Magnetic resonance imaging: Is there a role in clinical management for acute ischemic colitis?

AIM: To validate the utility of magnetic resonance imaging (MRI) for the clinical management of acute ischemic colitis (IC). METHODS: This is a magnetic resonance (MR) prospective evaluation of 7 patients who were proved to have acute IC on the basis of clinical, endoscopic and computed tomography (CT) findings and who were imaged in our institution between February 2011 and July 2012. The mean age of the patients was 72.28 years. Abdominal CTs were obtained using a 64-detector row configuration for all patients with un-enhanced and contrast-enhanced scans, in the late arterial phase (start delay 45-50 s) and in the portal venous phase (start delay 70-80 s). The MR examinations were performed using a 1.5T superconducting magnet, using Fast Imaging Employing Steady State Acquisition and T2-weighted fast-recovery fast-spin echo sequences in axial and coronal plane. CT and MRI examinations were analysed for the presence of colonic abnormalities and associated findings. RESULTS: Segmental involvement was seen in 6 patients (85.71%), with a mean length of involvement of 412 mm (range 145.5-1000 mm). Wall thickness varied between 6 mm and 17.5 mm (mean 10.52 mm) upon CT examinations and from 5 to 15 mm (mean 8.8 mm) upon MR examinations. The MRI appearance of the colonic wall varied over the time: Type I appearance with a 3 layer sandwich sign was seen in 5 out of 12 examinations (41.66%), patients underwent MR within a mean of 36 h (ranging from 1 to 54 h) after the CT examination. Type II and III appearance with a 2 layer sign, was seen in 4 examinations (33.33%), patients underwent MR within a mean of 420.5 h (ranging from 121 to 720 h) after the CT examination. In the remaining three MRI examinations, performed within a mean of 410 h (ranging from 99.5 to 720 h) the colonic wall appeared normal. CONCLUSION: MRI, only using precontrast images, may be used as a substitute for invasive procedures in diagnosis and follow-up of acute IC

Incidental and Underreported Pleural Plaques at Chest CT: Do Not Miss Them - Asbestos Exposure Still Exists

Pleural plaques (PPs) may be a risk factor for mortality from lung cancer in asbestos-exposed workers and are considered to be a marker of exposure. Diagnosing PPs is also important because asbestos-exposed patients should be offered a health surveillance that is mandatory in many countries. On the other hand PPs are useful for compensation purposes. In this study we aimed to evaluate the prevalence, as incidental findings, and the underreporting rate of PPs in chest CT scans (CTs) performed in a cohort of patients (1512) who underwent chest CT with a slice thickness no more than 1.25 mm. PPs were found in 76 out of 1482 patients (5.1%); in 13 out of 76 (17,1%) CTs were performed because of clinical suspicion of asbestos exposure and 5 of them (38%) were underreported by radiologist. In the remaining 63 cases (82.9%) there was no clinical suspicion of asbestos exposure at the time of CTs (incidental findings) and in 38 of these 63 patients (60.3%) PPs were underreported. Reaching a correct diagnosis of PPs requires a good knowledge of normal locoregional anatomy and rigorous technical approach in chest CT execution. However the job history of the patient should always be kept in mind

CT Perfusion in the Characterisation of Renal Lesions: An Added Value to Multiphasic CT

Objective. To prospectively evaluate if computed tomography perfusion (CTp) could be a useful tool in addition to multiphasic CT in renal lesion characterisation. Materials and Methods. Fifty-eight patients that were scheduled for surgical resection of a renal mass with a suspicion of renal cell carcinoma (RCC) were enrolled. Forty-one out of 58 patients underwent total or partial nephrectomy after CTp examination, and a pathological analysis was obtained for a total of 49 renal lesions. Perfusion parameters and attenuation values at multiphasic CT for both lesion and normal cortex were analysed. All the results were compared with the histological data obtained following surgery. Results. PS and MTT values were significantly lower in malignant lesions than in the normal cortex (P < 0.001 and P = 0.011, resp.); PS, MTT, and BF values were also statistically different between oncocytomas and malignant lesions. According to ROC analysis, the accuracy, sensitivity, and specificity to predict RCC were 95.92%, 100%, and 66.7%, respectively, for CTp whereas they were 89.80%, 93.35%, and 50%, respectively, for multiphasic CT. Conclusion. A significant difference between renal cortex and tumour CTp parameter values may suggest a malignant renal lesion. CTp could represent an added value to multiphasic CT in differentiating renal cells carcinoma from oncocytoma

Ischemic colitis diagnosed by magnetic resonance imaging during lenalidomide treatment in a patient with relapsed multiple myeloma

Multiple myeloma is the second most common hematological neoplasm that also affects young patients. The progression-free survival after autologous stem cell transplant has improved with the introduction of several novel agents such as lenalidomide, which may, however, increase the risk of adverse events

The role of US examination in the management of acute abdomen.

Acute abdomen is a medical emergency, in which there is sudden and severe pain in abdomen of recent onset with accompanying signs and symptoms that focus on an abdominal involvement. It can represent a wide spectrum of conditions, ranging from a benign and self-limiting disease to a surgical emergency. Nevertheless, only one quarter of patients who have previously been classified with an acute abdomen actually receive surgical treatment, so the clinical dilemma is if the patients need surgical treatment or not and, furthermore, in which cases the surgical option needs to be urgently adopted. Due to this reason a thorough and logical approach to the diagnosis of abdominal pain is necessary. Some Authors assert that the location of pain is a useful starting point and will guide a further evaluation. However some causes are more frequent in the paediatric population (like appendicitis or adenomesenteritis) or are strictly related to the gender (i.e. gynaechologic causes). It is also important to consider special populations such as the elderly or oncologic patients, who may present with atypical symptoms of a disease. These considerations also reflect a different diagnostic approach. Today, surely the integrated imaging, and in particular the use of multidetector Computed Tomography (MDCT) has revolutionised the clinical approach to this condition, simplyfing the diagnosis but burdening the radiologists with the problems related to the clinical management. However although CT emerging as a modality of choice for evaluation of the acute abdomen, ultrasonography (US) remains the primary imaging technique in the majority of cases, especially in young and female patients, when the limitation of the radiation exposure should be mandatory, limiting the use of CT in cases of nondiagnostic US and in all cases where there is a discrepancy between the clinical symptoms and negative imaging at US

Accuracy of MDCT in preoperative definition of maximum tumor diameter in patients with gastric cancer

purpose: The maximum tumor diameter (Dmax) is a prognostic factor in patients with gastric cancer, considering its dependance on the depth of invasion. The aim of our work has been to evaluate the accuracy of MDCT in the preoperative definition of Dmax in patients with gastric cancer, assuming surgical specimen measurements as gold standard, in order to obtain a pre- surgery prognostic evaluation. material and methods: Pre-surgery CT examinations of 47 patients (mean age 53.5, range 48-71) with diagnosis of gastric cancer were evaluated retrospectively and in a blind fashion by a radiologist with expertise in the oncologic field. The Dmax measured was obtained through 2D multiplanar curved reconstruction (ADW 4.6 GE Healthcare). The results were compared with macroscopic data after surgery.results: The mean value of Dmax obtained by surgical specimen was 50 mm (range 30-60) versus 63 mm (range 46-92) of Dmax measured through MDCT. If the Dmax values were stratified in three groups (group 1 smaller than 40 mm, group 2 between 40 and 80 mm, group 3 bigger than 80 mm), a correlation with MDCT results of 25%, 62% and 71%, respectively, was found. Conclusion: MDCT is an accurate technique to obtain an appropriate preoperative definition of Dmax, within the limits of tumor bigger than 40 mm. The revaluation of each case with Dmax smaller than 40 mm will supply additional information about the discrepancy (retraction of the stomach following immersion into formalin, diffusion in the submucosal layer)

Accuracy of MDCT in the Preoperative Definition of Peritoneal Cancer Index (PCI) in Patients with Advanced Ovarian Cancer Who Underwent Peritonectomy and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

PURPOSE The extent of peritoneal dissemination at the time of surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) was scored according to the peritoneal cancer index (PCI) that is considered a prognostic factor in patients with ovarian cancer. The aim of our work has been to evaluate the accuracy of MDCT in the preoperativehas been to evaluate the accuracy of MDCT in the preoperative definition of PCI in patients with advanced ovarian cancer who underwent peritonectomy and HIPEC after neoadjuvant CHT, in order to obtain a pre-surgery prognostic evaluation and a prediction of optimal cytoreduction. METHOD AND MATERIALS Pre-surgery CT examinations of 27 patients (2 performed with a 4 MDCT, 6 performed with a 16 MDCT and 19 with a 64 MDCT, with a mean age 56, range 40-71) with advanced ovarian cancer after neoadjuvant CHT were evaluated, retrospectively and in a blind fashion, by a Radiologist with expertise in the oncologic field. The PCI was scored following the Sugarbaker classification, based on lesion size and distribution (score value ranging from 1 to 39). The results were compared with macroscopic data after peritonectomy. RESULTS In 10/27 (37.03%) a complete correlation between the PCI score extrapolated with MDCT and the surgical PCI was found. If the PCI values were stratified in three groups (grade 1 = 0; grade 2 ≥1 <6 and grade 3 ≥6) a correlation with MDCT results of 100%, 80% and 93% respectively was found. In the 75% of the patients a correct identification of bowel mesentery involvement was realized. CONCLUSION MDCT is an accurate technique to obtain an appropriate preoperative definition of PCI before peritonectomy and HIPEC. CT examination with fluid distension of the bowel loops can therefore improve diagnostic performance. CLINICAL RELEVANCE/APPLICATION MDCT is an accurate technique to obtain a preoperative definition of peritoneal cancer index and therefore a pre-surgey prognostic evaluation in patient with ovarian cance

Sigmoid diverticulitis: US findings

Acute diverticulitis (AD) results from inflammation of a colonic diverticulum. It is the most common cause of acute left lower-quadrant pain in adults and represents a common reason for acute hospitalization, as it affects over half of the population over 65 years with a prevalence that increases with age. Although 85% of colonic diverticulitis will recover with a nonoperative treatment, some patients may have complications such as abscesses, fistulas, obstruction, and /or perforation at presentation. For these reasons, different classifications were introduced through times to help clinicians to develop a correct diagnosis and guide the treatment and for the same reasons imaging is used in most cases both to realise a differential diagnosis and to guide the therapeutic management. US and CT are both usefull in diagnosis of diverticolitis, and their sensibility and specificity are similar. However CT scanning is essential for investigating complicated diverticular disease especially where there are diffuse signs and clinical suspicion of secondary peritonitis; instead in most uncomplicated cases the experienced sonographer may quickly confirm a diagnosis guided by the clinical signs. US is to be recommended in premenopausal women, and in young people to reduce dose exposure