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Bidani K, Singh R, Chandra G, Rai R, Singh AK. Magnetic Resonance Imaging in Gastrointestinal and Genitourinary Emergencies. Magn Reson Imaging Clin N Am 2022; 30:501-513. [PMID: 35995476 DOI: 10.1016/j.mric.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
While computed tomography (CT) offers faster cross-sectional imaging in the emergency department, owing to its concerns for higher radiation exposure, magnetic resonance imaging (MRI) applications in acute settings are increasingly validated. A significant proportion of patients present to the emergency department with abdominopelvic symptoms, most commonly acute abdominal pain. Early detection with imaging and timely intervention can significantly decrease morbidity and mortality in conditions such as acute pancreatitis or ovarian torsion. MRI encompasses better soft-tissue resolution, nonusage of ionizing radiation and iodinated contrast media, nonoperator dependency, and higher reproducibility. This review discusses the MRI protocols and applications in abdominopelvic emergencies.
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Affiliation(s)
- Khyati Bidani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Ramandeep Singh
- Department of Emergency Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Garima Chandra
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Rubal Rai
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Ajay Kumar Singh
- Department of Emergency Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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2
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Chang H, Bates DDB, Gupta A, LeBedis CA. Use of MR in Pancreaticobiliary Emergencies. Magn Reson Imaging Clin N Am 2022; 30:479-499. [PMID: 35995475 DOI: 10.1016/j.mric.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents the MR protocols, imaging features, diagnostic criteria, and complications of commonly encountered emergencies in pancreaticobiliary imaging, which include pancreatic trauma, bile leak, acute cholecystitis, biliary obstruction, and pancreatitis. Various classifications and complications that can arise with these conditions, as well as artifacts that may mimic pathology, are also included. Finally, the emerging utility of abbreviated MR protocols is discussed.
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Affiliation(s)
- Hailey Chang
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA.
| | - David D B Bates
- Department of Radiology, Cornell University, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Avneesh Gupta
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
| | - Christina A LeBedis
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
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3
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Rajput MZ, Mellnick VM. The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 2: Trauma in Pregnancy, Vascular, and Genitourinary Injuries. Can Assoc Radiol J 2022; 73:689-696. [PMID: 35282712 DOI: 10.1177/08465371221077654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority-namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. Our second installment will focus on the use of MR in pregnant patients and in the characterization of vascular and genitourinary trauma. Body MR can be useful in pregnant patients in characterizing injuries both specific for and not specific for pregnancy. Placental injuries and hematomas in particular may be better seen on MR relative to CT, owing to its superior contrast resolution. MR angiography can be performed either without or with contrast and can be useful to monitor low-grade traumatic aortic injuries. Renal and ureteral injuries can be followed with MR to help identify urine leaks, either in a delayed presentation or in patients who have an iodinated contrast allergy. Lastly, penile injuries are often imaged with ultrasound, but may benefit from additional imaging with MR when the tunica albuginea cannot be completely seen due to overlying hematoma.
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Affiliation(s)
- Mohamed Z Rajput
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
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Rajput MZ, Mellnick VM. The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 1: Pancreatic and Hepatobiliary Injuries. Can Assoc Radiol J 2022; 73:680-688. [PMID: 35282708 DOI: 10.1177/08465371221077650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority-namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. This first installment will focus on pancreatic and hepatobiliary injuries. Pancreatic trauma may be difficult to diagnose on CT, and MR may aid in demonstrating pancreatic duct disruption, allowing for accurate grading according to American Association for the Surgery of Trauma (AAST) criteria. It may also be a useful modality for monitoring evolution of pancreatic injuries and/or pseudocyst development, guiding potential stenting, and/or drainage. Biliary injuries are also optimally evaluated with MR, particularly when aided by the use of hepatobiliary contrast material. This can allow for accurate delineation of biliary ductal anatomy and aid in planning percutaneous or endoscopic treatment of bile leaks.
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Affiliation(s)
- Mohamed Z Rajput
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
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5
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D'Souza N, Hicks G, Beable R, Higginson A, Rud B. Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. Cochrane Database Syst Rev 2021; 12:CD012028. [PMID: 34905621 PMCID: PMC8670723 DOI: 10.1002/14651858.cd012028.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Appendicitis remains a difficult disease to diagnose, and imaging adjuncts are commonly employed. Magnetic resonance imaging (MRI) is an imaging test that can be used to diagnose appendicitis. It is not commonly regarded as a first-line imaging test for appendicitis, but the reported diagnostic accuracy in some studies is equivalent to computed tomography (CT) scans. As it does not expose patients to radiation, it is an attractive imaging modality, particularly in women and children. OBJECTIVES The primary objective was to determine the diagnostic accuracy of MRI for detecting appendicitis in all patients. Secondary objectives: To investigate the accuracy of MRI in subgroups of pregnant women, children, and adults. To investigate the potential influence of MRI scanning variables such as sequences, slice thickness, or field of view. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase until February 2021. We searched the references of included studies and other systematic reviews to identify further studies. We did not exclude studies that were unpublished, published in another language, or retrospective. SELECTION CRITERIA We included studies that compared the outcome of an MRI scan for suspected appendicitis with a reference standard of histology, intraoperative findings, or clinical follow-up. Three study team members independently filtered search results for eligible studies. DATA COLLECTION AND ANALYSIS We independently extracted study data and assessed study quality using the Quality Assessment of Studies of Diagnostic Accuracy - Revised (QUADAS-2) tool. We used the bivariate model to calculate pooled estimates of sensitivity and specificity. MAIN RESULTS We identified 58 studies with sufficient data for meta-analysis including a total of 7462 participants (1980 with and 5482 without acute appendicitis). Estimates of sensitivity ranged from 0.18 to 1.0; estimates of specificity ranged from 0.4 to 1.0. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.94 to 0.97); summary specificity was 0.96 (95% CI 0.95 to 0.97). Sensitivity and specificity remained high on subgroup analysis for pregnant women (sensitivity 0.96 (95% CI 0.88 to 0.99); specificity 0.97 (95% CI 0.95 to 0.98); 21 studies, 2282 women); children (sensitivity 0.96 (95% CI 0.95 to 0.97); specificity 0.96 (95% CI 0.92 to 0.98); 17 studies, 2794 children); and adults (sensitivity 0.96 (95% CI 0.93 to 0.97); specificity 0.93 (95% CI 0.80 to 0.98); 9 studies, 1088 participants), as well as different scanning techniques. In a hypothetical cohort of 1000 patients, there would be 12 false-positive results and 30 false-negative results. Methodological quality of the included studies was poor, and the risk of bias was high or unclear in 53% to 83% of the QUADAS-2 domains. AUTHORS' CONCLUSIONS MRI appears to be highly accurate in confirming and excluding acute appendicitis in adults, children, and pregnant women regardless of protocol. The methodological quality of the included studies was generally low due to incomplete and low standards of follow-up, so summary estimates of sensitivity and specificity may be biased. We could not assess the impact and direction of potential bias given the very low number of high-quality studies. Studies comparing MRI protocols were few, and although we found no influence of MRI protocol variables on the summary estimates of accuracy, our results do not rule out that some MRI protocols are more accurate than others.
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Affiliation(s)
| | | | | | | | - Bo Rud
- Gastrounit, Copenhagen University Hospital Hvidovre , Hvidovre, Denmark
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Nepal P, Wells M, Ojili V, Khandelwal K, Lalwani N, Khandelwal A. Problem-solving with MRI in acute abdominopelvic conditions, part 1: gastrointestinal, hepatobiliary, and pancreatic diseases. Emerg Radiol 2021; 28:1161-1172. [PMID: 34247289 DOI: 10.1007/s10140-021-01960-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 01/11/2023]
Abstract
The purpose of this article is to review the benefit and added value and advantages of magnetic resonance imaging (MRI) compared with other cross-sectional imaging in patients presenting with abdominopelvic emergencies. During the past decade, there has been increased utilization of MRI in the emergency department with widespread availability of MR scanners, improvement in rapid imaging techniques, and methods to overcome motion-related artifacts. This has benefited patients at higher risk of radiation, particularly children and pregnant women, and patients with contraindications to iodinated contrast including allergy and renal dysfunction. Still the challenges are: on site MR scanner in the emergency department, after-hour services, as well as availability of time slot to rapidly scan emergency patient. MRI has additional advantages over other imaging modalities due to its high contrast resolution, which allows it to better characterize tissue and fluid collections, and may avoid the need for intravenous contrast. Radiologists must be familiar with the role and added value of MRI, spectrum of imaging findings, and problem-oriented modified MR protocols in abdominal and pelvic emergencies. In part 1, we will discuss the utility of MRI in gastrointestinal, hepatobiliary, and pancreatic diseases. In part 2, the authors will focus on the key MR imaging features of female pelvic gynecological diseases, pregnancy related complications, abdominal vascular complications, and renal diseases.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Michael Wells
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic, Austin, MN, USA
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ashish Khandelwal
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Affiliation(s)
- Jan Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Nina Buchtele
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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8
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Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, Leppaniemi A, Augustin G, Reva V, Wani I, Kirkpatrick A, Abu-Zidan F, Cicuttin E, Fraga GP, Ordonez C, Pikoulis E, Sibilla MG, Maier R, Matsumura Y, Masiakos PT, Khokha V, Mefire AC, Ivatury R, Favi F, Manchev V, Sartelli M, Machado F, Matsumoto J, Chiarugi M, Arvieux C, Catena F, Coimbra R. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:56. [PMID: 31867050 PMCID: PMC6907251 DOI: 10.1186/s13017-019-0278-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Leslie Kobayashi
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Walt Biffl
- Trauma Surgery Department, Scripps Memorial Hospital, La Jolla, CA USA
| | - Ari Leppaniemi
- General Surgery Department, Mehilati Hospital, Helsinki, Finland
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Imitiaz Wani
- Department of Surgery, DHS Hospitals, Srinagar, Kashmir India
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Gustavo Pereira Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Carlos Ordonez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Emmanuil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria Grazia Sibilla
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Peter T. Masiakos
- Pediatric Trauma Service, Massachusetts General Hospital, Boston, MA USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mazyr, Belarus
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics and Gynecology, University of Buea, Buea, Cameroon
| | - Rao Ivatury
- General and Trauma Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Francesco Favi
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Fernando Machado
- General and Emergency Surgery Department, Montevideo Hospital, Montevideo, Uruguay
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes, UGA-Université Grenoble Alpes, Grenoble, France
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
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Mervak BM, Wilson SB, Handly BD, Altun E, Burke LM. MRI of acute appendicitis. J Magn Reson Imaging 2019; 50:1367-1376. [PMID: 30883988 DOI: 10.1002/jmri.26709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022] Open
Abstract
Appendicitis is the most common cause of acute abdominal pain resulting in surgery. While historically ultrasound (US) and computed tomography (CT) have been used to evaluate for appendicitis and its related complications, magnetic resonance imaging (MRI) has become a highly accurate and increasingly utilized modality in the last two decades, particularly in the pediatric and pregnant patient populations in whom ionizing radiation is used reluctantly. This article discusses the advantages and disadvantages of MRI as a modality to evaluate for acute appendicitis, summarizes studies of the diagnostic performance relative to CT and US, provides a standard MR protocol, and describes MRI findings typical of acute appendicitis, common complications, and other differential diagnoses. Level of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:1367-1376.
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Affiliation(s)
- Benjamin M Mervak
- University of North Carolina Department of Radiology, Division of Abdominal Imaging, Chapel Hill, North Carolina, USA
| | - Sarah B Wilson
- University of North Carolina Radiology Residency Program, Chapel Hill, North Carolina, USA
| | - Brian D Handly
- University of North Carolina Department of Radiology, Division of Pediatric Imaging, Chapel Hill, North Carolina, USA
| | - Ersan Altun
- University of North Carolina Department of Radiology, Division of Abdominal Imaging, Chapel Hill, North Carolina, USA
| | - Lauren M Burke
- University of North Carolina Department of Radiology, Division of Abdominal Imaging, Chapel Hill, North Carolina, USA
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10
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Abstract
Acute abdominopelvic pain, a common symptom in emergency department patients, is challenging given the spectrum of differential diagnoses encompassing multiple organ systems, ranging from benign self-limiting to life-threatening and emergent. Diagnostic imaging is critical given its high accuracy and management guidance. A contrast-enhanced computed tomography (CT) scan is preferred given its widespread availability and speed of acquisition. MR imaging may be appropriate, usually performed for specific indications with tailored protocols. It is accurate for diagnosis and may be an alternative to CT. This article discusses the advantages and disadvantages, protocols, and appearances of MR imaging of common diagnoses.
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Affiliation(s)
- Jennifer W Uyeda
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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11
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Tonolini M, Bareggi E, Gambitta P. Advanced endoscopic interventions on the pancreas and pancreatic ductal system: a primer for radiologists. Insights Imaging 2019; 10:5. [PMID: 30689070 PMCID: PMC6352387 DOI: 10.1186/s13244-019-0689-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022] Open
Abstract
In recent years, technological advancements including endoscopic ultrasound (EUS) guidance and availability of specifically designed stents further expanded the indications and possibilities of interventional endoscopy. Although technically demanding and associated with non-negligible morbidity, advanced pancreatic endoscopic techniques now provide an effective minimally invasive treatment for complications of acute and chronic pancreatitis. Aiming to provide radiologists with an adequate familiarity, this pictorial essay reviews the indications, techniques, results and pre- and post-procedural cross-sectional imaging appearances of advanced endoscopic interventions on the pancreas and pancreatic ductal system. Most of the emphasis is placed on multidetector CT and MRI findings before and after internal drainage of pseudocysts and walled-off necrosis via EUS-guided endoscopic cystostomy, and on stent placement to relieve strictures or disruption of the main pancreatic duct, respectively in patients with chronic pancreatitis and disconnected pancreatic duct syndrome.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Emilia Bareggi
- Digestive Endoscopy, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
| | - Pietro Gambitta
- Digestive Endoscopy, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.,Present address: Head, Department of Gastroenterology / Digestive Endoscopy, New Hospital of Legnano, Via Papa Giovanni Paolo II, 20025, Legnano, Italy
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12
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Tonolini M, Valconi E, Vanzulli A, Bianco R. Radiation overexposure from repeated CT scans in young adults with acute abdominal pain. Emerg Radiol 2017; 25:21-27. [DOI: 10.1007/s10140-017-1554-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
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13
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Hruşcã A, Rãchişan AL, Rödl S, Sorantin E. Can Apparent Diffusion Coefficient Predict the Clinical Outcome in Drowned Children? Can Assoc Radiol J 2017; 68:217-223. [DOI: 10.1016/j.carj.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/22/2016] [Accepted: 12/06/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Pediatric cerebral hypoxic-ischemic injury frequently results in severe neurological outcome. Imaging with diffusion-weighted magnetic resonance imaging (DWi) demonstrates that the acute cerebral injury and apparent diffusion coefficient (ADC) allow the assessment of the severity of brain damage. The main objective was to examine if spatial distribution of reductions in ADC values is associated with clinical outcome in drowned children. Methods This is a retrospective study of 7 children (7 examinations) suffering from a hypoxic-ischemic event who underwent DWi. Seven subjects with normal DWi served as controls. The mean patient age was 4.88 ± 2.93 years and the male-to-female ratio was 5:2. The neurological outcome was divided into 2 categories: 4 children with Apallic syndrome and 3 deaths. We analysed the differences between the drowned children and the control group regarding clinical data, DWi abnormalities, and ADC values. Results The ADC values in the occipital and parietal grey matter were significantly different between the drowned children (765.14 ± 65.47 vs 920.95 ± 69.62; P = .003) and the control group (670.82 ± 233.99 vs 900.66 ± 92.72; P = .005). The ADC showed low values in the precentral area also ( P = .044). Conclusion The ADC reduction may be useful to predict the poor outcome in drowned children and can be a valuable tool for clinical assessment.
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Affiliation(s)
- Adrian Hruşcã
- Division of Medical Biophysics, University of Medicine & Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Andreea Liana Rãchişan
- Division of Pediatrics II, University of Medicine & Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Siegfried Rödl
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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14
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Rossi L, Pierigè F, Antonelli A, Bigini N, Gabucci C, Peiretti E, Magnani M. Engineering erythrocytes for the modulation of drugs' and contrasting agents' pharmacokinetics and biodistribution. Adv Drug Deliv Rev 2016; 106:73-87. [PMID: 27189231 DOI: 10.1016/j.addr.2016.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 01/14/2023]
Abstract
Pharmacokinetics, biodistribution, and biological activity are key parameters that determine the success or failure of therapeutics. Many developments intended to improve their in vivo performance, aim at modulating concentration, biodistribution, and targeting to tissues, cells or subcellular compartments. Erythrocyte-based drug delivery systems are especially efficient in maintaining active drugs in circulation, in releasing them for several weeks or in targeting drugs to selected cells. Erythrocytes can also be easily processed to entrap the desired pharmaceutical ingredients before re-infusion into the same or matched donors. These carriers are totally biocompatible, have a large capacity and could accommodate traditional chemical entities (glucocorticoids, immunossuppresants, etc.), biologics (proteins) and/or contrasting agents (dyes, nanoparticles). Carrier erythrocytes have been evaluated in thousands of infusions in humans proving treatment safety and efficacy, hence gaining interest in the management of complex pathologies (particularly in chronic treatments and when side-effects become serious issues) and in new diagnostic approaches.
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15
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Bates DD, LeBedis CA, Soto JA, Gupta A. Use of Magnetic Resonance in Pancreaticobiliary Emergencies. Magn Reson Imaging Clin N Am 2016; 24:433-48. [DOI: 10.1016/j.mric.2015.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Zytoon AA, Mohammed HH, Hosny DM. The Role of Magnetic Resonance Cholangiopancreatography in Diagnosis of Hepatobiliary Lesions. J Med Imaging Radiat Sci 2016; 47:66-73. [DOI: 10.1016/j.jmir.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
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D'Souza N, Thaventhiran A, Beable R, Higginson A, Rud B. Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Nigel D'Souza
- Salisbury District Hospital; Department of Colorectal Surgery; Odstock Road Salisbury UK
| | - Anthony Thaventhiran
- Southampton General Hospital, University Hospital Southampton NHS Foundation Trust; General Surgery; Tremona Road Southampton Hampshire UK SO16 6YD
| | - Richard Beable
- Queen Alexandra Hospital; Department of Radiology; Soutwick Hill Road Portsmouth Hampshire UK
| | - Antony Higginson
- Queen Alexandra Hospital; Department of Radiology; Soutwick Hill Road Portsmouth Hampshire UK
| | - Bo Rud
- Bispebjerg Hospital; Department of Surgical Gastroenterology K; 23 Bispebjerg Bakke Copenhagen NV Denmark DK 2400
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Gangadhar K, Kielar A, Dighe MK, O’Malley R, Wang C, Gross JA, Itani M, Lalwani N. Multimodality approach for imaging of non-traumatic acute abdominal emergencies. Abdom Radiol (NY) 2016; 41:136-48. [PMID: 26830620 DOI: 10.1007/s00261-015-0586-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
"Acute abdomen" includes spectrum of medical and surgical conditions ranging from a less severe to life-threatening conditions in a patient presenting with severe abdominal pain that develops over a period of hours. Accurate and rapid diagnosis of these conditions helps in reducing related complications. Clinical assessment is often difficult due to availability of over-the-counter analgesics, leading to less specific physical findings. The key clinical decision is to determine whether surgical intervention is required. Laboratory and conventional radiographic findings are often non-specific. Thus, cross-sectional imaging plays a pivotal role for helping direct management of acute abdomen. Computed tomography is the primary imaging modality used for these cases due to fast image acquisition, although US is more specific for conditions such as acute cholecystitis. Magnetic resonance imaging or ultrasound is very helpful in patients who are particularly sensitive to radiation exposure, such as pregnant women and pediatric patients. In addition, MRI is an excellent problem-solving modality in certain conditions such as assessment for choledocholithiasis in patients with right upper quadrant pain. In this review, we discuss a multimodality approach for the usual causes of non-traumatic acute abdomen including acute appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. A brief review of other relatively less frequent but important causes of acute abdomen, such as perforated viscus and bowel ischemia, is also included.
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Dhaka N, Samanta J, Kochhar S, Kalra N, Appasani S, Manrai M, Kochhar R. Pancreatic fluid collections: What is the ideal imaging technique? World J Gastroenterol 2015; 21:13403-13410. [PMID: 26730150 PMCID: PMC4690168 DOI: 10.3748/wjg.v21.i48.13403] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/18/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic fluid collections (PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis of duration of disease and contents, whether liquid alone or a mixture of fluid and necrotic debris. Management of these different types of collections differs because of the variable quantity of debris; while patients with pseudocysts can be drained by straight-forward stent placement, walled-off necrosis requires multi-disciplinary approach. Differentiating these collections on the basis of clinical severity alone is not reliable, so imaging is primarily performed. Contrast-enhanced computed tomography is the commonly used modality for the diagnosis and assessment of proportion of solid contents in PFCs; however with certain limitations such as use of iodinated contrast material especially in renal failure patients and radiation exposure. Magnetic resonance imaging (MRI) performs better than computed tomography (CT) in characterization of pancreatic/peripancreatic fluid collections especially for quantification of solid debris and fat necrosis (seen as fat density globules), and is an alternative in those situations where CT is contraindicated. Also magnetic resonance cholangiopancreatography is highly sensitive for detecting pancreatic duct disruption and choledocholithiasis. Endoscopic ultrasound is an evolving technique with higher reproducibility for fluid-to-debris component estimation with the added advantage of being a single stage procedure for both diagnosis (solid debris delineation) and management (drainage of collection) in the same sitting. Recently role of diffusion weighted MRI and positron emission tomography/CT with (18)F-FDG labeled autologous leukocytes is also emerging for detection of infection noninvasively. Comparative studies between these imaging modalities are still limited. However we look forward to a time when this gap in literature will be fulfilled.
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Yu HS, Gupta A, Soto JA, LeBedis C. Emergency abdominal MRI: current uses and trends. Br J Radiol 2015; 89:20150804. [PMID: 26514590 PMCID: PMC4985451 DOI: 10.1259/bjr.20150804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 12/21/2022] Open
Abstract
When evaluating the abdomen in the emergency setting, CT and ultrasound are the imaging modalities of choice, mainly because of accessibility, speed and lower relative cost. CT has the added benefit of assessing the whole abdomen for a wide spectrum of gastrointestinal disease, whereas ultrasound has the benefit of avoiding ionizing radiation. MRI is another tool that has demonstrated increasing utility in the emergency setting and also avoids the use of ionizing radiation. MRI also has the additional advantage of excellent soft-tissue contrast. However, widespread use of MRI in the emergency setting is limited by availability and relative cost. Despite such limitations, advances in MRI technology, including improved pulse sequences and coil technology and increasing clinician awareness of MRI, have led to an increased demand in abdominal MRI in the emergency setting. This is particularly true in the evaluation of acute pancreatitis; choledocholithiasis with or without cholecystitis; acute appendicitis, particularly in pregnant patients; and, in some cases, Crohn's disease. In cases of pancreatitis and Crohn's disease, MRI also plays a role in subsequent follow-up examinations.
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Affiliation(s)
- Hei S Yu
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Avneesh Gupta
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Christina LeBedis
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
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21
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Alternative diagnoses at paediatric appendicitis MRI. Clin Radiol 2015; 70:881-9. [PMID: 26072983 DOI: 10.1016/j.crad.2015.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/12/2015] [Accepted: 03/05/2015] [Indexed: 12/17/2022]
Abstract
As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis-colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed.
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22
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Diagnostic imaging for acute appendicitis: interfacility differences in practice patterns. Pediatr Surg Int 2015; 31:355-61. [PMID: 25700686 DOI: 10.1007/s00383-015-3669-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate trends and factors associated with interfacility differences in imaging modality selection in the diagnosis and management of children with suspected acute appendicitis. METHODS We conducted a retrospective review of diagnostic imaging selection and outcomes in patients <20 years of age who underwent appendectomy at a single Children's Hospital from June 2008 to June 2013. These results were then compared with those of referring hospitals. RESULTS A total of 232 children underwent appendectomy during the study period. Imaging results contributed to diagnostic and management decisions in 95.3 % of cases. CT scan was utilized as first-line imaging in 50 % of cases. CTs were preferentially performed at referring institutions (78 vs. 46 %, p < 0.001). Children were five times more likely to undergo CT at referring institutions (OR = 5.5, CI 3.0-10.2). Adjusting for demographics and Alvarado score, diagnostic imaging choice was independent of patient's clinical status. CONCLUSION This study demonstrates that initial presentation to a referring hospital independently predicts the use of CT scan for suspected acute appendicitis. Further efforts should be undertaken to develop a clinical pathway that minimizes radiation exposure in the diagnosis of acute appendicitis, with focus on access to pediatric abdominal ultrasound.
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Value of gadolinium-enhanced MRI in detection of acute appendicitis in children and adolescents. AJR Am J Roentgenol 2015; 203:W543-8. [PMID: 25341169 DOI: 10.2214/ajr.13.12093] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to determine both the value of gadolinium-enhanced MRI in children with suspected acute appendicitis and the best sequences for detecting acute appendicitis, to thereby decrease imaging time. MATERIALS AND METHODS This was a retrospective review of pediatric patients with suspected appendicitis who had undergone MRI at our institution between 2010 and 2011 after an indeterminate ultrasound examination. MRI examinations included T1-weighted unenhanced and contrast-enhanced, T2-weighted, and balanced steady-state free precession (SSFP) sequences in axial and coronal planes. Sequences were reviewed together and individually by five radiologists who were blinded to the final diagnosis. Radiologists were asked to score their confidence of appendicitis diagnosis using a 5-point scale. The diagnostic performance of each MR sequence was obtained by comparing the mean area under the curve (AUC) using receiver operating characteristic (ROC) analysis. RESULTS A total of 49 patients with clinically suspected appendicitis were included, of whom 16 received a diagnosis of appendicitis. The mean AUCs for reviewing all sequences together, contrast-enhanced sequences alone, T2-weighted sequences alone, and balanced SSFP alone were 0.984, 0.979, 0.944, and 0.910, respectively. No significant difference was observed between reviewing all sequences together versus contrast-enhanced sequences alone (p = 0.90) and T2-weighted sequences alone (p = 0.23). A significant difference was observed between contrast-enhanced sequences and balanced SSFP (p < 0.03). CONCLUSION Gadolinium-enhanced images and T2-weighted images are most helpful in the assessment of acute appendicitis in the pediatric population. These findings have led to protocol modifications that have reduced imaging time.
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24
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Naidoo P, Singh B. Current radiological strategies for the assessment of right lower quadrant abdominal pain. SA J Radiol 2014. [DOI: 10.4102/sajr.v18i1.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Right lower quadrant abdominal pain is a common clinical entity. Imaging and the radiologistplay an integral role in achieving a diagnosis, so guiding prompt management of patients.This review discusses the spectrum of pathology and imaging findings, and highlights and contrasts the preferred imaging modalities in different subsets of patients.
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25
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Manikkavasakar S, AlObaidy M, Busireddy KK, Ramalho M, Nilmini V, Alagiyawanna M, Semelka RC. Magnetic resonance imaging of pancreatitis: An update. World J Gastroenterol 2014; 20:14760-14777. [PMID: 25356038 PMCID: PMC4209541 DOI: 10.3748/wjg.v20.i40.14760] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/02/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance (MR) imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as non-ionizing nature and higher safety profile of intravascular contrast media, making it particularly valuable in radiosensitive populations such as pregnant patients, and patients with recurrent pancreatitis requiring multiple follow-up examinations. Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis. This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis, pancreatitis complications and other important differential diagnoses that mimic pancreatitis.
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26
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Moore MM, Brian JM, Methratta ST, Hulse MA, Choudhary AK, Eggli KD, Boal DKB. MRI for clinically suspected pediatric appendicitis: case interpretation. Pediatr Radiol 2014; 44:605-12. [PMID: 24442340 DOI: 10.1007/s00247-013-2866-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/28/2013] [Accepted: 12/19/2013] [Indexed: 12/01/2022]
Abstract
As utilization of MRI for clinically suspected pediatric appendicitis becomes more common, there will be increased focus on case interpretation. The purpose of this pictorial essay is to share our institution's case interpretation experience. MRI findings of appendicitis include appendicoliths, tip appendicitis, intraluminal fluid-debris level, pitfalls of size measurements, and complications including abscesses. The normal appendix and inguinal appendix are also discussed.
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Affiliation(s)
- Michael M Moore
- Division of Pediatric Radiology, Department of Radiology, Penn State Milton S. Hershey Medical Center, Mail Code H066, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA,
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Lubarsky M, Kalb B, Sharma P, Keim SM, Martin DR. MR imaging for acute nontraumatic abdominopelvic pain: rationale and practical considerations. Radiographics 2013; 33:313-37. [PMID: 23479698 DOI: 10.1148/rg.332125116] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Medical imaging is becoming an increasingly vital component of patient care in the emergency department. Computed tomography has been the diagnostic imaging method of choice for emergency department patients with acute abdominopelvic pain; however, the use of ionizing radiation and the potential need for exogenous contrast material adversely affect patient safety and work flow efficiency, respectively. Magnetic resonance (MR) imaging holds promise as an alternative for the evaluation of acute abdominopelvic pain. Critical causes of abdominopelvic pain may be detected with MR imaging without exogenous contrast material. MR imaging is sensitive for depicting tissue or fluid changes related to inflammation, a common process in causes of acute abdominopelvic pain. Fat suppression allows the detection of abnormal signal caused by inflamed tissue. MR imaging has proved sensitive in the detection of acute inflammatory diseases of the gallbladder and bile ducts, liver, pancreas, kidneys, collecting system, bowel, and pelvic soft tissues. Moreover, MR imaging without exogenous contrast material may be safely used in pregnant patients. Evolving roles for emergency department MR imaging include the assessment of vascular disease (including thromboembolic disease) and right upper quadrant pain. Emergency department MR imaging currently has limited availability, and its continued use will require further education regarding operation and image interpretation as well as further validation of cost-effectiveness. Nevertheless, current understanding of the diagnostic utility of this imaging method warrants continued study and the increased use of MR imaging in the evaluation of emergency department patients with acute abdominopelvic pain.
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Affiliation(s)
- Michael Lubarsky
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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28
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Schmid-Tannwald C, Oto A, Reiser MF, Zech CJ. Diffusion-weighted MRI of the abdomen: current value in clinical routine. J Magn Reson Imaging 2013; 37:35-47. [PMID: 23255414 DOI: 10.1002/jmri.23643] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 02/17/2012] [Indexed: 02/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) provides high tissue contrast without ionizing radiation exposure and unenhanced images are often diagnostic. Therefore, MRI is especially an attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Technical advantages have led to the increasing use of diffusion-weighted (DW) MRI in abdominal imaging, which provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. This review article presents the current status of noncontrast MRI with the focus of DW-MRI. Technical background and clinical applications are explained and discussed.
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Pablico-Lansigan MH, Situ SF, Samia ACS. Magnetic particle imaging: advancements and perspectives for real-time in vivo monitoring and image-guided therapy. NANOSCALE 2013; 5:4040-55. [PMID: 23538400 DOI: 10.1039/c3nr00544e] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Magnetic particle imaging (MPI) is an emerging biomedical imaging technology that allows the direct quantitative mapping of the spatial distribution of superparamagnetic iron oxide nanoparticles. MPI's increased sensitivity and short image acquisition times foster the creation of tomographic images with high temporal and spatial resolution. The contrast and sensitivity of MPI is envisioned to transcend those of other medical imaging modalities presently used, such as magnetic resonance imaging (MRI), X-ray scans, ultrasound, computed tomography (CT), positron emission tomography (PET) and single photon emission computed tomography (SPECT). In this review, we present an overview of the recent advances in the rapidly developing field of MPI. We begin with a basic introduction of the fundamentals of MPI, followed by some highlights over the past decade of the evolution of strategies and approaches used to improve this new imaging technique. We also examine the optimization of iron oxide nanoparticle tracers used for imaging, underscoring the importance of size homogeneity and surface engineering. Finally, we present some future research directions for MPI, emphasizing the novel and exciting opportunities that it offers as an important tool for real-time in vivo monitoring. All these opportunities and capabilities that MPI presents are now seen as potential breakthrough innovations in timely disease diagnosis, implant monitoring, and image-guided therapeutics.
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Affiliation(s)
- Michele H Pablico-Lansigan
- Department of Chemistry, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, USA
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Moore MM, Gustas CN, Choudhary AK, Methratta ST, Hulse MA, Geeting G, Eggli KD, Boal DKB. MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 2012; 42:1056-63. [PMID: 22677910 DOI: 10.1007/s00247-012-2412-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. OBJECTIVE To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. MATERIALS AND METHODS A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. RESULTS Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. CONCLUSION MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation.
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Affiliation(s)
- Michael M Moore
- Department of Radiology, Penn State Milton S Hershey Medical Center, Hershey, PA 17033-0850, USA.
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31
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Ortiz Liévano CJ. Papel de las imágenes en el enfoque diagnóstico del paciente con ictericia. MEDUNAB 2012. [DOI: 10.29375/01237047.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
La ictericia es un signo que describe la coloración amarillenta de piel, escleras y mucosas por acumulación de bilirrubina. Es causa frecuente de consulta en los servicios de urgencias y de consulta externa; de hecho, es muy frecuente en el periodo neonatal. La ictericia no es una entidad aislada sino es el reflejo de una enfermedad específica. Por tal motivo, luego de una adecuada evaluación clínica y teniendo los paraclínicos pertinentes, se inicia el estudio del cuadro por imágenes con una ecografía; según los hallazgos se continua el estudio tomografía abdominal con medio de contraste para evaluar el tracto biliar, resonancia magnética u otros métodos no invasivos según el estado del paciente y su disponibilidad. Dependiendo de los resultados es necesario continuar con colangiopancreatografía retrógrada endoscópica como método diagnóstico, terapéutico o ambos.
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Leeuwenburgh MMN, Wiarda BM, Bipat S, Nio CY, Bollen TL, Kardux JJ, Jensch S, Bossuyt PMM, Boermeester MA, Stoker J. Acute appendicitis on abdominal MR images: training readers to improve diagnostic accuracy. Radiology 2012; 264:455-63. [PMID: 22700556 DOI: 10.1148/radiol.12111896] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine if training with direct feedback helps to improve the diagnostic performance of inexperienced readers in the detection of appendicitis on magnetic resonance (MR) images. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the requirement for informed consent. Nine radiologists and eight residents without experience in evaluating MR images for acute abdominal conditions evaluated a training set of images from 100 MR imaging examinations of patients suspected of having appendicitis and received direct feedback after each evaluation. An expert panel made a diagnosis of appendicitis in 45 patients and an alternative diagnosis in 55 patients on the basis of histopathologic examination and follow-up. Readers recorded two diagnoses: the first after viewing images from conventional MR sequences (half-Fourier rapid acquisition with relaxation enhancement and true fast imaging with steady-state precession) and the second after viewing diffusion-weighted (DW) MR images. Reader sensitivity and specificity were calculated per set of 25 cases. RESULTS The average reader sensitivity for detecting appendicitis improved significantly after training (0.82 vs 0.92, P = .003); the average specificity improved nonsignificantly (0.82 vs 0.88, P = .10). Sensitivity for radiologists increased from 0.81 in the first set of 25 cases to 0.91 in the last set, and specificity improved from 0.82 to 0.85. For residents, sensitivity increased from 0.82 to 0.94, and specificity increased from 0.82 to 0.91. Sensitivity improved from 0.80 to 0.87 (P < .001) in all readings combined when DW images were read in addition to conventional MR images. CONCLUSION Diagnostic accuracy of inexperienced readers in the evaluation of abdominal MR images for acute appendicitis improved after training with direct feedback, and the addition of DW images improved reader sensitivity.
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Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations. AJR Am J Roentgenol 2012; 198:785-92. [PMID: 22451542 DOI: 10.2214/ajr.11.8223] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objectives of this article are to discuss the current evidence-based recommendations regarding the use of diagnostic imaging in the evaluation of pulmonary embolism, appendicitis, urolithiasis, and cholelithiasis during pregnancy. CONCLUSION Diagnostic imaging should be performed during pregnancy only with an understanding of the maternal and fetal risks and benefits, the comparative advantages of different modalities, and the unique anatomic and physiologic issues associated with pregnancy.
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Halpenny D, Barrett R, O'Callaghan K, Eltayeb O, Torreggiani WC. The MRI findings of a de Garengeot hernia. Br J Radiol 2012; 85:e59-61. [PMID: 22391502 DOI: 10.1259/bjr/27759683] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The presence of the appendix within a femoral hernia is rare. It was first described by the French surgeon Jacques Croissant de Garengeot in 1731. This phenomenon accounts for 0.8-1% of all femoral hernias. Acute appendicitis occurring within a femoral hernia is even rarer and is difficult to diagnose pre-operatively. This type of hernia is termed a de Garengeot hernia. The ultrasonographic and CT imaging features of de Garengeot hernias have been described previously. We report a case of a 57-year-old female who presented with a painful right-sided groin mass. She underwent MRI of the inguinal region, which successfully diagnosed this rare hernia pre-operatively. To our knowledge, this is the first description of a de Garengeot hernia diagnosed using MRI.
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Affiliation(s)
- D Halpenny
- Department of Radiology, Adelaide and Meath Hospitals, Tallaght, Dublin, Ireland
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Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emerg Radiol 2012; 19:341-8. [PMID: 22447440 DOI: 10.1007/s10140-012-1038-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/07/2012] [Indexed: 12/20/2022]
Abstract
Acute cholecystitis, which is usually associated with gallstones, is one of the commonest surgical causes of emergency hospital admission and may be further complicated by mural necrosis, perforation, and abscess formation. Magnetic resonance imaging (MRI) is increasingly available in the emergency setting. Technically improved equipment and faster acquisition protocols allow excellent tissue contrast and MRI is now an attractive modality for imaging acute abdominal disorders. The use of MRI with MR cholangiopancreatography in the emergency setting provides rapid, noninvasive, and confident diagnosis or exclusion of acute cholecystitis and of coexistent choledocholithiasis. To familiarize the reader with these cross-sectional imaging appearances, this paper reviews MRI findings consistent with uncomplicated cholecystitis. These include gallbladder distension, intraluminal sludge and gallstones, impacted stones obstructing the gallbladder neck or cystic duct, thickening of the gallbladder wall, abnormal signal intensity and edematous stratification, and pericholecystic and perihepatic fluid, plus increased enhancement of the gallbladder wall and adjacent liver parenchyma when intravenous paramagnetic contrast is used. Furthermore, MRI allows prompt detection and comprehensive visualization and characterization of cholecystitis-related complications such as gangrene, perforation, pericholecystic abscess, and intrahepatic fistulization. Some previous literature reports, and our experience, suggest that, when available, MRI should be recommended to provide prompt and efficient triage of patients with suspected cholecystitis and inconclusive clinical, laboratory, and sonographic findings. It facilitates appropriate therapeutic planning, including the timing of surgery (emergency or delayed), approach (laparoscopic or laparotomic), and need for preoperative or intraoperative removal of stone(s) in the common bile duct.
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Taking advantage of chemical shift imaging: using opposed-phase images to locate the normal appendix on MR. Clin Imaging 2012; 35:424-30. [PMID: 22040785 DOI: 10.1016/j.clinimag.2010.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 09/20/2010] [Indexed: 12/12/2022]
Abstract
Multiple sequences of 50 consecutive adult pelvic MRI exams were retrospectively reviewed by two radiologists to determine if opposed-phase T1 gradient echo imaging can assist in locating the normal appendix on pelvic MRI. If the appendix was visualized, it was always seen on the T2 sequence, except for one exam. The opposed-phase sequence had the second highest visualization rate, and the appendix was identified the least on the post-gadolinium sequence. The presence of a "button nose" sign was also assessed and was present in one third of cases.
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Abstract
PURPOSE OF REVIEW The diagnostic approach to children with possible appendicitis remains challenging. Although advances in imaging have improved diagnostic accuracy over clinical judgment alone, new management strategies continue to evolve. This review serves as an update on imaging, biomarkers, and management of appendicitis. RECENT FINDINGS Abdominal computed tomography (CT) and ultrasound continue to be the ancillary radiologic studies of choice for appendicitis. Recent studies on the use of CT have focused on the need for intravenous or enteral contrast. Despite lower diagnostic performance, ultrasound has the advantage of sparing patients from radiation exposure. MRI is being evaluated as an additional diagnostic modality. New biomarkers, beyond a standard white blood cell count or absolute neutrophil count, continue to be investigated, but these are not being routinely used in practice. Different management approaches are also being investigated, including nonoperative treatment with antibiotic therapy for early, acute appendicitis. SUMMARY The best use of advanced radiologic imaging for children with possible appendicitis is actively debated. CT continues to show superior accuracy as compared with ultrasound; however, screening ultrasounds for nonobese children have advantages. The combination of robust decision rules that incorporate biomarkers and the judicious use of CT will help define diagnostic strategies for appendicitis over the next decade.
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Abstract
Acute appendicitis is a common surgical emergency and the diagnosis can often be made clinically; however, many patients present with atypical findings. For these patients, there are multiple imaging modalities available to aid in the diagnosis of suspected appendicitis in an effort to avoid a negative appendectomy. Computed tomography is the test of choice in most patients in whom the diagnosis is not certain. Ultrasonography is particularly useful in children and pregnant women. Magnetic resonance imaging is recommended when ultrasonography is inconclusive. Appropriate use of these imaging studies avoids delays in treatment, prolonged hospitalization, and unnecessary surgery.
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Affiliation(s)
- Nancy A Parks
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 220, Memphis, TN 38163, USA
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Xiao B, Zhang XM. Magnetic resonance imaging for acute pancreatitis. World J Radiol 2010; 2:298-308. [PMID: 21160684 PMCID: PMC2999333 DOI: 10.4329/wjr.v2.i8.298] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 07/29/2010] [Accepted: 08/05/2010] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis is characterized by acute chemical injury of the pancreatic parenchyma and peripancreatic tissue. The increased frequency of death in acute pancreatitis is directly correlated with the degree and progress of pancreatic necrosis. Moreover, the occurrence of some local complications in acute pancreatitis, such as pancreatic hemorrhage, peripancreatic abscess or large pseudocyst, and pseudoaneurysm, could influence the choice of treatment for these patients. Magnetic resonance imaging (MRI) can be used to help evaluate the presence and degree of pancreatic necrosis, and is crucial for identifying complications of acute pancreatitis and predicting prognosis. The purpose of this article is to describe MRI techniques for acute pancreatitis, to review the spectrum of pancreatic and peripancreatic patterns, as well as to survey various complications secondary to acute pancreatitis on MRI. The role of MRI in the initial evaluation and staging of acute pancreatitis is emphasized.
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