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Qu M, Jia Z, Sun L, Wang H. Diagnostic accuracy of three-dimensional contrast-enhanced ultrasound for focal liver lesions: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28147. [PMID: 34941062 PMCID: PMC8701827 DOI: 10.1097/md.0000000000028147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) examination is a well-established technique for this purpose with several unique advantages. It is a real-time technology with high temporal resolution. With its unique ability to detect microvascular perfusion, it helps in better characterization of FLL.[1-4] Three-dimensional (3D) CEUS with quantitative analysis is updated in recent years. 3D-CEUS is a new ultrasonic diagnostic technique, which can observe the nourishing vessels of lesions from multiple angles. Previous studies showed that 3D-CEUS can detect tumor nourishing vessels to differentiate benign from malignant focal liver lesions (FLLs). However, the results of these studies have been contradictory. Therefore, this meta-analysis tested the hypothesis that 3D-CEUS is accurate in distinguishing benign and malignant FLLs. METHODS We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the April 30, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS This systematic review will determine the accuracy of 3D-CEUS in the differential diagnosis between benign and malignant FLLs. CONCLUSION Its findings will provide helpful evidence for the accuracy of 3D-CEUS in the differential diagnosis between benign and malignant FLLs. SYSTEMATIC REVIEW REGISTRATION INPLASY202150096.
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Gerasia R, Cannataci C, Maruzzelli L, Caruso C, Liotta F, Cucchiara A, Cortis K, Miraglia R. OCCUPATIONAL RADIATION DOSE PERFORMING HEPATOBILIARY MINIMALLY INVASIVE PROCEDURES IN CHILDREN WEIGHING LESS THAN 20 kg. Radiat Prot Dosimetry 2020; 188:56-64. [PMID: 31735959 DOI: 10.1093/rpd/ncz260] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/26/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
Our objective is to retrospectively evaluate the effective dose (E) of operators performing pediatric Hepatobiliary Minimally Invasive Procedures (HMIP). Between October 2015 and December 2017, 58 consecutive HMIP were performed on 26 children weighing less than 20 kg (mean 12.3 kg, median 13 kg, range 2.4-20 kg). About 31 vascular procedures (n = 9 hepatic venograms with/without stenting; n = 9 retrograde wedge portography; n = 8 transhepatic portography with angioplasty and/or stenting and n = 5 hepatic arteriography/embolization) and 27 non-vascular procedures (n = 6 percutaneous transhepatic biliary drainage (PTBD); n = 3 bilioplasty; n = 15 biliary catheter change and n = 3 cholangiogram) were performed. Electronic personal dosimeters were used to measure radiation doses to the interventional radiologist, radiographer and anesthesia nurse. The results shows the highest mean effective dose: interventional radiologist's in PTBD (1.18 μSv); radiographer's in hepatic veins phlebography with/without stenting (0.25 μSv) and nurse's in hepatic arteriography/embolization (0.26 μSv). Operators' E can vary depending on the complexity of procedure performed and the position of the operators within the angiosuite.
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Affiliation(s)
- Roberta Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Christine Cannataci
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, MSD9032 Msida, Malta
| | - Luigi Maruzzelli
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Calogero Caruso
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Ferdinanda Liotta
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Antonino Cucchiara
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Kelvin Cortis
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, MSD9032 Msida, Malta
| | - Roberto Miraglia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
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Abstract
Lung transplantation (LT) is an established method for treating end-stage lung disease. Although most of the post-lung transplant imaging surveillance is focused on chronic lung allograft rejection, abdominopelvic complications have been reported in 7-62% of patients. The reported wide range of post-LT abdominopelvic complications is thought to be secondary to lack of current standardized definitions. These complications encompass a heterogeneous group of disorders including upper and lower gastrointestinal (GI) disorders, inflammatory conditions of solid organs, lymphoproliferative disorders, and neoplasms; each with varying pathophysiology, timing, severity, and treatment. Clinical manifestations of these complications may overlap or be masked by immunosuppression; therefore, imaging plays a paramount role in the early management and treatment.
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Affiliation(s)
- Farouk Dako
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA.
| | - Partha Hota
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mansoor Kahn
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
| | - Maruti Kumaran
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
| | - Omar Agosto
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, 19123, USA
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Dietrich CF, Douira-Khomsi W, Gharbi H, Sharma M, Cui XW, Sparchez Z, Richter J, Kabaalioğlu A, Atkinson NSS, Schreiber-Dietrich D, Yi D. Cystic and alveolar echinococcosis of the hepatobiliary tract - the role of new imaging techniques for improved diagnosis. Med Ultrason 2020; 22:75-84. [PMID: 32096792 DOI: 10.11152/mu-2421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cystic echinococcosis (CE) or hydatidosis (hydatid cysts) is an infection with a wide spectrum of manifestations, from symptomatic infection to fatal disease. Ultrasound (US) allows screening, diagnosis, differential diagnosis, treatment guidance and follow-up of CE under many circumstances. Hydatid cysts are predominantly observed in the liver. Herewith we present a review to demonstrate established and innovative imaging features of CE of the hepatobiliary tract.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland, Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou , University, Zhengzhou, China,.
| | | | - Hassen Gharbi
- Department of Radiologie, Ibn Zohr Clinic, Tunis, Tunisia
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, India
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zeno Sparchez
- 3rd Medical Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Institute for Gastroenterology and Hepatology "O. Fodor" Cluj-Napoca, Romania
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
| | - Adnan Kabaalioğlu
- Akdeniz University Hospital, Department of Radiology, Antalya, Turkey
| | - Nathan S S Atkinson
- 0Department of Gastroenterology, Waitemata District Health Board, Auckland, New Zealand
| | - Dagmar Schreiber-Dietrich
- Pediatric Department, Caritas Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Germany
| | - Dong Yi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Kessner R, Nakamoto DA, Kondray V, Partovi S, Ahmed Y, Azar N. Contrast-Enhanced Ultrasound Guidance for Interventional Procedures. J Ultrasound Med 2019; 38:2541-2557. [PMID: 30714653 DOI: 10.1002/jum.14955] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.
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Affiliation(s)
- Rivka Kessner
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dean A Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Victor Kondray
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasmine Ahmed
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Pickhardt PJ, Nelson L. Acute non-traumatic abdominal pain by quadrant: relative yield of CT and clinical evaluation for diagnosis in 1000 patients. Abdom Radiol (NY) 2019; 44:2963-2970. [PMID: 31104074 DOI: 10.1007/s00261-019-02064-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/29/2022]
Abstract
OBJECTIVE To determine the relative diagnostic yield of contrast-enhanced CT in adults presenting with symptoms referable to a specific abdominal quadrant. METHODS Electronic health records review systematically identified patients meeting the following inclusion criteria: adults (≥ 18 years) undergoing IV contrast-enhanced abdominopelvic CT for acute non-traumatic symptoms referable to a specific abdominal quadrant (RLQ/LLQ/LUQ/RUQ). The CT-based diagnosis and any clinical diagnosis in the absence of CT diagnosis were recorded. The final cohort of 1000 subjects (mean age, 48.1 years; 647F/353M) consisted of consecutive sub-cohorts of 250 patients for each abdominal quadrant. Positive oral contrast was utilized in 91.6% (916/1000) of cases. RESULTS A positive CT diagnosis was provided in 47.3% (473/1000) of all patients, and was highest for LLQ (58.8%) and RLQ (58.0%) symptoms, including diverticulitis and appendicitis in 23.6% and 24.8% cases, respectively. CT positivity was lower for the LUQ (34.4%) and RUQ (38.0%) (p < 0.0001), with no single diagnosis representing > 5% of cases. However, all quadrants provided valuable triage of 218 hospital admissions (21.8%), 83.0% were CT positive, whereas 62.7% of 782 discharged patients were CT negative. Only 7.0% of CT-negative patients were admitted. A clinical-only diagnosis was provided in 9.3% of the total cohort (93/1000), representing 17.6% of the CT-negative cohort (93/527). CONCLUSION The rate of positive CT diagnosis is considerably higher for the lower abdominal quadrants, predominately due to appendicitis and diverticulitis. However, CT results (positive vs. negative) for all four quadrants strongly correlated with hospital admission versus discharge. Clinical-only diagnosis represented < 10% of all cases.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
| | - Leslie Nelson
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA
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Marín-Serrano E. The quality of abdominal ultrasound: a much-needed consensus. Rev Esp Enferm Dig 2019; 111:633-636. [PMID: 31232077 DOI: 10.17235/reed.2019.6177/2019] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The abdominal ultrasound (AU) is a diagnostic imaging modality that is yet to be established in most Gastrointestinal (GI) Units in Spain. This is largely due to the difficulties that GI specialists face with regard to the appropriate training received when starting the specialty. Insufficient resources have been allocated to develop AU units in many GI units where AUs are performed. The equipment is obsolete and there are no adaptations to the needs of the GI specialist to provide good medical care. Thus, due to all the above, the AU does not hold the position it deserves in our specialty. This probably stems from a lack of impulse and/or support to the technique, which has underestimated its usefulness and has limited the implementation of resources in the GI units. For the AU to overcome these obstacles, it needs to be considered as a process or a series of activities based on scientific evidence and the experience of professionals that achieves a result that covers the patients' needs with minimal risk. In this article, we defend the need to boost AU as a key discipline for the diagnosis of digestive diseases. Quality is considered as the key aspect on which this transformation and improvement is founded.
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Wang LW, Lin H, Xin L, Qian W, Wang TJ, Zhang JZ, Meng QQ, Tian B, Ma XD, Li ZS. Establishing a model to measure and predict the quality of gastrointestinal endoscopy. World J Gastroenterol 2019; 25:1024-1030. [PMID: 30833807 PMCID: PMC6397728 DOI: 10.3748/wjg.v25.i8.1024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tens of millions of gastrointestinal endoscopic procedures are performed every year in China, but the quality varies significantly and related factors are complex. Individual endoscopist- and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy.
AIM To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in mainland China.
METHODS Selected data on endoscopy experience, equipment, facility, qualification of endoscopists, and other relevant variables were collected from the National Database of Digestive Endoscopy of China. The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance. Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications.
RESULTS In 2012, gastroscopy/colonoscopy-related complications in mainland China included bleeding in 4,359 cases (0.02%) and perforation in 914 (0.003%). Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases (0.3%), bleeding in 2,151 (1.10%), perforation in 257 (0.13%) and biliary infection in 4,125 (2.11%). Moreover, 1,313 (5.0%) endoscopists encountered with medical malpractice, and 5,243 (20.0%) encountered with the disturbance from patients. The length of endoscopy experience, weekly working hours, weekly night shifts, annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance. However, the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications.
CONCLUSION The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance. More comprehensive data are needed to establish quality-predictive models for endoscopic complications.
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Affiliation(s)
- Luo-Wei Wang
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Han Lin
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Lei Xin
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Wei Qian
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Tian-Jiao Wang
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | | | - Qian-Qian Meng
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Bo Tian
- Department of Intensive Care Unit, Shanghai East Hospital, Tongji University, Shanghai 200120, China
| | - Xu-Dong Ma
- Department of Medical Quality, Medical and Health Administration, National Health Commission of China, Beijing 100044, China
| | - Zhao-Shen Li
- Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Shimpi TR, Shikhare SN, Chung R, Wu P, Peh WCG. Imaging of Gastrointestinal and Abdominal Emergencies in Binge Drinking. Can Assoc Radiol J 2019; 70:52-61. [PMID: 30691564 DOI: 10.1016/j.carj.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/29/2018] [Revised: 08/30/2018] [Accepted: 10/20/2018] [Indexed: 12/19/2022] Open
Abstract
Excess alcohol consumption is a leading cause of preventable morbidity and mortality globally. The pattern of consumption of alcoholic beverages has changed in our society in the recent past, with binge drinking becoming more and more common, especially among young adults. Abdominal pain following alcohol consumption can be secondary to a wide range of pathologies, the treatment algorithm of which can range from medical supportive treatment to more invasive life-saving procedures such as transarterial embolization and emergency laparotomy. Correct diagnosis, differentiation among these conditions, and implementing the correct management algorithm is heavily reliant on accurate and appropriate imaging. We review the pathophysiology, clinical presentation, imaging features and management options of acute abdominal emergencies secondary to binge drinking, based on a selection of illustrative cases.
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Affiliation(s)
- Trishna R Shimpi
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore.
| | - Sumer N Shikhare
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Raymond Chung
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Peng Wu
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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11
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Affiliation(s)
- Laura K Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA
| | - Sharon Yellin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA
| | - Alexander C Arroyo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA.
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Abstract
Ultrasonography (US) is frequently the first imaging modality used to examine women with symptoms involving the pelvis. It is widely available and involves no exposure to ionizing radiation. Images can be acquired with a transabdominal, endovaginal, or translabial approach, and the use of video clips and three-dimensional reconstructions can be helpful. US is excellent for assessment of the uterus, ovaries, and adnexa. Occasionally, nongynecologic pelvic diseases arising from the gastrointestinal, genitourinary, and musculoskeletal systems and the pelvic peritoneal and extraperitoneal spaces may be detected and can be a source of diagnostic dilemma. US can be helpful not only in the detection but also occasionally in the characterization of such entities. Computed tomography and magnetic resonance imaging are useful in complicated cases. In this article, the normal US appearance of the bowel and US signs of bowel disease and specific entities, including appendicitis, diverticular disease, bowel obstruction, appendiceal mucocele, and intestinal tumors, are reviewed. The lower urinary tract is included in the field of view in every pelvic US examination; commonly encountered entities related to the urinary bladder, distal ureter, and urethra are illustrated. In addition to arising in the gastrointestinal and genitourinary tracts, pathologic conditions in the pelvis can arise in the peritoneal or extraperitoneal space. Although conditions of the pelvic peritoneal and extraperitoneal spaces are rare, it is important to recognize these entities and distinguish them from the more common gynecologic diseases. Owing to the implications for diagnosis and management, radiologists and other physicians who perform pelvic US should be aware of the spectrum of nongynecologic pathologic entities that can be detected. ©RSNA, 2017.
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Affiliation(s)
- Akram M Shaaban
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Maryam Rezvani
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Jeffrey D Olpin
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Anne M Kennedy
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Ayman H Gaballah
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Bryan R Foster
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Christine O Menias
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (A.M.S., M.R., J.D.O., A.M.K.); Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.); Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Ore (B.R.F.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Young AS, Shyn PB, Johnson OW, Sainani NI, Nawfel RD, Silverman SG. Bending percutaneous drainage catheters to facilitate CT-guided insertion using curved trocar technique. Abdom Radiol (NY) 2017; 42:2160-2167. [PMID: 28361226 DOI: 10.1007/s00261-017-1108-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/30/2022]
Abstract
PURPOSE To assess the safety and efficacy of placing thoraco-abdominal drainage catheters under CT-guidance using a curved trocar technique. METHODS A retrospective study of 182 CT/CT-fluoroscopy-guided thoraco-abdominal catheter drainages was conducted; half were performed by residents or fellows under the supervision of one radiologist (Group 1) and the other half under the supervision of 10 other radiologists (Group 2). Group 1 procedures employed a curved catheter assembly placed using trocar technique (n = 44) or straight catheters placed with Seldinger technique (n = 47). Group 2 procedures employed a straight catheter placed using trocar technique (n = 16) or straight catheters placed with Seldinger technique (n = 75). Technical success, procedure time, radiation dose (CT Dose Index CTDIvol), and adverse events (Common Terminology Criteria for Adverse Events, 4.0) were compared between techniques and groups using Student's t test, Fisher's exact test or Chi-square analysis. RESULTS All procedures in groups 1 and 2 were technically successful. Mean procedure time for Group 1 curved trocar technique (28 ± 8 min) was shorter than groups 1 and 2 Seldinger technique (37 ± 11 min, p = .00002). Mean CTDIvol for Group 1 curved trocar technique (107.8 ± 54.2 mGy) was lower than groups 1 and 2 Seldinger technique (136.1 ± 99.7 mGy, p = 0.032). Adverse event rates for curved trocar, straight trocar, and Seldinger techniques were 2.3% (1/44), 0% (0/16), and 3.3% (4/122), respectively (p = 1); all were grade 1 or 2, and no catheter malfunctions occurred. CONCLUSIONS The curved catheter trocar technique is a safe and effective modification of the standard trocar technique that may facilitate CT-guided procedures impeded by CT gantry size limitations.
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Affiliation(s)
- Adam S Young
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Oren W Johnson
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Nisha I Sainani
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Richard D Nawfel
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
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Sutcliffe RP, Hollyman M, Hodson J, Bonney G, Vohra RS, Griffiths EA. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients. HPB (Oxford) 2016; 18:922-928. [PMID: 27591176 PMCID: PMC5094477 DOI: 10.1016/j.hpb.2016.07.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. PATIENTS AND METHODS Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. RESULTS Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p < 0.001), indication for surgery (p < 0.001), ASA (p < 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p < 0.001), and a score >6 identified patients at high risk of conversion (7.1% vs. 1.2%). CONCLUSION This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy.
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Affiliation(s)
- Robert P Sutcliffe
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Marianne Hollyman
- West Midlands Research Collaborative, Academic Department of Surgery, Birmingham University, UK
| | - James Hodson
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Glenn Bonney
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ravi S Vohra
- Nottingham Oesophago-Gastric Unit, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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15
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Sporea I. Ultrasound: "one stop shop" in hepatology. Med Ultrason 2016; 18:143-144. [PMID: 27239645 DOI: 10.11152/mu.2013.2066.182.isp] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.
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Baheti AD, Nicola R, Bennett GL, Bordia R, Moshiri M, Katz DS, Bhargava P. Magnetic Resonance Imaging of Abdominal and Pelvic Pain in the Pregnant Patient. Magn Reson Imaging Clin N Am 2016; 24:403-17. [PMID: 27150326 DOI: 10.1016/j.mric.2015.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/29/2022]
Abstract
The utility of MR imaging in evaluating abdominal and pelvic pain in the pregnant patient is discussed. Details regarding the indications, technical aspects, and imaging findings of various common abdominal and pelvic abnormalities in pregnancy are reviewed.
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Affiliation(s)
- Akshay D Baheti
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195, USA.
| | - Refky Nicola
- Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642, USA
| | - Genevieve L Bennett
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, USA
| | - Ritu Bordia
- Section of Neuroradiology, Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
| | - Mariam Moshiri
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195, USA
| | - Douglas S Katz
- Section of Neuroradiology, Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
| | - Puneet Bhargava
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195, USA
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17
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Affiliation(s)
- Mohamed E Abd El Bagi
- Department of Medical Imaging and Emergency Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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18
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Ricci ZJ, Mazzariol FS, Kaul B, Oh SK, Chernyak V, Flusberg M, Stein MW, Rozenblit AM. Hollow organ abdominal ischemia, part II: clinical features, etiology, imaging findings and management. Clin Imaging 2016; 40:751-64. [PMID: 27317221 DOI: 10.1016/j.clinimag.2016.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/19/2015] [Revised: 01/16/2016] [Accepted: 02/17/2016] [Indexed: 12/20/2022]
Abstract
Acute hollow organ ischemia commonly presents with acute pain prompting radiologic evaluation and almost always requires urgent treatment. Despite different risk factors and anatomic differences, ischemia is commonly due to low flow states but can also be due to arterial and venous occlusion. Radiologic diagnosis is critical as many present with nonspecific symptoms. Contrast-enhanced computed tomography (CT) is the modality of choice. Magnetic resonance imaging (MRI) is preferred in suspected appendicitis in pregnant patients and is superior in biliary necrosis. This article provides a pictorial review of the CT/MRI features of hollow abdominal organ ischemia while highlighting key clinical features, pathogenesis, and management.
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Affiliation(s)
- Zina J Ricci
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Fernanda S Mazzariol
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Bindu Kaul
- Department of Diagnostic Radiology, Jack D. Weiler Hospital of the Albert Einstein School of Medicine, 1825 Eastchester Rd., Bronx, NY 10461.
| | - Sarah K Oh
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Victoria Chernyak
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Milana Flusberg
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Marjorie W Stein
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Alla M Rozenblit
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
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Abstract
The application of endoscopic ultrasound (EUS) in children is growing, with studies demonstrating a positive impact of EUS in the management of childhood diseases. EUS has shown to be useful in the evaluation and management of a spectrum of childhood diseases including pancreaticobiliary disease, congenital anomalies, submuocsal lesions, biliary stones disease, inflammatory bowel disease, and eosinophilic esophagitis. Its diagnostic capabilities with fine-needle aspiration and core-needle biopsy are shown to be technically successful, safe, and effective in several pediatric studies. Therapeutic EUS procedures include endoscopic cystgastrostomy, celiac plexus neurolysis, and biliary access. This article discusses the role of EUS for diagnostic and therapeutic purposes in pediatrics.
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Affiliation(s)
- Arathi Lakhole
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #78, Los Angeles, CA 90027, USA
| | - Quin Y Liu
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine of USC, 4650 Sunset Boulevard, Mailstop #78, Los Angeles, CA 90027, USA.
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20
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Matsuoka S, Mutou H, Matsumoto N, Nakagawara H, Ogawa M, Moriyama M. Technique of Transbrachial Angiography and Treatment for Abdominal Diseases: A Study of 6262 Patients. Hepatogastroenterology 2015; 62:673-676. [PMID: 26897952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
For over 20 years, we have been using the transbrachial approach as the first-line option for abdominal angiography and transcatheter arterial chemoembolization (TACE). The present study involving 6262 patients (success rate of 99.8%) showed that the transbrachial approach could be used for superselective angiography or computed tomography during angiography (angio-CT) and was effective for hemostasis of abdominal aneurysmal hemorrhage, diverticular hemorrhage and partial splenic embolization. The approach was highly safe with no association with serious complications. Bleeding from the puncture site was reported in 225 cases (0.36%), numbness due to nerve damage at the puncture site. was reported in 376 cases (0.6%), and arteriovenous fistula in the puncture site was reported in 84 cases (0.13%). In the treatment of hepatic disease, the guiding catheter could be inserted deeper into the hepatic artery, and hemostasis after sheath removal required shorter time compared with the transfemoral approach. Based on its safety and usefulness, transbrachial angiography and intervention therapy is a first-line treatment for abdominal diseases.
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21
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Meng FS, Zhang ZH, Ji F. New endoscopic ultrasound techniques for digestive tract diseases: A comprehensive review. World J Gastroenterol 2015; 21:4809-4816. [PMID: 25944994 PMCID: PMC4408453 DOI: 10.3748/wjg.v21.i16.4809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/14/2015] [Accepted: 03/12/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS) is one of the most important modalities for the diagnosis of digestive tract diseases. EUS has been evolving ever since it was introduced. New techniques such as elastography and contrast enhancement have emerged, increasing the accuracy, sensitivity and specificity of EUS for the diagnosis of digestive tract diseases including pancreatic masses and lymphadenopathy. EUS-elastography evaluates tissue elasticity and therefore, can be used to differentiate various lesions. Contrast-enhanced EUS can distinguish benign from malignant pancreatic lesions and lymphadenopathy using the intravenous injection of contrast agents. This review discusses the principles and types of these new techniques, as well as their clinical applications and limitations.
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22
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Dickman E, Tessaro MO, Arroyo AC, Haines LE, Marshall JP. Clinician-performed abdominal sonography. Eur J Trauma Emerg Surg 2015; 41:481-92. [PMID: 26038027 DOI: 10.1007/s00068-015-0508-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 11/18/2014] [Accepted: 03/02/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Point-of-care ultrasonography is increasingly utilized across a wide variety of physician specialties. This imaging modality can be used to evaluate patients rapidly and accurately for a wide variety of pathologic conditions. METHODS A literature search was performed for articles focused on clinician-performed ultrasonography for the diagnosis of appendicitis, gallbladder disease, small bowel obstruction, intussusception, and several types of renal pathology. The findings of this search were summarized including the imaging techniques utilized in these studies. CONCLUSION Clinician performed point-of-care sonography is particularly well suited to abdominal applications. Future investigations may further confirm and extend its utility at the bedside.
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Affiliation(s)
- E Dickman
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA.
| | - M O Tessaro
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - A C Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
| | - L E Haines
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
| | - J P Marshall
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
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23
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Neciu C, Badea R, Chiorean L, Badea AF, Opincariu I. Oral and I.V. contrast enhanced ultrasonography of the digestive tract--a useful completion of the B-mode examination: a literature review and an exhaustive illustration through images. Med Ultrason 2015; 17:62-73. [PMID: 25745660 DOI: 10.11152/mu.2013.2066.171.cnrb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Contrast enhanced ultrasonography, using i.v. and/or oral/rectal contrast agents, represents a technical development of the US method, which has proved its applicability in the qualitative and quantitative assessment of the normal and pathological circulatory bed, as well as of the digestive lumen. The use of microbubbles and harmonics opens a new horizon in the detection and characterization of the inflammatory and tumoral conditions of the digestive tract. The interpretation of the data requires corroboration with the grey scale aspect of the examined lesion/area, as well as with the clinical context of the case and the results of other diagnosis techniques. The purpose of this paper is to review the main applications of CEUS in digestive tract pathology by analyzing the significant literature and guidelines in the light of our personal experience and demonstrating it through suggestive images.
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Affiliation(s)
- Cristian Neciu
- 3rd Surgery Clinic, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Anatomy and Embryology Department, "Iuliu Hatienganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Badea
- Ultrasonography Department, 3rd Medical Clinic, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatienganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.E-mail:
| | - Liliana Chiorean
- Ultrasonography Department, 3rd Medical Clinic, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatienganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandru Florin Badea
- Anatomy and Embryology Department, "Iuliu Hatienganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulian Opincariu
- Anatomy and Embryology Department, "Iuliu Hatienganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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24
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Fu WX, Wang Q, Zhang YS, Li Y, Xu T, He S, Ren H, Sun T. Application of ultrasound technology in the diagnosis and treatment of digestive tract diseases. Eur Rev Med Pharmacol Sci 2015; 19:602-606. [PMID: 25753877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ultrasound is commonly used in clinical examination which is economic, non-invasive and convenient. Ultrasound can be used for the examination of solid organs and hollow organs. Due to the presence of air, routine ultrasound examination of the digestive tract is not very appropriate, Because of the development of endosonography and its related technology, diagnosis and treatment of gastrointestinal diseases have been improved which is valuable in clinic. This review focused on the application of ultrasound technology in the diagnosis and treatment of digestive tract diseases.
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Affiliation(s)
- W-X Fu
- Department of Ultrasound in Medicine, Navy General Hospital of PLA, Beijing, PR China.
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25
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Alvarez-Sánchez MV, Napoléon B. Contrast-enhanced harmonic endoscopic ultrasound imaging: Basic principles, present situation and future perspectives. World J Gastroenterol 2014; 20:15549-15563. [PMID: 25400439 PMCID: PMC4229520 DOI: 10.3748/wjg.v20.i42.15549] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/23/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Over the last decade, the development of stabilised microbubble contrast agents and improvements in available ultrasonic equipment, such as harmonic imaging, have enabled us to display microbubble enhancements on a greyscale with optimal contrast and spatial resolution. Recent technological advances made contrast harmonic technology available for endoscopic ultrasound (EUS) for the first time in 2008. Thus, the evaluation of microcirculation is now feasible with EUS, prompting the evolution of contrast-enhanced EUS from vascular imaging to images of the perfused tissue. Although the relevant experience is still preliminary, several reports have highlighted contrast-enhanced harmonic EUS (CH-EUS) as a promising noninvasive method to visualise and characterise lesions and to differentiate benign from malignant focal lesions. Even if histology remains the gold standard, the combination of CH-EUS and EUS fine needle aspiration (EUS-FNA) can not only render EUS more accurate but may also assist physicians in making decisions when EUS-FNA is inconclusive, increasing the yield of EUS-FNA by guiding the puncture with simultaneous imaging of the vascularity. The development of CH-EUS has also opened up exciting possibilities in other research areas, including monitoring responses to anticancer chemotherapy or to ethanol-induced pancreatic tissue ablation, anticancer therapies based on ultrasound-triggered drug and gene delivery, and therapeutic adjuvants by contrast ultrasound-induced apoptosis. Contrast harmonic imaging is gaining popularity because of its efficacy, simplicity and non-invasive nature, and many expectations are currently resting on this technique. If its potential is confirmed in the near future, contrast harmonic imaging will become a standard practice in EUS.
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26
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Zhao JJ, Ling JQ, Fang Y, Gao XD, Shu P, Shen KT, Qin J, Sun YH, Qin XY. Intra-abdominal inflammatory myofibroblastic tumor: Spontaneous regression. World J Gastroenterol 2014; 20:13625-13631. [PMID: 25309095 PMCID: PMC4188916 DOI: 10.3748/wjg.v20.i37.13625] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/01/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory myofibroblastic tumors are usually treated by surgical resection. We herein report two cases of intra-abdominal inflammatory myofibroblastic tumors that were unresectable and underwent spontaneous regression without any treatment. Our case report and literature review show that regression is more common in the middle-aged and older male populations. Abdominal discomfort and fever were the most common symptoms, but the majority of patients had no obvious physical signs. There was no specific indicator for diagnosis. The majority of the lesions regressed within 3 mo and nearly all of the masses completely resolved within 1 year. We conclude that the clinical characteristics of inflammatory myofibroblastic tumors are variable and, accordingly, the disease needs to be subdivided and treated on an individual basis. Surgery is always the first-line treatment; however, for those masses assessed as unresectable, conservative therapy with intense follow-up should be considered.
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Fabbri C, Luigiano C, Lisotti A, Cennamo V, Virgilio C, Caletti G, Fusaroli P. Endoscopic ultrasound-guided treatments: are we getting evidence based--a systematic review. World J Gastroenterol 2014; 20:8424-48. [PMID: 25024600 PMCID: PMC4093695 DOI: 10.3748/wjg.v20.i26.8424] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/30/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023] Open
Abstract
The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field.
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Otjen JP, Rohrmann CA, Iyer RS. Imaging pediatric magnet ingestion with surgical-pathological correlation. Pediatr Radiol 2013; 43:851-9. [PMID: 23143402 DOI: 10.1007/s00247-012-2549-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/27/2012] [Accepted: 09/10/2012] [Indexed: 01/08/2023]
Abstract
Foreign body ingestion is a common problem in the pediatric population and a frequent cause for emergency room visits. Magnets are common household objects that when ingested can bring about severe, possibly fatal gastrointestinal complications. Radiography is an integral component of the management of these children. Pediatric and emergency radiologists alike must be aware of imaging manifestations of magnet ingestion, as their identification drives decision-making for consulting surgeons and gastroenterologists. Radiology can thus substantially augment the clinical history and physical exam, facilitating appropriate management. This manuscript sequentially presents cases of magnet ingestion featuring imaging findings coupled with surgical and pathological correlation. Each case is presented to highlight ways in which the radiologist can make impactful contributions to diagnosis and management. Clinical overview with pitfalls of magnet ingestion imaging and an imaging decision tree will also be presented.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105, USA
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29
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Abstract
BACKGROUND Ectopic thyroid tissue is a relatively rare condition and a developmental anomaly characterized by the aggregation of thyroid tissue. Usually, it occurs along the path of descent of the developing thyroid primordium from the foramen caecum, the most common being in the anterior midline of the neck at or below the level of the hyoid bone. Surgical removal of ectopic thyroid tissue is usually accomplished through an external incision in the neck. However, this procedure inevitably results in a neck scar. METHODS We report the case of a 30-year-old woman with ectopic thyroid tissue. We implemented a modified approach to ectopic thyroid tissue removal through a frenotomy incision of the mouth using an endoscope system. RESULTS A modified approach to ectopic thyroid tissue removal was used in this patient. The total operative time was 50 minutes, and the patient remains free of disease 15 months after excision. CONCLUSION Resection of ectopic thyroid tissue can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth.
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Affiliation(s)
- Seung Hoon Woo
- Department of Otolaryngology, Gyeongsang National University , Jinju, Korea
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30
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Piskunowicz M, Kosiak W, Batko T. Intravenous application of second-generation ultrasound contrast agents in children: a review of the literature. Ultraschall Med 2012; 33:135-140. [PMID: 22161614 DOI: 10.1055/s-0031-1281936] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CEUS examinations using second-generation ultrasound contrast agents (UCA) are conducted in children, despite not being registered for individuals less than 18 years of age. We searched the Medline® database through Pubmed® and Scopus database, in order to find articles in which UCA were administered intravenously in patients under the age of 18. We analyzed in detail 9 papers (7 case reports, 2 original research studies), describing the examinations with intravenous administration of the UCA in children, and 23 original papers, in which the study group included at least one individual under the age of 18. Neither of the analyzed studies included any reports of adverse effects after UCA administration.
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Pedrosa MC, Barth BA, Desilets DJ, Kaul V, Kethu SR, Pfau PR, Tokar JL, Varadarajulu S, Wang A, Wong Kee Song LM, Rodriguez SA. Enhanced ultrasound imaging. Gastrointest Endosc 2011; 73:857-60. [PMID: 21521561 DOI: 10.1016/j.gie.2011.01.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 01/26/2011] [Indexed: 12/18/2022]
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Adler M, Piessevaux H, Louis E, Lamy V, Michielsen P, Geubel A. Abdominal ultrasonography by the hepato-gastroenterologist: problems, demands, solutions. Acta Gastroenterol Belg 2011; 74:67-69. [PMID: 21563654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This document analyzes the reasons for organizing an abdominal ultrasound training for Belgian trainees in hepatogastroenterology. The hepatogastroenterology speciality should implement, together with the radiology speciality and the national scientific and professional associations, the minimum training requirements which are proposed by the European Board of Gastroenterology and Hepatology and the European Federation of Societies for Ultrasound in Medicine and Biology. Trainees in hepatogastroenterology should acquire the same theoretical and practical training as radiologists, they should be taught and supervised by competent instructors and have their expertise evaluated.
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Affiliation(s)
- M Adler
- Division of Hepatogastroenterology, Hôpital Erasme ULB, Brussels, Belgium.
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Mompoint D, Carlier RY, Orlikowski D. [Neuromuscular diseases: imaging of thoracic, digestive and urinary complications]. J Radiol 2010; 91:1419-1436. [PMID: 21242939 DOI: 10.1016/s0221-0363(10)70221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Neuromuscular diseases have different characteristics. Respiratory and cardiovascular manifestations are frequent and severe. Respiratory difficulties secondary to muscle involvement and bronchial secretions worsen complications related to a frequent scoliosis. CT is a useful complement to standard radiographs in the setting of acute symptomatic deterioration and for presurgical evaluation of a scoliosis. Echocardiography is performed to determine the presence of cardiomyopathy. Gastrointestinal motility disorders are assessed with standard barium studies or CT in the acute setting. Urinary tract involvement also is possible in these patients given the increased survival and follow-up imaging may be helpful for palliative management. The imaging features of frequent manifestations will be discussed along with the imaging appearance of a few specific entities.
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Affiliation(s)
- D Mompoint
- Service d'Imagerie Médicale, Hôpital Raymond Poincaré, 104 boulevard Raymond Poincaré, 92380 Garches, France.
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Abstract
Endoscopic ultrasound (EUS) is an increasingly available diagnostic and therapeutic tool used within the U.K. it has wide applications both in the gastrointestinal tract and mediastinum with its current main uses being in the staging of luminal malignancies and assessment of pancreatic and subepithelial lesions. The emergence of linear EUS has opened up new therapeutic avenues with fine needle aspiration, trucut biopsies, coeliac plexus blocks and transmural pseudocyst drainage all now possible. Future developments include localised brachytherapy/chemotherapy and alcohol ablation of unresectable pancreatic malignancies and EUS-guided endoscopic surgery.
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Thorlacius H, Tóth E, Vilmann P. [Endoscopic ultrasound in gastroenterology. Technique and clinical indications]. Lakartidningen 2009; 106:3152-3159. [PMID: 20077639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
Abdominal emergencies encompass traumatic events in the region of the abdomen as well as the clinical term acute abdomen. Multidetector CT (MDCT) represents one of the most important imaging modalities for detection and correct diagnosis in such abdominal emergencies. Based on the acquired data MDCT allows a stable imaging of the abdomen in an extremely short time even in critically ill patients. Multiplanar reconstructions can be created based on the high resolution data allowing an impressive visualization of the pathology. In this review article the most important abdominal pathologies of the abdomen diagnosed by MDCT are presented with special emphasis on the liver, bile ducts, spleen and kidneys as well as the gastro-intestinal tract. Additionally, MDCT imaging of the individual organ regions will be dealt with in detail.
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Affiliation(s)
- N Zorger
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, 93042, Regensburg.
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Rungsinaporn K, Phaisakamas T. Frequency of abnormalities detected by upper abdominal ultrasound. J Med Assoc Thai 2008; 91:1072-1075. [PMID: 18839847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The present study was undertaken to categorize frequency of abnormalities detected by upper abdominal ultrasound. MATERIAL AND METHOD The present study was conducted on 3,398 people between the ages of 16 and 93 years old, who had the annual health check-up between October 2003 and May 2004 at the Health Promotion Center Bangkok Hospital Medical Center (all of those participating were defined as "patients"). Of these, 1,930 are men (56.8%) and 1,468 are women (43.2%). In the present study, the data of age, gender, and upper abdominal ultrasound findings were assessed. RESULTS Of the 3,398 subjects, 1,782 patients (52.4%) had positive findings; 1,147 of which were men (64.4%) and 635 were women (35.6%). Fatty liver, being the most common positive finding, was observed in 1,219 patients (35.9%); 831 of which were men (68.2%) and 388 were women (31.8%). The finding of a liver mass, as the second positive finding, was observed in 209 patients (6.2%); of which were 124 patients (59.3%) with hepatic cyst, 51 patients (24.4%) with hemangioma, 16 patients (7.7%) with indetermined nodule, 11 patients (5.3%) with calcification, and 7 patients (3.4%) with malignant tumor while 664 patients (19.5%) had other positive findings. The top four included gallbladder polyp observed in 181 patients (5.3%), renal cyst observed in 155 patients (4.6%), gallstone observed in 141 patients (4.2%), and renal stone observed in 101 patients (3.0%). CONCLUSION The prevalence of abnormalities detected by upper abdominal ultrasound was 52.44%. The most common finding was fatty liver (35.87%). Although the majority of positive findings were benign conditions, some of them might have an adverse effect to the health condition of patients in the long run. The ultrasound findings also yielded the patient management to prevent subsequent disease and to perform medical treatment or follow up.
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Rossi FT. Endoscopic ultrasound. Minn Med 2008; 91:38-41. [PMID: 18616020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Endoscopic ultrasound (EUS) is being used to diagnose and evaluate a number of conditions of the gastrointestinal tract. This article describes the type of EUS equipment that is being used in clinical practice, the type of conditions for which it is used to diagnose and evaluate, and its therapeutic uses.
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Christensen AF, Ejlersen E, Rafaelsen SR. [Referral of patients with fever for ultrasound abdominal scans]. Ugeskr Laeger 2008; 170:1652-1654. [PMID: 18489877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the quality of ultrasound referrals of patients with fever and/or inflammation markers based on C-reactive protein (CRP) from the department of medicine to the department of radiology. MATERIALS AND METHODS The quality of 109 referrals was evaluated retrospectively based on sufficient anamnesis, description of objective findings, and presence of fever and/or inflammation markers and/or liver parameters. Fever was defined as a temperature above 37.5 degrees Celsius. RESULTS Ultrasound scans proved 50 positive findings and 59 were categorised normal. There was no significant difference in the referrals of registrars and other medical doctors with regard to the presence of positive scanning findings (p=0.26). No significant difference between radiologists and trained radiographers was observed with regard to the ultrasound scan result (p=0.34). In 55% of the cases the referrals contained no information on symptoms, objective findings (60%), presence of fever (26%) and CRP +/- liver parameters (36%) CONCLUSION The quality of the referrals of patients with fever from the department of medicine to the department of radiology is not optimal. Prospective studies are needed.
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Emmi V, Sganga G. [Diagnosis of intra-abdominal infections: clinical findings and imaging]. Infez Med 2008; 16 Suppl 1:19-30. [PMID: 18382148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Abdominal sepsis carries a high morbidity and mortality. Intra-abdominal infectious complications are one of the most common infectious etiologies seen in critically ill patients. Approximately 30% of patients admitted to an ICU with intra-abdominal infection succumb to their illness, and when peritonitis arises as a complication of a previous surgical procedure, or recurs during ICU admission, mortality rates exceed 50%. Thus early detection and treatment is essential to minimize patient complications. Critically ill patients are often clinically non valuable due to distracting injuries, respiratory failure, obtundation, or other pathology. Even when patients can be examined, the clinical exam is frequently unreliable and/or misleading. The diagnostic approach to identify abdominal problems will differ depending upon the hemo-dynamic stability of the patient. Patients who have low systolic blood pressures, who are pressor-dependent, may be too unstable to undergo studies that require trips away from the ICU or emergency department. Intra-abdominal pathology may be detected by ultrasound or diagnostic peritoneal lavage (DPL). When critically ill patients are stable enough to undergo some diagnostic evaluation of their abdomen the approach is somewhat simpler. Overall, computerized tomography (CT) is the imaging modality of choice for most intra-abdominal processes. For diagnosis of intra-abdominal conditions using CT scanning it is optimal if patients receive both oral and intravenous contrast. An exception to the use of CT scanning is evaluation of suspected biliary pathology, which is best imaged by ultrasound. It will identify cholecystitis with or without calculus and may show changes in the gallbladder or common bile duct associated with biliary obstruction.
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Affiliation(s)
- Vincenzo Emmi
- Rianimazione I, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
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Louvard Y, Chawla K, Lefevre T. Transradial approach for non-coronary diagnosis and intervention. Indian Heart J 2008; 60:A45-A50. [PMID: 19359749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Yves Louvard
- ICPS, Institut Hospitalier Jacques Cartier, Massy, France.
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Abstract
Ultrasound provides a diagnostic modality that allows a whole-body approach at the bedside of a critically ill patient in the search for infectious foci. Both common sites of infection, such as the lung and pleura, central veins, and maxillary sinuses, and also less common sites, such as gastrointestinal perforation, sepsis due to mesenteric ischemia, or even meningitis, provide characteristic ultrasound patterns. Optimal use of ultrasound also combines bedside diagnosis with subsequent interventional procedures that can decrease the need for transfer to other imaging and interventional suites. Experience has shown that fevers of unknown origin in the critical care unit often have ultrasound equivalents. Thus, if a comprehensive ultrasound examination is negative, it is now appropriate to speak of fever of unknown sonographic origin.
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Affiliation(s)
- Daniel A Lichtenstein
- Service de Réanimation Médicale, Hôpital Ambroise-Paré, Faculté Paris-Ouest, Boulogne, France.
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Válek V, Mechl M. Editorial. Eur J Radiol 2007; 62:151-2. [PMID: 17398054 DOI: 10.1016/j.ejrad.2007.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 02/05/2007] [Accepted: 02/05/2007] [Indexed: 11/23/2022]
Affiliation(s)
- Vlastimil Válek
- Section of Abdominal and Gastrointestinal Radiology RS CLS JEP, Czech Republic
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Abstract
Intraabdominal pathology, either primary or secondary, may frequently be found in critically ill patients. Without early diagnosis and treatment, the patient's condition may deteriorate and even progress to death. In this article, we provide a current review of the literature regarding liver, biliary, pancreatic, and splenic problems in critically ill patients and describe common ultrasound findings, including the appearance of free intraperitoneal air. According to the liver surface, edge, echotexture, and echogenicity, either diffuse liver diseases or focal liver diseases can be detected on ultrasound. By scanning the biliary tree and gallbladder, many right upper quadrant diseases can be diagnosed. The role of ultrasound for acute pancreatic pathology is to identify any lesions and to evaluate the severity of the diseases. Similarly, the spleen can be evaluated for relevant pathology in the critical care setting.
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Affiliation(s)
- Hsiu-Po Wang
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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46
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Abstract
Endoscopic ultrasound (EUS) has been developed since the early 1980s. Its clinical role in the diagnosis of gastrointestinal wall lesions and staging of gastrointestinal and lung cancer has evolved over the last two decades. Initially, it was either used as an imaging tool for gastrointestinal wall lesions or for staging of gastrointestinal tumours. However, in combination with fine-needle aspiration under real-time scanning, EUS is now being used in tissue sampling for diagnosis. In addition, EUS may be used therapeutically in coeliac plexus neurolysis or pseudocyst drainage. This review concentrates on the current applications of EUS.
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Affiliation(s)
- Grant R Caddy
- Department of Gastroenterology, St Vincent's Hospital, Victoria, Australia
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47
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Affiliation(s)
- P Fusaroli
- Gastroenterology Unit, University of Bologna AUSL di Imola, Ospedale di Castel S. Pietro Terme, Bologna, Italy
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48
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49
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Abstract
Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration have become important tools in evaluation of patients who have various gastrointestinal and nongastrointestinal disorders, and are being increasingly utilized at many centers. With over 10 years of worldwide published clinical data, the collective experience suggests that EUS is a safe tool. There are various measures that may be undertaken to help minimize the risks. In light of ongoing advances in interventional techniques and recognition of new procedural indications, the safety of all types of procedures and efforts to minimize EUS-related complications need to be periodically reexamined.
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Affiliation(s)
- Janak N Shah
- Division of Gastroenterology, University of California, San Francisco, 4150 Clement Street, San Francisco, CA 94121, USA.
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50
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Abstract
Radiological imaging is an important part of the evaluation and management of neonates with suspected anomalies of the gastrointestinal tract. Clinical presentation is often non-specific, commonly with abdominal distension and vomiting for which the underlying cause may or may not be clinically apparent. In a proportion of patients, the clinical assessment alone may suffice in providing the diagnosis and no further imaging is necessary. The reader must have an understanding of the normal radiographic appearances of the gastrointestinal tract in neonates and appreciate normal variants and differences to adults. In certain cases, the abdominal radiograph alone is diagnostic. In others, sonography and contrast studies are useful adjunct investigations and the indications for CT and MRI are few, but specific. Appropriate radiological investigation will help to establish the diagnosis and guide surgical intervention whilst also avoiding unnecessary radiation. Some of the conditions require transfer to specialist paediatric institutions for care. Thus, in some circumstances it is appropriate for imaging to be delayed and performed at the specialist centre with early referral often essential for the continued well being of the child.
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Affiliation(s)
- Padma Rao
- Department of Radiology, Royal Children's Hospital and the University of Melbourne, Flemington Road, Parkville, Melbourne, Vic. 3052, Australia.
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