Acta Chir Belg 2014; 114:364-369. [PMID: 26021679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Rigid proctosigmoidoscopy is recommended for measuring the height of rectal neoplasms but appears to be performed in only a minority of patients. Our aim was to compare endoscopic and radiological measurement of rectal tumour location with a focus on differentiation between mid and high rectal cancer. METHODS Medical records of 66 rectal cancer patients were reviewed. Tumour location defined at colonoscopy (66 patients), rigid proctosigmoidoscopy (20 patients) and endorectal ultrasound (35 patients) was recorded. Rectilinear and curvilinear methods were used to estimate the distance between the lower tumour level and the anal verge on sagittal CT or MR images (66 patients). Agreement, intra- and inter-observer variation of radiology-based measurements were -assessed using intra-class correlation (ICC) and within-subject coefficient of variation (WSCV). RESULTS Tumour location was performed at rigid proctosigmoidoscopy in 30% of patients. Intra- and inter-observer agreement for radiology-based measurements were high. Tumour location using the rectilinear method or proctosigmoidoscopy was similar on average, for a difference of only 0.34 cm (SD 2.0 cm, p = 0.330), although agreement was -moderate (ICC = 0.54, WSCV = 16.7%). Measurements based on colonoscopy and the curvilinear radiological method were -characterized by a systematic overestimation of the location, increasing with tumour height. CONCLUSIONS Radiology-based measurement of the lower tumour level is a reproducible alternative for tumour location at rigid or flexible endoscopy. Its validity should be further assessed.
Collapse
Affiliation(s)
- D Meylemans
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
8
|
Rommel N, Denys S, Liesenborghs C, Scheerens C, Selleslagh M, Goeleven A, Vanbeckevoort D, Omari T, Tack J, Dejaeger E. Automatische Impedantie Manometrie (AIM): objectieve diagnostiek van oro-faryngale dysfagie. Tijdschr Gerontol Geriatr 2014; 45:290-299. [PMID: 25273852 DOI: 10.1007/s12439-014-0097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AUTOMATED IMPEDANCE MANOMETRY (AIM): OBJECTIVE DIAGNOSIS OF OROPHARYNGEAL DYSPHAGIA: This review article aims to demonstrate the clinical potential of Automated Impedance Manometry (AIM) as a new, non-radiological technique for screening and diagnosis of oro-pharyngeal dysphagia. An integrated - rather than separate - analysis of pressure and impedance patterns generated in the pharynx when swallowing a food bolus, can be a useful complement to the radiological investigations considered as gold standard today. Major advantages are the objective nature of this technique and the fully automated calculation of various swallow parameters. A global measure of swallowing function can be derived (a Swallow Risk Index, SRI) and is related to (the severity of) the risk of aspiration and the presence of pharyngeal post-swallow residue. It was shown that aspiration on videofluoroscopy was accurately detected by using AIM with a sensitivity of 0.88 and a specificity of 0.96. AIM analysis can be performed quickly and is reliable in the hands of different end users. Various parameters are sufficiently sensitive to detect changes in bolus consistency and - as was recently found - are influenced by swallowing manoeuvers. Furthermore, different patterns of deviant swallow parameters can be found in different patient populations. Whether this observation can provide specific diagnoses and - as a consequence - more targeted treatments is currently under investigation.
Collapse
Affiliation(s)
- N Rommel
- Katholieke Universiteit (KU) Leuven, Neurowetenschappen, Experimentele Oto-Rino-Laryngologie (ExpORL), Faculteit Geneeskunde, Leuven, Belgium,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Langouche L, Casaer MP, Coudyzer W, Vanbeckevoort D, De Dobbelaer B, Güiza FG, Wouters PJ, Mesotten D, Van den Berghe G. Impact of early parenteral nutrition on muscle and adipose tissue compartments during critical illness. Crit Care 2013. [DOI: 10.1186/cc12191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
10
|
Tuyls S, Brouckaert O, Vanderstichele A, Vanderhaegen J, Amant F, Leunen K, Smeets A, Berteloot P, Van Limbergen E, Weltens C, Peeters S, Vanbeckevoort D, Floris G, Moerman P, Paridaens R, Wildiers H, Vergote I, Christiaens MR, Neven P. Abstract P6-05-05: Triple receptor comparison between primary breast cancer and metachronous or synchronous liver metastasis. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-05-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Decisions about systemic treatment in women with metastatic breast cancer are currently based on the presence of estrogen receptors (ER), progesterone receptors (PR) or Human Epidermal growth factor Receptor 2 (HER2 receptors) in the primary tumor. Recently, several studies have reported significant discordances in ER, PR and HER2 status between the primary tumor and metastatic lesions and this may vary by metastatic site. Prognostic implications remain unclear although alterations in ER, PR and/or HER2 can influence metastatic management. This study represents one of the largest studies evaluating how frequent receptor discordances occur in liver metastasis, whether this alters therapeutic options and impacts prognosis.
Patients and methods: 246 breast cancer patients with histological confirmed liver metastasis were analyzed in this retrospective study. Immunohistochemistry (IHC) and/or FISH were used to determine ER, PR and HER2 receptor status. We excluded patients when comparison between receptors of primary tumor and metastasis was impossible due to missing data (n = 85), when liver metastasis did not originate from breast cancer (n = 36) and when pathology was obtained from autopsy specimens (n = 38).
Results: 87 patients had matched tissue samples of primary tumor and liver metastasis with possible comparison of at least one of the receptors. Table 1 summarizes changes in ER, PR, HER2 between primary and metastatic lesion. Discordance in receptor status was associated with shorter time to death (63.3 months) compared to the concordant group (75.5 months).
Conclusions: A significant proportion of ER and PR show discordance between primary tumor and liver metastasis. However we could not establish the same level of discordance for the HER2 receptors as in other studies. In general, only about 1 in 5 patients gained new (endocrine or targeted) therapeutic options. Tissue confirmation remains important to evaluate whether metastatic disease has become endocrine insensitive (in approximately 1 in 5 patients), avoiding unnecessary delay in chemotherapy. Discordance in receptors may be associated with inferior prognosis.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-05-05.
Collapse
Affiliation(s)
- S Tuyls
- University Hospitals Leuven, Belgium
| | | | | | | | - F Amant
- University Hospitals Leuven, Belgium
| | - K Leunen
- University Hospitals Leuven, Belgium
| | - A Smeets
- University Hospitals Leuven, Belgium
| | | | | | - C Weltens
- University Hospitals Leuven, Belgium
| | - S Peeters
- University Hospitals Leuven, Belgium
| | | | - G Floris
- University Hospitals Leuven, Belgium
| | - P Moerman
- University Hospitals Leuven, Belgium
| | | | | | - I Vergote
- University Hospitals Leuven, Belgium
| | | | - P Neven
- University Hospitals Leuven, Belgium
| |
Collapse
|
11
|
Deylgat B, Topal H, Meurisse N, Jochmans I, Aerts R, Vanbeckevoort D, Monbaliu D, Pirenne J. Gastric outlet obstruction by a donor aortic tube after en bloc liver pancreas transplantation: a case report. Transplant Proc 2012; 44:2888-92. [PMID: 23146548 DOI: 10.1016/j.transproceed.2012.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We present the case of a 30-year-old female suffering from a type five maturity onset diabetes of the young deficiency, resulting in type 1 diabetes and terminal renal insufficiency. She also had chronic and refractory pruritis due to primary sclerosing cholangitis-like fibrosis. She underwent combined en bloc liver and pancreas transplantation and kidney transplantation. The postoperative course was complicated by a gastric outlet obstruction due to compression of the native gastroduodenal junction by the donor aortic tube. This was treated by construction of a roux-en-Y gastrojejunostomy at posttransplant day 24. To our knowledge, compression of the gastroduodenal junction by a donor aortic tube after combined liver and pancreas (or multivisceral) transplantation has not been reported previously.
Collapse
Affiliation(s)
- B Deylgat
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Omari TI, Dejaeger E, Tack J, Vanbeckevoort D, Rommel N. An impedance-manometry based method for non-radiological detection of pharyngeal postswallow residue. Neurogastroenterol Motil 2012; 24:e277-84. [PMID: 22594606 DOI: 10.1111/j.1365-2982.2012.01931.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postswallow residue is indicative of impaired pharyngeal bolus clearance. The integrated nadir impedance to impedance ratio (iZn/Z) is a novel functional variable that can be derived using automated impedance manometry (AIM). In this study, the postswallow pharyngeal iZn/Z was evaluated as a potential correlated postswallow residue and therefore predictor of ineffective swallowing. METHODS Optimal iZn/Z criteria were determine using a database of 50 randomly selected bolus swallows recorded with impedance, manometry, and videofluoroscopy. The iZn/Z was derived for a region of interest (ROI), spanning the mid-point of the pharyngeal stripping wave to the upper esophageal sphincter proximal margin, and from 0.25 to 1.25 s after the peak of the pharyngeal stripping wave. Videofluorscopy was scored by four experts using a six-point bolus residue scale (BRS) score. Optimized criteria for iZn/Z were then applied to a much larger database of 225 swallows scored for residue by one expert observer. KEY RESULTS Among individual database, swallows iZn/Z was significantly correlated with average expert BRS score (r = 0.748, P < 0.0001). An iZn/Z of ≥ 500 was optimally predictive of swallows with residue defined by a BRS score of 4 or more. Within the larger cohort, iZn/Z was higher in dysphagia patient swallows compared with controls [2 (1, 4) vs 1 (1, 3), P < 0.005] and swallows with an iZn/Z ≥ 500 had higher bolus residue scores [4 (1, 6) vs 2 (1, 4), P < 0.001]. CONCLUSIONS & INFERENCES The AIM derived iZn/Z is an easily determined objective non-radiological marker of clinically relevant postswallow residue and therefore has potential diagnostic relevance as a predictor of ineffective swallowing.
Collapse
Affiliation(s)
- T I Omari
- Gastroenterology Unit, Child, Youth & Women's Health Service, North Adelaide, SA, Australia.
| | | | | | | | | |
Collapse
|
13
|
Dobbels P, Van Overbeke L, Vanbeckevoort D, Hiele M. Acute abdomen due to intestinal angioedema induced by ACE inhibitors: not so rare? Acta Gastroenterol Belg 2009; 72:455-457. [PMID: 20163043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
During the last 5 years we identified 7 patients with a history of episodic acute abdominal pain and subobstruction due to intestinal angioedema secondary to the use of Angiotensin Converting Enzyme (ACE) inhibitors. These cases were all diagnosed in one gastroenterology department. This is thereby the largest single centre case series of ACE inhibitor-induced angioedema that has been published until now. Our findings suggest that this syndrome is far more frequent than international literature would let us believe. We also describe one of the first male cases diagnosed with this entity for which there is a significant female predominance. In the presence of an appropriate history and suggestive findings on CT scan, this diagnosis can relatively easily be made if one is sufficiently intent on it. An appropriate diagnosis can save these patients a lot of unnecessary diagnostic procedures and discomfort.
Collapse
Affiliation(s)
- P Dobbels
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
| | | | | | | |
Collapse
|
14
|
D'Hoore A, Vanbeckevoort D, Penninckx F. Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele. Br J Surg 2008; 95:1264-72. [PMID: 18720463 DOI: 10.1002/bjs.6322] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rectocele can be part of a more complex rectal prolapse syndrome including rectal intussusception and enterocele. This reflects insufficiency at different levels of support in the posterior pelvic compartment. A new technique involving reinforcement of the rectovaginal septum with mesh by a combined laparoscopic and perineal approach was evaluated. METHODS The study included 18 patients with a complex rectocele and grade 2-3 rectal intussusception and enterocele (eight patients). Patients had clinical, physiological and radiological follow-up. RESULTS There was no major perioperative morbidity and mean hospital stay was 4.5 (range 3-7) days. After a mean of 24.2 (range 13-35) months there was no clinical recurrence of rectocele. Symptoms of obstructed defaecation resolved in 14 of 17 patients. The Patient Assessment of Constipation Symptoms score decreased from a mean(s.d.) of 12.6(5.9) to 3.9(4.2), and a rectocele symptom score from 14.3(3.3) to 2.3(2.8). No new-onset constipation, urge or faecal incontinence nor new-onset dyspareunia was reported. Radiological investigation in eight patients revealed a sufficient anatomical repair at the different levels of support. A slight decrease in rectal compliance was measured, with no significant reduction in rectal capacity. CONCLUSION Complete rectovaginal septum reinforcement with mesh corrected complex rectoceles, with good functional outcome.
Collapse
Affiliation(s)
- A D'Hoore
- Department of Abdominal Surgery, University Clinics Gasthuisberg, Leuven, Belgium.
| | | | | |
Collapse
|
15
|
Affiliation(s)
- W Laleman
- Unit for Liver, Biliary and Pancreatic Diseases, Catholic University of Leuven, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
16
|
Jochmans I, Topal B, D'Hoore A, Aerts R, Vanbeckevoort D, Bielen D, Haustermans K, Van Cutsem E, Penninckx F. Yield of routine imaging after curative colorectal cancer treatment. Acta Chir Belg 2008; 108:88-92. [PMID: 18411580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND/AIM The use of imaging in the follow-up of patients after curative colorectal cancer resection is much debated. The American Society of Colon and Rectal Surgeons did not recommend routine imaging. This retrospective study assesses the yield of routine imaging to detect recurrent disease. METHODS In 1998, 108 consecutive patients underwent curative resection for colorectal carcinoma. Minimum followup in our institution was 3 years. Multidisciplinary follow-up at a joint clinic consisted out of a history, clinical examination, serum carcinoembryonic antigen (CEA), chest X-ray and abdominal ultrasound, at least every 6 months. Colonoscopy was performed within 1 year after operation and every 3 to 5 years thereafter. The incidence, timing, means of detection and resectability of recurrence were studied. RESULTS The recurrence rate was 22% (24 patients): liver metastases (11), extra-hepatic recurrence (10) and combined recurrence (3). Recurrent disease occurred in stage II or III cancer, except for two patients. It was diagnosed at a median of 21.5 months (range 4-79) after surgery. Means of detection were: symptoms in 2 (peritoneal disease, 8%), increasing CEA in 15 (63%), routine imaging in 6 (25%), and abdominal CT-scan in one patient. Curative resection of recurrent disease was possible in ten patients (42%): in 6/15 recurrences detected by CEA, in 3/6 recurrences detected by routine imaging, in 1 liver metastasis detected by CT and in none of the symptomatic patients. CONCLUSIONS A CEA level increasing above 5.0 microg/L was the most important diagnostic tool. However, one quarter of the recurrences were detected by routine imaging and half of them could be resected for cure. These data support routine imaging during follow-up.
Collapse
Affiliation(s)
- I Jochmans
- Department of Abdominal Surgery, University Clinic Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Vanbeckevoort D. Solid pancreatic masses: benign or malignant. JBR-BTR 2007; 90:487-489. [PMID: 18376761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Solid masses in the pancreas mostly occur in the pancreatic head and may be related to inflammation due to chronic pancreatitis or may be caused by malignancy. Ductal pancreatic carcinoma is the most common malignant pancreatic neoplasm, accounting for more than 90% of malignant solid pancreatic tumours. Endocrine tumours represent only a minority of those tumours. While endocrine tumours tend to exhibit symptoms earlier in the course of the disease (due to tumour-related hormone production), adenocarcinomas present in nearly all cases in advanced stages when curative resection is not feasible.
Collapse
Affiliation(s)
- D Vanbeckevoort
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
18
|
Breysem L, Kersemans P, Vanbeckevoort D, Ectors N, Smet MH. Nonfunctioning neuroendocrine tumor of the pancreas in an 8-year-old girl. JBR-BTR 2007; 90:528-531. [PMID: 18376771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a case of a nonfunctioning neuroendocrine pancreatic tumor in the pediatric age group. An 8-year-old child complains of vague abdominal pain and radiological investigations detect a tumoral mass in the pancreatic tail. Abdominal ultrasound, contrast enhanced computed tomography and magnetic resonance imaging demonstrate a round intrapancreatic solid moderately vascularized lesion of approximately 5 cm in diameter, with a smooth contour and well demarcated from the surrounding tissues. After surgical resection, the diagnosis of a hormonally inactive benign neuroendocrine tumor is histologically diagnosed. Patient's follow-up is uneventful.
Collapse
Affiliation(s)
- L Breysem
- Department of Radiology, University Hospitals Gasthuisberg, Leuven, Belgium.
| | | | | | | | | |
Collapse
|
19
|
Verwimp W, Feyaerts F, Vanbeckevoort D. Mesenteric inflammatory veno-occlusive disease (MIVOD). JBR-BTR 2007; 90:546. [PMID: 18376780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
20
|
Van Kerkhove F, Cannie M, Op de Beeck K, Timmerman D, Pienaar A, Smet MH, Bielen D, Vanbeckevoort D, Dymarkowski S. Ovarian torsion in a premenarcheal girl: MRI findings. ACTA ACUST UNITED AC 2006; 32:424-7. [PMID: 16933113 DOI: 10.1007/s00261-006-9072-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 07/19/2006] [Indexed: 10/24/2022]
Abstract
Adnexal torsion is an uncommon cause of severe lower abdominal pain in women and is often difficult to distinguish from other acute abdominal conditions. However, adnexal torsion should be considered in premenarcheal girls admitted with acute abdominal pain and evidence of an ovarian mass. Accurate and early radiological diagnosis is mandatory immediately after onset of clinical symptoms in order to preserve the viability of the ovary. Ultrasound (US) is usually the first line examination performed in an emergency setting, but computed tomography (CT) and magnetic resonance imaging (MRI) can be useful in case of ambiguous US findings, especially in patients with sub-acute symptoms and a suspected adnexal mass. This case report describes the additional value of MRI in a premenarcheal girl with sub-acute right fossa pain.
Collapse
Affiliation(s)
- F Van Kerkhove
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Heye S, Bielen D, Vanbeckevoort D. Left ovarian Brenner tumor. JBR-BTR 2005; 88:245-6. [PMID: 16302335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Ovarian Brenner tumors are uncommon neoplasms of the ovary, representing approximately 2% of all ovarian neoplasms. Nowadays there is general agreement that Brenner tumors are derived from the surface epithelium of the ovary or the pelvic mesothelium through transitional cell metaplasia. Association with other surface-derived neoplasms, either in the ipsilateral or contralateral ovary, is reported in 30% of the cases. We report a case of benign ovarian Brenner tumor and discuss the typical features on magnetic resonance imaging (MRI) and computed tomography (CT) scan as well as the differential diagnosis.
Collapse
Affiliation(s)
- S Heye
- Department of Radiology, University Hospitals Gasthuisberg, Leuven, Belgium.
| | | | | |
Collapse
|
22
|
Coremans G, Margaritis V, Van Poppel HP, Christiaens MR, Gruwez J, Geboes K, Wyndaele J, Vanbeckevoort D, Janssens J. Actinomycosis, a rare and unsuspected cause of anal fistulous abscess: report of three cases and review of the literature. Dis Colon Rectum 2005; 48:575-81. [PMID: 15875298 DOI: 10.1007/s10350-004-0809-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Primary perianal actinomycosis is rare. Sporadic cases, with lesions varying in extent have been reported. The infection is caused by the bacterium Actinomyces, which often is a saprophyte. Male gender and diabetes are risk factors, but the exact pathogenic mechanism remains speculative. The diagnosis is a challenge and often delayed, with a protracted history of masses and sinuses extending into the gluteal and genital region. The treatment, a combination of surgery and antibiotics, is poorly standardized. We report three cases and compare their characteristics to those of published cases, found by a computerized literature search (1968-2002). The lesions, a simple fistula-in-ano or a mass, were diagnosed in an early stage in all three patients. The infection always spread into the scrotum. There were no risk factors other than gender, except in one patient. The diagnosis was suspected by the observation of draining sulfur granules and promptly confirmed by histology in the three cases. All patients healed with antibiotics in addition to simple surgical procedures. Treatment consisted of amoxicillin for two weeks in two cases and more extended antimicrobial treatment in the third. These findings are contrasting with the classic picture of perianal actinomycosis. It is concluded that perianal actinomycosis can occur in the absence of risk factors and that early diagnosis requires a high degree of suspicion. An infection with Actinomyces should be suspected in the presence of lesions containing watery purulent material with sulfur granules. The indication for extended antibiotherapy combined with sphincter damaging surgery may need to be revised in the presence of early detection.
Collapse
Affiliation(s)
- G Coremans
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Affiliation(s)
- X De Meester
- Department of Internal Medicine, Unit for Liver, Biliary and Pancreatic Diseases, University Hospital Gasthuisberg, Catholic University of Leuven, Belgium
| | | | | | | |
Collapse
|
24
|
Coenegrachts K, Vanbeckevoort D, Deraedt K, Van Steenbergen W. Mri findings in primary non-Hodgkin's lymphoma of the liver. JBR-BTR 2005; 88:17-9. [PMID: 15792163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Primary lymphoma of the liver is a very rare malignancy. Most often, these lesions consist of diffuse large B-cell non-Hodgkin's lymphoma that occurs mostly in immunodeficient patients. To prove the primary nature of a hepatic lesion, a systemic lymphoproliferative disease should be ruled out. Secondary liver involvement during Hodgkin's and non-Hodgkin's lymphoma is frequent. In advanced cases the incidence varies from 25% to 50%. The present case describes the MRI features of a primary lymphoma of the liver presenting as a solitary nodule. The primary lymphoma presents as a T2-hyperintense homogeneous nodule, with a signal intensity comparable with the signal intensity of the spleen. Signal intensity is comparable on in and out of phase imaging. The nodule is slightly T1-hypointense and doesn't show any arterial contrast uptake. In the late venous phase a slight increase in signal intensity is noted. Two and a half minutes after the administration of contrast agent, the lesion is iso-attenuating with the liver parenchyma. This case is rare because of the concomitant presence of heterozygous sickle cell anaemia and the presence of Gamna-Gandy bodies in the splenic parenchyma. It remains uncertain whether the presence of the Gamna-Gandy bodies is associated with the liver lymphoma or with the underlying sickle cell anaemia, or with a combination of both.
Collapse
Affiliation(s)
- K Coenegrachts
- Department of Radiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
| | | | | | | |
Collapse
|
25
|
Maleux G, Vaninbroukx J, Aerts R, Topal B, Verslype C, Vanbeckevoort D, Wilms G. Transcatheter management of hepatic artery pseudoaneurysm following pancreaticoduodenectomy: a report of three cases. Acta Chir Belg 2004; 104:564-7. [PMID: 15571024 DOI: 10.1080/00015458.2004.11679615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pseudoaneurysm formation is a rare, but potentially life threatening delayed complication of major pancreatic surgery. Redo surgery several weeks after pancreaticoduodenectomy can be hazardous, especially in debilitated patients. Percutaneous, transcatheter exclusion of the pseudoaneurysm by means of embolic coils can be an efficient, safe and minimally invasive alternative to open surgery with good mid- and long-term results. We present our experience in Three patients undergoing transcatheter embolization of hepatic artery pseudoaneurysms detected several weeks after Whipple's operation.
Collapse
Affiliation(s)
- G Maleux
- Department of Radiology, University Hospitals, Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
26
|
De Bruecker Y, Ballaux F, Allewaert S, Vanbeckevoort D, Bielen D, Roskams T, Aerts R, Roex L, Simoens M. A solitary hepatic lesion: MRI-pathological correlation of an hepatic angiomyolipoma (2004:4b). Eur Radiol 2004; 14:1324-6. [PMID: 15221270 DOI: 10.1007/s00330-003-2183-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y De Bruecker
- Department of Radiology, University Hospitals, Catholic University of Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
Rupture of the gravid uterus is a rare, life-threatening obstetric complication. Major symptoms are hypovolemic shock and abdominal pain during late pregnancy or after vaginal delivery. Immediate surgical therapy is required. We report a case of uterine rupture after vaginal delivery diagnosed by means of ultrasonography and computed tomography.
Collapse
Affiliation(s)
- F Catry
- Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
28
|
Maleux G, Vaninbroukx J, Verslype C, Vanbeckevoort D, Van Hootegem P, Nevens F. Pancreatitis-induced extrahepatic portal vein stenosis treated by percutaneous transhepatic stent placement. Cardiovasc Intervent Radiol 2004; 26:395-7. [PMID: 14667123 DOI: 10.1007/s00270-003-0026-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
One month after onset of an acute biliary pancreatitis, a 75-year-old man developed refractory ascites. Duplex ultrasound and CT scan revealed a focal stenosis of the extrahepatic portal vein as confirmed by transhepatic direct portography. In the same session, this stenosis, responsible for symptomatic prehepatic portal hypertension, was successfully dilated and stented and afterwards a residual pressure gradient of 1 mmHg over the stented segment was measured. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination one year later is completely normal.
Collapse
Affiliation(s)
- G Maleux
- Department of Radiology, University Hospitals, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
29
|
Van de Moortele K, Vanbeckevoort D, Hendrickx S. Struma ovarii: US and CT findings. JBR-BTR 2003; 86:209-10. [PMID: 14527060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
We describe the ultrasound and CT findings in a case of struma ovarii. Ultrasound showed a multicystic mass with a well-vascularized solid part. CT demonstrated a multilocular cystic mass with calcifications and solid, enhancing components. To prevent radical surgery, struma ovarii should be included in the differential diagnosis when a mixed, multilocular, teratoma-like tumour of the ovary shows a well-vascularized, enhancing, central solid component.
Collapse
|
30
|
Breysem L, Bosmans H, Dymarkowski S, Schoubroeck DV, Witters I, Deprest J, Demaerel P, Vanbeckevoort D, Vanhole C, Casaer P, Smet M. The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis. Eur Radiol 2003; 13:1538-48. [PMID: 12695920 DOI: 10.1007/s00330-002-1811-6] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2002] [Revised: 10/14/2002] [Accepted: 12/06/2002] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the role of MR imaging of the fetus to improve sonographic prenatal diagnosis of congenital anomalies. In 40 fetuses (not consecutive cases) with an abnormality diagnosed with ultrasound, additional MR imaging was performed. The basic sequence was a T2-weighted single-shot half Fourier (HASTE) technique. Head, neck, spinal, thoracic, urogenital, and abdominal fetal pathologies were found. This retrospective, observational study compared MR imaging findings with ultrasonographic findings regarding detection, topography, and etiology of the pathology. The MR findings were evaluated as superior, equal to, or inferior compared with US, in consent with the referring gynecologists. The role of these findings in relation to pregnancy management was studied and compared with postnatal follow-up in 30 of 40 babies. Fetal MRI technique was successful in 36 of 39 examinations and provided additional information in 21 of 40 fetuses (one twin pregnancy with two members to evaluate). More precise anatomy and location of fetal pathology (20 of 40 cases) and additional etiologic information (8 of 40 cases) were substantial advantages in cerebrospinal abnormalities [ventriculomegaly, encephalocele, vein of Galen malformation, callosal malformations, meningo(myelo)cele], in retroperitoneal abnormalities (lymphangioma, renal agenesis, multicystic renal dysplasia), and in neck/thoracic pathology [cervical cystic teratoma, congenital hernia diaphragmatica, congenital cystic adenomatoid lung malformation (CCAM)]. This improved parental counseling and pregnancy management in 15 pregnancies. In 3 cases, prenatal MRI findings did not correlate with prenatal ultrasonographic findings or neonatal diagnosis. The MRI provided a more detailed description and insight into fetal anatomy, pathology, and etiology in the vast majority of these selected cases. This improved prenatal parental counseling and postnatal therapeutic planning.
Collapse
Affiliation(s)
- L Breysem
- Department of Radiology, University Hospitals, Herestraat 49, 3000, Leuven, Belgium,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Topal B, Van de Moortel M, Fieuws S, Vanbeckevoort D, Van Steenbergen W, Aerts R, Penninckx F. The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease. Br J Surg 2003; 90:42-7. [PMID: 12520573 DOI: 10.1002/bjs.4025] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The application of available predictive scoring systems for the detection of common bile duct (CBD) stones has not reduced the number of patients who undergo unnecessary endoscopic retrograde cholangiopancreatography. The aim of this study was to create a predictive model for CBD stones and to assess the value of magnetic resonance cholangiopancreatography (MRCP) in prediction. METHODS In 1998, 366 patients with gallstone disease (118 males, 248 females; mean age 57 (range 8-84) years) underwent cholecystectomy. Statistical analysis was performed on patient data obtained at the time of first presentation. RESULTS CBD stones were demonstrated in 43 (12 per cent) of 366 patients. The predictive model for common duct stones included ultrasonography showing CBD stones or bile duct dilatation, age greater than 60 years, fever, serum alkaline phosphatase level above 670 units/l and serum amylase level above 95 units/l. In patients with a predicted probability greater than 5 per cent, CBD stones were present in 11 per cent, compared with 1 per cent in patients with a probability of 5 per cent or less. MRCP had an observed sensitivity of 95 per cent, specificity of 100 per cent, positive predictive value of 100 per cent and negative predictive value of 98 per cent. CONCLUSION In patients with a predicted probability for CBD stones of more than 5 per cent, MRCP is recommended in order to confirm the presence or absence of stones and as guidance in further management.
Collapse
Affiliation(s)
- B Topal
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
32
|
De Backer AI, Mortelé KJ, Ros RR, Vanbeckevoort D, Vanschoubroeck I, De Keulenaer B. Chronic pancreatitis: diagnostic role of computed tomography and magnetic resonance imaging. JBR-BTR 2002; 85:304-10. [PMID: 12553661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis and detection of complications in patients with chronic pancreatitis are reviewed. CT and MRI diagnoses are based on changes in the pancreatic duct and parenchyma and on the detection of ductal calculi. Despite technical refinements of these imaging methods, the diagnosis of chronic pancreatitis remains often difficult because of the complexity of the morphologic changes and the false-negative results in the early stages of the disease. This article describes and illustrates the imaging features of chronic pancreatitis classified according to the underlying etiology.
Collapse
Affiliation(s)
- A I De Backer
- Department of Radiology, Algemeen Centrumziekenhuis Antwerpen, Campus Stuivenberg, Belgium
| | | | | | | | | | | |
Collapse
|
33
|
Thomeer M, Bielen D, Vanbeckevoort D, Dymarkowski S, Gevers A, Rutgeerts P, Hiele M, Van Cutsem E, Marchal G. Patient acceptance for CT colonography: what is the real issue? Eur Radiol 2002; 12:1410-5. [PMID: 12042947 DOI: 10.1007/s003300101082] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2001] [Revised: 07/02/2001] [Accepted: 07/09/2001] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the discomfort associated with CT colonography compared with colonoscopy and bowel purgation cleansing, and to evaluate patient preference between CT colonography and colonoscopy. In a total of 124 patients, scheduled for multidetector virtual CT colonography and diagnostic colonoscopy, patient acceptance and future preference were assessed during the different steps of the procedure (colon preparation, CT examination, and conventional colonoscopy). Patients who described contradictory findings between the degree of discomfort and their preference regarding follow-up examinations were retrospectively reinterviewed regarding the reason for this discrepancy. Colonoscopy was graded slightly more uncomfortable than virtual CT colonography, but the preparation was clearly the most uncomfortable part of the procedure. Concerning their preference regarding follow-up examinations, 71% of the patients preferred virtual CT colonography, 24% preferred colonoscopy, and 5% had no preference. Twenty-eight percent of the patients preferred virtual CT colonography despite that they thought it was equally or even more uncomfortable than colonoscopy. This was mainly due to the faster procedure (17 patients), the lower physical challenge (14 patients), and the lack of sedation (12 patients) of virtual CT colonography. Factors other than the discomfort related to the examinations play an important role in the patient's preference for virtual CT colonography, namely the faster procedure, the lower physical challenge, and the lack of sedation. Since the preparation plays a major decisive factor in the patient acceptance of virtual CT colonography, more attention should be given to fecal tagging.
Collapse
Affiliation(s)
- M Thomeer
- Department of Radiology, University Hospitals, Herestraat 49, 3000 Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Eerens I, Vanbeckevoort D, Vansteenbergen W, Van Hoe L. Autoimmune pancreatitis associated with primary sclerosing cholangitis: MR imaging findings. Eur Radiol 2002; 11:1401-4. [PMID: 11519549 DOI: 10.1007/s003300000742] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Autoimmune pancreatitis is a relatively rare type of chronic pancreatitis that may be associated with other autoimmune disorders. The imaging features of this entity may be misleading and suggest the presence of a malignant tumour. We present a case in which MR imaging allowed us to diagnose autoimmune pancreatitis associated with primary sclerosing cholangitis, which is another autoimmune-related disease. Typical MR characteristics of autoimmune pancreatitis include focal or diffuse enlargement of the pancreas, the absence of parenchymal atrophy and significant dilation proximal to the site of stenosis, the absence of peripancreatic spread, the clear demarcation of the lesion and the presence of a peripancreatic rim.
Collapse
Affiliation(s)
- I Eerens
- Department of Radiology, University Hospitals KU, Leuven, Belgium
| | | | | | | |
Collapse
|
35
|
Thomeer M, Vanbeckevoort D, Bielen D, Beenen L, Gevers A, Rutgeerts R, Marchal G. Virtual colonoscopy: a new screening tool for colorectal cancer? JBR-BTR : ORGANE DE LA SOCIETE ROYALE BELGE DE RADIOLOGIE (SRBR) = ORGAAN VAN DE KONINKLIJKE BELGISCHE VERENIGING VOOR RADIOLOGIE (KBVR) 2001; 84:155-63. [PMID: 11688729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
One of the new forays into the field of medical imaging is the 3-D computer imaging. Thanks to new and more performant computer processing and 3-D rendering methods it is nowadays possible to generate high resolution images of the inner surface of the colon based on CT and MR images. This article reviews the current status and research directions of virtual colonoscopy and its possible eligibility of becoming a new tool for colorectal screening.
Collapse
Affiliation(s)
- M Thomeer
- Department of Radiology, University Hospitals, Leuven, Belgium
| | | | | | | | | | | | | |
Collapse
|
36
|
Affiliation(s)
- L Janssen
- Department of Radiology, University Hospitals Gasthuisberg, Catholic University of Leuven, Belgium
| | | | | | | |
Collapse
|
37
|
Dewandel P, Schraepen T, Vanbeckevoort D, Geboes K, Delvaux V, Gevers A, Aerts R, Ponette E. Colitis cystica profunda. JBR-BTR 2001; 84:111-3. [PMID: 16619696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A 39-year-old woman with inflammatory bowel disease was admitted to the hospital because of cramping abdominal pain and diarrhea. Ultrasound of the abdomen revealed thickening of the wall of the descending colon. At endoscopy mucosa-covered nodules with substenosis were seen. A double-contrast examination showed narrowing in the transition zone between the descending colon and sigmoid with mucosal nodularities and barium spots in between. Examination of the resection specimen revealed colitis cystica profunda. After surgical treatment the history of the patient was uneventful.
Collapse
Affiliation(s)
- P Dewandel
- Department of Radiology, University Hospitals K.U. Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Dewandel P, Janssen L, Vanbeckevoort D, Dedeurwaerdere S, Miserez M, Ponette E. Ectopic gastric mucosa presenting as a polypoid mass within a Meckel's diverticulum. Eur Radiol 2001; 11:585-7. [PMID: 11354751 DOI: 10.1007/s003300000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 32-year-old man presented with severe abdominal pain located in the mesogastrium and right hemi-abdomen. A barium transit study showed a tubular structure of 6 cm arising from a bowel loop in the distal ileum, with an intraluminal polypoid mass near the bottom. Diagnosis of a benign lesion within a Meckel's diverticulum was made. Anatomopathology confirmed a Meckel's diverticulum and demonstrated that the polypoid mass was caused by an unusual great ectopic island of gastric mucosa.
Collapse
Affiliation(s)
- P Dewandel
- Department of Radiology, University Hospitals, K.U. Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
39
|
Maleux G, van Steenbergen W, Stockx L, Vanbeckevoort D, Wilms G, Marchal G. Multiple small pseudoaneurysms complicating pancreatitis: angiographic diagnosis and transcatheter embolization. Eur Radiol 2001; 10:1127-9. [PMID: 11003408 DOI: 10.1007/s003309900262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report a case of retroperitoneal hemorrhage due to multiple, small pseudoaneurysms complicating a chronic alcoholic pancreatitis. Cross-sectional imaging with CT and US could not clearly depict these vascular lesions. Selective arteriography of the superior mesenteric and gastroduodenal arteries clearly showed the small pseudoaneurysms and definitive treatment was performed by transcatheter embolization using coils. Eight months after successful embolization, the patient is asymptomatic without any recurrent bleeding.
Collapse
Affiliation(s)
- G Maleux
- Department of Radiology, University Hospitals, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
40
|
Vanbeckevoort D, Verswijvel G, Van Hoe L, Smet M. Congenital anomalies of the spleen. JBR-BTR 2000; 83:200-2. [PMID: 11126791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- D Vanbeckevoort
- Department of Radiology, University Hospitals Leuven, Belgium
| | | | | | | |
Collapse
|
41
|
Abstract
This article presents a case of appendicitis 7 years after open appendectomy. Together with the apparent CT findings we discuss the current literature of this issue.
Collapse
Affiliation(s)
- M Thomeer
- Department of Radiology, University Hospitals, Leuven, Belgium
| | | | | | | | | | | | | |
Collapse
|
42
|
Van Hoe L, De Jaegere T, Bosmans H, Stockx L, Vanbeckevoort D, Oyen R, Fagard R, Marchal G. Breath-hold contrast-enhanced three-dimensional MR angiography of the abdomen: time-resolved imaging versus single-phase imaging. Radiology 2000; 214:149-56. [PMID: 10644115 DOI: 10.1148/radiology.214.1.r00ja12149] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate a technique for time-resolved breath-hold contrast material-enhanced three-dimensional magnetic resonance (MR) angiography of the abdomen. MATERIALS AND METHODS In a prospective study, 43 patients underwent time-resolved MR angiography (acquisition time per data set, 7 seconds). The patients also underwent single-phase high-spatial-resolution MR angiography (acquisition time, 27 seconds) (n = 6), conventional angiography (n = 7), or both (n = 30). No bolus timing study was performed for time-resolved MR angiography. Image quality (presence of artifacts, ability to prevent venous overlap on arterial phase images, contrast enhancement) and demonstration of anatomic variants (renal arterial and venous variants, vena caval anomaly, visceral arterial variants) and vascular diseases were assessed. RESULTS Time-resolved MR angiographic images were characterized by fewer and less severe artifacts, less overlap of enhancing veins, and better contrast enhancement than were single-phase MR angiographic images (P < .05). The mean sensitivity and specificity were 90% (nine of 10) and 100% (1 73 of 1 73), respectively, for detection of arterial anatomic variants and 93% (28 of 30) and 100% (324 of 325), respectively, for detection of disease. The technique also proved to be reliable for demonstration of venous disease. CONCLUSION In comparison with current non-time-resolved MR angiographic techniques, time-resolved MR angiography is more robust and easier to perform and allows simultaneous evaluation of arterial and venous disease.
Collapse
Affiliation(s)
- L Van Hoe
- Department of Radiology, University Hospitals, Katholieke Universiteit Leuven, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Van Hoe L, Vanbeckevoort D, Oyen R, Itzlinger U, Vergote I. Cervical carcinoma: optimized local staging with intravaginal contrast-enhanced MR imaging--preliminary results. Radiology 1999; 213:608-11. [PMID: 10551250 DOI: 10.1148/radiology.213.2.r99oc23608] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ten patients suspected of having cervical carcinoma underwent magnetic resonance (MR) imaging before and after opacification of the vagina with a mixture of barium, water, and maltodextrin/calcium lactate. Use of vaginal contrast medium resulted in improved visualization of the vaginal wall, lumen, and fornices in all patients and in a change in local tumor stage in two patients (20%). This technique may contribute to improved noninvasive staging of cervical carcinoma.
Collapse
Affiliation(s)
- L Van Hoe
- Department of Radiology, University Hospitals Catholic University, Leuven, Belgium.
| | | | | | | | | |
Collapse
|
44
|
Roels K, Bogaert J, Van Hoe L, Vanbeckevoort D, Delvaux S. Xanthogranulomatous cholecystitis associated with a xanthogranulomatous pseudotumour on the left diaphragm. Eur Radiol 1999; 9:1139-41. [PMID: 10415252 DOI: 10.1007/s003300050808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We present a case of xanthogranulomatous cholecystitis associated with a xanthogranulomatous vegetation on the left diaphragm with breakthrough into the thoracic cavity. A similar case has not previously been reported.
Collapse
Affiliation(s)
- K Roels
- Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | | | | | | | | |
Collapse
|
45
|
Verswijvel G, Vanbeckevoort D, Maes B, Oyen R. Paroxysmal nocturnal haemoglobinuria. MRI of renal cortical haemosiderosis in two patients, including one renal transplant. Nephrol Dial Transplant 1999; 14:1586-9. [PMID: 10383034 DOI: 10.1093/ndt/14.6.1586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Verswijvel
- Department of Radiology, Catholic University of Leuven, University Hospitals, Belgium
| | | | | | | |
Collapse
|
46
|
Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J. Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 1999. [PMID: 10194705 DOI: 10.1002/(sici)1522-2586(199903)9:3%3c373::aid-jmri2%3e3.0.co;2-h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.
Collapse
Affiliation(s)
- D Vanbeckevoort
- Department of Radiology, University Hospitals, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
47
|
Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J. Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 1999; 9:373-7. [PMID: 10194705 DOI: 10.1002/(sici)1522-2586(199903)9:3<373::aid-jmri2>3.0.co;2-h] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.
Collapse
Affiliation(s)
- D Vanbeckevoort
- Department of Radiology, University Hospitals, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
We report a case of a woman diagnosed with a solitary true cyst of the pancreas. CT and especially MRI guided us in the diagnosis of this benign lesion. The cyst has been surgically removed because of secondary bile-duct obstruction causing painless jaundice. Clinical history, laboratory, imaging, and histological findings are reported.
Collapse
Affiliation(s)
- E Heindryckx
- Department of Radiology, University Hospitals, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
49
|
Heindryckx E, Van Hoe L, Vanbeckevoort D, Goris H, Ectors N, Aerts R, Marchal G. Quiz case of the month. The microscopic features defined this pancreatic mass as a macrocystic variant of serous cystadenoma. Eur Radiol 1998; 8:1497-8. [PMID: 9853243 DOI: 10.1007/s003300050581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E Heindryckx
- Department of Radiology, University Hospitals Leuven, Belgium
| | | | | | | | | | | | | |
Collapse
|
50
|
Van Hoe L, Gryspeerdt S, Vanbeckevoort D, De Jaegere T, Van Steenbergen W, Dewandel P, Baert AL, Marchal G. Normal Vaterian sphincter complex: evaluation of morphology and contractility with dynamic single-shot MR cholangiopancreatography. AJR Am J Roentgenol 1998; 170:1497-500. [PMID: 9609161 DOI: 10.2214/ajr.170.6.9609161] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study was to assess the usefulness of dynamic single-shot MR cholangiopancreatography in the evaluation of the morphology and contractility of the normal Vaterian sphincter complex and to assess whether i.v. injection of glucagon can improve visualization. SUBJECTS AND METHODS Sixty patients without signs of Vaterian sphincter complex dysfunction were studied. A fast single-shot MR imaging sequence was used to obtain 20 consecutive images of the Vaterian sphincter complex during successive episodes of breathholding. In patients of group A (n = 30), 10 images were obtained before and 10 after i.v. administration of a sphincter-relaxing agent (glucagon). In the patients of group B (n = 30), no glucagon was administered. The degree of visualization of the Vaterian sphincter complex was assessed. RESULTS Overall, the morphology and contractility of the Vaterian sphincter complex was adequately assessed in 57 patients (95%). However, the number of repetitions required to obtain this result varied greatly (mean, seven; range, two to 18). Glucagon had no apparent effect on the visibility of the most distal portion of the common bile duct. CONCLUSION Nonvisualization of the most distal portion of the common bile duct on MR cholangiopancreatography studies is a normal variant that can simulate disease. Obtaining serial breath-hold images using a single-shot technique is helpful to avoid diagnostic errors.
Collapse
Affiliation(s)
- L Van Hoe
- Department of Radiology, University Hospitals Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|