Low thoracic skeletal muscle index is associated with negative outcomes in 244 patients with respiratory COVID-19.

BACKGROUND: Sarcopenia is associated with negative outcomes in intensive care unit (ICU) patients and during chronic diseases. We aimed to evaluate if low skeletal muscle index (SMI) measured by computed tomography (CT) at the thoracic level is associated with poor outcomes in hospitalized patients with respiratory COVID-19. METHODS: Patients admitted to the hospital between March 1st and June 9, 2020 with a confirmed diagnosis of respiratory COVID-19 in the Emergency Department were included in this retrospective cohort study. SMI was assessed from a transverse CT image at the T12 level. We analysed the association between thoracic SMI and mortality, ICU admissions, infections, length of stay and gravity scores. RESULTS: We included 244 patients, whose median age was 62 (20-95) years, mean body mass index was 28,6 kg/m2, and 34% were obese patients. 102 patients (41,8%) had low thoracic SMI. On multivariable analysis, low thoracic SMI was associated with more infections (OR = 1,88 [1,06-2,98]) and increased length of stay (OR = 1,87 [1,14-3,49]) but not with mortality (OR = 1.37 [0.54-3.52]), whereas it was inversely associated with ICU admission (OR = 5,56 [1,96-16,67]. CONCLUSION: Low SMI measured by CT at the thoracic level T12 is associated with negative outcomes in patients with respiratory COVID-19.

The diagnostic value of the functional lumen imaging probe versus high-resolution anorectal manometry in patients with fecal incontinence.

BACKGROUND: The functional lumen imaging probe (EndoFLIP® ) is a new technology that measures the distensibility of the anal canal represented by the anal distensibility index. The aims of this study were (i) to compare the anal distensibility index to anal pressure in a cohort of patients with fecal incontinence (FI) and (ii) to compare the diagnostic value of the EndoFLIP® to that of high-resolution anorectal manometry (HRAM) in the same cohort of patients. METHODS: Eighty-three consecutive patients with FI who underwent EndoFLIP® and HRAM assessments were enrolled. The diagnostic value of the EndoFLIP® was compared to that of HRAM and agreement between EndoFLIP® and HRAM data was assessed. KEY RESULTS: More than 70% of the patients diagnosed with anal deficiency at rest and/or during voluntary contractions by HRAM had the same diagnosis using the EndoFLIP® . Two patients with higher distensibility indexes at rest had normal anal resting pressures. Sixteen patients with a normal EndoFLIP® index (ie, normal distensibility index at rest and during voluntary contractions) had an abnormal HRAM result. Seven of these 16 patients (44%) had no sphincter lesion or neuropathic disorder that could explain an abnormal anal sphincter function. CONCLUSIONS & INFERENCES: We demonstrated that the anal distensibility index and HRAM results are largely in agreement. We did, however, identify several discrepancies between the two techniques, indicating that they may be complementary.

Magnetization transfer ratio for the assessment of perianal fistula activity in Crohn's disease.

OBJECTIVES: Assessment of perianal fistulas is important to guide management of Crohn's disease (CD). Our objectives were to analyze the feasibility of magnetization transfer (MT) imaging to assess fistulas and to evaluate its contribution in assessing disease activity. METHODS: During 15 months, all patients referred for perianal fistulas in CD underwent 3T-MRI including diffusion, T2/T1-weighted gadolinium-enhanced sequences and MT sequences (one with an off-resonance saturation pulse of 800 and one with 1200 Hz). We collected Van Assche score, fistula activity signs by analyzing T2, diffusion and contrast enhancement. We calculated MT ratio (MTR) with a ROI in the largest fistula. RESULTS: Twenty-nine patients (mean 34.9 years, range 17-53) were included. Van Assche score was 11.7, range 4-21. In 22 patients, the fistula presented with a bright T2 and diffusion signal with contrast enhancement, and was characterized as active. Mean MTR was respectively 47.2 (range 12-68) and 34.3 (range 11-57) at 800 and 1200 Hz. MTR at 800 Hz was significantly lower in non-active (34, range 12-55) than in active fistulas (51, range 24-68) (p < 0.02). CONCLUSIONS: MTR is feasible for the assessment of fistulas in CD and in the future could be used to help identify active and non-active fistulas. KEY POINTS: • MTR is feasible for the assessment of perianal fistulas in CD. • MT allows quantitative imaging of perianal fistula activity in CD. • MTR could be used to help identify active and non-active fistulas in CD.

Relevance of 3D Cholangiography and Transient Elastography to Assess Cystic Fibrosis-Associated Liver Disease?

Background. Cystic fibrosis-associated liver disease (CFLD) is a major cause of death. The objective of our retrospective study was to describe the relevance of magnetic resonance imaging (MRI) and liver stiffness measurement (LSM) for CFLD evaluation. Methods. All cystic fibrosis adult patients evaluated by MRI and LSM were included. MR signs of portal hypertension (PHT), dysmorphia, or cholangitis were collected and LSM expressed in kPa and Metavir. Results. Of 25 patients, 52% had abnormal MRI. Median LSM was 5.7 kPa (3.4-9.9). Three patients had F2 score and one had F3 score. In patients with PHT, LSM was 7.85 kPa (3.7-9.9) compared to 5 (3.4-7.5) in others, p = 0.02. In patients with abnormal liver function tests, 50% had increased LSM (≥F2), whereas 94% with normal tests had normal LSM (p = 0.04). Seven patients had abnormal MRI despite normal ultrasonography. Conclusions. MRI and LSM provide useful information on CFLD and may help to screen patients with PHT.

Computed tomography-based virtual colonoscopy in the assessment of bowel endometriosis: The surgeon's point of view.

OBJECTIVE: To discuss the role of computed tomography-based virtual colonoscopy (CTC) in preoperative assessment of bowel endometriosis. METHODS: Retrospective study using data prospectively recorded, including 127 patients with colorectal endometriosis, having undergone CTC for bowel endometriosis. The study was conducted in a tertiary referral center during 38 consecutive months. Preoperative assessment included CTC, magnetic resonance imaging (MRI), endorectal ultrasound (ERUS) and clinical examination. Information concerning identification of deep infiltrating endometriosis (DIE) of the bowel, the length and height of colorectal involvement, stenosis of digestive lumen and associated digestive localizations were compared with intraoperative findings. RESULTS: Sensitivity and specificity of CTC for DIE of the rectum, the sigmoid colon, associated digestive localizations, and stenosis of the digestive lumen were respectively 97% and 84%, 93% and 88%, 84% and 97%, 96% and 96%. Intraoperative estimation of the length of digestive tract involved by DIE was closer to that provided by CTC than those provided by MRI and ERUS. When CTC revealed stenosis of digestive lumen, higher rates of colorectal resection (63% vs. 9.6%, < 0.001) and disc excision (25.9% vs. 11%, 0.03) were recorded. DISCUSSION: For those surgeons using various procedures for management of bowel endometriosis, accurate information on the length and height of bowel involvement, as well as the existence of bowel stenosis enables informed decision regarding the feasibility of conservative techniques versus bowel resection. Preoperative identification of associated localizations above the sigmoid colon is another major advantage related to CTC. CONCLUSIONS: CTC provides accurate data on the length and height of colorectal involvement by DIE, stenosis of digestive lumen and associated lesions of digestive tract, which impact on the choice of surgical procedure.

MRI defaecography in patients with faecal incontinence.

AIM: Faecal incontinence (FI) requires careful assessment of its aetiology to determine the most effective treatment. The aims of this study were to evaluate MRI defaecography in FI and to compare it with clinical examination combined with rigid rectoscopy in assessing the pelvic floor in patients with FI. METHOD: Consecutive patients with FI referred over a 3-year period to our tertiary centre for MRI defaecography were retrospectively studied. MRI images of the pelvic floor were compared with clinical examination and anuscopy and rectoscopy. RESULTS: Seventy-four female patients [mean age 60.5 (30.0-81.0) years] were recruited. MRI defaecography showed conditions which often overlapped, including internal intussusception in 19 (25.7%) and pelvic floor descent in 24 (32.4%). There was average agreement between MRI and clinical examination for a significant anterior rectocoele (κ = 0.40) and poor agreement between MRI and anuscopy/rectoscopy for intra-rectal (κ = 0.06) and intra-anal intussusception (κ = 0.11). CONCLUSION: Other than for anterior rectocoele, there is poor correlation between MRI defaecography and clinical examination with rigid rectoscopy. MRI can detect a variety of abnormal static and dynamic pelvic disorders. This includes enterocoele, which could result in a modification of the surgical approach to intussusception and anterior rectocoele.

Magnetic resonance colonography in severe attacks of ulcerative colitis.

OBJECTIVES: To evaluate the ability of MR colonography (MRC) to detect lesions in severe attacks of ulcerative colitis (UC) and to assess its concordance with rectosigmoidoscopy. METHODS: Eighteen patients underwent MRC and rectosigmoidoscopy. MRC consisted of a water-filled colonic procedure followed by T1/T2w images. Image quality was recorded. Inflammatory lesions and the existence of signs of severity were analysed. We calculated MR accuracy in the diagnosis of inflammatory lesions, as well as per segment and per patient concordance depending on the presence or absence of severe lesions. RESULTS: The MR image quality of the 108 segments was satisfactory. Endoscopy was used to study 36 segments (rectum and sigmoid). MRC had a positive predictive value of 100% and a sensitivity of 64% in the diagnosis of inflammatory lesions. Concordance for the diagnosis of severe lesions was excellent for the rectum (k = 0.85) and good for the sigmoid (k = 0.64). MRC diagnosed signs of severity in all patients affected at endoscopy. MRC also disclosed signs of severity located higher in the colon in four patients with nonsevere lesions at rectosigmoidoscopy. CONCLUSIONS: MRC can accurately diagnose inflammatory lesions in severe attacks of UC and significantly correlates with rectosigmoidoscopy in the diagnosis of severe lesions.

Fistulizing perianal Crohn's disease: contrast-enhanced magnetic resonance imaging assessment at 1 year on maintenance anti-TNF-alpha therapy.

BACKGROUND: The aim of the study was to assess perianal fistulas by magnetic resonance imaging (MRI) in patients with severe fistulizing Crohn's disease (CD) using maintenance antitumor necrosis factor alpha (TNF-α) therapy and to correlate MRI changes with clinical outcome. METHODS: Perineal MRI before and after a 1-year scheduled anti-TNF-α maintenance therapy was performed in 20 patients (14 females; mean age = 33.7). The Van Assche score (i.e., number of fistulas, localization, and extension, importance of T2 hyperintensity, presence of abscess) was calculated. Fistula track contrast enhancement was also used. Clinical outcome was defined as no response, response, or remission. RESULTS: Response and remission were observed in respectively 40% and 35% of cases. The Van Assche score varied from 13.8 (7-20) to 6.13 (0-12) in patients with a response or remission (P < 0.05). The T2 hyperintensity follow-up value decreased in patients in response or remission (P < 0.01). T2 hyperintensity disappeared or decreased in 14 out of 15 patients in clinical response or remission as compared to one among the five nonresponding patients (P < 0.01). The decrease in Van Assche score and hyperintensity value was not significantly different in patients in remission compared to those with response. Only one patient in clinical remission had a persisting contrast enhancement on MRI, whereas contrast enhancement persisted in all other patients not in remission (P = 0.002). CONCLUSIONS: The clinical benefit of maintenance anti-TNF-α therapy in perianal CD is associated with a significant improvement of the Van Assche score, particularly T2 hyperintensity. The disappearance of contrast enhancement was the only semiological MR feature associated with remission.

[Early imaging features after sleeve gastrectomy]. / Imagerie précoce de la réduction gastrique type gastrectomie en gouttière.

PURPOSE: Sleeve gastrectomy is a new bariatric surgical procedure with promising early results and low morbidity and mortality. We have evaluated the early imaging findings and value of upper GI study (UGI) and CT. PATIENTS AND METHODS: Twenty five patients (mean age=38.9 years, mean BMI=51.5 kg/m2) following sleeve gastrectomy for morbid obesity underwent UGI at day 1. CT was immediately performed in patients with suspected leak or as a follow-up examinations in patients with suspected complication. The different imaging features observed were recorded. RESULTS: UGI demonstrated 13 normal examinations (52%), an abnormal appearance in 11 cases (44%) with opacification of a lateral pouch, and one complication (leak confirmed on CT). Two patients underweent CT (day 3 and day 15) for suspected complication, with demonstration of leak in both cases. CONCLUSION: An abnormal appearance after sleeve gastrectomy is frequently observed on UGI. Routine UGI at day 1 is useful to detect large leaks. CT with oral contrast should be performed in all patients with imaging or clinical suspicion of leak.

[Role of defecography in female posterior pelvic floor abnormalities]. / Place de la défécographie dans les troubles de la statique pelvienne postérieure féminine.

Pelvic floor abnormalities often impact significantly the quality of life and result in a variety of symptoms, including chronic pelvic pain, fecal incontinence, and obstructed constipation. Fluoroscopic defecography and MR defecography enable identification of rectocele, rectal prolapse, enterocele, sigmoidocele with high prevalence in female patients with obstructed constipation, fecal incontinence, and chronic pelvic pain. In this manuscript, we describe the techniques and indications of the two techniques of defecography. We discuss the abnormalities of the posterior pelvic floor compartment at the origin of constipation, incontinence, chronic pelvic pain. Finally we compare the data obtained by clinical examination and defecography, remembering that 50% of enterocele and 100% of sigmoidocele are missed at clinical examination.

Ganglioneuromatosis: an unusual cause of ileal stricture mimicking Crohn's disease.

Ileal idiopathic forms of ganglioneuromatosis in adults are extremely rare and represent a challenging pathologic condition for the clinician. We present two cases of ileal ganglioneuromatosis consisting of stricturing lesions that mimicked clinical and radiologic features commonly observed in Crohn's disease patients with ileal involvement.