Role of pre and post oral and IV contrast MDCT scan of the abdomen in assessment of early complications after laparoscopic sleeve gastrectomy (LSG)

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgical procedure. Abdominal CT scan is a preferred useful modality in detection of early post sleeve gastrectomy complications, namely staple line leakage, bleeding, mesenteric vascular thrombosis and splenic infarction. The aim of our study is to assess the value of abdominal MDCT in diagnosis of suspected early complications following laparoscopic sleeve gastrectomy operations. Methods Data collection included clinical and laboratory data from the referral requests written by the surgeons. MDCT scan then was performed for all patients. Follow-up clinical data for all patients and follow-up surgical findings for some patients who needed surgical intervention were collected and correlated with the CT findings. Results This prospective study included 75 patients referred by their surgeons as clinically suspected to have acute post LSG complications. MDCT scan was done for all those patients and detected multiple post-operative complications in 68 patients (91%) with the most common one was staple line gastric leak in 30 patients (40%), other complications were also detected as intra-abdominal abscess, porto-mesenteric thrombosis, splenic infarction and pulmonary complications. CT findings were correlated with the clinical, surgical and laboratory data of the patients as well as the follow-up findings. Conclusions MDCT scan is a reliable imaging modality for detecting acute post LSG complications and correlates well with both the clinical presentation and patient's follow-up data

Diagnostic accuracy of the different pulse sequences of multi-parametric prostate MRI in the diagnosis of prostate cancer in the peripheral and transitional zones

Abstract Background One of the most prevalent malignancies among males is prostate carcinoma (PCa). For the diagnosis of PCa, multiparametric magnetic resonance imaging (mpMRI) constitutes by far the most accurate imaging technique. The PI-RADS v2.1 indications for dynamic contrast enhanced (DCE) sequence include identifying PI-RADS score 3 lesions, as clinically significant prostate carcinoma, aiding evaluation of examinations having poor quality of T2 as well as diffusion weighted imaging (DWI), and helping readers having relatively reduced expertise. Most articles don't provide outcomes pertaining to these indications, which weakens their conclusions. All MRI scans, even those with low quality T2 or DWI, were included in our study. Additionally, special emphasis on assessing peripheral zone lesions was made. Our objective was to assess the diagnostic accuracy of the various mpMRI pulse sequences, including the T2 sequence, diffusion and apparent diffusion coefficient (ADC) sequences, both T2 and diffusion sequences (biparametric (bp) MRI), DCE sequence, and the entire examination (mpMRI), in the diagnosis of PCa in the peripheral as well as the transitional zone using PI-RADS version 2.1 scoring system, once when malignant lesions are considered as those having PI-RADS scores 4 and 5 and once when PI-RADS categories 3, 4 and 5 were regarded as malignant. Results In the assessment of peripheral zone lesions, when PI-RADS categories 3, 4, and 5 were considered malignant, both bpMRI and mpMRI showed similar sensitivity (94.29%) and diagnostic accuracy (77.78%) while when considering scores 4 and 5 malignant, mpMRI demonstrated increased diagnostic accuracy and sensitivity but lower specificity (sensitivity was 82.86%/60%, specificity was 80%/100%, and diagnostic accuracy was 82.22%/68.89% for mpMRI/bpMRI test comparaison). Both bpMRI and mpMRI had similar sensitivity (95.83%) and diagnostic accuracy (71.05%) when PI-RADS categories 3, 4, and 5 were regarded as malignant; however, mpMRI demonstrated better diagnostic accuracy and sensitivity considering scores 4 and 5 malignant (sensitivity was 77.08% for mpMRI compared to 60.42% for bpMRI and diagnostic accuracy was 82.89% for mpMRI compared to 75% for bpMRI). Conclusions Both bpMRI and mpMRI demonstrated similar diagnostic accuracy when PI-RADS categories 3, 4, and 5 were taken into account as malignant while mpMRI had higher diagnostic accuracy considering categories 4 and 5 malignant