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Erbay IH, Alexiadis A, Rochev Y. Computational insights into colonic motility: Mechanical role of mucus in homeostasis and inflammation. Comput Biol Med 2024; 176:108540. [PMID: 38728996 DOI: 10.1016/j.compbiomed.2024.108540] [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: 10/13/2023] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024]
Abstract
Colonic motility plays a vital role in maintaining proper digestive function. The rhythmic contractions and relaxations facilitate various types of motor functions that generate both propulsive and non-propulsive motility modes which in turn generate shear stresses on the epithelial surface. However, the interplay between colonic mucus, shear stress, and epithelium remains poorly characterized. Here, we present a colonic computational model that describes the potential roles of mucus and shear stress in both homeostasis and ulcerative colitis (UC). Our model integrates several key features, including the properties of the mucus bilayer and faeces, intraluminal pressure, and crypt characteristics to predict the time-space mosaic of shear stress. We show that the mucus thickness which could vary based on the severity of UC, may significantly reduce the amount of shear stress applied to the colonic crypts and effect faecal velocity. Our model also reveals an important spatial shear stress variance in homeostatic colonic crypts that suggests shear stress may have a modulatory role in epithelial cell migration, differentiation, apoptosis, and immune surveillance. Together, our study uncovers the rather neglected roles of mucus and shear stress in intestinal cellular processes during homeostasis and inflammation.
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Affiliation(s)
- I H Erbay
- School of Physics, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - A Alexiadis
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Y Rochev
- School of Physics, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland.
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Finocchiaro M, Banfi T, Donaire S, Arezzo A, Guarner-Argente C, Menciassi A, Casals A, Ciuti G, Hernansanz A. A Framework for the Evaluation of Human Machine Interfaces of Robot-Assisted Colonoscopy. IEEE Trans Biomed Eng 2024; 71:410-422. [PMID: 37535479 DOI: 10.1109/tbme.2023.3301741] [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: 08/05/2023]
Abstract
The Human Machine Interface (HMI) of intraluminal robots has a crucial impact on the clinician's performance. It increases or decreases the difficulty of the tasks, and is connected to the users' physical and mental stress. OBJECTIVE This article presents a framework to compare and evaluate different HMIs for robotic colonoscopy, with the objective of identifying the optimal HMI that minimises the clinician's effort and maximises the clinical outcomes. METHODS The framework comprises a 1) a virtual simulator (clinically validated), 2) wearable sensors measuring the cognitive load, 3) a data collection unit of metrics correlated to the clinical performance, and 4) questionnaires exploring the users' impressions and perceived stress. The framework was tested with 42 clinicians investigating the optimal device for tele-operated control of robotic colonoscopes. Two control devices were selected and compared: a haptic serial-kinematic device and a standard videogame joypad. RESULTS The haptic device was preferred by the endoscopists, but the joypad enabled better clinical performance and reduced cognitive and physical load. CONCLUSION The framework can be used to evaluate different aspects of a HMI, both hardware and software, and determine the optimal HMI that can reduce the burden on clinicians while improving the clinical outcome. SIGNIFICANCE The findings of this study, and of future studies performed with this framework, can inform the design and development of HMIs for intraluminal robots, leading to improved clinical performance, reduced physical and mental stress for clinicians, and ultimately better patient outcomes.
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Tiralongo F, Di Pietro S, Milazzo D, Galioto S, Castiglione DG, Ini’ C, Foti PV, Mosconi C, Giurazza F, Venturini M, Zanghi’ GN, Palmucci S, Basile A. Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template. Diagnostics (Basel) 2023; 13:3628. [PMID: 38132212 PMCID: PMC10742435 DOI: 10.3390/diagnostics13243628] [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: 10/13/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Acute colonic diverticulitis (ACD) is the most common complication of diverticular disease and represents an abdominal emergency. It includes a variety of conditions, extending from localized diverticular inflammation to fecal peritonitis, hence the importance of an accurate diagnosis. Contrast-enhanced computed tomography (CE-CT) plays a pivotal role in the diagnosis due to its high sensitivity, specificity, accuracy, and interobserver agreement. In fact, CE-CT allows alternative diagnoses to be excluded, the inflamed diverticulum to be localized, and complications to be identified. Imaging findings have been reviewed, dividing them into bowel and extra-intestinal wall findings. Moreover, CE-CT allows staging of the disease; the most used classifications of ACD severity are Hinchey's modified and WSES classifications. Differential diagnoses include colon carcinoma, epiploic appendagitis, ischemic colitis, appendicitis, infectious enterocolitis, and inflammatory bowel disease. We propose a structured reporting template to standardize the terminology and improve communication between specialists involved in patient care.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Stefano Di Pietro
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Dario Milazzo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Sebastiano Galioto
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Corrado Ini’
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy;
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | | | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
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Scharitzer M, Lampichler K, Popp S, Mang T. [Computed tomography and magnetic resonance imaging of colonic diseases]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01150-7. [PMID: 37219728 DOI: 10.1007/s00117-023-01150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Early diagnosis of a luminal colonic disease is of essential clinical importance to start timely optimised therapy and detect complications early. OBJECTIVES This paper aims to provide an overview of the use of radiological methods in diagnosing neoplastic and inflammatory luminal diseases of the colon. Characteristic morphological features are discussed and compared. MATERIALS AND METHODS Based on an extensive literature review, the current state of knowledge regarding the imaging diagnosis of luminal pathologies of the colon and their importance in patient management is presented. RESULTS Technological advances in imaging have made the diagnosis of neoplastic and inflammatory colonic diseases using abdominal computed tomography and magnetic resonance imaging the established standard. Imaging is performed as part of the initial diagnosis in clinically symptomatic patients, to exclude complications, as a follow-up assessment under therapy and as an optional screening method in asymptomatic individuals. CONCLUSIONS Accurate knowledge of the radiological manifestations of the numerous luminal disease patterns, the typical distribution pattern and characteristic bowel wall changes are essential to improve diagnostic decision-making.
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Affiliation(s)
- Martina Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich.
| | - Katharina Lampichler
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich
| | - Sabine Popp
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich
| | - Thomas Mang
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Waehringer Guertel 18-20, 1090, Wien, Österreich
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Lin Y, Kou S, Nie H, Luo H, Eltahir A, Chapman W, Hunt S, Mutch M, Zhu Q. Deep learning based on co-registered ultrasound and photoacoustic imaging improves the assessment of rectal cancer treatment response. BIOMEDICAL OPTICS EXPRESS 2023; 14:2015-2027. [PMID: 37206148 PMCID: PMC10191638 DOI: 10.1364/boe.487647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 05/21/2023]
Abstract
Identifying complete response (CR) after rectal cancer preoperative treatment is critical to deciding subsequent management. Imaging techniques, including endorectal ultrasound and MRI, have been investigated but have low negative predictive values. By imaging post-treatment vascular normalization using photoacoustic microscopy, we hypothesize that co-registered ultrasound and photoacoustic imaging will better identify complete responders. In this study, we used in vivo data from 21 patients to develop a robust deep learning model (US-PAM DenseNet) based on co-registered dual-modality ultrasound (US) and photoacoustic microscopy (PAM) images and individualized normal reference images. We tested the model's accuracy in differentiating malignant from non-cancer tissue. Compared to models based on US alone (classification accuracy 82.9 ± 1.3%, AUC 0.917(95%CI: 0.897-0.937)), the addition of PAM and normal reference images improved the model performance significantly (accuracy 92.4 ± 0.6%, AUC 0.968(95%CI: 0.960-0.976)) without increasing model complexity. Additionally, while US models could not reliably differentiate images of cancer from those of normalized tissue with complete treatment response, US-PAM DenseNet made accurate predictions from these images. For use in the clinical settings, US-PAM DenseNet was extended to classify entire US-PAM B-scans through sequential ROI classification. Finally, to help focus surgical evaluation in real time, we computed attention heat maps from the model predictions to highlight suspicious cancer regions. We conclude that US-PAM DenseNet could improve the clinical care of rectal cancer patients by identifying complete responders with higher accuracy than current imaging techniques.
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Affiliation(s)
- Yixiao Lin
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Sitai Kou
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Haolin Nie
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Hongbo Luo
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Ahmed Eltahir
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Will Chapman
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Steven Hunt
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew Mutch
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Xi Y, Li Y, Ying S, Yan J, Shi Z. Bacterial lipopolysaccharide with different administration routes affects intestinal mucosal morphological, immunological, and microbial barrier functions in goslings. Poult Sci 2023; 102:102599. [PMID: 36940655 PMCID: PMC10033283 DOI: 10.1016/j.psj.2023.102599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
The current study was conducted to evaluate the effects of different administration routes of bacterial lipopolysaccharide (LPS) on intestinal mucosal morphological, immunological, and microbial barrier functions in goslings. First, we compared intestinal villi morphology of goslings under intraperitoneal or oral LPS treatment through hematoxylin and eosin staining. Then, we determined the signatures of the microbiome in the ileum mucosa of goslings subjected to oral LPS treatment at 0, 2, 4, and 8 mg/kg BW by 16S sequencing, and analyzed the changes in intestinal barrier functions and permeability, levels of LPS in the ileum mucosa, plasma, and liver tissue, and the induced inflammatory response of Toll-like receptor 4 (TLR4). As a result, intraperitoneal LPS injection resulted in a thicker intestinal wall in the ileum within a short time, whereas villus height was less affected; in contrast, oral LPS treatment exerted a stronger influence on villus height but not on intestinal wall thickness. We also found that oral LPS treatment affected the structure of the intestinal microbiome, reflected by changes in the clustering of intestinal microbiota. The average abundance of Muribaculaceae showed an increasing trend with increasing LPS levels, and that of the genus Bacteroides decreased, compared with the control group. In addition, oral LPS treatment with 8 mg/kg BW affected the intestinal epithelial morphology, damage the mucosal immune barrier, downregulated the expression of tight junction proteins, increased circulating D-lactate levels, and stimulated the secretion of various inflammatory mediators and activation of the TLR4/MyD88/NFκB pathway. This study presented the injuries of intestinal mucosal barrier function induced by LPS challenges in goslings and provided a scientific model for searching the novel strategies to attenuate the immunological stress and gut injury caused by LPS.
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Affiliation(s)
- Yumeng Xi
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base, Ministry of Science and Technology, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Yue Li
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base, Ministry of Science and Technology, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Shijia Ying
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base, Ministry of Science and Technology, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Junshu Yan
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base, Ministry of Science and Technology, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China.
| | - Zhendan Shi
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base, Ministry of Science and Technology, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
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Berton M, Bettonte S, Stader F, Battegay M, Marzolini C. Repository Describing the Anatomical, Physiological, and Biological Changes in an Obese Population to Inform Physiologically Based Pharmacokinetic Models. Clin Pharmacokinet 2022; 61:1251-1270. [PMID: 35699913 PMCID: PMC9439993 DOI: 10.1007/s40262-022-01132-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
Abstract
Background Obesity is associated with physiological changes that can affect drug pharmacokinetics. Obese individuals are underrepresented in clinical trials, leading to a lack of evidence-based dosing recommendations for many drugs. Physiologically based pharmacokinetic (PBPK) modelling can overcome this limitation but necessitates a detailed description of the population characteristics under investigation. Objective The purpose of this study was to develop and verify a repository of the current anatomical, physiological, and biological data of obese individuals, including population variability, to inform a PBPK framework. Methods A systematic literature search was performed to collate anatomical, physiological, and biological parameters for obese individuals. Multiple regression analyses were used to derive mathematical equations describing the continuous effect of body mass index (BMI) within the range 18.5–60 kg/m2 on system parameters. Results In total, 209 studies were included in the database. The literature reported mostly BMI-related changes in organ weight, whereas data on blood flow and biological parameters (i.e. enzyme abundance) were sparse, and hence physiologically plausible assumptions were made when needed. The developed obese population was implemented in Matlab® and the predicted system parameters obtained from 1000 virtual individuals were in agreement with observed data from an independent validation obese population. Our analysis indicates that a threefold increase in BMI, from 20 to 60 kg/m2, leads to an increase in cardiac output (50%), liver weight (100%), kidney weight (60%), both the kidney and liver absolute blood flows (50%), and in total adipose blood flow (160%). Conclusion The developed repository provides an updated description of a population with a BMI from 18.5 to 60 kg/m2 using continuous physiological changes and their variability for each system parameter. It is a tool that can be implemented in PBPK models to simulate drug pharmacokinetics in obese individuals.
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Affiliation(s)
- Mattia Berton
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Sara Bettonte
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Gastrointestinal Computed Tomography Findings in Chronic Granulomatous Disease with Subgroup Clinicopathologic Analysis. Dig Dis Sci 2022; 67:1831-1842. [PMID: 33934254 DOI: 10.1007/s10620-021-06978-4] [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: 06/30/2020] [Accepted: 03/30/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is a rare primary immunodeficiency which can lead to gastrointestinal (GI) complications including inflammatory bowel disease. Radiographic findings in this cohort have not been well described. AIMS To describe the frequency and spectrum of gastrointestinal abnormalities seen on computed tomography (CT) in patients with CGD and determine whether radiography was predictive of endoscopic or histopathologic inflammatory findings. METHODS A retrospective review was conducted on 141 consecutive CGD patients seen at the National Institutes of Health between 1988 and 2011. All corresponding CTs were reviewed for gastrointestinal abnormalities including wall thickening. Endoscopic and histopathologic findings were reviewed in subjects with documented endoscopy within 30 days of an imaging study. Findings were compared between patients with and without wall thickening on CT to determine whether bowel wall thickening was predictive of endoscopic or histologic inflammatory findings. RESULTS Two hundred and ninety-two CTs were reviewed. GI wall thickening was present on CT in 61% of patients (n = 86). Among a subgroup of 20 patients who underwent endoscopy at the time of their imaging, there was a statistically significant correlation between radiographic gastrointestinal wall thickening and endoscopic inflammation in the same intestinal segment (p = 0.035). Additionally, there was a significant correlation between radiographic gastrointestinal wall thickening and inflammatory features on histopathology (p = 0.02). CONCLUSIONS GI abnormalities are commonly observed on CT in CGD patients. Bowel wall thickening correlates with endoscopic and histopathologic evidence of inflammation. These findings may be used to better facilitate directed endoscopic assessment and histopathologic sampling in patients with CGD.
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Kwok K, Tran T, Lew D. Polypectomy for Large Polyps with Endoscopic Mucosal Resection. Gastrointest Endosc Clin N Am 2022; 32:259-276. [PMID: 35361335 DOI: 10.1016/j.giec.2021.12.004] [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: 02/04/2023]
Abstract
Beginning in 1955, when the saline injection was first described to prevent transmural injury during polyp fulguration, endoscopic mucosal resection (EMR) has grown exponentially, both in scope and in practice. Because EMR is an organ-preserving technique even for large polyps, this allows for comparable outcomes to surgery, but substantially improved cost savings and significantly reduced morbidity and mortality. To achieve this, however, one must master the 4 fundamental components that are critical to the success of EMR- time, team, tools, and technique. This article aims to provide a compendium of state of the art updates within the field of endoluminal resection.
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Affiliation(s)
- Karl Kwok
- Interventional Endoscopy, Division of Gastroenterology, Kaiser Permanente, Los Angeles Medical Center, 1526 North Edgemont Street, 7th Floor, Los Angeles, CA 90027, USA.
| | - Tri Tran
- Department of Medicine, Kaiser Permanente, Los Angeles Medical Center, 4867 W Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Daniel Lew
- Division of Gastroenterology, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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AVCI MA. Endoscopic Findings of the Gastrointestinal Tract and Conjunctions with Preceding Tomography Findings. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.924320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Ghahremani GG. Intramural diverticulosis and diverticulitis of the colon: Pictorial essay. Clin Imaging 2021; 81:150-156. [PMID: 34743065 DOI: 10.1016/j.clinimag.2021.10.006] [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: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 11/03/2022]
Abstract
Diverticulosis of the colon is a gradually progressive disease that usually starts in early adulthood and increases with advancing age in its anatomical extent and the size of diverticula. It is important to recognize the initial stages of diverticular development in young patients in order to properly diagnose and manage the potential complications of this very common intestinal disorder. This article presents the pathological and radiological features of early diverticular formation, when the mucosal outpouchings are very small and contained within the colonic wall as distinct intramural lesions. The subsequent development of intramural diverticulitis and the spectrum of its manifestations on barium enema examination or Computed tomography (CT) are illustrated.
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Affiliation(s)
- Gary G Ghahremani
- Department of Radiology, University of California-San Diego Medical Center, 200 W. Arbor Drive, San Diego, CA 92103, USA.
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12
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Intraoperative Control of Hemoglobin Oxygen Saturation in the Intestinal Wall during Anastomosis Surgery. PHOTONICS 2021. [DOI: 10.3390/photonics8100427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
During surgery for colon cancer, monitoring of the oxygen saturation of hemoglobin in the tissues under study makes it possible to assess the degree of blood supply to the anastomosis areas of the colon. Adequate blood supply in this area is decisive in terms of the consistency of the anastomosis and can significantly reduce the risk leakage of anastomosis. In this work, we propose a new approach to assessing the hemoglobin oxygen saturation based on measuring both the diffuse reflectance and transmittance spectra of the colon wall tissues. The proposed method is based on the use of two fiber-optic tools for irradiation from both sides—the intestinal lumen and the outside of the intestinal wall. The spectra are recorded from the external side. To determine the degree of hemoglobin saturation, two algorithms, both based on the Taylor series expansion of the coefficient of light attenuation by tissues, are proposed. The results of a clinical study of the proposed approach on volunteers were obtained, allowing to draw a conclusion about the applicability of the approach in a clinical setting.
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Quantitative Assessment of Radiologically Indeterminate Local Colonic Wall Thickening on Iodine Density Images Using Dual-Layer Spectral Detector CT. Acad Radiol 2021; 28:1368-1374. [PMID: 32622742 DOI: 10.1016/j.acra.2020.06.012] [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: 03/18/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES To assess local colonic wall thickening (LCWT, thicknesses: >3 mm, lengths: <5 cm) quantitatively on iodine density images using dual-layer spectral detector computed tomography (DLSCT). MATERIALS AND METHODS This retrospective study included 80 patients who underwent both conventional contrast-enhanced CT and colonoscopy within one month. The region of interest was delineated on the chosen images with the iodine density image model. The iodine concentration (IC), normalized IC (NIC), and thickness of the colonic wall in the lesion area were compared between the pathological and nonpathological groups. RESULTS There were 50 patients whose area of LCWT discovered at CT scans displayed colon neoplasia at colonoscopy. The other 30 patients with LCWT on CT images showed normal appearances during colonoscopy. There was no significant difference in colonic wall thickness between the pathological and nonpathological (p> 0.05) LCWT groups. The IC and NIC of patients with colon neoplasms were significantly higher than those with nonpathologic LCWT (both p< 0.001). The ROC curve showed that when IC and NIC was 1.49 mg/mL and 0.33, the sensitivity and specificity for diagnosing colon neoplasm were 91.5% and 75.8%, 85.1% and 84.8%, respectively. CONCLUSION IC and NIC values from DLSCT could provide a satisfied diagnostic value to identify LCWT caused by colon neoplasia.
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Kurokawa R, Hagiwara A, Tanishima T, Inui S, Kurokawa M, Nakaya M, Gonoi W, Amemiya S, Nakai Y, Fujita N, Ota Y, Baba A, Abe O. CT imaging findings of lenvatinib-induced enteritis. Abdom Radiol (NY) 2021; 46:3066-3074. [PMID: 33674959 DOI: 10.1007/s00261-021-03006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the relationship between abnormal findings on abdomino-pelvic CT and adverse events in oncologic patients treated with lenvatinib, and their relationship with treatment planning. METHODS This single institutional retrospective study included 58 patients with unresectable hepatocellular carcinoma or unresectable thyroid carcinoma (mean age ± standard deviation 69.6 ± 10.0 years; range 39-84 years; 48 men) who underwent CT between October 2016 and July 2020. Two radiologists who were blinded to clinical information including the presence or absence of diarrhea evaluated the imaging findings, including the presence/absence of enteritis in each intestinal segment. Gastrointestinal adverse events (diarrhea, decreased appetite, nausea, and vomiting) and other drug-induced adverse events requiring treatment or follow-up during lenvatinib treatment were also investigated. The frequency of these adverse events was compared between the patients with and without enteritis using Fisher's exact test or the Mann-Whitney U test. RESULTS Enteritis was found on CT in the majority (33/58 [56.9%]) of the patients, and most of them (25/33 [75.8%]) showed duodenojejunitis. The frequency of gastrointestinal adverse events (28/33 [84.8%] vs. 13/25 [56.0%], p = 0.009), diarrhea (20/33 [60.6%] vs. 3/25 [12.0%], p < 0.001), and drug interruptions (25/33 [75.8%] vs. 10/25 [40.0%], p = 0.008) and the number of other adverse events (3.9 ± 1.7 vs. 2.3 ± 1.3, p < 0.001) were significantly higher in the patients with enteritis on CT than in those without. CONCLUSIONS Lenvatinib-induced enteritis frequently involved the duodenum and jejunum and was related to a significantly higher frequency of treatment interruptions and gastrointestinal adverse events.
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Affiliation(s)
- Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tomoya Tanishima
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shohei Inui
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mariko Kurokawa
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Moto Nakaya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shiori Amemiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yudai Nakai
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nana Fujita
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Akira Baba
- Department of Radiology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Kurokawa M, Kurokawa R, Hagiwara A, Gonoi W, Harayama S, Koizumi K, Yoshino K, Hishima T, Baba A, Ota Y, Abe O, Takaki Y. CT imaging findings of anti-PD-1 inhibitor-related enterocolitis. Abdom Radiol (NY) 2021; 46:3033-3043. [PMID: 33638055 DOI: 10.1007/s00261-021-02986-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Immune checkpoint inhibitors promote the antitumor activity of T cells; however, there is a risk of side effects. The aim of this study was to characterize the computed tomography (CT) findings of one such side effect, anti-programmed cell death-1 antibody-related enterocolitis (αPD-1-EC). METHODS This single-institution retrospective study included 21 patients with αPD-1-EC who underwent CT between January 2015 and April 2020. Two board-certified radiologists independently evaluated the CT findings, including the pattern of intestinal wall enhancement, maximum bowel wall thickness, maximum appendiceal diameter, and involvement of enterocolitis in each intestinal segment. Symptoms and their severity were also investigated. RESULTS Pancolitis and skip lesions involving both the rectosigmoid colon and the cecum were found in 9 patients each (42.9%). The rectum was the most frequently involved lesion (18/21, 85.7%), and appendiceal involvement was found in 11 patients (52.4%). The most frequent wall enhancement pattern was the gray pattern (i.e., mild homogeneous enhancement of the thickened bowel wall). The mean maximum diameter of the involved appendix was 9.6 ± 4.5 mm (range 4.5-18 mm). Frequent symptoms included diarrhea (21/21), fever (8/21), and abdominal pain (7/21). Other concomitant immune-related adverse events were found in 6 patients. CONCLUSIONS Pancolitis, skip lesions, and appendiceal involvement were frequent in patients with αPD-1-EC. When combining these characteristic findings with other clinical findings, such as low-grade diarrhea, other concomitant immune-related adverse events, and anti-PD-1 therapy administration, CT may be a useful diagnostic tool for αPD-1-EC.
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Affiliation(s)
- Mariko Kurokawa
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shinjiro Harayama
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Koichi Koizumi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Koji Yoshino
- Department of Dermato Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Akira Baba
- Department of Radiology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasunobu Takaki
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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McCandless M, Gerald A, Carroll A, Aihara H, Russo S. A Soft Robotic Sleeve for Safer Colonoscopy Procedures. IEEE Robot Autom Lett 2021; 6:5292-5299. [PMID: 34027062 PMCID: PMC8132950 DOI: 10.1109/lra.2021.3073651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Colonoscopy is the gold standard for colorectal cancer diagnosis; however, limited instrument dexterity and no sensor feedback can hamper procedure safety and acceptance. We propose a soft robotic sleeve to provide sensor feedback and additional actuation capabilities to improve safety during navigation in colonoscopy. The robot can be mounted around current endoscopic instrumentation as a disposable "add-on", avoiding the need for dedicated or customized instruments and without disrupting current surgical workflow. We focus on design, finite element analysis, fabrication, and experimental characterization and validation of the soft robotic sleeve. The device integrates soft optical sensors to monitor contact interaction forces between the colon and the colonoscope and soft robotic actuators that can be automatically deployed if excessive force is detected, to guarantee pressure redistribution on a larger contact area of the colon. The system can be operated by a surgeon via a graphic user interface that displays contact force values and enables independent or coordinated pressurization of the soft actuators upon demand, in case deemed necessary to aid navigation or distend colon tissue.
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Affiliation(s)
- Max McCandless
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
| | - Arincheyan Gerald
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
| | - Ashlyn Carroll
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
| | - Hiroyuki Aihara
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Sheila Russo
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
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Hooshangnejad H, Youssefian S, Guest JK, Ding K. FEMOSSA: Patient-specific finite element simulation of the prostate-rectum spacer placement, a predictive model for prostate cancer radiotherapy. Med Phys 2021; 48:3438-3452. [PMID: 34021606 DOI: 10.1002/mp.14990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Major advances in delivery systems in recent years have turned radiotherapy (RT) into a more effective way to manage prostate cancer. Still, adjacency of organs at risk (OARs) can severely limit RT benefits. Rectal spacer implant in recto-prostatic space provides sufficient separation between prostate and rectum, and therefore, the opportunity for potential dose escalation to the target and reduction of OAR dose. Pretreatment simulation of spacer placement can potentially provide decision support to reduce the risks and increase the efficacy of the spacer placement procedure. METHODS A novel finite element method-oriented spacer simulation algorithm, FEMOSSA, was developed in this study. We used the finite element (FE) method to model and predict the deformation of rectum and prostate wall, stemming from hydrogel injection. Ten cases of prostate cancer, which undergone hydrogel placement before the RT treatment, were included in this study. We used the pre-injection organ contours to create the FE model and post-injection spacer location to estimate the distribution of the virtual spacer. Material properties and boundary conditions specific to each patient's anatomy were assigned. The FE analysis was then performed to determine the displacement vectors of regions of interest (ROIs), and the results were validated by comparing the virtually simulated contours with the real post-injection contours. To evaluate the different aspects of our method's performance, we used three different figures of merit: dice similarity coefficient (DSC), nearest neighbor distance (NND), and overlapped volume histogram (OVH). Finally, to demonstrate a potential dosimetric application of FEMOSSA, the predicted rectal dose after virtual spacer placement was compared against the predicted post-injection rectal dose. RESULTS Our simulation showed a realistic deformation of ROIs. The post-simulation (virtual spacer) created the same separation between prostate and rectal wall, as post-injection spacer. The average DSCs for prostate and rectum were 0.87 and 0.74, respectively. Moreover, there was a statistically significant increase in rectal contour similarity coefficient (P < 0.01). Histogram of NNDs showed the same overall shape and a noticeable shift from lower to higher values for both post-simulation and post-injection, indicative of the increase in distance between prostate and rectum. There was less than 2.2- and 2.1-mm averaged difference between the mean and fifth percentile NNDs. The difference between the OVH distances and the corresponding predicted rectal dose was, on average, less than 1 mm and 1.5 Gy, respectively. CONCLUSIONS FEMOSSA provides a realistic simulation of the hydrogel injection process that can facilitate spacer placement planning and reduce the associated uncertainties. Consequently, it increases the robustness and success rate of spacer placement procedure that in turn improves prostate cancer RT quality.
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Affiliation(s)
- Hamed Hooshangnejad
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sina Youssefian
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Civil and Systems Engineering, The Johns Hopkins University, Baltimore, Maryland, USA
| | - James K Guest
- Department of Civil and Systems Engineering, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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18
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Lee DK, Cho KY, Cho HH, Seo JW. Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance. Pediatr Gastroenterol Hepatol Nutr 2021; 24:279-287. [PMID: 34046331 PMCID: PMC8128780 DOI: 10.5223/pghn.2021.24.3.279] [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] [Received: 01/18/2020] [Revised: 01/04/2021] [Accepted: 02/16/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The clinical implications of bowel wall thickening (BWT) on abdominal computed tomography (CT) among children are unknown. We aimed to suggest a new method for measuring BWT and determining its clinical significance in children. METHODS We retrospectively analyzed 423 patients with acute abdomen who underwent abdominal CT; 262 were classified into the BWT group. For this group, the pediatric radiologist described the maximal bowel wall thickness (MT), normal bowel wall thickness (mm) (NT), and their ratios for each segment of the bowel wall. RESULTS In the thickened bowel walls, the thickness differed significantly between the small bowel (6.83±2.14 mm; mean±standard deviation) and the colon (8.56±3.46 mm; p<0.001). The ratios of MT to NT in the small bowel (6.09±3.17) and the colon (7.58±3.70) were also significantly different (p<0.001). In the BWT group, 35 of 53 patients had positive fecal polymerase chain reaction results; 6 patients infected with viruses predominantly had BWT in the small intestine, while the terminal ileum and the colon were predominantly affected in 29 patients with bacterial infections. In the initially undiagnosed 158 patients with BWT, the symptoms improved spontaneously without progression to chronic gastrointestinal disease. CONCLUSION This study provides a clinical reference value for BWT in the small intestine and colon using a new method in children. The BWT on abdominal CT in children might indicate nonspecific findings that can be observed and followed up without additional evaluation, unlike in adults.
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Affiliation(s)
- Do Kyung Lee
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ky Young Cho
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun-Hae Cho
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jeong Wan Seo
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea
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Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study. Surg Endosc 2021; 36:155-166. [PMID: 33532930 DOI: 10.1007/s00464-020-08250-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although reduced port laparoscopic surgery (RPLS), defined as laparoscopic surgery performed with the minimum possible number of ports and/or small-sized ports, is less invasive than conventional laparoscopic surgery by reducing the number of surgical wounds, an extension of the incision is still needed for specimen extraction, which can undermine the merits of RPLS. OBJECTIVE To determine the impact of natural orifice specimen extraction (NOSE) in patients undergoing RPLS for colorectal cancer. The endpoints were perioperative outcome and oncologic safety at 3 years. SETTING Single-center experience (2013-2019). PATIENTS We retrospectively analyzed our prospectively collected patient records (American Joint Committee on Cancer (AJCC) stage I-III sigmoid or upper rectal cancer (tumor diameter ≤ 5 cm) who underwent curative anterior resection via RPLS. We excluded patients who did not undergo intestinal anastomosis. INTERVENTIONS Perioperative and oncologic outcomes were compared between patients undergoing natural orifice (RPLS-NOSE) or conventional (mini-laparotomy) specimen extraction (RPLS-CSE). Patients were matched by propensity scores 1:1 for tumor diameter, AJCC stage, American Society of Anesthesiologists score and tumor location. RESULTS Of 119 eligible patients, 104 were matched (52 RPLS-NOSE; 52 RPLS-CSE) by propensity scores. Compared with RPLS-CSE, RPLS-NOSE was associated with longer operative time (223.9 vs. 188.7 min; p = 0.003), decreased use of analgesics (morphine dose 33.9 vs. 43.4 mg; p = 0.011) and duration of hospital stay (4.2 vs. 5.1 days; p = 0.001). No statistically significant difference was found in morbidity or wound-related complication rates between the two groups. After a median follow-up of 34.3 months, no local recurrence was observed in RPLS-NOSE. The 3-year disease-free survival did not differ statistically significantly between groups (90.9 vs. 90.5%; p = 0.610). CONCLUSION NOSE enhances the advantages of RPLS by avoiding the need for abdominal wall specimen extraction in patients with tumor diameter ≤ 5 cm. Surgical and oncologic safety are comparable to RPLS with CSE.
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Ding J, Zhang W, Wang L, Zhu Z, Wang J, Ma J. Idiopathic mesenteric phlebosclerosis: clinical and CT imaging characteristics. Quant Imaging Med Surg 2021; 11:763-771. [PMID: 33532275 DOI: 10.21037/qims-20-301] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The aim of our study was to evaluate the clinical characteristics and computed tomography (CT) imaging findings of idiopathic mesenteric phlebosclerosis (IMP). Methods From January 2013 to May 2019, the clinical data of 10 patients diagnosed with IMP were analyzed retrospectively. Computed tomography angiography (CTA) and colonoscopy were performed in all 10 patients. All CT imaging findings were evaluated by three radiologists, including the form and distribution of calcification, the bowel's thickness, and the surrounding fat gap. The calcification score was calculated according to the extent of the involved mesenteric veins. The colonic wall thickness was defined as the average value of the thickest and thinnest regions of the intestinal wall. The correlation between the calcification scores and the colonic wall thickness was analyzed using Spearman's correlation analysis. Results All 10 patients were male with an average age of 59.6 years (range, 51-83 years). The average smoking index was 712 (range, 0-1,800). Among them, 7 patients had a history of long-term excessive daily intake of medicinal liquor or Chinese herbal medicine. Clinical symptoms of abdominal pain, diarrhea, bloating, and nausea were found. Colonoscopy showed dark purple discolorations of the edematous mucosa, engorged blood vessels, extensive erosion, ulceration, and multi-focal nodular surface in all patients. CT demonstrated colonic wall thickening, calcification along the mesenteric vein, and blurry surrounding fat gap in all 10 patients. Mesenteric venous calcification involved the terminal ileum, the ascending and transverse colon in all patients, and the descending colon and sigmoid colon's involvement in two patients. A total of 33 segments of the intestinal wall were involved. The median calcification score was 6 points, the mean thickness of the colonic wall was 10.73±3.22 mm, and there was no significant correlation (P=0.782) between calcification score and thickness of the colonic wall. Conclusions The main features of IMP are mesenteric venous calcification, colonic wall thickness, and pericolic fat stranding, and there is no correlation between calcification score and colonic wall thickness. Therefore, CT imaging combined with colonoscopy can improve the diagnostic accuracy of IMP.
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Affiliation(s)
- Jian Ding
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Weiqiang Zhang
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Lizhang Wang
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zefeng Zhu
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jia Wang
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianbing Ma
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Minordi LM, Larosa L, Berte G, Pecere S, Manfredi R. CT of the acute colonic diverticulitis: a pictorial essay. Diagn Interv Radiol 2020; 26:546-551. [PMID: 33180020 DOI: 10.5152/dir.2020.19645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute colonic diverticulitis (ACD) is an acute episode of severe and prolonged lower abdominal pain due to diverticular inflammation, usually associated with change in bowel movements, fever, and leukocytosis. Worldwide, computed tomography (CT) of the abdomen and pelvis with intravenous contrast is accepted as the best imaging method for evaluating the diverticular inflammation, serving the following functions: confirming the presence of ACD; evaluation of the disease severity and degree; therapy planning guide in presence of complications (such as abscess or intestinal perforation); diagnosis of other diseases that may simulate diverticular inflammation. In the literature, we found values of CT sensitivity for diverticular inflammation from 79% to 99%; CT is useful in differentiating other diseases, which may cause abdominal pain, when diverticular inflammation is not the cause, such as neoplasm, inflammatory bowel disease, appendix inflammations, epiploic appendix inflammation and colon ischemia. The trick to differentiate diverticulitis from other inflammatory diseases that involve the colon is the identification of diverticula in the pathological intestinal loop. In the last years, a radiological classification was created in order to guide the management of ACD in patients treated conservatively or with interventional procedures. The new classification system divides ACD into two groups: complicated and uncomplicated. Uncomplicated ACD is defined if only thickening of the intestinal wall is present, with increase of the perivisceral fat density. Complicated ACD is divided into 4 stages, depending on presence of microperforation without abscess and/or peritoneum involvement (stage 1 A), presence of abscess with diameter ≤4 cm (stage 1 B), presence of abscess with diameter >4 cm (stage 2 A), presence of distant air >5 cm from the pathological loop (stage 2 B), presence of diffuse fluid in at least two distant abdominal quadrants without distant free air (stage 3), presence of diffuse fluid and distant free air (stage 4). In this pictorial essay, we describe CT findings of the ACD and explain classification of the disease and its common and uncommon complications.
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Affiliation(s)
- Laura Maria Minordi
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia,Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Roma, Italia
| | - Luigi Larosa
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia,Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Roma, Italia
| | - Giovanna Berte
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Silvia Pecere
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia;Dipartmento di Scienze gastroenterologiche, Endocrino-metaboliche e nefro-urologiche, Gastroenterologia e Oncologia medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Disease Center, Area di Medicina Interna, Roma, Italia
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia,Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Roma, Italia
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22
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Gut wrenching: cases of missed gastrointestinal tumors and their mimics on computed tomography. Emerg Radiol 2020; 28:389-399. [PMID: 33025217 DOI: 10.1007/s10140-020-01832-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: 05/06/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
Computed tomography (CT) of the abdomen and pelvis is one of the most common imaging studies ordered through the emergency department (ED). Because these studies are ordered for the detection of acute abnormalities and due to the relatively low incidence in patients presenting through the ED, gastrointestinal tumors are commonly missed. Moreover, many CT findings of malignant tumors overlap with benign entities, which can present a diagnostic challenge. This review article will describe the common CT findings of gastric, small bowel, colon, and appendiceal cancer as well as some of the common benign gastrointestinal conditions with similar imaging findings.
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Durrant E, Abu Mughli R, O’Neill SB, Jiminez-Juan L, Berger FH, Ezra O’Keeffe M. Evaluation of Bowel and Mesentery in Abdominal Trauma. Can Assoc Radiol J 2020; 71:362-370. [DOI: 10.1177/0846537120908132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Since the advent of multidetecter computed tomography (CT), radiologist sensitivity in detection of traumatic bowel and mesenteric abnormalities has significantly improved. Although several CT signs have been described to identify intestinal injury, accurate interpretation of these findings can remain challenging. Early detection of bowel and mesenteric injury is important as it alters patient management, disposition, and follow-up. This article reviews the common imaging findings of traumatic small bowel and mesenteric injury.
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Affiliation(s)
- Eric Durrant
- Department of Emergency and Trauma Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rawan Abu Mughli
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Siobhán B. O’Neill
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Laura Jiminez-Juan
- Department of Cardiothoracic Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ferco H. Berger
- Department of Emergency and Trauma Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Ezra O’Keeffe
- Department of Emergency and Trauma Radiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Daniel F, Alsheikh M, Ghieh D, Hosni M, Tayara Z, Tamim H, Abi-Ghanem AS, El-Merhi F. Bowel wall thickening on computed tomography scan: Inter-observer agreement and correlation with endoscopic findings. Arab J Gastroenterol 2020; 21:219-223. [PMID: 32653241 DOI: 10.1016/j.ajg.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 02/16/2020] [Accepted: 04/09/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND STUDY AIMS Bowel wall thickening (BWT) on computed tomography (CT) has been frequently reported by radiologists. There are no clear guidelines regarding the level of thickening that is correlated with definite pathology. Radiologists usually rely on their overall subjective impression, and studies on inter-observer agreement (IOA) are lacking. This study evaluated IOA concerning BWT found on abdominal CT and identified the corresponding findings on endoscopy. PATIENTS AND METHODS Reports of abdominal CTs performed between January 2000 and December 2015 containing the term 'thickening' were retrieved from the radiology department database. Corresponding patients who later underwent endoscopy were included. IOA concerning BWT was evaluated using a randomly mixed sample of 80 patients with normal findings or pathological BWT on endoscopy. A search for predictive factors for the subsequent finding of malignancy on endoscopy was performed using multivariate analysis. RESULTS During the study period, 6142 CT scans described thickening, equivalent to a BWT prevalence of 13.7%. Ninety-one patients (mean age, 58 years) were included in the analysis. Thickening was found most commonly in the stomach (38.5%), followed by the rectum (22%) and small intestine (14%). Twenty-seven patients (29.7%) exhibited diffuse BWT, whereas 64 patients showed localised BWT (70.3%). Biopsy was performed for 64 of 91 patients with endoscopies. Among these patients, 8.8% exhibited normal findings, whereas inflammation and malignancy were discovered in 25 and 51.6% of patients, respectively, with a positive predictive value for malignancy of 0.36. The IOA concerning CT for predicting significantly pathological BWT was moderate (mean κ = 0.6). A strong association was evident between the presence of lymph nodes on CT and the presence of neoplastic lesions. CONCLUSION Our study strongly recommends endoscopic follow-up of patients exhibiting BWT irrespective of the thickening location, especially if it is associated with lymphadenopathy. IOA between radiologists was moderate.
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Affiliation(s)
- Fady Daniel
- Department of Internal Medicine, Gastroenterology Division, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Mira Alsheikh
- Department of Internal Medicine, Gastroenterology Division, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Diamond Ghieh
- Department of Diagnostic Radiology, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Mohammad Hosni
- Department of Internal Medicine, Gastroenterology Division, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Ziad Tayara
- Department of Diagnostic Radiology, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Hani Tamim
- Biostatisitics Unit, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Alain S Abi-Ghanem
- Department of Diagnostic Radiology, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Fadi El-Merhi
- Department of Diagnostic Radiology, American University of Beirut, Riad El Solh, Beirut 1107 2020, Lebanon; Department of Imaging, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Ibrahim HMM, El-Ashker MR. Reference Values and Repeatability of Transabdominal Ultrasonographic Gastrointestinal Tract Thickness and Motility in Healthy Donkeys (Equus asinus). J Equine Vet Sci 2020; 92:103153. [PMID: 32797781 DOI: 10.1016/j.jevs.2020.103153] [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: 03/03/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 01/03/2023]
Abstract
The present study aimed to provide reference ranges for the wall thickness and motility pattern of the gastrointestinal tract from a sample of donkeys (Equus asinus) population using B-mode ultrasonography. In the present study, 30 clinically healthy donkeys (Equus asinus) (15 males and 15 females), aged 2-20 year old and weighed 100-280 kg were randomly selected for B-mode ultrasonographic scanning of the abdomen. The wall thickness of the stomach, duodenum, jejunum, left colon, right colon, and cecum was assessed. Moreover, the motility pattern of the duodenum, jejunum, left colon, right colon, and cecum was evaluated over a period of 3 minutes. Abdominal ultrasonographic scanning of the gastrointestinal tract of healthy donkeys explored that the stomach, duodenum, jejunum, left colon, right colon, and cecum could be visualized easily. The wall thickness of the stomach, duodenum, jejunum, left colon, right colon, and cecum was 7.0 ± 0.9 mm, 3.3 ± 1.0 mm, 5.4 ± 0.6 mm, 5.1 ± 0.5 mm, 5.4 ± 0.5 mm, and 5.4 ± 0.6 mm, respectively. The thickest part of the gastrointestinal tract is the stomach, whereas the thinnest part is the duodenum. The motility pattern of the duodenum, jejunum, left colon, right colon, and cecum was 7.7 ± 1.3 contractions/3 minutes, 6.9 ± 1.1 contractions/3 minutes, 4.1 ± 1.2 contractions/3 minutes, 5.5 ± 1.3 contractions/3 minutes, and 4.0 ± 0.8 contractions/3 minutes, respectively. Both the duodenum and jejunum contractions were significantly higher than that of the left colon, right colon, and cecum. This is the first study reporting the reference values for both the wall thickness and motility pattern of the gastrointestinal tract in healthy donkeys (Equus asinus) in Egypt. Good knowledge of these standard and reference values of the wall thickness and motility pattern of gastrointestinal tract structures represents a step in the early diagnosis of the gastrointestinal disorders, including colic in such animal species.
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Affiliation(s)
- Hussam M M Ibrahim
- Department of Internal Medicine, Infectious and Fish Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt.
| | - Maged R El-Ashker
- Department of Internal Medicine, Infectious and Fish Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
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Mang T, Bräuer C, Gryspeerdt S, Scharitzer M, Ringl H, Lefere P. Electronic cleansing of tagged residue in CT colonography: what radiologists need to know. Insights Imaging 2020; 11:47. [PMID: 32170498 PMCID: PMC7070139 DOI: 10.1186/s13244-020-00848-9] [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: 10/23/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
CT colonography (CTC) is the radiological examination of choice for the diagnosis of colorectal neoplasia. Faecal tagging is considered a mandatory part of bowel preparation. However, the colonic mucosa, obscured by tagged residue, is not accessible to endoluminal 3D views and requires time-consuming 2D evaluation. Electronic cleansing (EC) software algorithms can overcome this limitation by digitally subtracting tagged residue from the colonic lumen. Ideally, this enables a seamless 3D endoluminal evaluation. Despite this benefit, EC is a potential source of a wide range of artefacts. Accurate EC requires proper CTC examination technique and faecal tagging. The digital subtraction process has been shown to affect the relevant morphological features of both colonic anatomy and colonic lesions, if submerged under faecal residue. This article summarises the potential effects of EC on CTC imaging, the consequences for reporting and patient management, and strategies to avoid pitfalls. Furthermore, potentially negative effects on clinical reporting and patient management are shown, and problem-solving techniques, as well as recommendations for the appropriate use of EC techniques, are presented. Radiologists using EC should be familiar with EC-related effects on polyp size and also with correct measurement techniques.
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Affiliation(s)
- Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
| | - Christian Bräuer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Stefaan Gryspeerdt
- Department of Radiology, AZ Delta, Bruggesteenweg 90, B-8800, Roeselare, Belgium
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Helmut Ringl
- Department of Radiology, Danube Hospital Vienna, Langobardenstrasse 122, A-1220, Wien, Austria
| | - Philippe Lefere
- Department of Radiology, AZ Delta, Bruggesteenweg 90, B-8800, Roeselare, Belgium
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Mills A, Mellnick VM, Itani M. Imaging of Bowel Wall Thickening in the Hospitalized Patient. Radiol Clin North Am 2020; 58:1-17. [DOI: 10.1016/j.rcl.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Mang T, Scharitzer M. [Imaging of gastrointestinal inflammation : Characteristic patterns and signs]. Radiologe 2019; 58:281-291. [PMID: 29572712 DOI: 10.1007/s00117-018-0376-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CLINICAL PROBLEM Pathological conditions of the gastrointestinal tract can result from various disorders, including inflammatory, infectious, neoplastic, and ischemic diseases. RADIOLOGICAL STANDARD PROCEDURES Cross-sectional imaging techniques have largely replaced many of the conventional fluoroscopic examinations, such as small bowel follow-through and double-contrast barium enema. The former allow for time-efficient, accurate, and minimally invasive diagnostics. Therefore, they have become important diagnostic tools for the evaluation of inflammatory diseases of the gastrointestinal tract. The distension of the intestinal lumen with orally administered neutral contrast media improves not only the evaluation of the intraluminal aspect, but also of the cross-sectional appearance. Furthermore, with cross-sectional imaging techniques, the additional assessment of the extraintestinal structures and organs is also possible. METHODICAL INNOVATIONS AND ASSESSMENT With the ongoing development of scanner and software technology, pathologic conditions of the gastrointestinal wall can be characterized in more detail by both computed tomography and magnetic resonance imaging. A structured approach, based on the analysis of typical radiological signs and patterns, combined with the evaluation of extraintestinal findings may help to assign the observed imaging findings to specific disease groups. RECOMMENDATIONS This article summarizes common signs and typical patterns frequently seen in inflammatory conditions of the gastrointestinal tract. A systematic approach for structured analysis of specific and nonspecific imaging features and common pitfalls may aid in the interpretation and help to narrow the spectrum of potential differential diagnoses.
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Affiliation(s)
- T Mang
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - M Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Walter SS, Maurer M, Storz C, Weiss J, Archid R, Bamberg F, Kim JH, Nikolaou K, Othman AE. Effects of Radiation Dose Reduction on Diagnostic Accuracy of Abdominal CT in Young Adults with Suspected Acute Diverticulitis: A Retrospective Intraindividual Analysis. Acad Radiol 2019; 26:782-790. [PMID: 30268717 DOI: 10.1016/j.acra.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the effects of radiation dose reduction on image quality and diagnostic accuracy of abdominal computed tomography (CT) in young adults with suspected acute diverticulitis. MATERIALS AND METHODS Fifty-four patients ≤40 years who received contrast-enhanced abdominal CT for suspected acute diverticulitis were included. Low-dose CT (LDCT) datasets (25%, 50%, and 75% of the original dose) were generated using sinogram synthesis and quantum noise modeling. A five-point scale was used to assess images qualitatively (overall image quality, noise, artefacts, and sharpness) and for diagnostic confidence (5 being the best possible outcome). Furthermore, the diagnostic accuracy was determined for the presence of acute diverticulitis. RESULTS Among 54 patients (mean age: 35.2 ± 5.3 years, 77.8% male), the prevalence of acute diverticulitis was high (57.4%). Subjective image quality was highest for original datasets and lowest for LDCT datasets with 25% of the original dose (median [interquartile range]: 5 [5] vs. 3 [2-3], p < 0.001). Diagnostic confidence was high for all datasets down to 50% of the original dose, while 25% LDCT datasets were associated with a significantly decreased diagnostic confidence (p < 0.001). Diagnostic accuracy was high for all LDCT and original datasets (sensitivity: 100%, negative predictive value [NPV]: 100% for 75% and 100% dose levels; sensitivity: 96.8%, NPV: 95.8% for 50% dose level; sensitivity: 93.6%, NPV: 91.7% for 25% dose level, respectively). Inter-rater agreement regarding the detection of diverticulitis was almost perfect at doses ≥50% (kappa: >0.81), while lower for datasets of 25% of the original radiation dose agreement (kappa: 0.67-0.78). CONCLUSION Radiation dose reduction down to 50% of the original radiation exposure permits high image quality, diagnostic confidence, and accuracy for the assessment of acute diverticulitis in abdominal CT in young adults without the use of iterative reconstruction algorithms.
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McCabe-Lankford EE, Brown TL, Levi-Polyachenko NH. Assessing fluorescence detection and effective photothermal therapy of near-infrared polymer nanoparticles using alginate tissue phantoms. Lasers Surg Med 2018; 50:1040-1049. [PMID: 29953621 DOI: 10.1002/lsm.22955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Photothermal therapy (PTT) uses light absorbing materials to generate heat for treatment of diseases, like cancer. The advantages of using PTT components that absorb in the near-infrared (NIR) include reduced tissue auto-fluorescence and higher penetration depths. However, NIR laser light can still be scattered and absorbed by biological tissues, thus decreasing the amount of the energy reaching the PTT agents. We have developed two distinct formulations of NIR-absorbing nanoparticles, one which can be utilized for PTT only, and another for both PTT and fluorescence imaging of colorectal cancer. In this work, the fluorescence detection limit and the PTT heating potential of the two nanoparticle types were determined using alginate tissue phantoms. The objective of this study was to determine the PTT efficiency and theranostic potential of the nanoparticles by irradiating 3D collagen tumor spheroids, containing nanoparticles and CT26 mouse colorectal cancer cells, through increasing tissue phantom thicknesses and then quantifying cell death. Materials and Methods Our lab has previously developed nanoparticles based on the semiconducting, conjugated polymer poly[4,4-bis(2-ethylhexyl)-cyclopenta[2,1-b;3,4-b']dithiophene-2,6-diyl-alt-2,1,3-benzoselenadiazole-4,7-diyl] (PCPDTBSe). We have also made a hybrid nanoparticle that heats and fluoresces by combining PCPDTBSe polymer with the fluorescent poly[(9,9-dihexylfluorene)-co-2,1,3-benzothiadiazole-co-4,7-di(thiophen-2-yl)-2,1,3-benzothiadiazole] (PFBTDBT10) polymer to yield nanoparticles termed Hybrid Donor-Acceptor Polymer Particles (H-DAPPs). H-DAPPs and PCPDTBSe nanoparticles were added to three-dimensional collagen gel tumor spheroids in order to represent nanoparticles in a tumor. Alginate tissue phantoms, comprised of an optical scattering agent (Intralipid) and an optical absorbing material (hemoglobin) in order to mirror biological tissue scattering effects, were used to simulate increasing tissue thickness between the nanoparticles and the PTT energy source. RESULTS Fluorescence from the H-DAPPs was detectable through 6 mm of tissue phantoms. It was found that less than 10% of the laser energy could penetrate through 9 mm of tissue phantoms and only 60% of the laser energy passed through the 1.5 mm phantoms, regardless of laser power. PTT experiments, using 800 nm light at 2.2 W/cm2 for 60 s through tissue phantoms to stimulate nanoparticle-doped tumor spheroids, showed 55% cell death through 3 mm of tissue phantoms using H-DAPPs. Results from using the PCPDTBSe nanoparticles showed 72% cell death through 3 mm and over 50% cell death through 6 mm of tissue phantoms. CONCLUSION The results of this work validated the heating potential and fluorescence detection limitations of two theranostic polymer nanoparticles by utilizing alginate tissue phantoms and 3D tumor spheroids. H-DAPPs and PCPDTBSe polymer nanoparticles can be utilized as effective PTT agents by exploiting their absorption of NIR light and H-DAPPs have advantageous fluorescence for imaging colorectal cancer. The data generated from this study design can allow for other NIR absorbing and fluorescing nanoparticle formulations to be evaluated prior to in vivo experimentation. Lasers Surg. Med. 50:1040-1049, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Eleanor E McCabe-Lankford
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157
| | - Theodore L Brown
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157
| | - Nicole H Levi-Polyachenko
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157
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Classification of Healthy and Cancer States of Colon Epithelial Tissues Using Opto-magnetic Imaging Spectroscopy. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0414-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lin WC, Chen JH, Westphalen AC, Liao CH, Chen CH, Chen CM, Lin CH. The role of CT in predicting the need for surgery in patients diagnosed with mesenteric phlebosclerosis. Medicine (Baltimore) 2016; 95:e5139. [PMID: 27741142 PMCID: PMC5072969 DOI: 10.1097/md.0000000000005139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To determine if imaging findings on computed tomography (CT) can predict the need of surgery in patients with idiopathic mesenteric phlebosclerosis (IMP).This retrospective study included 28 patients with IMP. Abdominal CT images were reviewed to determine the extent and severity of mesenteric calcifications and the presence of findings related to colitides. We compared the number of colonic segments with mesenteric venous calcification, a total calcification score, and the rate of colonic wall thickening, pericolic fat stranding, and bowel loop dilatation between patients undergoing surgery (surgery group) and patients without surgery (nonsurgery group). Comparisons were made using the Mann-Whitney U test and Fisher exact test. Receiver operating characteristic analysis was also performed. Inter-reader agreement for the calcification scores was analyzed using kappa statistics.The number of colonic segments with mesenteric venous calcification and the total calcification scores were both significantly higher in the surgery group than the nonsurgery group (4.33 vs 2.96, P = 0.003; and 15.00 vs 8.96, P <0.001). The areas under the receiver operating characteristics to identify patients who need surgery were 0.96 and 0.92, respectively. The prevalence of bowel loop dilatation in the surgery group was also significantly higher than that in the nonsurgery group (16% vs 100%, P = 0.011).Evaluation of the severity and extent of IMP based on the total mesenteric venous calcification score, number of involved colonic segments, and the presence bowel loop dilatation on CT may be useful to indicate the outcomes of conservative treatment and need for surgery.
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Affiliation(s)
- Wei-Ching Lin
- Department of Radiology, China Medical University Hospital
- School of Medicine
- Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung
| | - Jeon-Hor Chen
- E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- Center for Functional Onco-Imaging, School of Medicine, University of California, Irvine
| | - Antonio Carlos Westphalen
- Departments of Radiology and Biomedical Imaging, and Urology, University of California, San Francisco, CA
| | - Chun-Han Liao
- Department of Radiology, China Medical University Hospital
| | | | - Chun-Ming Chen
- Department of Radiology, China Medical University Hospital
- Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung
| | - Chien-Heng Lin
- Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung
- Division of Pediatric Pulmonology, China Medical University Children's Hospital
- Asia University, Taichung, Taiwan
- Correspondence: Chien-Heng Lin, Division of Pediatric Pulmonology, China Medical University Children's Hospital, 2 Yuh-Der Road, Taichung, 40447, Taiwan (e-mail: )
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Bardhan KD, Cullis J, Williams NR, Arasaradnam RP, Wilson AJ. Quantification of 18FDG in the Normal Colon-A First Step in Investigating Whether Its Presence Is a Marker of a Physiological Process. PLoS One 2016; 11:e0147838. [PMID: 26821281 PMCID: PMC4731074 DOI: 10.1371/journal.pone.0147838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
The visibility of the colon in positron emission tomography (PET) scans of patients without gastrointestinal disease indicating the presence of 18F Fluorodeoxyglucose (18FDG) is well recognised, but unquantified and unexplained. In this paper a qualitative scoring system was applied to PET scans from 30 randomly selected patients without gastrointestinal disease to detect the presence of 18FDG in 4 different sections of the colon and then both the total pixel value and the pixel value per unit length of each section of the colon were determined to quantify the amount of 18FDG from a randomly selected subset of 10 of these patients. Analysis of the qualitative scores using a non-parametric ANOVA showed that all sections of the colon contained 18FDG but there were differences in the amount of 18FDG present between sections (p<0.05). Wilcoxon matched-pair signed-rank tests between pairs of segments showed statistically significant differences between all pairs (p<0.05) with the exception of the caecum and ascending colon and the descending colon. The same non-parametric statistical analysis of the quantitative measures showed no difference in the total amount of 18FDG between sections (p>0.05), but a difference in the amount/unit length between sections (p<0.01) with only the caecum and ascending colon and the descending colon having a statistically significant difference (p<0.05). These results are consistent since the eye is drawn to focal localisation of the 18FDG when qualitatively scoring the scans. The presence of 18FDG in the colon is counterintuitive since it must be passing from the blood to the lumen through the colonic wall. There is no active mechanism to achieve this and therefore we hypothesise that the transport is a passive process driven by the concentration gradient of 18FDG across the colonic wall. This hypothesis is consistent with the results obtained from the qualitative and quantitative measures analysed.
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Affiliation(s)
- Karna D. Bardhan
- Department of Gastroenterology, Rotherham General Hospital, Rotherham S60 2UD, United Kingdom
- School of Medicine, University of Sheffield, Sheffield S10 2TN, United Kingdom
- * E-mail:
| | - James Cullis
- Nuclear Medicine, Department of Clinical Physics and Bioengineering, University Hospital, Coventry CV2 2DX, United Kingdom
| | - Nigel R. Williams
- Nuclear Medicine, Department of Clinical Physics and Bioengineering, University Hospital, Coventry CV2 2DX, United Kingdom
| | - Ramesh P. Arasaradnam
- Department of Gastroenterology, University Hospital, Coventry CV2 2DX, United Kingdom
- Clinical Sciences Research Institute, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Adrian J. Wilson
- Department of Research, Development and Innovation, University Hospital, Coventry CV2 2DX, United Kingdom
- Department of Physics, University of Warwick, Coventry CV4 7AL, United Kingdom
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Cruz C, Abujudeh HH, Nazarian RM, Thrall JH. Ischemic colitis: spectrum of CT findings, sites of involvement and severity. Emerg Radiol 2015; 22:357-65. [PMID: 25732355 DOI: 10.1007/s10140-015-1304-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023]
Abstract
To summarize the frequency of findings on IV contrast, enhanced computer tomography (CT) in 335 patients with pathologically proven ischemic colitis (IC) determine the most frequent locations and patterns of involvement and establish the correlation of these findings with the severity of IC. 231 patients were excluded for not having a concomitant CT or for having underlying comorbidities. 104 cases were analyzed. Scans were evaluated for abnormal wall enhancement (AE), bowel wall thickening (BWT), bowel dilatation (DIL), mesenteric fat stranding (FS), venous engorgement (VE), pericolonic free fluid (FF), and pneumatosis (PN) and portomesenteric venous gas. Segmental versus pancolonic involvement was noted. Severity was determined by histopathology criteria. Data obtained are as follows: female to male incidence, 69 % (70) vs. 31 % (34); average age, 64.5; and positive CT, 102/104 (98.1 %). The most frequent findings include FS (88 %), BWT (88 %), and AE (82 %) regardless of severity of involvement. Statistically significant increased risk ratio and likelihood of severe ischemia for PN, DIL, and FF individually. BWT, DIL, FS, FF, VE, and PN together have a probability for severe IC of 91.8 %. A correlation between fewer findings and milder IC was found (R (2) = 0.6771). The most frequently involved segments: descending (64 %) and sigmoid colon (54 %). Splenic flexure (SF) was infrequently involved (n = 8, 7.84 %). Females had two times higher incidence of IC. The most frequent CT findings in IC are FS, BWT, and AE regardless of the severity. PN is suggestive of severe IC. Segmental involvement is the predominant pattern. The distal colon is more frequently involved. SF contrary to the conventional literature is not disproportionately involved in IC.
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Affiliation(s)
- Cinthia Cruz
- , 25 New Chardon Street 449A, Boston, MA, 02114, USA,
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Mellnick VM, Menias CO. Computed tomography of colonic and appendiceal emergencies. Semin Roentgenol 2014; 49:202-9. [PMID: 24836494 DOI: 10.1053/j.ro.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
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Panos MZ, Koumi A. Argon plasma coagulation in the right and left colon: safety-risk profile of the 60W-1.2 l/min setting. Scand J Gastroenterol 2014; 49:632-41. [PMID: 24694332 DOI: 10.3109/00365521.2014.903510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIM The 40W-0.8 l/min setting is widely recommended for argon plasma coagulation (APC) in the right colon. Until March 2012, we used the 60W-1.2 l/min setting for all sites of the colon. By auditing our experience, we assessed the safety-risk profile of the 60W-1.2 l/min setting in the right and left colon. PATIENTS AND METHODS All cases treated with APC by a single endoscopist, using the 60W-1.2 l/min setting for all sites of the colon between October 2001 and December 2007 were identified retrospectively and site, type, number of lesions, and complications were recorded. Between January 2008 and March 2012, information was recorded prospectively. RESULTS In the retrospective audit, 290 lesions (101 cecum/ascending, 120 sigmoid/descending, 69 transverse) were treated in 241 patient endoscopies. There were no perforations. In the prospective audit, 156 lesions (83 cecum/ascending, 47 sigmoid/descending, 26 transverse) were treated in 132 patient endoscopies. There was 1/83 (1.2%) perforation in the cecum/ascending colon and none in the transverse or sigmoid/descending (n.s.). Combined, the results yield a cecal/ascending perforation rate of 1/153 (0.6%) patient endoscopies, 1/184 (0.5%) lesions treated and overall perforation rate for all sites of the colon of 1/373 (0.3%) patient endoscopies and 1/446 (0.2%) lesions. Post-polypectomy syndrome and delayed bleeding each occurred in 3/373 (0.8%) patient endoscopies and 3/446 (0.7%) lesions. There were no deaths. CONCLUSION In the cecum and ascending colon, the APC perforation rate at the 60W-1.2 l/min setting was no higher than in the left colon and is similar to that reported in previously published series. Therefore, it appears safe, provided the precautions we describe are strictly followed.
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Affiliation(s)
- Marios Z Panos
- Department of Gastroenterology, Euroclinic of Athens , Athens , Greece
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Thickened gastrointestinal wall findings on computed tomography in children: a reason for endoscopy? J Pediatr Gastroenterol Nutr 2013; 57:305-10. [PMID: 23575298 DOI: 10.1097/mpg.0b013e3182952eaa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Bowel wall thickening on computed tomography (CT) scans in children may raise concern for inflammatory bowel disease (IBD). The significance of this radiological finding is unclear. Our purpose was to evaluate the clinical outcomes with regard to IBD in children with no known underlying disease, presenting with abdominal pain and thickened bowel wall on CT scan. METHODS A retrospective analysis of pediatric patients with abdominal pain and CT findings of thickened bowel wall was performed between 2006 and 2010. Endoscopic findings, clinical variables, and follow-up assessments were evaluated. RESULTS Fifty-six patients presenting with abdominal pain and thickened bowel wall findings on CT scan were identified. Overall, 30 (54%) had terminal ileum wall thickening, 17 (30%) had isolated colonic wall thickening, and 9 (16%) had other small bowel wall thickening. Of the 56 patients, 21 (38%) underwent endoscopy, of which 14 (67%) had positive findings-11 (79%) had histologic evidence of chronic colitis, and 5 (36%) had duodenitis/ileitis. Ultimately, 11/56 (20%) were diagnosed as having IBD, 8/56 (14%) with functional abdominal pain/constipation, 9/56 (16%) appendicitis, 10/56 (18%) infectious gastroenteritis, and 18/56 (32%) with miscellaneous diagnoses. Median levels of erythrocyte sedimentation rate, C-reactive protein, albumin, and platelet count were significantly abnormal in the IBD group compared to the non-IBD group. Additional follow-up of those who did not undergo endoscopic evaluation revealed no new diagnoses of IBD. CONCLUSIONS The presence of thickened bowel wall on CT scans is a nonspecific finding in children. Laboratory evaluation may help distinguish which patients require additional evaluation and endoscopy.
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Patel B, Mottola J, Sahni VA, Cantisani V, Ertruk M, Friedman S, Bellizzi AM, Marcantonio A, Mortele KJ. MDCT assessment of ulcerative colitis: radiologic analysis with clinical, endoscopic, and pathologic correlation. ACTA ACUST UNITED AC 2012; 37:61-9. [PMID: 21603899 DOI: 10.1007/s00261-011-9741-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Evaluate the utility of multidetector-row computed tomography (MDCT) in assessing the severity of ulcerative colitis (UC) in comparison with clinical assessment, colonoscopy, and histopathology. MATERIALS AND METHODS Patients with UC evaluated with at least one abdominal contrast-enhanced CT study (CECT) within 7 days of colonoscopy with biopsy were included. CECT of 23 patients (12 male; mean age 40 years; age range, 20-72 years) were retrospectively evaluated in consensus by two radiologists. A total of 138 lower GI tract segments were evaluated by CECT and graded for the presence of bowel wall thickening, mucosal hyperenhancement, mural stratification, mesenteric hyperemia, pericolonic stranding, and lymph nodes. A cumulative CT severity score was calculated and correlated with clinical, colonoscopic, and histopathologic severity grades. RESULTS The cumulative CT score and individual CECT scores for bowel wall thickening, mucosal hyperenhancement, and mural stratification showed positive correlation with clinical severity (P < 0.05). All individual CECT features as well as the cumulative CT score demonstrated statistically significant correlation with colonoscopic severity (P < 0.0001). Only wall thickening on CECT demonstrated significant correlation with histopathologic severity (P = 0.01). CONCLUSION Disease severity assessment by MDCT demonstrates positive correlation with severity established by clinical assessment and colonoscopy. Only increasing wall thickness, as graded on MDCT, correlates with histopathologic disease severity.
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Affiliation(s)
- Bijal Patel
- Division of Abdominal Imaging & Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Wang HW, Jiang JK, Lin CH, Lin JK, Huang GJ, Yu JS. Diffuse reflectance spectroscopy detects increased hemoglobin concentration and decreased oxygenation during colon carcinogenesis from normal to malignant tumors. OPTICS EXPRESS 2009; 17:2805-17. [PMID: 19219185 DOI: 10.1364/oe.17.002805] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Blood content and tumor oxygen level are important biomarkers and prognostic indicators in patients with colorectal cancer (CRC). However, noninvasive measurements of both quantities in human colon are limited. In this study, we extracted the total hemoglobin concentration (THC) and oxygen saturation (StO(2)) of normal, premalignant, and malignant colonic tissues in 27 patients using a diffuse reflectance instrument and algorithms based on the diffusion equation. The mean+/-standard error of THC and StO(2) from all normal sites (n=26) is 93.4+/-17.1microM and 67.2+/-3.7%, respectively. THC increased to 136.9+/-23.8microM and 153.8+/-38.6microM and StO(2) decreased to 51.3+/-7.0% and 26.4+/-6.1% for premalignant and malignant tissues, respectively. The disease-to-normal THC ratios are 3.2+/-1.1 and 4.4+/-1.9 and the disease-to-normal StO(2) ratios are 0.7+/-0.1 and 0.5+/-0.1 for pr alignant and malignant tissues, respectively. These results demonstrate the feasibility of a robust optical method to assess colon THC and StO2 at all stages of carcinogenesis in vivo so that the angiogenesis and hypoxia of the disease and the therapeutic role can be studied in CRC patients.
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Affiliation(s)
- Hsing-Wen Wang
- Institute of Biophotonics, National Yang-Ming University, Taipei, 11221, Taiwan.
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Magnetic Resonance Colonography for the Evaluation of Colonic Inflammatory Bowel Disease. J Comput Assist Tomogr 2008; 32:848-54. [DOI: 10.1097/rct.0b013e31815b63ff] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ghekiere O, Lesnik A, Hoa D, Laffargue G, Uriot C, Taourel P. Value of computed tomography in the diagnosis of the cause of nontraumatic gastrointestinal tract perforation. J Comput Assist Tomogr 2007; 31:169-76. [PMID: 17414748 DOI: 10.1097/01.rct.0000237809.11123.8e] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify computed tomographic features with a high predictive value to differentiate gastroduodenal ulcer perforations from other causes of perforations in patients with a non-traumatic-free pneumoperitoneum. MATERIALS AND METHODS Computed tomographic scans of 81 patients with a non-traumatic-free pneumoperitoneum were reviewed for direct visualization of the perforation site and indirect findings of the perforation, including the presence, amount, and localization of air and ascites in the peritoneal cavity, mural thickness of the gastrointestinal tract, perigastrointestinal fat stranding, intestinal ischemia, fecal peritonitis, abscess, and portomesenteric venous gas. RESULTS The perforation site was directly visualized in 16 (41%) of 39 patients with gastroduodenal ulcer perforation and in 5 (12%) of 42 patients with other causes of perforation. The findings with a positive predictive value of more than 90% for gastroduodenal ulcer perforation were the presence of local fluid between the duodenum and the pancreatic head and the combination of local gastroduodenal wall thickening and fat stranding. The presence of abscess in the peritoneal cavity or fecal peritonitis, portomesenteric gas, or bowel ischemia findings had a positive predictive value of 100% for the diagnosis of other perforations. CONCLUSIONS Indirect computed tomographic findings are helpful for differentiating gastroduodenal ulcer perforation from other causes of perforations.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France
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Goulet CJ, Disario JA, Emerson L, Hilden K, Holubkov R, Fang JC. In vivo evaluation of argon plasma coagulation in a porcine model. Gastrointest Endosc 2007; 65:457-62. [PMID: 17321247 DOI: 10.1016/j.gie.2006.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 09/07/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND Argon plasma coagulation (APC) is a noncontact form of monopolar electrocautery. One purported advantage of APC includes a limit to the depth of injury. It is unclear from previous studies whether the depth of injury is limited to superficial tissue layers with the settings used in clinical practice. OBJECTIVE To evaluate the depth and the area of APC-induced injury by using new modes of APC delivery in an in vivo porcine model in the setting of colonoscopy. DESIGN Blinded quasi-experiment. SUBJECTS Six swine. INTERVENTION Colonoscopy with the swine under general anesthesia, with application of APC in 2 different pulsed modes and varying power settings and duration of application. MAIN OUTCOME MEASUREMENTS Surface area and depth of colonic mucosal injury. Qualitative histologic analysis of each site of APC application was performed on formalin-fixed specimens after euthanizing the swine. RESULTS Muscularis propria injury occurred in 22% of lesions with 10 W, 62% of lesions with 20 W, 86% of lesions with 40 W, and 80% of lesions with 60 W. Muscularis propria injury occurred in 42% of lesions at 1 second, 66% of lesions at 3 seconds, and 69% of lesions at 5 seconds. Depth of injury was significantly correlated with total energy delivered (P = .001, r = 0.75). Surface area was significantly associated with total energy delivered (P < .001, r = 0.81). LIMITATIONS This study was performed in distal swine colon rather than human colon. Colon tissue response to APC injury may differ from swine to human colon. The application distance from the APC probe to the colonic tissue may have varied between applications. CONCLUSIONS Muscularis propria injury occurs across a broad range of clinically used APC settings. The frequency of deep injury and the surface area of the lesion increases with total energy delivered. The lowest power settings (10-20 W) and the shortest durations have the lowest risk of deep tissue injury.
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Affiliation(s)
- Christopher J Goulet
- GI Division, University of Utah Health Sciences Center, 30 N 1900 E., Salt Lake City, UT 84132, USA
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Luccichenti G, Cademartiri F, Sianesi M, Roncoroni L, Pavone P, Krestin GP. Radiologic assessment of rectosigmoid cancer before and after neoadjuvant radiation therapy: comparison between quantitation techniques. AJR Am J Roentgenol 2005; 184:526-30. [PMID: 15671374 DOI: 10.2214/ajr.184.2.01840526] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Volumetric analysis was compared with conventional unidimensional measurements for follow-up of rectosigmoid cancer before and after radiation therapy. SUBJECTS AND METHODS Fifteen patients with rectosigmoid cancer underwent helical CT before and after neoadjuvant radiation therapy. The helical CT examination was performed after colon distention with air and IV administration of an antiperistaltic drug. Two scans were obtained: one with the patient in the supine position and the other with the patient in the prone position after contrast medium injection. The maximal wall thickness and the volumetric analysis of the tumor were obtained through manual segmentation. RESULTS The mean of the differences between the volumetric analysis of the scans obtained before and after radiation therapy was 8.3 +/- 10.3 (SD) mL (-22.7%) (p <0.05). The mean of the differences between the maximal wall thickness of the pre- and post-radiation therapy scans was 3.4 +/- 2.6 mm (-19.1%) (p <0.05). A significant difference was observed between the variation of the maximal wall thickness and the variation of volumetric analysis in pre- and post-radiation therapy scans (p <0.05). The patients could be classified in different response categories depending on the measurement method and on the response criteria. CONCLUSION Volumetric analysis of rectosigmoid cancer is feasible. A long-term study is needed to correlate volumetric assessment with patient outcome.
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Fisher D, Rajon D, Breitz H, Goris M, Bolch W, Knox S. Dosimetry model for radioactivity localized to intestinal mucosa. Cancer Biother Radiopharm 2005; 19:293-307. [PMID: 15285876 DOI: 10.1089/1084978041425043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This paper provides a new model for calculating radiation-absorbed doses to the full thickness of the small and large intestinal walls, and to the mucosal layers. The model was used to estimate the intestinal radiation doses from yttrium-90-labeled-DOTA-biotin binding to NR-LU-10-streptavidin in patients. METHODS We selected model parameters from published data and observations, and used the model to calculate energy-absorbed fractions using the EGS4 radiation transport code. We determined the cumulated (90)Y activity in the small and large intestines of patients from gamma camera images, and calculated absorbed doses to the mucosal layer and to the whole intestinal wall. RESULTS The mean absorbed dose to the wall of the small intestine was 16.2 mGy/MBq (60 cGy/mCi) administered from (90)Y localized in the mucosa, and 70 mGy/MBq (260 cGy/mCi) to the mucosal layer within the wall. Doses to the large intestinal wall and to the mucosa of the large intestine were lower than those for the small intestine by a factor of about 2.5. These doses are greater by factors of about 5 to 6 than those that would have been calculated using the standard MIRD models that assume the intestinal activity is in the bowel contents. CONCLUSIONS The specific uptake of radiopharmaceuticals in mucosal tissues may lead to dose-related intestinal toxicities. Tissue dosimetry at the sub-organ level is useful for a better understanding of intestinal tract radiotoxicity and associated dose-response relationships.
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Affiliation(s)
- Darrell Fisher
- Pacific Northwest National Laboratory, 902 Battelle Boulevard P7-27, Richland, WA 99352, USA.
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Danse EM, Jamart J, Hoang P, Laterre PF, Kartheuser A, Van Beers BE. Focal bowel wall changes detected with colour Doppler ultrasound: diagnostic value in acute non-diverticular diseases of the colon. Br J Radiol 2004; 77:917-21. [PMID: 15507414 DOI: 10.1259/bjr/18038687] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We performed a study to determine if colour Doppler findings may help to identify the cause of wall thickening in acute non-diverticular diseases of the colon. The study group included 66 patients admitted to the emergency department with a final diagnosis of infectious colitis (n=23), inflammatory colitis (n=10), ischaemic colitis (n=23) and malignant tumours (n=10). The following ultrasound features were assessed: maximal wall thickness, wall stratification, arterial flow in the colonic wall and arteriolar resistive index. Higher values of wall thickness were observed in malignant tumour (18.2+/-6.2 mm, p<0.001). Moderately thickened wall (6.6+/-1.3 mm, p< or =0.06), preserved stratification (90% versus 46% in the remainder of the study population) and lower resistive index (0.51+/-0.10, p< or =0.05) were significantly related to inflammatory colitis. Absence of arterial flow was more frequently observed in ischaemia (43% versus 12% in the remainder of the study population). In conclusion, despite some overlap, both ultrasound and colour Doppler features are helpful in the differential diagnosis of colonic thickening related to non-diverticular colonic lesions.
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Affiliation(s)
- E M Danse
- Department of Radiology, Université Catholique de Louvain, St-Luc University Hospital, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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Wiesner W, Hauser A, Steinbrich W. Accuracy of multidetector row computed tomography for the diagnosis of acute bowel ischemia in a non-selected study population. Eur Radiol 2004; 14:2347-56. [PMID: 15378337 DOI: 10.1007/s00330-004-2462-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 07/09/2004] [Accepted: 07/16/2004] [Indexed: 02/06/2023]
Abstract
The diagnostic accuracy of multidetector row computed tomography for the prospective diagnosis of acute bowel ischemia in the daily clinical routine was analyzed. Two hundred ninety-one consecutive patients with an acute or subacute abdomen, examined by MDCT over a time period of 5 months, were included in the study. All original CT diagnoses made during the daily routine by radiological generalists were compared to the final diagnoses made by using all available medical information from endoscopies, surgical interventions, autopsies and follow-up. Finally, all CT examinations of patients with an initial CT diagnosis or a final diagnosis of bowel ischemia were reread by a radiologist specialized in abdominal imaging in order to analyze the CT findings and the reasons for initially false negative or false positive CT readings. Twenty-four patients out of 291 (8.2%) had acute bowel ischemia. The age of affected patients ranged from 50 to 94 years (mean age: 75.7 years). Eleven patients were male, and 13 female. Reasons for acute bowel ischemia were: arterio-occlusive (n=11), non-occlusive (n=5), strangulation (n=2), over-distension (n=3) and radiation (n=3). The prospective sensitivity, specificity, PPV and NPV of MDCT for the diagnosis of acute bowel ischemia in the daily routine were 79.17, 98.51, 90.48 and 98.15%. MDCT reaches a similarly high sensitivity in diagnosing acute bowel as angiography. Furthermore, it has the advantage of being helpful in most of its clinical differential diagnoses and of being less invasive with the consecutive possibility of being used earlier in the diagnostic process with all the resulting positive effects on the patients prognosis. Therefore, nowadays MDCT should probably be used as the first step imaging modality of choice in patients with suspected acute bowel ischemia.
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Affiliation(s)
- Walter Wiesner
- Institute of Diagnostic Radiology, University Hospital Basel, Basel, Switzerland.
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Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH. Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma. Radiology 2004; 249:524-33. [PMID: 14960973 DOI: 10.1148/radiol.2492072055] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Computed tomographic (CT) scanning using intravenous and oral contrast material has traditionally been advocated for the evaluation of intra-abdominal injury, including blunt bowel and mesenteric injuries (BBMIs). The necessity of oral contrast in detecting these injuries has recently been called into question. The purpose of this study was to determine the sensitivity and specificity of CT scanning without oral contrast for BBMIs. METHODS We prospectively enrolled 500 consecutive blunt trauma patients who received CT imaging and interpretation (CT-Read1) of the abdomen from July 2000 to November 2001. All patients were imaged without oral contrast, but with intravenous contrast. CT images were reviewed within 24 hours of admission by a research radiologist (CT-Read2) blinded to CT-Read1. For study purposes, true BBMI was determined to be present if either laparotomy or autopsy identified bowel or mesenteric injury, or both CT-Read2 and the hospital discharge summary described bowel or mesenteric injury. Three-month telephone follow-up was also completed. RESULTS CT-Read1 detected 19 of 20 bowel and mesenteric injuries. CT-Read1 missed one duodenal perforation. There were two patients with false-positive interpretations of CT-Read1 for bowel injury. The sensitivity and specificity of CT imaging for the detection of BBMIs were 95.0% and 99.6%, respectively. CONCLUSION CT imaging of the abdomen without oral contrast for detection of BBMIs compares favorably with CT imaging using oral contrast.
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Affiliation(s)
- Todd L Allen
- Department of Emergency medicine, LDS Hospital, Salt Lake City, Utah 84143, USA.
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Abstract
MR enteroclysis provides adequate image quality and sufficient distention of the entire small bowel. The functional information provided by MR enteroclysis equals that provided by conventional enteroclysis, which implies the ability reliably to depict even low-grade SBO. The inherent advantages of enteroclysis over conventional enteroclysis are the potential to detect extraluminal pathologic conditions and the ability to provide detailed information about the wall of the small bowel and the entire abdomen. Unlike conventional enteroclysis, MR enteroclysis does not have problems with overlapping bowel loops. MR enteroclysis has the potential to be an excellent diagnostic method for examinations of small bowel disease because of the functional information, the soft tissue contrast, and multiplanar imaging capabilities.
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Affiliation(s)
- Heinz Werner Umschaden
- Department of Radiology, General Hospital Wolfsberg, Paul Hackhoferstrasse 9, 9400 Wolfsberg, Austria.
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