References She
1. Schreyer AG, Seitz J, Feuerbach S et al 2004 Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease IBD . Inflamm Bowel Dis 10 45-54 2. Markose G, Ng CS, Freeman AH 2003 The impact of helical computed tomography on the diagnosis of unsuspected inflammatory bowel disease in the large bowel. Eur Radiol 13 107-113 3. Furukawa A, Saotome T, Yamasaki M et al 2004 Cross-sectional imaging in Crohn disease. Radiographics 24 689-702 4. Horton KM, Corl...
Disadvantages of CTE and Pitfalls
Nasoenteric tube placement is necessary for infusion, but its associated discomfort is alleviated by the use of conscious sedation and smaller tubes 16 . Conscious sedation requires dedicated personnel and makes the procedure longer and more expensive. In small institutions and non-tertiary care facilities this may not be practical. In patients who require nasogastric suction and potentially need a small bowel examination, the initial use of a decompression entero-clysis catheter circumvents...
Perianal Fistulas
Perianal fistulas primarily occur as the result of fistulous disease originating in the anal glands near the anal crypts cryptoglandular hypothesis , or in patients with Crohn's disease 13 . Infection of the anal glands may result in abscess formation. It is a relatively common condition with a prevalence of approximately 0.01 , predominantly affecting young adults. The tracks may have a simple superficial course, or may have a complicated course. The complicated tracks may be intersphincteric...
Hepatic Metastases
At US, metastases may appear hypoechoic, isoechoic or hyperechoic in echogenicity. On a dynamic contrast-enhanced CT study, most metastases appear hypovascular and hypodense relative to liver parenchyma on portal venous phase. Hypervascular metastases, most commonly seen in renal cell, pancreatic islet cell tumors, sarcomas and breast tumor patients, may become isodense and may be difficult to detect during the redistribution phase of enhancement. These hypervascular metastases are more easily...
Normal Radiological Anatomy of the Adrenal Glands
The adrenal glands are enclosed within the perinephric fascia and are usually surrounded by a sufficient amount of fat for identification on computed tomography CT or magnetic resonance imaging MRI . The right adrenal gland lies immediately posterior to the inferior vena cava IVC . The left adrenal gland lies anteromedial to the upper pole of the left kidney and posterior to the pancreas and splenic vessels. The shape of the adrenals can vary, depending on the orientation of the gland and the...
Cystic Dilatation of the Extrahepatic Bile Duct
Mechanical biliary obstruction is the most common cause of extrahepatic bile duct dilatation. Upon initial imaging, an obstructive lesion should be sought. Once an obstructive lesion is excluded, congenital etiologies of bile duct dilatation should be considered. Choledochal cysts, unlike obstructive dilatation, generally have more focal ex-trahepatic bile duct dilatation or are typically more expansive than is usually encountered in mechanical dilatation Fig. 2 . It may be more difficult to...
Ductal Adenocarcinoma of the Pancreas
About 90 of all neoplasm of the pancreas are ductal adenocarcinomas. It is a common neoplastic disease with a poor prognosis. It is estimated that approximately 32,000 Americans will die of this disease in 2005 22 . Pancreas carcinoma is the fourth leading cause of death in the USA and its five-year survival rate remains dismal, at less than 5 . This poor outcome is largely related to the aggressiveness of the tumor and in most cases, to late diagnosis. The initial diagnosis of pancreatic...
Spindle CellStromal Tumors
Gastrointestinal stromal tumors GISTs and leiomy-omas are by far the most common benign mesenchymal tumors of the GI tract 9 . Leiomyomas are thought to usually arise from the smooth muscle of the wall. GISTs are now considered to arise from the interstitial cells of Fig. 11. Submucosal, benign, spindle cell tumor of the gastric antrum protruding into the lumen with a very smooth covering surface of stretched, but otherwise intact, surface epithelium Fig. 11. Submucosal, benign, spindle cell...
Neuroendocrine Tumors of the Pancreas Functioning Neuroendocrine Tumors
Among functioning neuroendocrine tumors NET, formerly called islet cell tumors of the pancreas, insulinoma is the most common tumor, followed by gastrinoma, glucagonoma, VIPoma and other secretory neoplasms, which are more rarely encountered. In functioning pancreatic adenomas, the clinical diagnosis is based on clinical data and laboratory tests that usually permit an accurate diagnosis. Cross-sectional imaging is used only for localizing the pancreatic neoplasm. NETs represent a challenge to...
Cholangiographic Techniques Using Iodinated Contrast Material
The term CT cholangiography refers to MSCT acquisition usually including 2D or 3D reformatted images obtained after the administration of intravenous cholangio-graphic agents. Since bile duct opacification depends on intact hepatic excretory function, it cannot be used in patients with significant hyperbilirubinemia. For this reason, but also because the cholangiographic agents are unavailable in several countries, CT cholangiography has only a minor role in daily practice. ERCP and...
Gallbladder Polypoid Mass
Polypoid gallbladder masses are commonly demonstrated by US as incidental findings when the gallbladder is imaged on sonography. Polyps are estimated to be present in approximately 3 of gallbladders. The differential diagnosis for a gallbladder polyp includes cholesterol polyp, adenoma, adenomyomatous hyperplasia, inflammatory polyp, heterotopia, neurofibroma, carcinoma, carcinoid tumor, lymphoma, and metastasis. The majority of gallbladder polyps are benign. The management of gallbladder...
Gallbladder Wall Thickening
Focal or diffuse gallbladder wall thickening is most commonly caused by cholecystitis. Noninflammatory conditions that may produce gallbladder wall thickening include heart failure, cirrhosis, hepatitis, hypoalbuminemia, and renal failure. Gallbladder carcinoma should be suggested when there are features of focal mass, lymphadenopathy, extension of the process to adjacent organs, hepatic metastases, or biliary obstruction at the level of the porta hepatis 1 . Xanthogranulomatous cholecystitis...
Diverticulitis
It is estimated that 10-25 of individuals with diverticu-losis will suffer from episodes of peridiverticular inflammation during their lifetime. In the United States, this complication accounts for approximately 200,000 hospi-talizations and a health care expenditure of four billion dollars annually. Among patients who are hospitalized, 10-20 require emergency operations. Inflammatory change in the pericolic fat Fig. 4 is the hallmark of diverticulitis on CT, and is seen in 98 of cases. The...
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Fig. 2. Complex interlobar hepatic transection a, b Axial MDCT images obtained during portal venous phase of scanning show a complex laceration L extending between the right and left hepatic lobes. Moderate hemoperitoneum large arrow is present. a Laceration extends to involve the retrohepatic inferior vena cava arrowheads . b More inferiorly, laceration involves the main portal vein with blood tracking along the right and left portal branches arrowheads Active hemorrhage, pseudoaneurysms and...
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Fig. 4. Prominent invagination of muscular fibers of the diaphragm Fig. 4. Prominent invagination of muscular fibers of the diaphragm Fig.5. Pedunculated accessory hepatic lobe. On these six sequential images, one can see the pedicle on the first image. On the subsequent images, while it has the same degree of enhancement as the liver, it mimics a mass in the gastro hepatic ligament or the pancreas Fatty infiltration of the liver is commonly associated with obesity, diabetes mellitus, Cushing's...
Chronic Pancreatitis
CP is determined by a continuing aseptic inflammation of the gland, characterized by irreversible morphological and functional damage. The most common reasons are chronic alcohol abuse 70 and cholelithiasis 20 , rare cases are caused by cystic fibrosis or are idiopathic, without any apparent cause. Typically, patients 30-40 years of age present with a history of epigastric pain 95 , weight loss 95 and signs of endo- exocrine deficiency diabetes mellitus 58 , malabsorption syndrome and...
Typhlitis
Typhlitis neutropenic colitis is a potentially fatal infection of the cecum and ascending colon caused by enteric pathogens in patients with severe immunosuppression. It is most frequently seen in patients with acute leukemia receiving chemotherapy, but also occurs in the setting of AIDS, aplastic anemia, multiple myeloma, or bone marrow transplantation. Bacteria, viruses, and fungi penetrate the damaged cecal mucosa and proliferate due to the profound neutropenia. There is edema and...
Appendicitis
Acute appendicitis is the most common abdominal surgical emergency, affecting 250,000 individuals in the United States annually. The lifetime risk of developing acute appendicitis is 8.6 for men and 6.7 for women. Radiologists play a critical role in evaluating patients with suspected appendicitis and minimizing complications by confirming or excluding the diagnosis in atypical cases. They can also reduce the number of misdiag-noses and negative laparotomies, provide a correct alternate...
Epiploic Appendagitis
Primary epiploic appendagitis is a relatively uncommon condition that results from an acute inflammation of the appendices epiploicae. This disorder is often associated Fig. 5. Epiploic appendagitis. Inflammatory changes are present in the pericolic fat circle . The central portion of the inflammatory change is fat density, indicating an inflamed epiploic appendage Fig. 5. Epiploic appendagitis. Inflammatory changes are present in the pericolic fat circle . The central portion of the...
Precapsule Endoscopy
Except for emergent clinical investigation for possible small bowel diseases where abdominal CT will remain the primary method of investigation, the role of imaging is likely to undergo reassessment based on results of WCE in the elective work-up of patients 1 . In the patient without risk factors for a potentially obstructing small bowel lesion, radiology has a limited role. As stated earlier, where the indication raises the possibility of early Crohn's or NSAID enteropathy, air...
Rectal Cancer Diagnostic Workup
Adenocarcinoma is the most common rectal malignancy. The diagnosis is usually histologically established prior to imaging. Cross-sectional imaging is used to stage the tumor. The treatment of rectal cancer depends on the extent of disease and has changed substantially over the last decade. EUS and MRI are important in the management of these patients. T2-weighted sequences are pivotal in MRI of rectal cancer. These provide optimal contrast between the rectal wall and surrounding fat and organs....
Info Hdg
Fig. 8. The cervix after LEEP procedure, mimicking a cystic lesion. Notice the cystic area on the sagittal transvaginal sonogram Pitfalls as the Result of Implantation of Tissue and Prosthesis Whenever postoperative radiation therapy is contemplated in the pelvis, one of the limiting factors in its optimization is the low level of radiation tolerance of the small intestine 10 . Omental fat, synthetic absorbable mesh, or occasionally breast implant have been used during surgery to lift the small...
Miscellaneous Applications
CT enteroclysis has been of value in resolving the false positive and false negative interpretation of non-enteral volume-challenged small bowel studies that arise from the Table 4. CTE with neutral enteral amp iv contrast 1. Unexplained GI bleeding - history of prior malignancy. 2. Unexplained anemia in elderly or younger patients without diarrhea. No heme positive stool. 3. Known Crohn's disease Staging Fig. 4 . 4. Small bowel obstruction SBO - no evidence of significant small bowel...
Idkd 2006 1
Division of Emergency Radiology, Brigham and Women's Hospital, Boston, MA, USA Computed tomography CT is the established method for the imaging evaluation of traumatic injury to the abdomen and pelvis. This role has been galvanized in the era of multidetector CT MDCT because of the greater speed and flexibility afforded by this modality. MDCT can now image the head, entire spine and torso, often in less time than would be typical for obtaining a standard three-view radiographic trauma series...
Gastrointestinal Stromal Tumors GISTs
Histologically, GISTs are typically spindle cell tumors that have a prominent, nerve sheath tumor-like nuclear palisading pattern. Other GISTs may show prominent perinuclear vacuoles. GISTs may also have an epithelioid appearance, containing cells with round nuclei and abundant cytoplasm. It is now believed that GISTs are derived from the intestinal cells of Cajal. Recent application of immunohistochemical studies has revealed strong and uniform expression of the KIT CD117, stem cell factor...
Info Tjr
Fig. 1. A 74-year-old man with known diabetes mellitus presents with acute abdominal pain in the right upper quadrant. a Plain abdominal radiograph shows a fluid-gas level in the distended gallbladder and gas in the gallbladder wall open arrow . b MDCT depicts the dilated gallbladder with intramural gas open arrow , indicative of emphysematous cholecystitis. In addition, extraluminal extramural gas is present due to walled-off gallbladder perforation arrow . Hydronephrosis and parenchymal...
Cmv Esophagitis
a Incomplete relaxation of pharyngoesophageal sphincter b May be normal at beginning of examination c Often combined overlap syndromes a Incomplete relaxation of pharyngoesophageal sphincter b May be normal at beginning of examination c Often combined overlap syndromes with a pulse rate of 12 to 15 pps can be used, which exposes the patient to less radiation. During the entire bolus passage through the esophagus, the patient should not swallow, as this would immediately interrupt peristalsis....
Idkd 2006 Gpg
Diseases of the Stomach and Duodenum Basics of Radiologic-Pathologic Correlation 1 Department of Radiology, University of Washington Medical Center, Seattle, WA, USA 2 Department of Radiology, Lahey Clinic Medical Center, Burlington, MA, USA The purpose of this workshop is to apply basic principles of radiologic-pathologic correlation to the differential diagnosis of diseases of the stomach and duodenum. Tumors and inflammatory or reactive processes will be emphasized and used as illustrative...