In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation.

PURPOSE: Accurate estimation of esophageal hiatus surface area (HSA) prior to surgical repair of hiatal hernia is difficult. The ability to do so may assist with following progression of hiatal hernias, choosing the optimal surgical approach and post-surgical evaluation. We developed a method for measurement of HSA using multi-planar reconstruction (MPR) of multi-detector computed tomography (MDCT) scans and sought to validate our method using intra-operative HSA measurements. METHODS: Patients with thoracic or abdominal CT scans who were scheduled to undergo hiatal hernia repair were identified. A radiologist performed MPR of each MDCT scan to obtain the measured HSA (mHSA). Estimated HSA (eHSA) was obtained using intra-operative measurements of crura length and distance between crural edges. The association between eHSA and the corresponding mHSA was assessed using Pearson correlation. The intra-class correlation coefficient was calculated to assess both intra-observer and inter-observer agreement for the MDCT-MPR technique. RESULTS: Of 30 subjects included, 16 (53.3%) were female and the median age was 68.5 years. All patients underwent robotic-assisted laparoscopic hiatal hernia repair. The median HSA was 8.1 cm2 based on intra-operative measurements and 9.9 cm2 based on CT measurements. The correlation coefficient for eHSA and corresponding mHSA was 0.83 (p < 0.001). The intra-class correlation coefficient was 0.97 (p < 0.001) for intra-observer agreement and 0.97 (p < 0.001) for inter-observer agreement. CONCLUSION: We developed a MDCT-MPR technique that measures HSA in vivo. This technique is reproducible and can be used for pre-operative planning and post-operative follow-up of patients with symptomatic hiatal hernia.

Rosai-Dorfman disease of the breast: A potential marker of systemic disease.

Rosai-Dorfman disease (RDD) is a rare idiopathic benign proliferative disorder of histiocytes. RDD typically presents with cervical lymph node involvement; however, extranodal sites such as the breast can also be involved and should prompt evaluation for additional sites of disease.

Smartphone-based Compression-Induced Scope with Temperature Sensor for Inflammatory Breast Cancer Screening.

The Smartphone-based Compression-induced Scope (SCIS) is a mobile device designed to sense the mechanical properties of tumors. Here, an SCIS system with an infrared temperature (SCIS-T) sensor is developed. The color and texture information of target skin are extracted from the SCIST images using a color-based edge detection technique and a texture filter. This new system provides mechanical properties (size, elasticity) of the inclusion as well as the skin surface (color, temperature, texture) characteristics. The application of this system is in the identification of inflammatory breast cancer, which is characterized by color, texture, and temperature change. The device is tested using chicken breast phantoms with embedded silicone inclusion.

Laparoscopic adjustable gastric band erosion with intragastric band migration: A rare but serious complication.

Although laparoscopic adjustable gastric banding is considered the most minimally invasive surgical technique for the treatment of morbid obesity, the procedure has a reported overall complication rate of up to 26%. Among the various complications, gastric band erosion with intragastric band migration is the most worrisome because of the risk of subsequent obstruction, peritonitis, and sepsis. Therefore, prompt and accurate diagnosis is crucial during imaging evaluation of these patients in the late postoperative setting. In this article, we report a case of a 47-year-old woman with a gastric band that had eroded into the gastric wall with intragastric migration demonstrating classic findings on fluoroscopic and computed tomography imaging.

Tumor size and elasticity estimation using Smartphone-based Compression-Induced scope.

A simple-to-use, noninvasive, and risk-free system, which will provide accurate identification of potentially life threatening malignant tumors using tactile pressure, is developed. The Smartphone-based Compression-Induced (SCI) Scope will allow physicians to quickly capture the mechanical properties of a benign or malignant tumor with the convenience of a smartphone platform. The size and elasticity property is described using estimating methods from the pressure-induced images of SCI Scope. The device is based on the Apple iPhone 6. The image will be captured through a waveguide. The image information in combination with the force sensor value will be transmitted wirelessly to a computer for processing. The size and elasticity estimation experiments with SCI Scope showed that the size estimation error of 2.31% and estimated relative elastic modulus error of 23.9%.

Localized mediastinal amyloidosis: A misnomer?

Amyloidosis is a disease related to abnormal protein folding and deposition of that abnormal protein between cells of the body in various tissues and organs, resulting in multiple clinical manifestations. We report a case of amyloidosis with atypical features, isolated to the mediastinum, in a 75-year-old male who presented with fatigue and shortness of breath. Amyloidosis that is isolated to the mediastinum without pulmonary parenchymal involvement is exceptionally rare. It has been hypothesized that localized mediastinal amyloidosis manifesting as amyloidomas is a distinct clinical subtype with a better prognosis than classic systemic amyloidosis. This paper describes the radiologic features of localized mediastinal amyloidosis (along with its pathologic correlation) and compares systemic and isolated disease.

Computer-aided detection of colorectal polyps: can it improve sensitivity of less-experienced readers? Preliminary findings.

PURPOSE: To determine whether computer-aided detection (CAD) applied to computed tomographic (CT) colonography can help improve sensitivity of polyp detection by less-experienced radiologist readers, with colonoscopy or consensus used as the reference standard. MATERIALS AND METHODS: The release of the CT colonographic studies was approved by the individual institutional review boards of each institution. Institutions from the United States were HIPAA compliant. Written informed consent was waived at all institutions. The CT colonographic studies in 30 patients from six institutions were collected; 24 images depicted at least one confirmed polyp 6 mm or larger (39 total polyps) and six depicted no polyps. By using an investigational software package, seven less-experienced readers from two institutions evaluated the CT colonographic images and marked or scored polyps by using a five-point scale before and after CAD. The time needed to interpret the CT colonographic findings without CAD and then to re-evaluate them with CAD was recorded. For each reader, the McNemar test, adjusted for clustered data, was used to compare sensitivities for readers without and with CAD; a Wilcoxon signed-rank test was used to analyze the number of false-positive results per patient. RESULTS: The average sensitivity of the seven readers for polyp detection was significantly improved with CAD-from 0.810 to 0.908 (P=.0152). The number of false-positive results per patient without and with CAD increased from 0.70 to 0.96 (95% confidence interval for the increase: -0.39, 0.91). The mean total time for the readings was 17 minutes 54 seconds; for interpretation of CT colonographic findings alone, the mean time was 14 minutes 16 seconds; and for review of CAD findings, the mean time was 3 minutes 38 seconds. CONCLUSION: Results of this feasibility study suggest that CAD for CT colonography significantly improves per-polyp detection for less-experienced readers.

A retrospective review of enteroclysis in patients with obscure gastrointestinal bleeding and chronic abdominal pain of undetermined etiology.

Our purpose was to determine the diagnostic utility of enteroclysis in the evaluation of obscure gastrointestinal bleeding and abdominal pain of unknown etiology. This is a retrospective review of 97 consecutive patients (mean age, 54.1+/-17.5 [SD] years; 49 male and 48 female) who underwent enteroclysis at Temple University Hospital from January 1994 to October 2001 for the evaluation of obscure GI bleeding or chronic abdominal pain of undetermined etiology. Prior to enteroclysis all patients had an EGD and colonoscopy, which were nondiagnostic for their symptoms. Sixty-three patients (64.9%) had enteroscopy performed prior to enteroclysis that was also negative. Enteroclysis results were defined as positive based on anatomical or functional abnormalities. Analysis of the data included the percentage yield of positive exams, the percentage of positive results per symptom category, and the percentage of patients with a change in clinical management based on positive enteroclysis results. Ninety-seven patients underwent enteroclysis. The indications for enteroclysis were obscure GI bleeding in 67 patients (69.1%) and chronic abdominal pain in 30 patients (30.9%). The number of positive exams was 19 (19.6%). Fourteen of the 67 patients with the indication of GI bleeding had a positive exam (21%), while 5 of the 30 patients with chronic abdominal pain had a positive result (16.7%). There was a change in clinical management due to the enteroclysis results in 10 patients: 7 patients with GI bleeding (10%) and 3 patients with chronic abdominal pain (10%). Positive enteroclysis findings included adhesions (7), filling defects and masses (5), strictures (2), small bowel diverticulosis (1), mucosal abnormalities (3), and a motility disorder (1). The overall positive yield for enteroclysis was 19.6%, with a yield of 16.7% for chronic abdominal pain and 21% for gastrointestinal bleeding. Enteroclysis results changed the clinical management in approximately 10% of the patients.

Laparoscopic esophagomyotomy for achalasia: does anterior hemifundoplication affect clinical outcome?

OBJECTIVE: To determine whether the addition of anterior hemifundoplication to laparoscopic esophagomyotomy for achalasia yields better clinical outcomes than laparoscopic esophagomyotomy alone. SUMMARY BACKGROUND DATA: Although hemifundoplication may prevent gastroesophageal reflux after esophagomyotomy for achalasia, it may also lead to persistent dysphagia in these patients with esophageal aperistalsis. METHODS: This is a retrospective study of 51 consecutive patients (mean age 47.5 +/- 12.6 years) who had laparoscopic esophagomyotomy for achalasia by our group between August 1995 and January 2001. In 29 patients (57%) an anterior hemifundoplication was added to the esophagomyotomy. In 22 patients (43%), no wrap was added. Patients scored (0 = none; 1 = mild; 2 = moderate; 3 = severe) symptom severity (dysphagia, regurgitation, heartburn, chest pain) preoperatively and postoperatively. Weight gain, use of gastrointestinal (GI) medication, tolerance to food, and patient satisfaction were also assessed. RESULTS: Mean patient follow-up was 33 months, and there were no operative deaths. Four patients were converted to open operation (8%). The wrap and no wrap groups were similar in terms of esophageal dilation, preoperative symptom severity and duration (5.7 +/- 7.1 versus 6.1 +/- 7.0 years), and preoperative weight loss (18 +/- 15 versus 20 +/- 20 pounds). Both groups had similar improvement in symptom grade postoperatively and equivalent satisfaction rates (86%). Postoperative weight gain, GI medication use, and food intolerance was also similar. Postoperatively, patients in the wrap group did not have higher dysphagia scores or lower heartburn scores than the no wrap group. CONCLUSION: The addition of anterior hemifundoplication to esophagomyotomy for achalasia does not improve or worsen clinical results.