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1.
Endoscopy ; 46(10)oct. 2014.
Article in English | BIGG - GRADE guidelines | ID: biblio-965359

ABSTRACT

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. ESGE/ESGAR do not recommend barium enema in this setting (strong recommendation, high quality evidence). 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence). 3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). 4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp  ≥  6  mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence). 5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence).


Subject(s)
Humans , Colorectal Neoplasms/diagnostic imaging , Colonic Polyps , Colonic Polyps/therapy , Colonic Polyps/diagnostic imaging , Preoperative Care , Colorectal Neoplasms , Colonoscopy , Contrast Media , Colonography, Computed Tomographic , Early Detection of Cancer , Watchful Waiting , Contraindications , Neoplasm Staging
2.
Clin Radiol ; 66(6): 510-6, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21376309

ABSTRACT

AIM: To obtain information regarding the demographics of attendees of computed tomography colonography (CTC) training workshops organized by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), in particular their prior expertise and current practice. MATERIALS AND METHODS: Attendees at five CTC training workshops conducted in Edinburgh (UK), Malmo (Sweden), Amsterdam (Netherlands), Pisa and Stresa (Italy) between February 2007 and April 2010 completed an online questionnaire. Responses were collated and descriptive statistics produced. RESULTS: Three hundred and forty-eight delegates responded; a response rate of 73%. There was wide geographical variability encompassing 20 European member-states and seven countries outside Europe. The overwhelming majority were radiologists (336; 97%). Of the respondents, 299 (86%) were already interpreting CTC in clinical practice but of these, 158 (54%) had no prior formal training in CTC whereas 21 (8%) had attended a previous workshop. Furthermore, of those reporting CTC, 227 (76%) had interpreted fewer than 50 cases. CONCLUSIONS: Despite political imperatives for other groups to interpret CTC, the vast majority of those attending training are radiologists. Worryingly, a significant proportion of these are apparently reporting CTC in clinical practice without adequate training.


Subject(s)
Colonic Polyps/diagnostic imaging , Colonography, Computed Tomographic , Colorectal Neoplasms/diagnostic imaging , Education, Medical, Continuing/standards , Radiology, Interventional/education , Clinical Competence , Colonography, Computed Tomographic/standards , Europe , Female , Humans , Male , Radiology, Interventional/standards , Sensitivity and Specificity
4.
Radiologe ; 48(2): 126-34, 2008 Feb.
Article in German | MEDLINE | ID: mdl-18214416

ABSTRACT

An examination technique adapted to comply with the demands of CT colonography is not only a basic requirement for a high-quality examination and correct ascertainment of the findings; it is also essential for far-reaching applications of this method of examination. The technique of CT colonography is based on good patient preparation with the aid of fecal tagging, adequate distension of the colon with CO(2) and acquisition of data with the patient both prone and supine in a thin-slice technique using a low-dose protocol. The different technical aspects of CT colonography are explained in this paper.


Subject(s)
Colonic Neoplasms/diagnostic imaging , Colonic Polyps/diagnostic imaging , Colonography, Computed Tomographic/methods , Algorithms , Artifacts , Colonoscopy , Contrast Media/administration & dosage , Humans , Image Processing, Computer-Assisted/methods , Intestinal Mucosa/diagnostic imaging , Sensitivity and Specificity , Software
5.
JBR-BTR ; 88(4): 175-7, 2005.
Article in English | MEDLINE | ID: mdl-16176073

ABSTRACT

We report a case of a Meckel diverticulum connected with the umbilicus through a fibrotic cord causing small bowel obstruction. On admission, the patient presented with an acute abdomen. A plain upright radiography of the abdomen, an ultrasonography of the abdomen, and an enema with gastrografin were performed, showing a small bowel obstruction at the level of the pre-terminal ileum, without revealing the cause. Urgent surgery followed, showing a persistent omphalomesenteric duct connected to the abdominal wall through a fibrotic cord, with a secondary volvulus of the small bowel. The remnant was resected and the volvulus reduced. The post-operative course was uneventful. Because of the serious complications and even possible mortality due to ischemic disease of the affected small bowel the possibility of a complicated persistent omphalomesenteric duct should be kept in mind, even if the preoperative work-up does not reveal a Meckel diverticulum.


Subject(s)
Ileal Diseases/etiology , Intestinal Obstruction/etiology , Meckel Diverticulum/complications , Abdomen, Acute/etiology , Child, Preschool , Humans , Intestinal Volvulus/etiology , Male , Vitelline Duct/pathology
6.
Eur Radiol ; 15(6): 1192-202, 2005 Jun.
Article in English | MEDLINE | ID: mdl-15702335

ABSTRACT

The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann-Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.


Subject(s)
Cathartics , Colon/diagnostic imaging , Colonic Polyps/diagnostic imaging , Colonography, Computed Tomographic , Feces , Adult , Aged , Aged, 80 and over , Bisacodyl , Citric Acid , Colonic Polyps/diagnosis , Colonoscopy , Female , Humans , Male , Middle Aged , Organometallic Compounds , Statistics, Nonparametric
8.
JBR-BTR ; 83(5): 238-42, 2000 Oct.
Article in English | MEDLINE | ID: mdl-11201538

ABSTRACT

This study evaluates the use of pulse spray pharmacomechanical thrombolysis (PSPMT) in combination with a low dose urokinase infusion and a possible secondary percutaneous treatment in the management of acute multiple limb ischemia. A retrospective analysis of 185 patients treated with PSPMT revealed eight patients with acute simultaneous ischemia of more than 1 limb. Seven patients presented with acute ischemia of both lower limbs; one patient presented with acute ischemia of the left arm and both lower limbs. All patients were treated using a combination of PSPMT and low dose urokinase infusion. The combination of PSPMT and low dose urokinase infusion was completely successful in 6 cases. In 1 patient with bronchogenic carcinoma PSPMT failed and immediate surgical thrombectomy was performed. In the other patient we obtained clot dissolution with thrombolysis in one leg, residual clots at the popliteal level in the other leg however had to be removed by surgical embolectomy. Embolism was the cause of the occlusion in 6 patients. Atherosclerotic disease appeared to be the underlying cause in the other 2 patients. Atherosclerotic disease was treated with balloon angioplasty and stenting. In the 8 patients with multiple limb ischemia, combination of PSPMT, low dose urokinase infusion, and possibly secondary treatment was useful and constituted a valuable alternative to open surgery. Acute occlusion of the abdominal aorta and acute leg ischemia have a high mortality and amputation rate with variable results in treatment. The use of thrombolysis has reduced the necessity of surgery in arterial occlusive disease and simplifies the treatment of native artery occlusion. Especially in patients with long and multi-level occlusions with poor outflow, thrombolysis seems to be the treatment of choice. In our analysis of 8 cases with acute multiple limb ischemia we review our experience with the combination of pulse spray pharmacomechanical thrombolysis (PSPMT), low dose continuous urokinase infusion and a possible subsequent percutaneous treatment of the obstructing lesion. The final purpose was to investigate if this combination is a successful and safe method in the treatment of acute multiple limb ischemia.


Subject(s)
Arm/blood supply , Ischemia/drug therapy , Leg/blood supply , Plasminogen Activators/therapeutic use , Thrombolytic Therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Acute Disease , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Male
9.
Eur Radiol ; 9(8): 1553-5, 1999.
Article in English | MEDLINE | ID: mdl-10525864

ABSTRACT

We report a rare case of an expanding post-traumatic lateral abdominal wall haematoma. A superselective arteriogram of the deep circumflex iliac artery showed extravasation from the ascending branch, urging emergency therapy. Microcoil and Gelfoam embolisation was successfully performed. Haematomas of the abdominal wall can be divided in the common rectus sheath haematomas and the rare haematomas of the lateral abdominal wall. Differentiating both entities is essential, since there is a strong difference in their vascular supply. The typical vascular supply of the lateral abdominal wall is discussed, with emphasis on the ascending branch of the deep circumflex iliac artery.


Subject(s)
Abdominal Injuries/complications , Abdominal Muscles , Hematoma/etiology , Wounds, Nonpenetrating/complications , Adult , Embolization, Therapeutic , Hematoma/diagnosis , Hematoma/therapy , Humans , Iliac Artery/injuries , Male , Rupture , Tomography, X-Ray Computed
11.
JBR-BTR ; 81(3): 131-3, 1998 Jun.
Article in English | MEDLINE | ID: mdl-10547262

ABSTRACT

A case of benign fibrous pleural mesothelioma is reported. Imaging studies as well as clinical features suggested malignant pleural mesothelioma. The lesion was judged resectable and no metastases were found. At surgery it was found to be a benign pleural fibrous mesothelioma. Because of the considerable overlap of imaging characteristics between the two entities, the authors conclude that determination of resectability rather than differentiation between benign and malignant mesothelioma should be the primary goal to be achieved by imaging techniques.


Subject(s)
Mesothelioma/diagnostic imaging , Pleural Neoplasms/diagnostic imaging , Aged , Biopsy , Diagnosis, Differential , Humans , Male , Mesothelioma/pathology , Pleural Neoplasms/pathology , Tomography, X-Ray Computed
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