Imaging Modalities for the Noninvasive Assessment of Fibrosis in Crohn's Disease

The development of strictures in Crohn's disease is a main cause of hospitalization and often represent an indication for surgery. The differentiation between inflammatory and fibrotic strictures is useful to determine the optimal treatment. Today, the availability of noninvasive methods to assess the presence and extension of strictures offers new tools for the diagnosis and follow-up of the disease. Bowel ultrasound, power doppler ultrasound, contrast-enhanced ultrasound, magnetic resonance imaging offer the additional advantage that they do not expose patients to ionizing radiation. In this paper we provide an update on the accuracy of these noninvasive methods for the diagnosis of Crohn's disease

Multimodal imaging in the diagnosis and evaluation of intestinal malrotations in adults: a case report

Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of the fetal intestines around the axis of the superior mesenteric artery during fetal development. It is rare in adulthood and the true incidence is difficult to estimate because most patients are asymptomatic. The diagnosis is usually performed with several radiological and surgical methods. We report a case of a woman who presented with cramp-like abdominal pain localized to the right iliac fossa. The patient underwent abdominal ultrasound, radiological examination without and with contrast, and computed tomography with three-dimensional volume rendering reconstruction. Although small bowel follow-through is often enough to recognize the type of malrotation, using multimodal imaging may offer a better definition of this abnormality with a better definition of the kind of malrotation, by adding additional anatomical information. In our case, the imaging clearly showed malrotation of the small bowel with reverse rotation of the colon. Hence a multimodal imaging strategy proved useful for the diagnosis of intestinal malrotation in an adult afflicted by chronic cramp-like abdominal pain

Ruolo della radiofrequenza laparoscopica o laparotomica nella terapia dell’epatocarcinoma su cirrosi

bjective: The aim of this paper is to evaluate retrospectively the results of radiofrequency ablation with surgical access, in term of overall and disease free survival, in patients affected by hepatocelluar carcinoma with underlying cirrhosis. Methods: Fifteen patient underwent radiofrequency ablation with surgical access in the Digestive Surgery Unit of the University of Florence between April 2002 and November 2008. Three patients had laparoscopic access, and twelve laparotomic access. All patients were evaluated not eligible for liver resection because of low residual functional reserve. Nine patients had single nodules, while six had multinodular disease. Mean diameter of nodules was 3.2 cm (range 0.8-5.2 cm). A cool tip needle (radionix, valleylab) was used for radiofrequency ablation, using single needle for nodules 3cm. Results: Overall survival and disease free survival was 93.3% and 86.2% respectively at 12 months and 36.8% and 18.8% at 30 months. Mean survival was 14.13 months (range 4.07-29.9 months). Multinodular disease and nodules diameter did not influence survival (p>0.5). Conclusion: Radiofrequency ablation is an important therapeutic option for patients affected by hepatocellular carcinoma non suitable for liver resection, with good results in term of overall and disease-free survival, with very low percentage of morbidity and mortality. Surgical access has to be performed only for patients not elegible for liver resection

Radiofrequency on the liver remnant after liver resection to reach the haemostasis not otherwise achievable with conventional techniques

AbstractINTRODUCTIONDuring liver resection, in same case of inflamed, steatotic or neo-vascularized liver parenchyma, reaching of haemostasis on the liver resection surface could be very difficult for the surgeon because of the presence of fragile tissue that does not allows the proper placement of stitches, and the conventional method fail.PRESENTATION OF CASEThe authors describe a novel technique in which, after a formal liver resection, liver haemostasis is achieved using radiofrequency energy on the resected surface. A patient affected by a hystiocytic sarcoma localized on the VI-V and IVa segments was scheduled for liver resection. During the resection a diffuse bleeding from the resected surface started with little success obtained with conventional method. So we decided to use the coagulative necrosis generated by the radiofrequency, using a cool type cluster needle, hand-piece with 3 needle, bending 2 needles in a way resembling a “fork”, to reach a complete and definitive haemostasis.DISCUSSIONHaemostasis remains a critical issue in liver surgery not only for the catastrophic effect of haemorrhage but also because it is correlated to complications rate and to survival. The coagulative necrosis generated by the radiofrequency could be used to facilitate the creation of a necrotic plane to be transacted.CONCLUSIONThe use of the radiofrequency energy, delivered through needles, is suggested when the conventional techniques fail to reach a proper haemostasis after a liver resection or, to consider its use, prior to resect the liver in presence of fragile parenchyma

Initial LDCT appearance of incident lung cancers in the ITALUNG trial

OBJECTIVES: To characterize early features of lung cancers detected with low-dose computed tomography (LDCT) screening. MATERIALS AND METHODS: Two radiologists reviewed prior LDCTs in 20 incident cancers diagnosed at annual repeat screening rounds and 83 benign nodules observed in the ITALUNG trial. RESULTS: No abnormality was observed in 3 cancers. Focal abnormalities in prior LDCT were identified in 17(85%) cancers (14 adenocarcinomas; 14 stage I). Initial abnormalities were intra-pulmonary in 10, subpleural in 4 and perifissural in 3. Average mean diameter was 9mm (range 4.5-18mm). Nine exhibited solid, 4 part-solid and 4 non-solid density. The margins were smooth and regular in 5 cases, lobulated in 6, irregular with spiculations in 3 and blurred in 3. Ten (59%) initial focal abnormalities had a round or oval nodular shape, but 7(41%) had a non-nodular complex (n=5) or "stripe-like" (n=2) shape. Bronchus sign was observed in 3 cases and association with cystic airspace in 2 cases. Non-solid density, complex or "stripe-like" shape, bronchus sign and association with cystic airspace had a specificity higher than 90%, but positive predictive value of every feature of incident lung cancers was low (range 10.4-50%). CONCLUSIONS: The vast majority of cancers diagnosed at annual repeat show corresponding focal lung abnormalities in prior LDCTs. Perifissural location and non-nodular shape do not exclude the possibility of early lung cancer. Since specificity of the early features of incident lung cancer is incomplete and their positive predictive value is low, all focal pulmonary abnormalities detected in screened subjects should be re-evaluated in subsequent LDCTs

The characteristic scale as a consistent indicator of lung nodule size in CT imaging

Nodule growth as observed in CT scans is the primary malignancy clue of indeterminate small lung nodules. A new approach to assess the 3D size of lung nodules which is based on LoG scale space theory is described. Validation using private (ITALUNG) and public (LIDC) data-set are described