Additional benefit of procalcitonin to C-reactive protein to assess disease activity and severity in Crohn's disease.

BACKGROUND: Serum procalcitonin level may reflect non-infectious inflammation. AIM: To assess the correlation of serum procalcitonin level with clinical, biological, endoscopic and radiological markers of disease activity in inflammatory bowel diseases (IBD), and to evaluate the additional diagnostic benefit of measuring serum procalcitonin level to that of C-reactive protein (CRP) for disease activity appraisal. METHODS: We performed a prospective observational study. Spearman's rank correlation and receiver operating characteristic analysis were used to evaluate correlation and diagnostic accuracy respectively. RESULTS: In Crohn's disease (CD) (n = 30), serum procalcitonin level was strongly correlated with clinical, biological, endoscopic and radiological disease activity markers. In CD, the serum procalcitonin level >0.14 µg/L demonstrated a high accuracy for detecting severe disease (Sensitivity = 100%; Specificity = 96%; AUROC = 0.963; P = 0.0001). The diagnostic accuracy of the 'serum procalcitonin level-CRP strategy' (CRP >5 mg/L and serum procalcitonin level >0.05 µg/L) was significantly superior to that of CRP alone for diagnosing severe CD (AUROC = 0.783 vs. 0.674; P = 0.01). In ulcerative colitis (UC) (n = 27), serum procalcitonin level was correlated with CRP and with endoscopic and radiological disease activity markers. CONCLUSIONS: In CD, the serum procalcitonin level was correlated with all disease activity markers and a cut-off of 0.14 µg/L could distinguish severe forms of the disease. The 'serum procalcitonin level-CRP strategy' was superior to CRP alone for diagnosing active or severe CD.

[Liver calcifications in adults: the KUB stars are too frequently neglected in the CT era]. / Calcifications hépatiques de l'adulte: les stars de l'ASP trop souvent négligées à l'ère du scanner.

Liver calcifications have been extensively described on plain radiographs, either from KUB or angiography examinations. On the other hand, their characteristics are seldom reported on cross-sectional imaging: they are frequently considered as non-specific compared to multiple other imaging features. However, clinical practice demonstrates that in specific situations (such as parasitic infections and calcified metastases), the presence of calcifications may be a determining factor in avoiding misdiagnosis with potential deleterious effects to the patient. Both CT and US can detect a large number of "benign" calcifications without associated focal lesion and knowledge of their imaging features is useful to avoid unnecessary additional imaging work-up. A review of the literature and a series of 100 cases of liver calcifications on CT are presented to review the imaging features of calcified liver lesions and isolated liver calcifications without associated focal lesion.

Benign intraductal papillary-mucinous neoplasm of the pancreas associated with spontaneous pancreaticogastric and pancreaticoduodenal fistulas.

Invasive intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas may be associated with pancreaticogastric fistulas as shown by case reports. We report the case of a benign IPMN associated with pancreaticogastric and pancreaticoduodenal fistulas. A 70-year-old woman was admitted with intestinal obstruction. Computed tomography and MRI showed a large dilatation of the main pancreatic duct (>1 cm) with intraductal nodules, and pancreaticogastric and pancreaticoduodenal fistulas. Several features in imaging were present to support a malignant IPMN, so that the patient underwent a pancreaticoduodenectomy. The histopathological examination of the surgical specimen showed a benign IPMN. This case proves that a benign IPMN can cause pancreaticogastric and pancreaticoduodenal fistulas, probably resulting from mechanical factors.

[Imaging of the postoperative biliary tract]. / Imagerie des voies biliaires opérées.

For a long time, imaging of the biliary tract after surgical procedures was performed with invasive procedures such as endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. Due to recent advances in diagnostic imaging, non-invasive techniques are now favored. While US remains the initial imaging modality, it is frequently followed by CT and/or MRCP. Image interpretation should always be performed in keeping with clinical and laboratory findings as well as the type of surgical procedure. The most appropriate imaging modality is selected based on these data. In patients with jaundice or biliary tract stenosis, MRCP, with use of an optimal technique and 3D acquisition, is the imaging modality of choice. In non-jaundiced patients with non-distended biliary tract and suspected bile leak, MRCP should be completed by the injection of a liver-specific contrast agent with biliary excretion to achieve non-invasive biliary tract opacification. In patients with malignancy, CT is preferred due to its high spatial resolution and ability to demonstrate small anastomotic tumor recurrences. CT should also be performed in patients with suspected hepatic artery or portal vein injury in addition to biliary tract injury or to detect distant complications.