[Show abstract][Hide abstract] ABSTRACT: Intestinal intussusception in adults is a rare condition, accounting for about 0.003-0.02 % of all hospital admissions. This condition in adults represents only 5 % of all cases of intussusceptions and is different from paediatric intussusception, which is usually idiopathic. In contrast, almost 90 % of cases in adults are secondary to various pathologies that serve as a lead point, such as polyps, Meckel's diverticulum, colonic diverticulum, or malignant or benign neoplasm. The aim of the present study was to assess the capabilities of multislice computed tomography (MSCT) in the diagnosis and correct characterisation of intussusception, especially in distinguishing between intussusceptions with a lead point and those without. Indeed, although the MSCT findings that help to differentiate between lead point and non-lead point intussusceptions have not been well studied, abdominal MSCT remains the most sensitive radiological tool to confirm bowel intussusceptions. Moreover, differentiating intussusceptions with a lead point condition from those without is crucial for directing the patient towards the most appropriate treatment, avoiding surgery when not necessary.
La radiologia medica 08/2014; 120(1). DOI:10.1007/s11547-014-0454-4 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To explore the physiopathology and magnetic resonance imaging (MRI) findings in an animal model of acute arterial mesenteric ischemia (AAMI) with and without reperfusion.
In this study, 8 adult Sprague-Dawley rats underwent superior mesenteric artery (SMA) ligation and were then randomly divided in two groups of 4. In group I, the ischemia was maintained for 8 h. In group II, 1-h after SMA occlusion, the ligation was removed by cutting the thread fixed on the back of the animal, and reperfusion was monitored for 8 h. MRI was performed using a 7-T system.
We found that, in the case of AAMI without reperfusion, spastic reflex ileus, hypotonic reflex ileus, free abdominal fluid and bowel wall thinning are present from the second hour, and bowel wall hyperintensity in T2-W sequences are present from the fourth hour. The reperfusion model shows the presence of early bowel wall hyperintensity in T2-W sequences after 1 h and bowel wall thickening from the second hour.
Our study has shown that MRI can assess pathological changes that occur in the small bowel and distinguish between the presence and absence of reperfusion after induced acute arterial ischemia.
World Journal of Gastroenterology 10/2013; 19(40):6825-33. DOI:10.3748/wjg.v19.i40.6825 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gastrointestinal tract ischemia and infarction comprises different clinical syndromes characterized by inadequate blood perfusion to the bowel. The age of onset depends on gender and the etiology of the ischemia, even if the majority of patients are over age 60. These disorders have been increasing over the past decade and constitute approximately 1–2 % of admissions for abdominal pain in the USA and 3.7 % of surgical intervention for acute abdomen in Italy. The increase in incidence can be attributed to various factors, including increased clinical awareness, aging population, and improvement in diagnostic imaging techniques. The mortality rate is very high, between 50 and 90 %, hence, timely diagnosis is essential to improve the outcome. The pathogenesis and symptoms of intestinal ischemia are extremely variable, and the diagnosis largely depends on clinical suspicion.
A recent classification of ischemic bowel diseases, developed by the American Gastroenterological Association (AGA) in 2000, defines three clinical categories: acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI) also known as intestinal angina, and ischemic colitis (IC).
Geriatric Imaging, Edited by Guglielmi G; Peh W CG; Guermazi A, 10/2013: chapter 28: pages 753-769; Springer 2013., ISBN: ISBN 978-3-642-35578-3
[Show abstract][Hide abstract] ABSTRACT: Bowel obstruction is a common but difficult clinical problem in terms of appropriate and timely management. In clinical practice, radiologists play a key role not only in making the diagnosis but also in guiding physicians toward appropriate and timely management of many indeterminate cases and situations. In this chapter, small and large bowel obstruction is illustrated, from pathophysiology to imaging, emphasizing the role of multidetector computed tomography (MDCT) in the diagnosis and management of bowel obstruction. Furthermore, the place of allied imaging modalities such as plain film and ultrasonography is comprehensively illustrated.
[Show abstract][Hide abstract] ABSTRACT: Crohn's disease is a chronic granulomatous inflammatory disease of the gastrointestinal tract, which can involve almost any segment from the mouth to the anus. Typically, Crohn's lesions attain segmental and asynchronous distribution with varying levels of seriousness, although the sites most frequently involved are the terminal ileum and the proximal colon. A single gold standard for the diagnosis of CD is not available and the diagnosis of CD is confirmed by clinical evaluation and a combination of endoscopic, histological, radiological, and/or biochemical investigations. In recent years, many studies have been performed to investigate the diagnostic potential of less invasive and more patient-friendly imaging modalities in the evaluation of Crohn's disease including conventional enteroclysis, ultrasonography, color-power Doppler, contrast-enhanced ultrasonography, multidetector CT enteroclysis, MRI enteroclysis, and 99mTc-HMPAO-labeled leukocyte scintigraphy. The potential diagnostic role of each imaging modality has to be considered in different clinical degrees of the disease, because there is no single imaging technique that allows a correct diagnosis and may be performed with similar results in every institution. The aim of this paper is to point out the advantages and limitations of the various imaging techniques in patients with suspected or proven Crohn's disease.
Gastroenterology Research and Practice 01/2012; 2012(2):816920. DOI:10.1155/2012/816920 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare magnetic resonance (MR) enteroclysis with MR enterography to verify whether nasoenteric intubation in patients affected by Crohn's disease can provide supplementary information to that afforded by MR study of the small bowel.
In a 12-month period, 40 patients (28 women and 12 men, mean age 35 years) affected by Crohn's disease underwent MR imaging. Distension of the small-bowel loops was obtained by administering polyethylene glycol: 15 patients were given the mixture by mouth (MR enterography), whereas the remaining 25 received it via nasoenteric intubation (MR enteroclysis). Our study protocol included morphological sequences taken before and after intravenous injection of contrast medium and real-time functional sequences. Accuracy criteria for the execution of the examinations were designed according to 11 bands.
Complete distension of the small-bowel loops was obtained in the 25 patients who underwent MR enteroclysis, with the additional advantage of a suitable assessment of those segments involved in the pathological process. This was not the case for the 15 patients who underwent MR enterography, because both the jejunum and the small-bowel loops appeared partially collapsed.
MR enteroclysis is the most effective technique for studying the small bowel in Crohn's disease, as it not only provides a suitable morphological assessment but also supplies functional information.
La radiologia medica 10/2010; 116(3):389-406. DOI:10.1007/s11547-010-0605-1 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obscure gastrointestinal bleeding is defined as bleeding of unknown origin, that persists or recurs after negative conventional barium contrast studies and upper and lower tract endoscopy. The causes of such a bleeding frequently arise in the small bowel, and they are represented by mucosal vascular abnormalities, neoplasms and other conditions such as Crohn's disease, Meckel's diverticulum, and vasculitis. Conventional barium contrast studies and push enteroscopy allow only a limited small bowel examination; moreover, intraoperative endoscopy may be inconclusive, since the small bowel is difficult to evaluate given its length and tortuous course. In the same way, angiographic diagnosis is stricktly related to the activity rate of hemorrhage. Wireless capsule endoscopy and multidetector-row CT enteroclysis are two recently developed minimally invasive techniques that may provide a complete small bowel examination, the first offering a direct visualization of the mucosal aspect, the second allowing evaluation of mural and extramural pathologies. This review is an update of the technique and clinical application of capsule endoscopy and multidetector-row CT enteroclysis in patients suffering from obscure small bowel bleeding.
[Show abstract][Hide abstract] ABSTRACT: Inflammatory bowel disease, including Crohn's disease and UC, is a chronic disorder of the gastrointestinal tract. The inflammatory process in UC is confined to the mucosa and submucosa and it involves only the colon. In contrast, in Crohn's disease the inflammation process extends through the bowel wall layers and it can involve any part of gastrointestinal tract. Moreover, inflammatory bowel disease of the colon may be associated with complications, such as toxic megacolon, fulminant colitis, acute bleeding, fistulas and abscesses. Radiographic imaging studies are useful for the diagnosis of inflammatory bowel disease, and may be used to assess the extent and severity of disease, rule out complications, and monitor the response to therapy. The double-contrast barium study is a valuable technique for diagnosing inflammatory bowel disease colonic alterations, even in patients with early mucosal abnormalities. The earliest finding of UC is characterized by a fine granular appeareance of the colonic mucosa, usually involving the rectosigmoid junction. In chronic UC double-contrast enema may reveal marked colonic shortening with tubular narrowing of the bowel and loss of haustration. The earliest radiographics findings of Crohn's disease are represented by aphthous ulcers. As disease progresses, aphthous ulcers may enlarge and coalesce to form stellate or linear areas of ulceration. In advanced Crohn's disease, transmural ulceration may lead to the development of fissures, sinus tracts, fistulas, and abscesses. Cross sectional studies such as computed tomography, magnetic resonance imaging and sometimes ultrasound, are useful alternative tools not only in the assessment of bowel wall abnormalities, but also for the assessment of extraluminal alterations in patients with advanced disease.
European Journal of Radiology 04/2007; 61(3):442-8. DOI:10.1016/j.ejrad.2006.07.028 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In caso di sospetto IMT, noi eseguiamo di routine l’ecografia delle anse intestinali ad integrazione dell’esame diretto dell’addome.
L’esame ecografico conferma e supporta la diagnosi, offre importanti rilievi aggiuntivi ed aiuta nella confidenza diagnostica
[Show abstract][Hide abstract] ABSTRACT: I progressi tecnologici della TC spirale, dapprima monostrato e poi multistrato, hanno permesso di eliminare gli artefatti
legati alla peristalsi intestinale e consentito un’idonea contrastografia parietale. Ci ha determinato una migliore rappresentazione
e, quindi, una pi corretta valutazione delle anse intestinali e del mesentere. In virt di tale tecnologia si possono ottenere
ricostruzioni multiplanari (MPR) di ottima qualit. La TCMS con mdc ev , attualmente, il gold standard nello studio dell’IMT.
[Show abstract][Hide abstract] ABSTRACT: I vari meccanismi di formazione dell’occlusione acuta del piccolo intestino consentono delle suddivisioni. L’IMT si forma
occlusione del colon;
[Show abstract][Hide abstract] ABSTRACT: The development in helical computed tomography (CT) from single-detector to multidetector equipment has overcome peristaltic
intestinal artefacts, allowing optimal bowel visualisation and contrast enhancement (CE). As a result, this permits a finer
representation and a more accurate evaluation of the bowel and mesentery. Furthermore, technological advances now allow optimal
multiplanar reconstruction (MPR). To date, contrast-enhanced multidetector CT (MDCT) has become the gold standard in the evaluation
of small-bowel obstruction (SBO).
[Show abstract][Hide abstract] ABSTRACT: The main clinical and radiological problem consists of differentiating the obstruction with a purely occlusive risk from the
obstruction in which vascular risk is added. The pure obstruction allows for elective surgery and a restoration of a more
complete hydroelectrolytic equilibrium. Nasogastric intubation may avoid urgent surgical intervention. An additional benefit
is that the tone and motility of the bowel loops and their intramural condition may improve with aspiration. The lower tension
reduces stasis, intestinal diameter and intraperitoneal fluid, and it may sometimes completely resolve the occlusive condition.
On the other hand, the obstruction with vascular risk does not show significant clinical improvement after nasogastric tube
placement. Deliberation and delayed surgery must be avoided.
[Show abstract][Hide abstract] ABSTRACT: Le nuove tecniche di imaging hanno ridimensionato il ruolo della radiologia convenzionale nello studio dell’addome acuto.
Tuttavia, l’esame diretto dell’addome svolge ancora un ruolo:
nella ricerca di corpi estranei radiopachi;
nell’identificazione di pneumoperitoneo;
nei controlli post-operatori;
nello studio dei morfo-dinamismi intestinali acuti.
[Show abstract][Hide abstract] ABSTRACT: Il problema clinico e radiologico essenziale consiste nel differenziare gli ilei a rischio occlusivo puro da quelli in cui
si somma il rischio vascolare. L’ileo occlusivo puro consente una preparazione all’intervento meno affrettata ed un riequilibrio
idro-elettrolitico pi completo. L’intubazione naso-gastrica pu evitare l’intervento chirurgico urgente. Le condizioni tonocinetiche
ed intramurali delle anse possono, infatti, trarre giovamento dall’aspirazione. La detensione comporta la riduzione del ristagno,
del calibro intestinale e del liquido intraperitoneale e a volte pu portare alla risoluzione completa del quadro occlusivo.
Al contrario, l’ileo a rischio vascolare non presenta significativi miglioramenti clinici dopo il posizionamento di sondino
naso-gastrico. Ogni esitazione ed ogni ritardo dell’atto chirurgico devono essere evitati.
[Show abstract][Hide abstract] ABSTRACT: The new imaging modalities have changed the role of conventional radiology in the study of the acute abdomen. Nevertheless, the abdominal plain film can still be used:
in searching for radiopaque foreign bodies;
in identifying free intraperitoneal air;
in postsurgical follow-up;
in the study of acute intestinal behaviours.
[Show abstract][Hide abstract] ABSTRACT: When small-bowel obstruction (SBO) is suspected, we usually perform an ultrasound (US) of the small bowel in order to correlate
the results with those of the abdominal plain film. US is able to not only confirm and support the initial diagnosis, it also
offers additional findings and enhances the overall diagnostic confidence.
[Show abstract][Hide abstract] ABSTRACT: 1.
Ispessimento parietale patologico senza stratificazione, ecogeno, lievemente disomogeneo. Ridotta distensibilità del lume
a contenuto liquido.
Rilievi di normalità dell’intestino tenue superiore. Riduzione del lume dell’intestino inferiore con scomparsa, pressoché
completa, del normale rilievo plicale ed atrofia della mucosa. Anse rigide. Formazione di alcuni pseudo-diverticoli sul versante
convesso anti-mesenterico dell’ileo medio-distale. ”Effetto massa” con aumento del “vuoto” tra le anse per ispessimento del
No. Assenza di storia clinica significativa per malattia di Crohn. Il chirurgo non ha riferito nulla a proposito di un eventuale
stato flogistico ileale pre-esistente. Pattern ecografico assolutamente atipico per enterite di Crohn. Mancanza di ulcerazioni e fissurazioni.
[Show abstract][Hide abstract] ABSTRACT: 1.
Le frecce mostrano, a livello dell’anastomosi, deiscenza della sutura con stravaso di mdc baritato.
Sì, esistono delle “impronte digitate” sotto forma di caratteristici difetti di riempimento a forma di “impronta di pollice”
sul versante mesenterico delle anse del tratto distale dell’anastomosi entero-enterica. Scomparsa del rilievo plicale ed atrofia
della mucosa. Anse rigide. Ispessimento del mesentere con “effetto massa”.