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1.
Eur Radiol ; 29(4): 2034-2044, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30302591

ABSTRACT

PURPOSE: To compare the accuracy of MR enterography (MRE) using combined T2-weighted and contrast-enhanced (CE) sequences with that of combined T2- and diffusion-weighted (DW) sequences for the detection of complex enteric Crohn's disease (CD). MATERIALS: Thirty-eight patients who underwent surgery for CD complications and preoperative MRE from 2011 to 2016 were included. MRE examinations were blindly analyzed independently by one junior and one senior abdominal radiologist for the presence of fistula, stenosis and abscesses. During a first reading session, T2-weighted images (WI), steady-state sequences and DW-MRE were reviewed (set 1). During a separate distant session, T2-WI, True-FISP and CE-MRE were reviewed (set 2). Performance of each reader was evaluated by comparison with the standard of reference established using intraoperative and pathological findings. RESULTS: Forty-eight fistulas, 43 stenoses and 11 abscesses were found. For the senior radiologist, sensitivity for the detection of fistula, stenosis and abscess ranged from 80% to 100% for set 1 and 88% to 100% for set 2 and specificity ranged from 56% to 70% for set 1 and 53% to 93% for set 2, with no significant difference between the sets (p = 0.342-0.429). For the junior radiologist, sensitivity ranged from 53% to 63% for set 1 and 64% to 88% for set 2 and specificity ranged from 0% to 25% for set 1 and 17% to 40% for set 2 (p = 0.001 and 0.007, respectively). CONCLUSION: For a senior radiologist, DW-MRE has similar sensitivity as CE-MRE for the detection of CD complications. For a junior radiologist, CE-MRE yields the best results compared with DW-MRE. KEY POINTS: • For experienced readers, DWI has similar diagnostic capability as contrast-enhanced MR imaging for the diagnosis of Crohn's disease complications. • For senior radiologists, gadolinium chelate injection could be waived for the diagnosis of Crohn's disease complications. • The interpretation of DWI for Crohn's disease complications requires some experience.


Subject(s)
Contrast Media/pharmacology , Crohn Disease/diagnostic imaging , Image Enhancement/methods , Intestine, Small/diagnostic imaging , Magnetic Resonance Imaging/methods , Postoperative Complications/diagnosis , Preoperative Care/methods , Adolescent , Adult , Crohn Disease/surgery , Diffusion Magnetic Resonance Imaging/methods , Digestive System Surgical Procedures/adverse effects , Female , Humans , Male , Middle Aged , Young Adult
3.
Diagn Interv Imaging ; 98(10): 663-675, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28185840

ABSTRACT

Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.


Subject(s)
Duodenal Diseases/diagnostic imaging , Duodenum/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Adenoma/diagnostic imaging , Arteriovenous Malformations/diagnostic imaging , Brunner Glands/diagnostic imaging , Brunner Glands/pathology , Choristoma/diagnostic imaging , Diverticulum/diagnostic imaging , Duodenum/anatomy & histology , Gastrointestinal Stromal Tumors/diagnostic imaging , Hamartoma/diagnostic imaging , Hemangioma/diagnostic imaging , Humans , Hyperplasia/diagnostic imaging , Intestinal Polyposis/diagnostic imaging , Leiomyoma/diagnostic imaging , Lipoma/diagnostic imaging , Lymphoma/diagnostic imaging , Magnetic Resonance Imaging , Neuroendocrine Tumors/diagnostic imaging , Pancreas , Tomography, X-Ray Computed , Tuberculosis, Gastrointestinal/diagnostic imaging
5.
J Visc Surg ; 153(5): 361-369, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27618699

ABSTRACT

Magnetic resonance imaging (MRI) plays now a major role in patients with colorectal cancer regarding tumor staging, surgical planning, therapeutic decision, assessment of tumor response to chemoradiotherapy and surveillance of rectal cancer, and detection and characterization of liver or peritoneal metastasis of colorectal cancers. Diffusion-weighted MRI (DW-MRI) is a functional imaging tool that is now part of the standard MRI protocol for the investigation of patients with colorectal cancer. DW-MRI reflects micro-displacements of water molecules in tissues and conveys high degrees of accuracy to discriminate between benign and malignant colorectal conditions. Thus, in addition to morphological imaging, DW-MRI has an important role to accurately detect colorectal neoplasms and peritoneal implants, to differentiate benign focal liver lesions from metastases and to detect tumor relapse within fibrotic changes. This review provides a comprehensive overview of basic principles, clinical applications and future trends of DW-MRI in colorectal cancers.


Subject(s)
Colorectal Neoplasms/diagnosis , Diffusion Magnetic Resonance Imaging/methods , Humans , Reproducibility of Results
6.
Eur J Surg Oncol ; 42(2): 266-72, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26683262

ABSTRACT

OBJECTIVE: To determine if the presence of cardiophrenic angle lymph nodes (CPALNs) on multidetector-row computed tomography (MDCT) can be considered as an indicator of peritoneal carcinomatosis (PC) in patients with colorectal cancer (CRC). MATERIAL AND METHODS: Two groups of 101 patients each were retrospectively included. Group 1 included patients with PC from CRC and Group 2 included patients with CRC without PC. MDCT examinations were analyzed by two readers working in consensus for the presence or absence of CPALNs and, when present for their dimensions (short and long axis), location (right, left or bilateral) and shape (oval or rounded). RESULTS: Prevalence of CPALNs was 29% in Group 1 and 32% in Group 2. No differences in prevalence of CPALNs were found between the two groups (P = 0.458). Presence of CPALNs had a sensitivity of 29% (95%CI: 23-35%) for the diagnosis of PC and a specificity of 68% (95%CI = 62-74%). No differences in CPALN dimensions, location and shape were found between these two groups. CONCLUSION: Presence of CPALNs cannot be considered as an indicator of PC in patients with CRC. In addition, when present, CPALNs have similar dimensions, location and shapes in patients with PC from CRC than in those without PC.


Subject(s)
Carcinoma/diagnosis , Colorectal Neoplasms/pathology , Lymph Nodes/diagnostic imaging , Peritoneal Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Carcinoma/secondary , Case-Control Studies , Diaphragm , Female , Heart , Humans , Male , Middle Aged , Multidetector Computed Tomography , Peritoneal Neoplasms/secondary , Retrospective Studies , Sensitivity and Specificity
7.
Diagn Interv Imaging ; 96(6): 593-606, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25953525

ABSTRACT

The use of stents in the gastrointestinal tract has been subjected to major changes. Initially, the use of stents was restricted to malignant strictures in patients with metastatic disease. But thanks to reduction of the morbidity and mortality rates, they are now used with curative intention and in patients with benign diseases after careful selection. However, for patients presenting with colon obstruction due to an advanced colon carcinoma, the mortality and morbidity are still high. The purpose of this review is to provide an overview of indications, techniques and further developments of the stents in the gastrointestinal tract and to highlight the predominant role of multidetector row computed tomography (MDCT) in the detection of potential complications.


Subject(s)
Gastrointestinal Diseases/surgery , Stents , Gastrointestinal Diseases/diagnostic imaging , Humans , Multidetector Computed Tomography , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology
8.
Diagn Interv Imaging ; 96(9): 871-83, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25846686

ABSTRACT

Inflammatory bowel diseases (IBD) are associated with an increased risk of gastrointestinal cancers and more specifically in sites affected by chronic inflammation. However, patients with IBD have also an increased risk for developing a variety of extra-intestinal cancers. In this regard, hepatobiliary cancers, such as cholangiocarcinoma, are more frequently observed in IBD patients because of a high prevalence of primary sclerosing cholangitis, which is considered as a favoring condition. Extra-intestinal lymphomas, mostly non-Hodgkin lymphomas, and skin cancers are also observed with an increased incidence in IBD patients by comparison with that in patients without IBD. This review provides an update on demographics, risk factors and clinical features of extra-intestinal malignancies, including cholangiocarcinoma, hepatocellular carcinoma and lymphoma, that occur in patients with IBD along with a special emphasis on the multidetector row computed tomography and magnetic resonance imaging features of these uncommon conditions.


Subject(s)
Inflammatory Bowel Diseases/diagnosis , Magnetic Resonance Imaging/methods , Multidetector Computed Tomography/methods , Neoplasms/diagnosis , Humans , Neoplasms/etiology , Risk Factors
9.
Diagn Interv Imaging ; 96(6): 571-7, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25771477

ABSTRACT

PURPOSE: The purpose of this study was to retrospectively evaluate the incidence of intraperitoneal bleeding and other major complications of transjugular liver biopsy (TJLB) and analyze their outcome and management. MATERIALS AND METHODS: The clinical files of 341 consecutive patients who had TJLB were retrospectively analyzed. There were 237 men and 104 women (mean age: 51.38±12.8 years; range: 17-89 years). All patients had TJLB because standard percutaneous transhepatic biopsy was contraindicated. Patients' files were reviewed to search for major and minor procedure-related complications during or immediately after TJLB. RESULTS: TJLBs were technically successful in 331/341 patients (97.07%; 95%CI: 94.67-98.58%). Major complications consisted exclusively of intraperitoneal bleeding due to liver capsule perforation and were observed in 2/341 patients (0.59%; 95%CI: 0.07-2.10%). They were treated using transcatheter arterial or venous embolization with a favorable outcome. The most frequent minor complications were abdominal pain (35/341; 10.26%; 95%CI: 7.25-13.99%) and supraventricular arrhythmia (15/341; 4.40%; 95%CI: 2.48-7.15%). No cases of inadvertent injury of the carotid artery were observed. CONCLUSION: Major complications during TJLB are extremely rare and can be managed using arterial or venous embolization with a favorable outcome. Our results reinforce the general assumption that TJLB is a safe and well-tolerated technique.


Subject(s)
Hemoperitoneum/etiology , Liver/pathology , Postoperative Complications/etiology , Radiography, Interventional/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy/methods , Female , Hemoperitoneum/epidemiology , Hemoperitoneum/therapy , Humans , Incidence , Jugular Veins , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Retrospective Studies , Treatment Outcome , Young Adult
11.
Diagn Interv Imaging ; 96(3): 227-37, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25482665

ABSTRACT

Recent refinements in cross-sectional imaging have dramatically modified the investigation of the jejunum. Improvements in multidetector row computed tomography (MDCT) and magnetic resonance (MR) imaging technology have made detection and characterization of jejunal abnormalities easier. Current options include MDCT and MR imaging using either enterography or enteroclysis. The goal of this pictorial review is to outline the current imaging techniques that are used to investigate the jejunum and illustrate the most common conditions that affect this small bowel segment with a specific focus on MDCT and MR imaging using enterography or enteroclysis. MR imaging used in conjunction with optimal jejunal distension appears as the modality of choice for the diagnosis of a wide range of jejunal abnormalities. MDCT remains the first line imaging modalities because of an acute presentation in a substantial number of patients.


Subject(s)
Jejunal Diseases/diagnosis , Jejunal Neoplasms/diagnosis , Magnetic Resonance Imaging , Clinical Protocols , Humans , Multidetector Computed Tomography
12.
Diagn Interv Imaging ; 96(2): 133-49, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24835625

ABSTRACT

Acute colitis is often diagnosed on multidetector row computed tomography (MDCT) because patients with this condition present with abdominal pain and a variety of nonspecific symptoms. Acute colitis has multiple causes with varying degrees of severity. Analysis of the extent of colonic involvement, presence of specific MDCT imaging features and associated signs should help radiologist narrow the diagnosis. Integrating the results of clinical examination and biological tests is mandatory, and in case of ambiguous or nonspecific MDCT findings, endoscopy and colon biopsy should always be considered for a definite diagnosis. The purpose of this review is to discuss and illustrate MDCT features that are helpful for characterizing acute colitis in adults and to provide an update in current MDCT features.


Subject(s)
Colitis/diagnostic imaging , Multidetector Computed Tomography , Acute Disease , Adult , Colitis/classification , Colitis/etiology , Humans
13.
Diagn Interv Imaging ; 96(2): 187-200, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24994585

ABSTRACT

Fast scanning along with high resolution of multidetector computed tomography (MDCT) have expanded the role of non-invasive imaging of splanchnic arteries. Advancements in both MDCT scanner technology and three-dimensional (3D) imaging software provide a unique opportunity for non-invasive investigation of splanchnic arteries. Although standard axial computed tomography (CT) images allow identification of splanchnic arteries, visualization of small or distal branches is often limited. Similarly, a comprehensive assessment of the complex anatomy of splanchnic arteries is often beyond the reach of axial images. However, the submillimeter collimation that can be achieved with MDCT scanners now allows the acquisition of true isotropic data so that a high spatial resolution is now maintained in any imaging plane and in 3D mode. This ability to visualize the complex network of splanchnic arteries using 3D rendering and multiplanar reconstruction is of major importance for an optimal analysis in many situations. The purpose of this review is to discuss and illustrate the role of 3D MDCT angiography in the detection and assessment of abnormalities of splanchnic arteries as well as the limitations of the different reconstruction techniques.


Subject(s)
Angiography/methods , Multidetector Computed Tomography , Vascular Diseases/diagnostic imaging , Viscera/blood supply , Arteries , Humans
14.
Diagn Interv Imaging ; 95(1): 11-5, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24007769

ABSTRACT

Transjugular liver biopsy is a safe, effective and well-tolerated technique to obtain liver tissue specimens in patients with diffuse liver disease associated with severe coagulopathies or massive ascites. Transjugular liver biopsy is almost always feasible. The use of ultrasonographic guidance for percutaneous puncture of the right internal jugular vein is recommended to decrease the incidence of local cervical minor complications. Semiautomated biopsy devices are very effective in obtaining optimal tissue samples for a precise and definite histological diagnosis with a very low rate of complication. The relative limitations of transjugular liver biopsy are the cost, the radiation dose given to the patient, the increased procedure time by comparison with the more common percutaneous liver biopsy, and the need of a well-trained interventional radiologist.


Subject(s)
Biopsy, Needle/methods , Fluoroscopy/methods , Jugular Veins , Liver Diseases/pathology , Liver/pathology , Ultrasonography, Interventional/methods , Biopsy, Needle/adverse effects , Biopsy, Needle/instrumentation , Equipment Design , Fluoroscopy/adverse effects , Fluoroscopy/instrumentation , Humans , Ultrasonography, Interventional/adverse effects , Ultrasonography, Interventional/instrumentation
15.
Diagn Interv Imaging ; 94(6): 619-27, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23545001

ABSTRACT

PURPOSE: To compare the capabilities of apparent diffusion coefficient (ADC) and normalized ADC using the pancreatic parenchyma as reference organ in the characterization of focal pancreatic lesions. PATIENTS AND METHODS: Thirty-six patients with focal pancreatic lesions (malignant, n=18; benign tumors, n=10; focal pancreatitis, n=8) underwent diffusion-weighted MR imaging (DWI) at 1.5-Tesla using 3 b values (b=0, 400, 800 s/mm(2)). Lesion ADC and normalized lesion ADC (defined as the ratio of lesion ADC to apparently normal adjacent pancreas) were compared between lesion types using nonparametric tests. RESULTS: Significant differences in ADC values were found between malignant (1.150 × 10(-3)mm(2)/s) and benign tumors (2.493 × 10(-3)mm(2)/s) (P=0.004) and between benign tumors and mass-forming pancreatitis (1.160 × 10(-3)mm(2)/s) (P=0.0005) but not between malignant tumors and mass-forming pancreatitis (P=0.1092). Using normalized ADC, significant differences were found between malignant tumors (0.933 × 10(-3)mm(2)/s), benign tumors (1.807 × 10(-3)mm(2)/s) and mass-forming pancreatitis (0.839 × 10(-3)mm(2)/s) (P<0.0001). CONCLUSION: Our preliminary results suggest that normalizing ADC of focal pancreatic lesions with ADC of apparently normal adjacent pancreatic parenchyma provides higher degrees of characterization of focal pancreatic lesions than the conventional ADC does.


Subject(s)
Diffusion Magnetic Resonance Imaging/methods , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Pancreatic Neoplasms/diagnosis , Pancreatitis, Chronic/diagnosis , Adenocarcinoma/diagnosis , Adult , Aged , Aged, 80 and over , Cystadenoma, Mucinous/diagnosis , Cystadenoma, Serous/diagnosis , Female , Humans , Male , Middle Aged , Neuroendocrine Tumors/diagnosis , Pancreas/pathology , Sensitivity and Specificity , Statistics, Nonparametric , Young Adult
16.
Br J Surg ; 99(7): 1011-20, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22556137

ABSTRACT

BACKGROUND: The aim of this study was to assess the accuracy of preoperative imaging in detecting the extent of disease and predicting the operative approach in patients with Crohn's disease. METHODS: Patients with Crohn's disease who were scheduled to undergo operation were evaluated before operation using computed tomography enteroclysis (CTE) and magnetic resonance enterography (MRE). Preoperative imaging findings were correlated with intraoperative and pathological findings to estimate the capabilities of preoperative imaging in detecting lesions due to Crohn's disease. The operative approach determined before surgery was compared with the procedure actually performed, which was based on intraoperative findings. RESULTS: Fifty-two patients with Crohn's disease were studied; 26 were evaluated before surgery with CTE and 26 with MRE. Eighty-nine lesions due to Crohn's disease were confirmed surgically (60 small bowel stenoses, 21 fistulas and 8 abscesses). CTE confirmed the presence of 38 of 41 lesions (sensitivity 93 per cent) and MRE 48 of 48 lesions (sensitivity 100 per cent); a correct estimation of the disease with an exact prediction of the operative approach was obtained in 49 (94 per cent) of 52 patients. Discrepant findings between preoperative imaging and operative findings were observed in three patients (6 per cent), who had CTE. CONCLUSION: Preoperative imaging using CTE or MRE is highly accurate for assessing Crohn's disease lesions before operation, allowing correct prediction of the operative approach.


Subject(s)
Crohn Disease/surgery , Ileitis/surgery , Jejunal Diseases/surgery , Magnetic Resonance Imaging/standards , Tomography, X-Ray Computed/standards , Adult , Aged , Anastomosis, Surgical/methods , Cecum/surgery , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/pathology , Crohn Disease/diagnostic imaging , Crohn Disease/pathology , Female , Humans , Ileitis/diagnostic imaging , Ileitis/pathology , Ileum/surgery , Jejunal Diseases/diagnostic imaging , Jejunal Diseases/pathology , Laparoscopy/methods , Male , Middle Aged , Preoperative Care/methods , Preoperative Care/standards , Reference Standards , Retrospective Studies , Sensitivity and Specificity , Young Adult
17.
Gut ; 60(5): 658-65, 2011 May.
Article in English | MEDLINE | ID: mdl-21266723

ABSTRACT

OBJECTIVE: Reports on the accuracy of computed tomographic colonography (CTC) mainly involve series from expert institutions. The aims of this study were to assess CTC accuracy in a nationwide population and to relate it to radiologist performance in their initial training. DESIGN: Nationwide multicentre trial. SETTING: Twenty-eight radiologists, working in 26 mostly academic clinical units, were involved in the study after having attended a formal specialised 2-day training session on CTC. They worked through a training set of 52 cases with automatic feedback after an attempt at each case. PATIENTS: The study enrolled 845 patients with average and high risk of colorectal cancer, 737 of whom had both complete CTC and videocolonoscopy data, which constituted the dataset. INTERVENTIONS: Patients underwent same-day CTC followed by videocolonoscopy with segmental unblinding of CTC results. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive and negative predictive values for detection of polyps ≥ 6 mm in per-patient and per-lesion analyses of CTC without computer-aided detection. RESULTS: Sensitivity, specificity and positive and negative predictive values for patients with polyps ≥ 6 mm were 69% (95% CI 61% to 77%), 91% (95% CI 89% to 94%), 67% (95% CI 59% to 74%) and 92% (95% CI 90% to 94%), respectively. Univariate analysis showed that the detection rate for polyps ≥ 6 mm was linked to neither radiologist case volume nor number of polyps, but was related to sensitivity achieved in the training set. Pooled sensitivity was 72% (95% CI 63% to 80%) versus 51% (95% CI 40% to 60%) for radiologists achieving above and below median sensitivity in the training set (61%), respectively. Multivariate analysis showed that sensitivity for polyps ≥ 6 mm in the training set was the only remaining significant predictive factor for subsequent performance. CONCLUSIONS: Radiologist sensitivity CTC for detection of polyps ≥ 6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps.


Subject(s)
Clinical Competence , Colonography, Computed Tomographic/standards , Colorectal Neoplasms/diagnostic imaging , Radiology/standards , Aged , Colonic Polyps/diagnosis , Colonic Polyps/diagnostic imaging , Colonic Polyps/pathology , Colonography, Computed Tomographic/methods , Colonoscopy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Education, Medical, Continuing/methods , Epidemiologic Methods , Female , France , Humans , Male , Middle Aged , Occult Blood , Radiology/education , Video Recording
20.
Gastroenterol Clin Biol ; 33(10-11 Suppl): F75-81, 2009 Oct.
Article in French | MEDLINE | ID: mdl-19733458

ABSTRACT

Stenosis is the most frequent complication during Crohn's disease. The lesion can be inflammatory, or due to a fibrosing or neoplastic process. The medical treatment with anti-inflammatory drugs is usually sufficient as first line treatment; fibrous lesions require endoscopic or surgical procedures while neoplastic lesions require surgery. A multidisciplinary approach (radiologic, medical, surgical and endoscopic) is needed. In a first part, we discuss the definition of stenosis and the modalities of imaging (particularly MRI) and of treatment (particularly with TNFalpha antagonists). Then we expose the strategy for the management of the most frequent clinical situations: occlusion, ileal inflammatory stenosis, stenosis of an ileocolonic anastomosis and chronic fibrous stenosis. The treatment decision takes into account the results of radiological assessment, CRP level and the effects of the previous treatments.


Subject(s)
Crohn Disease/complications , Crohn Disease/therapy , Ileal Diseases/etiology , Ileal Diseases/therapy , Intestinal Obstruction/etiology , Intestinal Obstruction/therapy , Laparoscopy , Crohn Disease/diagnosis , Diagnosis, Differential , Drug Therapy, Combination , Glucocorticoids/therapeutic use , Humans , Ileal Diseases/diagnosis , Immunosuppressive Agents/therapeutic use , Intestinal Obstruction/diagnosis , Risk Assessment , Risk Factors , Severity of Illness Index , Treatment Outcome
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