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Radiology 02/2013; 266(2):689-90. · 5.73 Impact Factor
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Radiology 02/2013; 266(2):688. · 5.73 Impact Factor
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Radiology 02/2013; 266(2):688-9. · 5.73 Impact Factor
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ABSTRACT: Magnetic resonance (MR) imaging is rapidly increasing clinical acceptance to evaluate the small bowel and can be the initial imaging method to investigate small bowel diseases. MR examinations may provide the first opportunity to detect and characterize tumours of the small bowel. Intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel neoplasms. MR enteroclysis should be recommended for the initial investigation in patients suspected of having small bowel tumours. In this article, the MR findings of primary small bowel neoplasms are described and the MR findings for the differential diagnosis are discussed.
Cancer Imaging 01/2013; 13:92-9. · 1.50 Impact Factor
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ABSTRACT: MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantages of these techniques over traditional barium fluoroscopic examinations due to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility. MRI has many properties that make it well suited to imaging of the small bowel: the lack of ionizing radiation, the improved tissue contrast that can be obtained by using a variety of pulse sequences, and the ability to perform real time functional imaging. Moreover, MR modalities allow visualization of the entire bowel, without overlapping bowel loops, as well as the detection of both intra- and extraluminal abnormalities.The intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel diseases.
Abdominal Imaging 09/2012; · 1.73 Impact Factor
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ABSTRACT: Small-bowel radiology has undergone dramatic changes in the past 2 decades. Despite important recent advances in small-bowel endoscopy, radiologic imaging remains important for patients suspected of having or with established small-bowel disease. Cross-sectional imaging techniques (computed tomography and magnetic resonance [MR] imaging), used to investigate both extraluminal abnormalities and intraluminal changes, have gradually replaced barium contrast examinations, which are, however, still used to examine early mucosal disease. MR imaging techniques clearly highlight endoluminal, mural and extramural enteric details and provide vascular and functional information, thereby enhancing the diagnostic value of these techniques in small-bowel diseases. Two MR imaging based techniques are currently utilized: MR enteroclysis and MR enterography. In enteroclysis, enteric contrast material is administered through a nasoenteric tube, whereas in enterography, large volumes of enteric contrast material are administered orally. MR enteroclysis ensures consistently better luminal distention than does MR enterography in both the jejunum and the ileum and more accurately depicts endoluminal abnormalities and early disease, particularly at the level of the jejunal loops. Moreover, MR enteroclysis provides a high level of accuracy in the diagnosis and exclusion of small-bowel inflammatory and neoplastic diseases and can be used for the first radiologic evaluation, while MR enterography may effectively be used to follow up both Crohn disease patients without jejunal disease and in pediatric patients where nasogastric intubation might be a problem. MR enteroclysis may also reveal subtle transition points or an obstruction in the lower small bowel, which may escape detection when more routine methods, including enterography, are used. MR imaging offers detailed morphologic information and functional data of small-bowel diseases and provides reliable evidence of normalcy, thereby allowing the diagnosis of early or subtle structural abnormalities and guiding treatment and decisions in patient care.
Radiology 08/2012; 264(2):333-48. · 5.73 Impact Factor
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ABSTRACT: There is evidence that emergencies in pregnancy are subject to mismanagement; however, the percentage of error in the diagnosis of emergencies in pregnancies has not been studied in-depth. The purpose of this article is to review the most common emergencies in pregnancies, focusing the attention on errors in images. The topics covered are divided into gynecological and nongynecological, and for each pathology, the possible errors in the diagnostic pathway, the possible technical errors in the execution of the examination, and in the end, the possible errors in interpretation of the images have been dealt with. These last two entities are often connected, in the fact that a substandard examination can stem interpretation errors, but the systemization of the error is a valid approach in helping to learn from these errors, reducing the possibility that the same error can represent itself.
Seminars in ultrasound, CT, and MR. 08/2012; 33(4):347-70.
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ABSTRACT: PURPOSE: The role of MR enteroclysis/enterography (MRE) in the diagnosis of small bowel (SB) tumor has not been fully evaluated. The aims of this study were to assess the capability of MRE correctly identifying the site, stage and histology of such neoplasms. METHODS: MR enteroclysis/enterography was employed in consecutive patients suspected of having an SB tumor following negative upper and lower endoscopies. The SB was subdivided into proximal jejunum, middle SB and distal ileum. The histological examination (HE) of the surgical specimen was the reference standard. RESULTS: One hundred and fifty-eight patients were examined. Thirty-one out of 32 (96.9 %) SB detected by HE were correctly identified by MRE. The concordance rate between MRE and HE was 100 % for localization, and 87.1, 80.6 and 96.8 % for T, N and M stages, respectively. The concordance rate was 62.2 % for histological diagnosis. CONCLUSIONS: The high concordance rates between MRE and HE for the localization of SB tumors and for their staging have a significant impact upon surgical planning, particularly if laparoscopy is being considered. A preoperative histological diagnosis is not sufficiently reliable.
Surgery Today 07/2012; · 1.22 Impact Factor
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ABSTRACT: Imaging of the placenta can have a profound impact on patient management, owing to the morbidity and mortality associated with various placental conditions. Placental conditions affecting the mother and fetus include molar pregnancies, placental hematoma, abruption, previa, accreta, vasa previa, chorioangioma, and retained products of conception. Although uncommon, abnormalities of the placenta are important to recognize owing to the potential for maternal and fetal morbidity and mortality. Sonography remains the first imaging modality for evaluation of the placenta. Magnetic resonance (MR) imaging has many unique properties that make it well-suited for imaging of the placenta: the multi-planar capabilities, the improved tissue contrast that can be obtained using a variety of pulse sequences and parameters and the lack of ionizing radiation; MR imaging can be of added diagnostic value when further characterization is required. In this article, we review the appearances and the role of MRI in diagnosis and management of these conditions. We present our clinical perspective on diagnosing these challenging problems with MRI and review the imaging findings that can lead to a correct diagnosis.
Abdominal Imaging 07/2012; · 1.73 Impact Factor
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ABSTRACT: A 47-year-old patient is presented who was admitted to the emergency department with complaints of right-sided flank pain and hypertension. His creatinine and glomerular filtration rate were 2.5 mg/dl and 37 ml/min respectively, so that contrast media administration was contraindicated. The unenhanced magnetic resonance angiography image obtained with 3D in-flow inversion recovery sequence showed right renal artery dissection, without aortic dissection. Selective renal angiography confirmed the diagnosis and a stent was placed in the renal artery. The patient was free of pain after stenting, with normalized laboratory values and blood pressure.
Urologia Internationalis 07/2012; · 0.99 Impact Factor
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ABSTRACT: Osteoid osteoma is a benign tumour in young adults. The clinical manifestations are generally typical nocturnal pain that prevents sleep and that is alleviated with aspirin. When the typical clinical and radiological features are present, diagnosis is not difficult. Problems in the differential diagnosis may arise in connection with an unusual location. We report on the clinical features, radiographic and histopathological findings, treatment, and results of four patients who were managed for an intra- or juxta-articular osteoid osteoma at our medical centre between 2000 and 2002 and in whom the initial diagnosis was erroneous and delayed from 1 to 10years. In order to remove these lesions, we performed a CT-guided en block retrograde resection under arthroscopic control for juxta-articular osteoid osteomas (knee) and an arthroscopy-assisted en block antegrade resection in two cases of intra-articular osteoid osteoma (elbow and shoulder). None of the osteoid osteomas recurred in the follow-up period, and each patient got relief from pain.
Archives of Orthopaedic and Trauma Surgery 04/2012; 126(10):660-667. · 1.37 Impact Factor
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ABSTRACT: To compare the accuracy of magnetic resonance (MRI) and colour Doppler-ultrasound (US) in the diagnosis of late pregnancy bleeding and to assess the accuracy of the different MR sequences in visualizing the origin of haemorrhage.
42 patients in the third trimester of pregnancy underwent to US and MRI for the evaluation of painless vaginal bleeding. Multiplanar HASTE, True Fisp, 3D T1 GRE and sagittal DWI sequences were acquired. Two radiologists, blinded to the results of US, reviewed each case, resolving by consensus any discrepancy. Reference standards were surgical and pathological findings.
The reference standards identified 22 placenta previa, 11 placental abruptions (1 coincident with a placental chorioangioma), 1 thrombohaematoma and 1 fibroma with haemorrhagic degeneration. MRI identified correctly all these condition with an interobserver agreement of 0.955. DWI and T1 weighted sequences were statistically superior to Haste and True Fisp sequences in detecting the cause of bleeding (p < .001). US had 6 false negatives and 2 false positive results, its diagnostic accuracy resulting lower than MRI (p = .001).
MRI accurately evaluates pregnancy bleeding with an excellent interobserver agreement and can grant new and additional data when US is negative.
European Radiology 04/2011; 21(9):1841-9. · 3.22 Impact Factor
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Leukemia research 03/2011; 35(10):1423-4. · 2.36 Impact Factor
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The American surgeon 02/2011; 77(2):E30-2. · 1.28 Impact Factor
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ABSTRACT: To evaluate the accuracy of magnetic resonance (MR) imaging and color Doppler ultrasonography (US) in the diagnosis of abruption, to assess the accuracy of the different MR imaging sequences in the visualization of clots, and to evaluate the correlation between MR imaging findings and clinical outcome.
This study protocol was approved by the institutional review board, and written informed consent was obtained from all patients. Between March 2008 and June 2010, 60 consecutive patients (mean gestational age, 30.7 weeks [range, 27-38 weeks]; mean age, 29 years [range, 20-38 years]) who were referred for US and MR imaging owing to a putative diagnosis of abruption were assessed. Multiplanar half-Fourier rapid acquisition with relaxation enhancement, true fast imaging with steady-state precession, three-dimensional T1-weighted gradient-echo MR imaging, and sagittal diffusion-weighted MR imaging were performed. Two radiologists independently reviewed each case, resolving by consensus any diagnostic discrepancy. During a second imaging analysis, the same readers randomly and independently assessed the single sequences. The signal intensity of hematoma was correlated with clinical outcome. The reference standard for abruption was the presence of clots and/or fibrin at inspection of the placenta after delivery. The diagnostic efficacy of US and MR imaging was calculated with 95% confidence intervals. Interobserver agreement was assessed by using the Cohen κ test.
The performance of US and MR imaging was calculated in 39 patients who gave birth less than 10 days after MR imaging; these women were considered to have an adequate reference standard. Abruption was found at delivery in 19 patients. Abruption was identified in 10 of the 19 patients (52%) with US and in all 19 (100%) with MR imaging (P = .002), with an interobserver agreement of 0.949. Diffusion- and T1-weighted sequences helped identify 19 (100%) and 18 (95%) of the 19 abruptions, respectively; interrater agreement was very good for all sequences (κ = 0.892-1.0). Hematomas classified as hyperacute or acute worsened to abruption grade II, with the mother being symptomatic or the fetus distressed.
MR imaging can accurately depict placental abruption, with excellent interobserver agreement, and should be considered after negative US findings in the presence of late pregnancy bleeding if the diagnosis of abruption would change management.
Radiology 02/2011; 259(1):222-30. · 5.73 Impact Factor
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Journal of Surgical Research 11/2010; 164(1):e49-52. · 2.25 Impact Factor
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ABSTRACT: The aim of this prospective study was to compare the diagnostic yield of MR enterography (MRE) with small-bowel capsule endoscopy (SBCE) in paediatric patients with suspected Crohn's disease (CD).
Paediatric patients with suspected CD were considered eligible to be enrolled in the study. All patients underwent diagnostic work-up including 1.5-T MRE, ileo-colonoscopy and oesophagogastroduodenoscopy. SBCE was not performed if MRE showed SB stricture or extra-intestinal findings consistent with symptoms.
Sixty consecutive paediatric patients (36 male; average age 14) were enrolled into the study. A positive diagnosis for CD was made in 19 patients, 29 had a negative result and 12 were affected by other gastro-intestinal conditions. SBCE was performed in 37 patients (61.7%); 23 patients were excluded (strictures in five, extra-intestinal findings in 11 and parents' refusal in seven cases). The accuracy, sensitivity, and specificity of MRE and SBCE were 98.3%, 100%, 97.6%, and 91.9%, 90.9%, 92.3%, respectively.
Both MRE and SBCE are accurate methods for patients with suspected CD. MRE can be used as a primary imaging technique in suspected CD, in that it allows access to the ileal stricture, which forms a contra-indication for SBCE and provides extra-intestinal information.
European Radiology 10/2010; 21(4):823-31. · 3.22 Impact Factor
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ABSTRACT: To investigate the usefulness of magnetic resonance imaging (MRI) in the evaluation of pregnant women with acute abdominal and pelvic pain after sonographically (US) indeterminate findings.
Forty pregnant patients with acute abdominal and/or pelvic pain, in whom ultrasound was indeterminate, were included in this study. Multiplanar MR images of the abdomen and pelvis were obtained and independently reviewed by two radiologists with discrepancies were resolved by consensus.
Correlation of prospective clinical MR interpretations with surgical and obstetric records and clinical follow-up showed correct identification of disease entities in all 40/40 patients. The following disease processes were correctly identified using MRI in 21/40 patients: appendicitis (n = 5), ileal volvulus (n = 1), common bile duct lithiasis (n = 2), pubic chondrosarcoma (n = 1), uterine dehiscence (n = 1), placental hematoma (n = 3), iliac venous thrombosis (n = 2), ulcerative colitis (n = 1), acute pancreatitis (n = 1), hydronephrosis (n = 1), ovarian dermoid (n = 1), and ovarian torsion (n = 2). 19 of the 40 patients had normal findings on MR examinations and unremarkable follow-up. Interobserver agreement for lesion detection was excellent (0.95 k).
Magnetic resonance imaging (MRI) is an accurate investigation in detecting the cause of acute abdominal and pelvic pain during pregnancy and should be considered after US indeterminate findings.
Abdominal Imaging 10/2010; 36(5):596-603. · 1.73 Impact Factor
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ABSTRACT: Endoscopic balloon dilation (EBD) is an attractive conservative therapy for Crohn's disease (CD) with stricture; however, its long-term efficacy has been questioned because many patients require more dilations or postdilation surgery. Most reports are retrospective, and no pediatric data are available.
To assess the effectiveness of corticosteroid intralesional injection after EBD in preventing stricture recurrence.
Single-center prospective, randomized, double-blind, controlled trial.
Tertiary-referral university hospital.
Between November 2005 and January 2009, 29 pediatric patients with stricturing CD were enrolled.
Enrolled patients were randomized to receive intrastricture injection of corticosteroid (CS) (n = 15) or placebo (n = 14) after EBD. Patients were followed clinically via small intestine contrast US and intestinal magnetic resonance imaging at 1, 3, 6, and 12 months; all underwent colonoscopy 12 months after dilation.
Time free of repeat dilation and time free of surgery in the 2 groups.
One of the 15 patients receiving CS required redilation, whereas the latter was needed in 5 of the 14 placebo patients; surgery was needed in 4 of the placebo patients, but in none of those receiving CS. The 2 groups statistically differed in the time free of redilation (P = .04) as well as for time free of surgery after EBD (P = .02), which were worse in the placebo group compared with the CS group. There were no significant differences in baseline demographics between the 2 groups.
Sample size, participation bias, and short-term follow-up.
In pediatric CD with stricture, intralesional CS injection after EBD is an effective strategy for reducing the need both for redilation and surgery.
Gastrointestinal endoscopy 10/2010; 72(6):1201-8. · 6.71 Impact Factor
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Gabriele Masselli,
Antonio Picarelli,
Marco Di Tola,
Valerio Libanori,
Giuseppe Donato,
Elisabetta Polettini,
Alessandra Piermattei,
Piergaspare Palumbo,
Angelo Pittalis,
Annarita Saponara, Gianfranco Gualdi
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ABSTRACT: To prospectively determine mural perfusion dynamics in patients with untreated celiac disease by using dynamic contrast material-enhanced magnetic resonance (MR) imaging and to compare these dynamics with those in a control population and in patients with celiac disease treated with a gluten-free diet.
Institutional review board approval and informed consent from all participants were obtained. Sixty consecutive patients with untreated celiac disease, 45 patients with celiac disease treated with a gluten-free diet for at least 1 year, and 30 control subjects were enrolled in this study. Dynamic contrast-enhanced MR imaging was performed by using a 1.5-T MR unit. For each MR imaging examination, maximum enhancement, slope of enhancement, and time-signal intensity curves were calculated at the level of the descending duodenal wall. Duodenal wall thickness was also evaluated. Statistical evaluation was performed by using one-way analysis of variance, and the results were confirmed by using the Bartlett test for equal variances and complemented by using Bonferroni multiple comparison, linear correlation, and the Student t test for paired data.
Mean maximum enhancement of the duodenal wall was significantly higher in patients with untreated celiac disease (229.1 +/- 46.4 [standard deviation]) than in patients with treated celiac disease (109.8 +/- 27.8) and control subjects (94.7 +/- 17.9) (P < .001 for each comparison). All 60 untreated patients showed a curve characterized by fast enhancement and washout (type 4), while all 45 treated patients and the 30 control subjects showed a curve characterized by slow constant enhancement (type 2). Mean duodenal wall thickness was not significantly different between untreated patients (2.2 mm +/- 0.4), treated patients (2.0 mm +/- 0.3), and control subjects (2.0 mm +/- 0.4) (one-way analysis of variance, P = .4177; Bartlett test, P = .6951).
The results of this study suggest that dynamic evaluation of the bowel wall by using contrast-enhanced MR imaging can be an effective and reproducible way to show the inflammation state in celiac disease.
Radiology 09/2010; 256(3):783-90. · 5.73 Impact Factor
