CONCORDANZA INTER-OSSERVATORE ED ACCURATEZZA DIAGNOSTICA DELLA TC NELLA VALUTAZIONE DEL DANNO ESOFAGO-GASTRICO DOPO INGESTIONE DI CAUSTICI

Scopo: Recenti studi hanno proposto l’utilizzo della TC con mezzo di contrasto in luogo dell’endoscopia nella valutazione in emergenza del danno esofago-gastrico secondario ad ingestione di caustici. Lo scopo di questo studio è valutare la concordanza inter-osservatore e l’accuratezza diagnostica della TC nella valutazione del danno esofagogastrico dopo ingestione di caustici. Materiali e metodi: Gli esami TC eseguiti da 15 pazienti dopo ingestione di caustici sono stati retrospettivamente ed indipendentemente analizzati da due Radiologi esperti in radiologia addominale e due specializzandi in Radiologia. La concordanza inter-osservatore nella valutazione del danno esofago-gastrico è stata calcolata secondo il metodo kappa di Cohen. L’accuratezza diagnostica della TC è stata valutata utilizzando l’endoscopia o i risultati patologici come riferimento. Risultati: La concordanza inter-osservatore per i lettori esperti/ giovani è risultata pari a .277/.156 per la valutazione dell’esofago e .625/.095 per la valutazione dello stomaco. I valori medi di sensibilità, specificità e accuratezza della TC nell’identificazione della necrosi transmurale esofagea/gastrica sono risultati pari a 37.5%/14.3%, 79.5%/97%, e 71.8%/58.3%. Conclusioni: La TC ha una concordanza inter-osservatore variabile nella gradazione del danno e una bassa sensibilità nell’identificazione della necrosi transmurale, pertanto non sembra in grado di poter sostituire l’endoscopia nella valutazione in emergenza del danno esofagogastrico dopo ingestione di caustici

Magnetic resonance imaging of autoimmune pancreatitis: A review of literature [Resonancia magnética de la pancreatitis autoinmune: una revisión de la literatura]

Autoimmune pancreatitis (AIP) is a distinct form of chronic pancreatitis caused by an autoimmune pathogenetic mechanism. It affects males (60%) slightly more frequently, and generally occurs between 40 to 60 years, although the possible range is much wider (14-80 years). Histologically AIP is characterised by the presence of a dense inflammatory infiltrate, with variable extension. It can be focal or diffuse throughout the whole pancreas. Clinical presentation in most cases is non-specific, with patients presenting with mild abdominal pain, rarely, acute pancreatitis symptoms, weight loss, and jaundice. Several studies reported multiple organ involvement due to the autoimmune process, suggesting a systemic nature of the disease. In 2011 the International Consensus Diagnostic Criteria for autoimmune pancreatitis (ICDC) defined the guidelines, and magnetic resonance imaging (MRI) and MR-cholangiopancreatography (MRCP) became the reference diagnostic technique in the diagnosis of the disease. This paper will review the imaging characteristics, the differential diagnosis, and the imaging features after treatment and follow up. Furthermore, our experience in this uncommon and challenging disease is reviewe

Autoimmune pancreatitis: MRI-MRCP characteristics

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Pancreatic duct stenosis: Differential diagnosis between malignant and benign conditions at secretin-enhanced MRCP

To define imaging criteria of benign and malignant nature in patients with main pancreatic duct (MPD) stenosis

Paraduodenal pancreatitis as a mimicker of pancreatic adenocarcinoma: MRI evaluation

To evaluate the MRI features of paraduodenal pancreatitis (PDP) and to define useful signs to differentiate PDP from pancreatic ductal adenocarcinoma (PDAC)

Stenosis of the main pancreatic duct in focal form of autoimmune pancreatitis: imaging findings on MR-MRCP

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Advanced pancreatic adenocarcinoma: CT evaluation before and after neoadjuvant treatment with fluorouracil, leucovorin, oxaliplatin and irinotecan and correlation with histopathology

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Type 1 and Type 2 Autoimmune Pancreatitis: Distinctive Clinical and Pathological Features, But Are There Any Differences at Magnetic Resonance? Experience From a Referral Center

This study aimed to evaluate magnetic resonance imaging findings of autoimmune pancreatitis (AIP) and to find radiological patterns that could differentiate type 1 and type 2 AIP

Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection

Objectives: To assess factors associated with radical resection (R0) of pancreatic ductal adenocarcinoma (PDAC) after induction treatment with FOLFIRINOX. Methods: Patients with either locally advanced (LA) and borderline resectable (BR) PDAC undergoing surgical exploration after FOLFIRINOX were retrospectively enrolled. Two pancreatic radiologists reviewed the CT blinded to the final outcome and assessed chemotherapy response and resectability. Patients were then divided into R0 resected (group A) and not resected/R1 resected (group B), which were compared. Results: Of 59 patients included, 19 were defined as unresectable (32%), 33 borderline resectable (56%) and 7 resectable (12%) during the blind radiological evaluation after FOLFIRINOX. Once in a surgical setting, 27% were non-resectable, whereas 73% received surgical resection with a 70% R0 rate. Consequent sensitivity and specificity were 86% and 29%. At imaging review, significant decreases in longest tumour dimension were observed in both groups: from 32 mm (95% CI 15\u201355) to 21 (10\u201344) in group A and from 34 (18\u201370) to 26 (7\u201360) in group B, p < 0.05. However, a significant increase in tumour attenuation in all phases was only observed for R0 resected, from 52 HU (26\u201375) to 65 (35\u201392) in arterial phase (p < 0.001) and from 62 (36\u201396) to 78 (40\u2013120) in the venous (p = 0.001). Conclusion: After neoadjuvant FOLFIRINOX, CT predicted resectability with acceptable sensitivity but low specificity. The observation of increased tumour attenuation at CT scan after FOLFIRINOX treatment might represent a reliable predictor of R0 resection. Key Points: \u2022 CT drives the assessment of PDAC resectability after FOLFIRINOX \u2022 CT predicts resectability with acceptable sensitivity but low specificity \u2022 Significant increase in tumour attenuation was only observed for R0 resected PDAC \u2022 Tumour attenuation after FOLFIRINOX represents a reliable predictor of R0 resection

CT features of non-hypervascular endocrine tumours of the pancreas: a comparison with pancreatic adenocarcinoma

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