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Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology 2024; 310:e232298. [PMID: 38441091 DOI: 10.1148/radiol.232298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high health care utilization and costs. Radiologic techniques including CT angiography, catheter angiography, CT enterography, MR enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist, which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided. © Radiological Society of North America and the American College of Gastroenterology, 2024. Supplemental material is available for this article. This article is being published concurrently in American Journal of Gastroenterology and Radiology. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Citations from either journal can be used when citing this article. See also the editorial by Lockhart in this issue.
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Affiliation(s)
- Neil Sengupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David M Kastenberg
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David H Bruining
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Melissa Latorre
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jonathan A Leighton
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Olga R Brook
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael L Wells
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Flavius F Guglielmo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Haresh V Naringrekar
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael S Gee
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jorge A Soto
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Seong Ho Park
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Don C Yoo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Vijay Ramalingam
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Alvaro Huete
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Ashish Khandelwal
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Avneesh Gupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Brian C Allen
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Mark A Anderson
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Bari R Dane
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Farnoosh Sokhandon
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David J Grand
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Justin R Tse
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jeff L Fidler
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
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Kania LM, Dave J, Guglielmo FF, Naringrekar HV, Alturki A, Civan JM, Bundschuh MA, Mitchell DG. The Early-Enhancing Hepatic Vein: Differentiating Focal Nodular Hyperplasia and Hepatic Adenoma With Pathologic Validation in MRI. J Magn Reson Imaging 2023; 58:1191-1197. [PMID: 36744579 DOI: 10.1002/jmri.28629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) and hepatic adenoma (HA) are two common benign liver lesions with different management options. In particular, resection is considered for large HA lesions to avoid possible bleeding complications or rarely malignant degeneration. PURPOSE To determine whether early enhancement of a draining hepatic vein (EDHV) and absence of perilesional enhancement (PLE) on arterial phase MR images are useful for distinguishing FNH from HA. STUDY TYPE Retrospective. POPULATION A total of 34 patients: 16 with FNH and 18 with HA lesions. FIELD STRENGTH/SEQUENCE A1.5 T, axial T1 fat-suppressed arterial postcontrast. ASSESMENT Four abdominal radiologists blinded to pathologic diagnosis assessed for the presence or absence of EDHV in association with the lesion, definitively characterized by pathology. This was considered present if contrast could be identified in a hepatic vein contiguous with the lesion in question. Secondarily, PLE was evaluated. STATISTICAL TESTS Fleiss's multirater kappa statistic, Chi-squared statistic, Phi-coefficient. Significance level P < 0.05. RESULTS Considering all observations obtained from the four readers, an EDHV was identified with FNH 48.5% of the time. EDHV was seen with HA in 8.8% of cases. PLE was seen with significantly greater frequency in HA. The presence of an EDHV was associated with the absence of PLE. DATA CONCLUSION In a lesion that may be either an FNH or HA, confident identification on arterial phase images of an EDHV should lead the reader to favor FNH, while the presence PLE should dissuade the reader from FNH. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Leann M Kania
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jaydev Dave
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | | | | | - Jesse M Civan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark A Bundschuh
- Penn State Hershey Medical Center, Division of Gastroenterology and Hepatology, Hershey, Pennsylvania, USA
| | - Donald G Mitchell
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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3
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Guglielmo FF, Barr RG, Yokoo T, Ferraioli G, Lee JT, Dillman JR, Horowitz JM, Jhaveri KS, Miller FH, Modi RY, Mojtahed A, Ohliger MA, Pirasteh A, Reeder SB, Shanbhogue K, Silva AC, Smith EN, Surabhi VR, Taouli B, Welle CL, Yeh BM, Venkatesh SK. Liver Fibrosis, Fat, and Iron Evaluation with MRI and Fibrosis and Fat Evaluation with US: A Practical Guide for Radiologists. Radiographics 2023; 43:e220181. [PMID: 37227944 DOI: 10.1148/rg.220181] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Quantitative imaging biomarkers of liver disease measured by using MRI and US are emerging as important clinical tools in the management of patients with chronic liver disease (CLD). Because of their high accuracy and noninvasive nature, in many cases, these techniques have replaced liver biopsy for the diagnosis, quantitative staging, and treatment monitoring of patients with CLD. The most commonly evaluated imaging biomarkers are surrogates for liver fibrosis, fat, and iron. MR elastography is now routinely performed to evaluate for liver fibrosis and typically combined with MRI-based liver fat and iron quantification to exclude or grade hepatic steatosis and iron overload, respectively. US elastography is also widely performed to evaluate for liver fibrosis and has the advantage of lower equipment cost and greater availability compared with those of MRI. Emerging US fat quantification methods can be performed along with US elastography. The author group, consisting of members of the Society of Abdominal Radiology (SAR) Liver Fibrosis Disease-Focused Panel (DFP), the SAR Hepatic Iron Overload DFP, and the European Society of Radiology, review the basics of liver fibrosis, fat, and iron quantification with MRI and liver fibrosis and fat quantification with US. The authors cover technical requirements, typical case display, quality control and proper measurement technique and case interpretation guidelines, pitfalls, and confounding factors. The authors aim to provide a practical guide for radiologists interpreting these examinations. © RSNA, 2023 See the invited commentary by Ronot in this issue. Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Flavius F Guglielmo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Richard G Barr
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Takeshi Yokoo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Giovanna Ferraioli
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - James T Lee
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Jonathan R Dillman
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Jeanne M Horowitz
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Kartik S Jhaveri
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Frank H Miller
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Roshan Y Modi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Amirkasra Mojtahed
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Michael A Ohliger
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Ali Pirasteh
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Scott B Reeder
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Krishna Shanbhogue
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Alvin C Silva
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Elainea N Smith
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Venkateswar R Surabhi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Bachir Taouli
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Christopher L Welle
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Benjamin M Yeh
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
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Tahmasebi A, Wessner CE, Guglielmo FF, Wang S, Vu T, Liu JB, Civan J, Lyshchik A, Forsberg F, Li H, Qu E, Eisenbrey JR. Comparison of Magnetic Resonance-Based Elastography and Ultrasound Shear Wave Elastography in Patients With Suspicion of Nonalcoholic Fatty Liver Disease. Ultrasound Q 2023; 39:100-108. [PMID: 36943721 DOI: 10.1097/ruq.0000000000000638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT This study investigated the correlation between magnetic resonance elastography (MRE) and shear wave ultrasound elastography (SWE) in patients with clinically diagnosed or suspected nonalcoholic fatty liver disease (NAFLD). Subjects with or at risk of NAFLD identified by magnetic resonance imaging (MRI) proton density fat fraction (PDFF) were prospectively enrolled. For each patient, 6 valid 2-dimensional SWE measurements were acquired using a Logiq E10 scanner (GE HealthCare, Waukesha, WI). A reliability criterion of an interquartile range to median ratio of ≤15% was used for SWE to indicate quality dataset. Magnetic resonance elastography, and MR-fat quantification data were collected the same day as part of the patient's clinical standard of care. Magnetic resonance imaging PDFF was used as a reference to quantify fat with >6.4% indicating NAFLD. Pearson correlation and t-test were performed for statistical analyses. A total of 140 patients were enrolled, 112 of which met SWE reliability measurement criteria. Magnetic resonance elastography and 2-dimensional SWE showed a positive correlation across all study subjects ( r = 0.27; P = 0.004). When patients were grouped according to steatosis and fibrosis state, a positive correlation was observed between MRE and SWE in patients with fibrosis ( r = 0.30; P = 0.03), without fibrosis ( r = 0.27; P = 0.03), and with NAFLD ( r = 0.28; P = 0.02). No elastography technique correlated with liver fat quantification ( P > 0.52). Magnetic resonance elastography was significantly different between patients with and without fibrosis ( P < 0.0001). However, this difference was not apparent with SWE ( P = 0.09). In patients with suspected or known NAFLD, MRE, and SWE demonstrated a positive correlation. In addition, these noninvasive imaging modalities may be useful adjunct techniques for monitoring NAFLD.
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Affiliation(s)
| | | | | | | | | | | | - Jesse Civan
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Hongbo Li
- Department of Ultrasound, The People's Hospital of Longhua, Southern Medical University, Shenzhen
| | - Enze Qu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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5
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Dane B, Gupta A, Wells ML, Anderson MA, Fidler JL, Naringrekar HV, Allen BC, Brook OR, Bruining DH, Gee MS, Grand DJ, Kastenberg D, Khandelwal A, Sengupta N, Soto JA, Guglielmo FF. Dual-Energy CT Evaluation of Gastrointestinal Bleeding. Radiographics 2023; 43:e220192. [PMID: 37167088 DOI: 10.1148/rg.220192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Gastrointestinal (GI) bleeding is a potentially life-threatening condition accounting for more than 300 000 annual hospitalizations. Multidetector abdominopelvic CT angiography is commonly used in the evaluation of patients with GI bleeding. Given that many patients with severe overt GI bleeding are unlikely to tolerate bowel preparation, and inpatient colonoscopy is frequently limited by suboptimal preparation obscuring mucosal visibility, CT angiography is recommended as a first-line diagnostic test in patients with severe hematochezia to localize a source of bleeding. Assessment of these patients with conventional single-energy CT systems typically requires the performance of a noncontrast series followed by imaging during multiple postcontrast phases. Dual-energy CT (DECT) offers several potential advantages for performing these examinations. DECT may eliminate the need for a noncontrast acquisition by allowing the creation of virtual noncontrast (VNC) images from contrast-enhanced data, affording significant radiation dose reduction while maintaining diagnostic accuracy. VNC images can help radiologists to differentiate active bleeding, hyperattenuating enteric contents, hematomas, and enhancing masses. Additional postprocessing techniques such as low-kiloelectron voltage virtual monoenergetic images, iodine maps, and iodine overlay images can increase the conspicuity of contrast material extravasation and improve the visibility of subtle causes of GI bleeding, thereby increasing diagnostic confidence and assisting with problem solving. GI bleeding can also be diagnosed with routine single-phase DECT scans by constructing VNC images and iodine maps. Radiologists should also be aware of the potential pitfalls and limitations of DECT. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Bari Dane
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Avneesh Gupta
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Michael L Wells
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Mark A Anderson
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Jeff L Fidler
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Haresh V Naringrekar
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Brian C Allen
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Olga R Brook
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David H Bruining
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Michael S Gee
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David J Grand
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David Kastenberg
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Ashish Khandelwal
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Neil Sengupta
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Jorge A Soto
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Flavius F Guglielmo
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
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6
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Tahmasebi A, Wang S, Wessner CE, Vu T, Liu JB, Forsberg F, Civan J, Guglielmo FF, Eisenbrey JR. Ultrasound-Based Machine Learning Approach for Detection of Nonalcoholic Fatty Liver Disease. J Ultrasound Med 2023. [PMID: 36807314 DOI: 10.1002/jum.16194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/05/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Current diagnosis of nonalcoholic fatty liver disease (NAFLD) relies on biopsy or MR-based fat quantification. This prospective study explored the use of ultrasound with artificial intelligence for the detection of NAFLD. METHODS One hundred and twenty subjects with clinical suspicion of NAFLD and 10 healthy volunteers consented to participate in this institutional review board-approved study. Subjects were categorized as NAFLD and non-NAFLD according to MR proton density fat fraction (PDFF) findings. Ultrasound images from 10 different locations in the right and left hepatic lobes were collected following a standard protocol. MRI-based liver fat quantification was used as the reference standard with >6.4% indicative of NAFLD. A supervised machine learning model was developed for assessment of NAFLD. To validate model performance, a balanced testing dataset of 24 subjects was used. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy with 95% confidence interval were calculated. RESULTS A total of 1119 images from 106 participants was used for model development. The internal evaluation achieved an average precision of 0.941, recall of 88.2%, and precision of 89.0%. In the testing set AutoML achieved a sensitivity of 72.2% (63.1%-80.1%), specificity of 94.6% (88.7%-98.0%), positive predictive value (PPV) of 93.1% (86.0%-96.7%), negative predictive value of 77.3% (71.6%-82.1%), and accuracy of 83.4% (77.9%-88.0%). The average agreement for an individual subject was 92%. CONCLUSIONS An ultrasound-based machine learning model for identification of NAFLD showed high specificity and PPV in this prospective trial. This approach may in the future be used as an inexpensive and noninvasive screening tool for identifying NAFLD in high-risk patients.
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Affiliation(s)
- Aylin Tahmasebi
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shuo Wang
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Trang Vu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jesse Civan
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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7
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Campbell JP, Teigen L, Manski S, Blumhof B, Guglielmo FF, Shivashankar R, Shmidt E. Sarcopenia Is More Prevalent Among Inflammatory Bowel Disease Patients Undergoing Surgery and Predicts Progression to Surgery Among Medically Treated Patients. Inflamm Bowel Dis 2022; 28:1844-1850. [PMID: 35166776 DOI: 10.1093/ibd/izac013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sarcopenia is common in inflammatory bowel disease (IBD); however, estimates of its prevalence and impact on clinical outcomes are variable. This study sought to compare the prevalence of sarcopenia in IBD patients starting new biologics vs patients undergoing IBD surgeries, and its association with common clinical predictors of nutritional status, adverse events, and clinical outcomes. METHODS This was a multicenter retrospective cohort study of IBD patients who had a computed tomography (CT) scan within 6 months prior to new biologic initiation (medical cohort) or IBD surgery (surgery cohort). The lowest sex-specific quartile of the total psoas area index at the L3 level defined sarcopenia. Prevalence and predictors of sarcopenia, performance of common clinical nutritional markers, and association with adverse events and clinical outcomes at 1 year were determined. RESULTS A total of 156 patients were included (48% medical cohort, 52% surgery cohort). Sarcopenia was more common in the surgery cohort (32% vs 16%; P < .02). In the medical cohort, sarcopenia predicted need for surgery at 1 year (odds ratio, 4.75; 95% confidence interval, 1.10-20.57; P = .04). Low albumin and body mass index (BMI) were associated with the presence of sarcopenia; however, 24% of sarcopenic patients had both normal BMI and albumin. CONCLUSIONS Sarcopenia is more prevalent among IBD patients undergoing surgery and predicts the need for surgery in patients starting new biologic therapy. Low albumin and BMI were similar between cohorts, suggesting a unique role for sarcopenia as a relevant clinical marker of lean muscle mass depletion for surgically and medically treated IBD patients.
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Affiliation(s)
- James P Campbell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Scott Manski
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian Blumhof
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Raina Shivashankar
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eugenia Shmidt
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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8
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Fidler JL, Guglielmo FF, Brook OR, Strate LL, Bruining DH, Gupta A, Allen BC, Anderson MA, Wells ML, Ramalingam V, Gunn ML, Grand DJ, Gee MS, Huete A, Khandalwal A, Sokhandon F, Park SH, Yoo DC, Soto JA. Management of gastrointestinal bleeding: Society of Abdominal Radiology (SAR) Institutional Survey. Abdom Radiol (NY) 2022; 47:2-12. [PMID: 34554300 DOI: 10.1007/s00261-021-03232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
Despite guidelines developed to standardize the diagnosis and management of gastrointestinal (GI) bleeding, significant variability remains in recommendations and practice. The purpose of this survey was to obtain information on practice patterns for the evaluation of overt lower GI bleeding (LGIB) and suspected small bowel bleeding. A 34-question electronic survey was sent to all Society of Abdominal Radiology (SAR) members. Responses were received from 52 unique institutions (40 from the United States). Only 26 (50%) utilize LGIB management guidelines. 32 (62%) use CT angiography (CTA) for initial evaluation in unstable patients. In stable patients with suspected LGIB, CTA is the preferred initial exam at 21 (40%) versus colonoscopy at 24 (46%) institutions. CTA use increases after hours for both unstable (n = 32 vs. 35, 62% vs. 67%) and stable patients (n = 21 vs. 27, 40% vs 52%). CTA is required before conventional angiography for stable (n = 36, 69%) and unstable (n = 15, 29%) patients. 38 (73%) institutions obtain two post-contrast phases for CTA. 49 (94%) institutions perform CT enterography (CTE) for occult small bowel bleeding with capsule endoscopy (n = 26, 50%) and CTE (n = 21, 40%) being the initial test performed. 35 (67%) institutions perform multiphase CTE for occult small bowel bleeding. In summary, stable and unstable patients with overt lower GI are frequently imaged with CTA, while CTE is frequently performed for suspected occult small bowel bleeding.
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Affiliation(s)
- Jeff L Fidler
- Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA.
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Lisa L Strate
- Department of Gastroenterology, University of Washington, 325 9th Ave, Box 359728, Seattle, WA, 98105, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA
| | - Avneesh Gupta
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, 3rd Floor FGH Building, Boston, MA, 02118, USA
| | - Brian C Allen
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA
| | - Vijay Ramalingam
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Martin L Gunn
- Department of Radiology, University of Washington, 325 9th Ave, Box 359728, Seattle, WA, USA
| | - David J Grand
- Department of Radiology, Warren Alpert School of Medicine, Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Alvaro Huete
- Department of Radiology, Pontifical Catholic University, Marcoleta 367, Santiago, Chile
| | - Ashish Khandalwal
- Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA
| | - Farnoosh Sokhandon
- Department of Radiology, Beaumont Health, IC 115, 3601 West Thirteen Mile Rd., Royal Oak, MI, 48073, USA
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Don C Yoo
- Department of Radiology, Warren Alpert School of Medicine, Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, 3rd Floor FGH Building, Boston, MA, 02118, USA
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Metra BM, Guglielmo FF, Halegoua-DeMarzio DL, Civan JM, Mitchell DG. Beyond the Liver Function Tests: A Radiologist's Guide to the Liver Blood Tests. Radiographics 2021; 42:125-142. [PMID: 34797734 DOI: 10.1148/rg.210137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver blood tests (often also known as liver chemistries, liver tests, or the common misnomer liver function tests) are routinely used in diagnosis and management of hepatobiliary disease. Abnormal liver blood test results are often the first indicator of hepatobiliary disease and a common indication for abdominal imaging with US, CT, or MRI. Most of the disease entities can be categorized into hepatocellular or cholestatic patterns, with characteristic traits on liver blood tests. Each pattern has a specific differential, which can help narrow the differential diagnosis when combined with the clinical history and imaging findings. This article reviews the major liver blood tests as well as a general approach to recognizing common patterns of hepatobiliary disease within these tests (hepatocellular, cholestatic, acute liver failure, isolated hyperbilirubinemia). Examples of hepatobiliary disease with hepatocellular or cholestatic patterns are presented with characteristic test abnormalities and imaging findings. The commonly encountered scenario of chronic hepatitis with possible fibrosis is also reviewed, with discussion of potential further imaging such as elastography. The role of liver blood tests and imaging in evaluating complications of hepatic transplant is also discussed. Overall, integrating liver blood test patterns with imaging findings can help the radiologist accurately diagnose hepatobiliary disease, especially in cases where imaging findings may not allow differentiation between different entities. ©RSNA, 2021.
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Affiliation(s)
- Brandon M Metra
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Flavius F Guglielmo
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Dina L Halegoua-DeMarzio
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Jesse M Civan
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Donald G Mitchell
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
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10
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Guglielmo FF, Wells ML, Bruining DH, Strate LL, Huete Á, Gupta A, Soto JA, Allen BC, Anderson MA, Brook OR, Gee MS, Grand DJ, Gunn ML, Khandelwal A, Park SH, Ramalingam V, Sokhandon F, Yoo DC, Fidler JL. Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms. Radiographics 2021; 41:1632-1656. [PMID: 34597220 DOI: 10.1148/rg.2021210043] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastrointestinal (GI) bleeding is a common potentially life-threatening medical condition frequently requiring multidisciplinary collaboration to reach the proper diagnosis and guide management. GI bleeding can be overt (eg, visible hemorrhage such as hematemesis, hematochezia, or melena) or occult (eg, positive fecal occult blood test or iron deficiency anemia). Upper GI bleeding, which originates proximal to the ligament of Treitz, is more common than lower GI bleeding, which arises distal to the ligament of Treitz. Small bowel bleeding accounts for 5-10% of GI bleeding cases commonly manifesting as obscure GI bleeding, where the source remains unknown after complete GI tract endoscopic and imaging evaluation. CT can aid in identifying the location and cause of bleeding and is an important complementary tool to endoscopy, nuclear medicine, and angiography in evaluating patients with GI bleeding. For radiologists, interpreting CT scans in patients with GI bleeding can be challenging owing to the large number of images and the diverse potential causes of bleeding. The purpose of this pictorial review by the Society of Abdominal Radiology GI Bleeding Disease-Focused Panel is to provide a practical resource for radiologists interpreting GI bleeding CT studies that reviews the proper GI bleeding terminology, the most common causes of GI bleeding, key patient history and risk factors, the optimal CT imaging technique, and guidelines for case interpretation and illustrates many common causes of GI bleeding. A CT reporting template is included to help generate radiology reports that can add value to patient care. An invited commentary by Al Hawary is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Flavius F Guglielmo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Michael L Wells
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - David H Bruining
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Lisa L Strate
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Álvaro Huete
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Avneesh Gupta
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Jorge A Soto
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Brian C Allen
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Mark A Anderson
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Olga R Brook
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Michael S Gee
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - David J Grand
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Martin L Gunn
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Ashish Khandelwal
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Seong Ho Park
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Vijay Ramalingam
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Farnoosh Sokhandon
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Don C Yoo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Jeff L Fidler
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
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Deepak P, Ludwig DR, Fidler JL, Guglielmo FF, Bruining DH. Medical and Endoscopic Management of Crohn Disease. Top Magn Reson Imaging 2021; 30:43-61. [PMID: 33528211 DOI: 10.1097/rmr.0000000000000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.
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Affiliation(s)
- Parakkal Deepak
- Washington University Inflammatory Bowel Diseases Center, Division of Gastroenterology, Washington University in Saint Louis School of Medicine, St. Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
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Abstract
ABSTRACT Magnetic resonance enterography (MRE) is a well-established imaging technique that is commonly used for evaluating a variety of bowel diseases, most commonly inflammatory bowel disease which is increasing in prevalence. Inflammatory bowel disease is composed of 2 related, but distinct disease entities: Crohn disease (CD) and ulcerative colitis. In ulcerative colitis, inflammation is generally limited to the mucosa and invariably involves the rectum, and often the more proximal colon. CD is typified by transmural inflammation with skip lesions occurring anywhere from the mouth to anus, but characteristically involves the terminal ileum. The transmural involvement of CD may lead to debilitating ulceration and, ultimately, development of sinus tracts, which can be associated with abscesses and fistulae as extraenteric manifestations of the disease. Because much of the small bowel and extraenteric disease cannot be adequately assessed with conventional endoscopy, imaging plays a crucial role in initial diagnosis and follow-up. MRE does not use ionizing radiation which is important for these patients, many of which present earlier in life and may require multiple imaging examinations. In this article, we review the clinical indications, patient preparation, and optimal technique for MRE. We also discuss the role and proper selection of intravenous gadolinium-based contrast material, oral contrast material, and antiperistaltic agents, including pediatric considerations. Finally, we review the recommended and optional pulse sequence selection, including discussion of a "time-efficient" protocol, reviewing their utility, advantages, and limitations. Our hope is to aid the radiologist seeking to develop a robust MRE imaging program for the evaluation of bowel disease.
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Affiliation(s)
- Manjil Chatterji
- Department of Radiology, Weill Cornell College of Medicine, New York, NY
| | | | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
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Trunz LM, Guglielmo FF, Selvarajan SK, Naringrekar HV, Alturki A, Dave JK, Mitchell DG. Biliary excretion of gadobenate dimeglumine causing degradation of magnetic resonance cholangiopancreatography (MRCP). Abdom Radiol (NY) 2021; 46:562-569. [PMID: 32743690 DOI: 10.1007/s00261-020-02686-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the effect of gadobenate dimeglumine on magnetic resonance cholangiopancreatography (MRCP) and determine an appropriate time frame for performing MRCP sequences. MATERIALS AND METHODS 2D MRCP sequences obtained after intravenous administration of gadobenate dimeglumine or gadobutrol over 14 months were reviewed retrospectively in randomized order by five abdominal radiologists, using a 3-point scale to rate biliary and pancreatic duct clarity (1 = no-, 2 = limited-, 3 = good visualization). Intraclass correlation coefficients were computed and mean scores were compared for both agents. For gadobenate dimeglumine exams, time delays between arterial phase and MRCP acquisition times were analyzed concerning duct clarity. For gadobutrol, only exams with delays ≥ 15 min were included. RESULTS 134 exams (107 gadobenate dimeglumine, 27 gadobutrol) were included. Moderate reliability for pancreatic duct visualization and excellent reliability for visualization of intrahepatic bile ducts and upper and lower extrahepatic bile ducts were noted. No difference in mean scores was noted for pancreatic duct visualization (p = 0.66). Bile duct segment scores were lower with gadobenate dimeglumine (mean: 2.1-2.6) compared with gadobutrol (mean: 2.8-2.9) (p ≤ 0.006). For gadobenate dimeglumine, visualization scores varied depending on the delay between the arterial phase and MRCP acquisition (p ≤ 0.047). Good visualization for all bile duct segments was noted with delays of 7.2-9.4 min (95% confidence interval; mean 8.3 min). CONCLUSION Bile duct clarity degraded on MRCP images with an increasing delay following gadobenate dimeglumine injection. 2D MRCP, thus, should be performed within 7.2 min after obtaining the arterial phase sequence to ensure good visualization of the entire biliary system.
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Affiliation(s)
- Lukas M Trunz
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA.
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Santosh K Selvarajan
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Haresh V Naringrekar
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Abdullah Alturki
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th Street, Philadelphia, PA, 19107, USA
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Gandhi NS, Dillman JR, Grand DJ, Huang C, Fletcher JG, Al-Hawary MM, Anupindi SA, Baker ME, Bruining DH, Chatterji M, Fidler JL, Gee MS, Grajo JR, Guglielmo FF, Jaffe TA, Park SH, Rimola J, Taouli B, Taylor SA, Yeh B. Computed tomography and magnetic resonance enterography protocols and techniques: survey of the Society of Abdominal Radiology Crohn's Disease Disease-Focused Panel. Abdom Radiol (NY) 2020; 45:1011-1017. [PMID: 31982931 DOI: 10.1007/s00261-020-02407-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To survey Society of Abdominal Radiology Crohn's Disease (CD) Disease-Focused Panel (DFP) members to understand state-of-the-art CT/MR enterography (CTE/MRE) protocols and variability between institutions. METHODS This study was determined by an institutional review board to be "exempt" research. The survey consisted of 70 questions about CTE/MRE patient preparation, administration of contrast materials, imaging techniques, and other protocol details. The survey was administered to DFP members using SurveyMonkey® (Surveymonkey.com). Descriptive statistical analyses were performed. RESULTS Responses were received from 16 DFP institutions (3 non-USA, 2 pediatric); 15 (94%) were academic/university-based. 10 (63%) Institutions image most CD patients with MRE; 4 (25%) use CTE and MRE equally. Hypoperistaltic medication is given for MRE at 13 (81%) institutions versus only 2 (13%) institutions for CTE. Most institutions have a technologist or nurse monitor oral contrast material drinking (n = 12 for CTE, 75%; n = 11 for MRE, 69%). 2 (13%) institutions use only dual-energy capable scanners for CTE, while 9 (56%) use either a single-energy or dual-energy scanner based on availability. Axial CTE images are reconstructed at 2-3 mm thickness at 8 (50%) institutions, > 3 mm at 5 (31%), and < 2 mm at 3 (19%) institutions. 13 (81%) institutions perform MRE on either 1.5 or 3T scanners without preference. All institutions perform MRE multiphase postcontrast imaging (median = 4 phases), ranging from 20 to 600 s after contrast material injection. CONCLUSION CTE and MRE protocol knowledge from DFP institutions can help radiology practices optimize/standardize protocols, potentially improving image quality and patient outcomes, permitting objective comparisons between examinations, and facilitating research.
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Affiliation(s)
- Namita S Gandhi
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David J Grand
- Department of Radiology, Rhode Island Hospital, Providence, RI, USA
| | - Chenchan Huang
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | | | - Mahmoud M Al-Hawary
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia & University of Pennsylvania, Philadelphia, PA, USA
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manjil Chatterji
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tracy A Jaffe
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Benjamin Yeh
- Department of Radiology, University of California, San Francisco, USA
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Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, Bruining DH, Chatterji M, Darge K, Fidler JL, Gandhi NS, Gee MS, Grajo JR, Huang C, Jaffe TA, Park SH, Rimola J, Soto JA, Taouli B, Taylor SA, Baker ME. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. Radiographics 2020; 40:354-375. [DOI: 10.1148/rg.2020190091] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Affiliation(s)
- Flavius F. Guglielmo
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
| | - Sudhakar K. Venkatesh
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
| | - Donald G. Mitchell
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
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Guglielmo FF, Mitchell DG, O'Kane PL, Deshmukh SP, Roth CG, Burach I, Burns A, Dulka S, Parker L. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign. ACTA ACUST UNITED AC 2016; 40:1150-6. [PMID: 25326259 DOI: 10.1007/s00261-014-0258-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. MATERIALS AND METHODS 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. RESULTS For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. CONCLUSION Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.
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Affiliation(s)
- Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA,
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Wnorowski AM, Guglielmo FF, Mitchell DG. How to perform and interpret cine MR enterography. J Magn Reson Imaging 2015; 42:1180-9. [DOI: 10.1002/jmri.24981] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/02/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Amelia M. Wnorowski
- Thomas Jefferson University Hospital; Department of Radiology; Philadelphia Pennsylvania USA
| | - Flavius F. Guglielmo
- Thomas Jefferson University Hospital; Department of Radiology; Philadelphia Pennsylvania USA
| | - Donald G. Mitchell
- Thomas Jefferson University Hospital; Department of Radiology; Philadelphia Pennsylvania USA
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Guglielmo FF, Mitchell DG, O’Kane PL, Deshmukh SP, Roth CG, Burach I, Burns A, Dulka S, Parker L. Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign. ACTA ACUST UNITED AC 2014; 40:1138-49. [PMID: 25445157 DOI: 10.1007/s00261-014-0293-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Guglielmo FF, Mitchell DG, Roth CG, Deshmukh S. Hepatic MR Imaging Techniques, Optimization, and Artifacts. Magn Reson Imaging Clin N Am 2014; 22:263-82. [DOI: 10.1016/j.mric.2014.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Proper selection of a gadolinium-based contrast agent (GBCA) for body magnetic resonance imaging (MRI) cases requires understanding the indication for the MRI exam, the key features of the different GBCAs, and the effect that the GBCA has on the selected imaging protocol. The different categories of GBCAs require timing optimization on postcontrast sequences and adjusting imaging parameters to obtain the highest T1 contrast. Gadoxetate disodium has many advantages when evaluating liver lesions, although there are caveats and limitations that need to be understood. Gadobenate dimeglumine, a high-relaxivity GBCA, can be used for indications when stronger T1 relaxivity is needed.
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Affiliation(s)
- Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA.
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA
| | - Shiva Gupta
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, FCT15.5013, Houston, TX 77030, USA
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Ghobrial PM, Neuberger I, Guglielmo FF, Mitchell DG, Parker L, O'Kane PL, Roth CG, Deshmukh SP, Borowski A. Cine MR enterography grading of small bowel peristalsis: evaluation of the antiperistaltic effectiveness of sublingual hyoscyamine sulfate. Acad Radiol 2014; 21:86-91. [PMID: 24331269 DOI: 10.1016/j.acra.2013.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES To use a cine balanced steady-state free precession magnetic resonance enterography (cine MRE) pulse sequence to assess the effectiveness of a sublingual (SL) antiperistaltic agent, hyoscyamine sulfate. MATERIALS AND METHODS Institutional review board approval was granted with an exemption for informed consent in this Health Insurance Portability and Accountability Act-compliant, retrospective, single-institution study. Of the 288 MRE examinations performed between October 1, 2007 and January 15, 2011, 92 using SL hyoscyamine sulfate for antiperistalsis were included for review, each with cine MRE before and after medication. These 184 cine MRE data sets were randomized, blinded for treatment, and independently reviewed by five attending abdominal radiologists, who rated the degree of whole abdomen bowel motility on each cine MRE data set on a 5-point scale. Pre- and postmedication mean peristalsis ratings, standard deviation, mean difference, and treatment effect sizes were calculated. A repeated measures analysis of variance test was performed using a significance threshold of P = .05. Interobserver reliabilities were also calculated. RESULTS Mean peristalsis ratings ranged 2.63-3.34 and 2.36-3.03, before and after medication administration, respectively. The mean differences ranged from 0.22 to 0.46, which are treatment effect sizes of 0.20 to 0.37. The decrease in peristalsis observed by the five reviewing radiologists after SL hyoscyamine sulfate administration was significant (df = 1/182, f = 7.35, P < .01). The interobserver reliabilities were 0.34 for the pretest and 0.33 for the posttest. CONCLUSIONS Although cine MRE sequences show decreased bowel peristalsis after the use of SL hyoscyamine sulfate, the small size of the observed treatment effect is likely insufficient to justify its use for MRE.
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Deshmukh SP, Gonsalves CF, Guglielmo FF, Mitchell DG. Role of MR Imaging of Uterine Leiomyomas before and after Embolization. Radiographics 2012; 32:E251-81. [DOI: 10.1148/rg.326125517] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Guglielmo FF, Kurtz AB, Wechsler RJ. Prospective comparison of computed tomography and duplex sonography in the evaluation of recently inserted Kimray-Greenfield filters into the inferior vena cava. Clin Imaging 1990; 14:216-20. [PMID: 2224624 DOI: 10.1016/0899-7071(90)90076-n] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A prospective comparison of contrast-enhanced computed tomography (CT) and duplex sonography (DS) was performed to examine the Kimray-Greenfield filter in the inferior vena cava (IVC) in the immediate postoperative period. Fourteen patients were studied for five complications: IVC thrombosis, malpositioning, pericaval hematoma, filter angulation, and prong perforation. Our results found CT to be more efficacious because it was a) able to evaluate more patients with fewer technically inadequate scans and b) more definitive in all categories. However, when visualized, DS was as accurate as CT in the evaluation of thrombosis.
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Affiliation(s)
- F F Guglielmo
- Department of Radiology, Jefferson Medical College and Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
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Abstract
A case of a recurrent submandibular pleomorphic adenoma with metastasis in which both the primary tumor and metastasis were histologically benign is reported and the literature reviewed.
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Affiliation(s)
- F F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107
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