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Zhang XY, Li C, Lin J, Zhou Y, Shi RZ, Wang ZY, Jiang HB, Wang YY. Intestinal obstruction caused by early stage primary ileum adenocarcinoma: A case report and review of literature. World J Gastrointest Oncol 2025; 17:104919. [DOI: 10.4251/wjgo.v17.i4.104919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 02/06/2025] [Accepted: 02/25/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Ileum adenocarcinoma (IA), a type of small bowel adenocarcinoma, is a rather uncommon factor associated with obstruction in small bowel. Owing to its location and indefinite clinical symptoms, the diagnosis of IA is difficult, and survival is usually poor. With respect to the rarity of this disease, very few studies have reported such cases to provide a reference for treatment.
CASE SUMMARY In this manuscript, a case of a 48-year-old man presented with chronic right lower abdominal pain and distention, queasiness and emesis. A computed tomography scan revealed intestinal wall thickening and an intestinal obstruction in the terminal ileum. He was diagnosed with inflammatory bowel disease. However, his symptoms were not relieved after conservative treatment. The patient subsequently underwent exploratory laparotomy, and a tumour in the ileum measuring approximately 2.0 cm × 2.0 cm that was located 20 cm from the ileocolic valve was discovered incidentally and was operatively resected along with the enlarged lymph nodes. Pathological examination revealed a stage IIA (T3N0M0) ulcerative IA. Along with imaging examinations, a diagnosis of primary IA with no lymph or distant metastases was considered. The patient was discharged and recovered well as of the writing of this manuscript.
CONCLUSION IA should be considered as a differential diagnosis in cases of intestinal obstruction, and the recommended method for local disease treatment is surgery.
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Affiliation(s)
- Xiao-Yue Zhang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Chao Li
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jie Lin
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yan Zhou
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Rui-Zhe Shi
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Zhong-Yu Wang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Hai-Bo Jiang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yuan-Yuan Wang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Hong M, Lin Z, Zhong H, Zhang Y, Yang D, Zhong S, Zhuang X, Yue X. Improved Diagnostic Performance Using Dual-Energy CT-Derived Slope Parameter Images in Crohn's Disease. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01330-4. [PMID: 39538051 DOI: 10.1007/s10278-024-01330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 10/19/2024] [Accepted: 11/02/2024] [Indexed: 11/16/2024]
Abstract
The objective of the study is to explore the image quality and diagnosis performance of the dual-energy CT-derived slope parameter images (SPI) generated by the algorithm based on the slope function in the diagnosis of Crohn's disease (CD). Seventy-six CD patients and 53 disease-free control group subjects who underwent dual-energy CT enterography were retrospectively collected. Portal venous phase 120kVp-like and virtual monoenergetic images at 40-100 keV (VMI40-100) were reconstructed. SPIs corresponding to the spectral curve between 40 and 100 keV (SPI40-100) were generated using Python. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of normal and abnormal intestinal walls were calculated. Image quality, noise, and contrast were independently scored by two radiologists using a 5-point scale. Four radiologists conducted CD diagnosis with three reading models (120kVp-like, 120kVp-like with optimal VMI, and 120kVp-like with SPI40-100). The diagnostic performances of the three reading models for diagnosing CD were evaluated using receiver operating characteristic (ROC) curves. The CNR in SPI40-100 was higher than in the other images (P < 0.05). The subjective evaluation showed that there was no statistical difference between the contrast of SPI40-100 and VMI40 (P > 0.05), but that of the two images was higher than the other images (P < 0.05). The scoring on the overall image quality of VMI50 was superior to that of other images (P < 0.05). The combined model of 120kVp-like with SPI40-100 had the strongest confidence (cases with high confidence: 36, 58, 49, 47 for radiologists 1, 2, 3, 4) and the highest efficiency in diagnosing CD (areas under the ROC curve: 0.973, 0.977, 0.982, 0.991 for radiologists 1, 2, 3, 4). SPI40-100 generated by the algorithm based on the slope function exhibited good image quality. The combined model of 120kVp-like with SPI40-100 could improve radiologists' diagnostic efficiency and confidence in diagnosing CD.
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Affiliation(s)
- Min Hong
- Department of Radiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, No. 2999 Jinshan Road, Huli District, Xiamen, 361004, Fujian Province, China
| | - Ziying Lin
- Department of Radiology, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, No. 201-209 Hubinnan Road, Siming District, Xiamen, 361004, Fujian Province, China
| | - Hua Zhong
- Department of Radiology, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, No. 201-209 Hubinnan Road, Siming District, Xiamen, 361004, Fujian Province, China
| | - Yan Zhang
- The Second Department of Radiology, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, Fujian Province, China
| | - Dan Yang
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Sihui Zhong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Xiangrong Zhuang
- Department of Radiology, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, No. 201-209 Hubinnan Road, Siming District, Xiamen, 361004, Fujian Province, China.
| | - Xin Yue
- Department of Radiology, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, No. 201-209 Hubinnan Road, Siming District, Xiamen, 361004, Fujian Province, China.
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Tu H, Chen Q, Tu J, Dong B, Zhu F, Wang S, Dai Y, Chen X. Small Bowel Gastrointestinal Stromal Tumors: The Value of CT Enterography in Assessing Pathological Aggressiveness. J Comput Assist Tomogr 2024; 48:713-718. [PMID: 38626734 DOI: 10.1097/rct.0000000000001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
OBJECTIVE This study aimed to characterize the computed tomography (CT) enterography features of the small bowel gastrointestinal stromal tumors (GIST) and to determine the association with pathological aggressiveness. METHODS Computed tomography enterography images of 30 patients with the histologically confirmed small bowel GIST were retrospectively enrolled. Tumor size, location, border, growth pattern, enhancement pattern, necrosis, calcification, ulceration, internal air, nodal metastasis, liver metastasis, peritoneal metastasis, and draining vein were evaluated. Relationships between imaging features and pathological aggressiveness were analyzed using χ 2 test or Fisher exact test. Correlations among CT features were analyzed using Spearman correlation analysis. RESULTS There were significant differences in tumor size between different risk levels ( F = 8.388, P < 0.001). There were statistically significant differences in the 5 imaging manifestations of necrosis, ulcer, tumor boundary, drainage vein, and intratumoral gas ( P < 0.05). There was a significant negative correlation between tumor size and enhancement type as well as clear tumor boundary. There was a significant positive correlation between tumor size and necrosis, ulcer, drainage vein, intratumoral gas, liver metastasis, and peritoneal metastasis. CONCLUSIONS Some CT enterography imaging features might be useful in the determination of the pathological aggressiveness in the patients with small bowel GIST.
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Affiliation(s)
| | | | | | | | - Feng Zhu
- From the Departments of Radiology
| | | | - Yanmiao Dai
- Gastroenterology, Kunshan Hospital of Chinese Medicine
| | - Xu Chen
- Department of Radiology, The First People's Hospital of Kunshan, Suzhou, Jiangsu Province, China
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Wu S, Yu H, Liu Y, Zhou H, Zhou Y. Small bowel adenocarcinoma of the jejunum detected by double contrast enhanced ultrasound: a case report of a novel ultrasound modality. Front Oncol 2024; 14:1288041. [PMID: 38962263 PMCID: PMC11219900 DOI: 10.3389/fonc.2024.1288041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Background Small Bowel Adenocarcinoma (SBA) is rare, occult and life-threatening malignancy in digestive system. Given low incidence and nonspecific symptoms, SBA is frequently detected in later stages. Double contrast enhanced ultrasound (DCEUS) is an innovative imaging technique applied to visualize the gastrointestinal tract, merging intravenous contrast-enhanced ultrasound with oral contrast-enhanced ultrasound. In this case, DCEUS was utilized and successfully detected an SBA of the jejunum. Case presentation A Chinese woman, aged 64, sought consultation in the gastroenterology department at our hospital, reporting symptoms of abdominal pain. Three months before entering the hospital, she underwent gastroscopy and colonoscopy which suggested chronic gastritis, and she was treated with oral drugs. However, her symptoms were not relieved, and even worsened. To further investigate, DCEUS was performed. The oral contrast agent dilated the luminal space of the upper gastrointestinal tract, resolving the hindrance caused by gas in the gastrointestinal tract and creating an acoustic window for scanning. Through this acoustic window, oral agent contrast-enhanced ultrasound (OA-CEUS) revealed a localized thickening of jejunal intestinal wall measuring 4x3 cm. Following intravenous injection of ultrasound contrast agent, the jejunal lesion exhibited faster enhancement and heterogeneous hyper-enhancement. Finally, the patient underwent jejunal tumor resection. Pathological examination revealed a jejunal adenocarcinoma. Conclusion The timely diagnosis of SBA can be challenging. DCEUS may have the potential to contribute to diagnosis and detailed evaluation of SBA, particularly in cases involving jejunum. Further researches are needed to fully explore the benefits of DCEUS in the standard diagnostic approach for small bowel diseases.
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Affiliation(s)
| | | | | | | | - Yang Zhou
- Department of Medical Ultrasound, Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
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Sun YN, Li YY, Zheng MQ, Liang YF, Ji R, Yang XX, Qu JY, Li Z, Zuo XL, Li YQ. Individualized small bowel preparation for computed tomography enterography: A prospective randomized controlled trial. J Gastroenterol Hepatol 2024; 39:1008-1015. [PMID: 38326979 DOI: 10.1111/jgh.16473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/01/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND AIM The study aims to evaluate the feasibility of body mass index (BMI)-based individualized small bowel preparation for computed tomography enterography (CTE). METHODS In this prospective randomized controlled study, patients undergoing CTE were randomly assigned to the individualized group or standardized group. Those in individualized group were given different volumes of mannitol solution based on BMI (1000 mL for patients with BMI < 18.5 kg/m2, 1500 mL for patients with 18.5 kg/m2 ≤ BMI < 25 kg/m2 and 2000 mL for patients with BMI ≥ 25 kg/m2) while patients in the standardized group were all asked to consume 1500-mL mannitol solution. CTE images were reviewed by two experienced radiologists blindly. Each segment of the small bowel was assessed for small bowel image quality and disease detection rates. Patients were invited to record a diary regarding adverse events and acceptance. RESULTS A total of 203 patients were enrolled and randomly divided into two groups. For patients with BMI < 18.5 kg/m2, 1000-mL mannitol solution permitted a significantly lower rate of flatulence (P = 0.045) and defecating frequency (P = 0.011) as well as higher acceptance score (P = 0.015), but did not affect bowel image quality and diseases detection compared with conventional dosage. For patients with BMI ≥ 25 kg/m2, 2000-mL mannitol solution provided better overall image quality (P = 0.033) but comparable rates of adverse events and patients' acceptance compared with conventional dosage. CONCLUSIONS Individualized bowel preparation could achieve both satisfactory image quality and patients' acceptance thus might be an acceptable alternative in CTE.
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Affiliation(s)
- Yi-Ning Sun
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yue-Yue Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Meng-Qi Zheng
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yong-Feng Liang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao-Xiao Yang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Jun-Yan Qu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
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Rossi RE, Busacca A, Brandaleone L, Masoni B, Massironi S, Fraquelli M, Repici A. Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound? Curr Gastroenterol Rep 2023; 25:430-439. [PMID: 37979097 DOI: 10.1007/s11894-023-00907-3] [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] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW The incidence of celiac disease (CD) has increased over the last decades in part due to better disease awareness. Small bowel ultrasound (sb US) enables dynamic assessment of the bowel; although this topic has been addressed, the use of sb US in the diagnosis and in the follow-up of CD patients is limited to a few specialized tertiary referral centers. Herein, we aimed at summarizing the available literature on this topic to better define the potential clinical implications of sb US in CD, also through a comparison with other available diagnostic techniques. RECENT FINDINGS According to available data, sb US can be of help in confirming or excluding CD in patients with clinical suspicion; specifically, the finding of increased gall bladder volume, free abdominal fluid and enlargement of mesenteric lymph nodes reliably and accurately predicts the diagnosis of CD, whereas the absence of bowel dilatation and increased peristalsis may exclude the diagnosis. However, the place of intestinal US in the diagnostic algorithm of CD is likely to vary depending on the probability of the disease in a given population. There are only a few studies on the role of sb US in complicated CD, even if recent reports suggest a possible clinical role. There is a lack of data on follow-up of CD patients, particularly with the aim of detecting a poor diet adherence. According to current data sb US parameters have been shown to be of value in confirming and excluding the diagnosis of CD. Prospective studies with large sample size are warranted to determine whether to include sb US in the available guidelines for CD diagnosis and monitoring.
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Affiliation(s)
- Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Anita Busacca
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Brandaleone
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Benedetta Masoni
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Ospedale San Gerardo, and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Repici
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
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Wang Y, Zhang X, Yang Z, Wang T, Zhu D, Gao J, Zhang PP, Wang P, Shi X. Long-term follow-up of endoscopic papillectomy and the value of preventive pancreatic stent placement (with videos). Gastroenterol Rep (Oxf) 2023; 11:goad050. [PMID: 37867926 PMCID: PMC10585593 DOI: 10.1093/gastro/goad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023] Open
Abstract
Background Early-stage ampullary adenomas have only been reported in a small case series on endoscopic management. Hence, this study aimed to evaluate the long-term outcomes of early ampullary adenoma with endoscopic management and identify the risk factors for acute pancreatitis after endoscopic papillectomy (EP). Methods In this study, 115 patients who underwent EP at Changhai Hospital (Shanghai, China) between January 2012 and December 2018 were retrospectively analysed. Endoscopy was performed at 1, 3, 6, and 12 months after EP. Data were statistically analysed using the t-test or the Mann-Whitney U test. Results A total of 107 patients were included in this study and the follow-up period was 75 ± 43 months. The average age of the 107 patients was 54.6 years and the average tumor size was 17 mm. The average age of the patients (53.7 ± 10.7 years vs 55.2 ± 10.5 years, P = 0.482), minimum tumor size (13 vs 19 mm, P = 0.063), and complete resection rate (84.78% vs 85.25%, P = 0.947) did not differ significantly between the stent placement and non-stent placement groups. Post-EP acute pancreatitis rates in the non-stent placement and stent placement groups were 11.48% and 4.35%, respectively. The risk of post-EP acute pancreatitis was significantly associated with the preoperative carcinoembryonic antigen level in univariate analysis, but not in multivariate analysis. The risk of post-EP acute pancreatitis was not significantly associated with the placement of the pancreatic stent in either univariate or multivariate analysis. Moreover, delayed proximal pancreatic duct stenosis was not noted in either group during long-term follow-up. Conclusions EP is a satisfactory option for treating adenomas of the ampulla of the duodenum.
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Affiliation(s)
- Yuling Wang
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Xiaoqing Zhang
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Zhenhua Yang
- Department of Nephrology, Gongli Hospital, Pudong New Area, Shanghai, P. R. China
| | - Teng Wang
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Dongqing Zhu
- Department of Radiology, Changzheng Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Jie Gao
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Ping-Ping Zhang
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Peiqin Wang
- Department of Gastroenterology, Changzheng Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Xingang Shi
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
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Vlachou E, Koffas A, Toumpanakis C, Keuchel M. Updates in the diagnosis and management of small-bowel tumors. Best Pract Res Clin Gastroenterol 2023; 64-65:101860. [PMID: 37652650 DOI: 10.1016/j.bpg.2023.101860] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
Small-bowel tumors represent a rare entity comprising 0.6% of all new cancer cases in the US, and only 3% of all gastrointestinal neoplasms. They are a heterogenous group of neoplasms comprising of about forty different histological subtypes with the most common being adenocarcinoma, neuroendocrine tumors, stromal tumors and lymphomas. Their incidence has been reportedly increasing over recent years, partly owing to the advances and developments in the diagnostic modalities. Small-bowel capsule endoscopy, device assisted enteroscopy and dedicated small-bowel cross-sectional imaging are complimentary tools, supplementing each other in the diagnostic process. Therapeutic management of small-bowel tumors largely depends on the histological type and staging at diagnosis. The aim of the present review article is to discuss relevant advances in the diagnosis and management of small-bowel tumors.
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Affiliation(s)
- Erasmia Vlachou
- Evgenidion Clinic Agia Trias SA, Papadiamantopoulou 20, Athens, 11528, Greece.
| | - Apostolos Koffas
- Gastrointestinal and Liver Services, Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London, E1 1FR, UK.
| | - Christos Toumpanakis
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, Pond St, London, NW3 2QG, UK.
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Germany.
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Mitrovic N, Stevanovic D, Jasarovic D, Lazic A. Adenocarcinoma of the duodenojejunal flexure: our recent experience. Eur Surg 2023. [DOI: 10.1007/s10353-022-00792-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Epidemiology, Risk Factors and Diagnosis of Small Bowel Adenocarcinoma. Cancers (Basel) 2022; 14:cancers14092268. [PMID: 35565398 PMCID: PMC9103761 DOI: 10.3390/cancers14092268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/10/2022] [Accepted: 04/22/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Small bowel adenocarcinoma is a rare tumor. Diagnosis is often obtained at an advanced stage and prognosis remains poor. The aim of this review is to report the recent epidemiological and risk factor data related to small bowel adenocarcinoma. New diagnostic tools are also described in this review. Abstract Adenocarcinomas of the small intestine are rare tumors but their incidence is increasing. There is a slight male predominance. The median age at diagnosis is the 6th decade. The most frequent primary location is the duodenum. There is no clearly identified environmental risk factor, but adenocarcinomas of the small intestine are associated in almost 20% of cases with predisposing diseases (Crohn’s disease, Lynch syndrome, familial adenomatous polyposis, Peutz–Jeghers syndrome and celiac disease).
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Routine contrast-enhanced CT is insufficient for TNM-staging of duodenal adenocarcinoma. Abdom Radiol (NY) 2022; 47:3436-3445. [PMID: 35864264 PMCID: PMC9463261 DOI: 10.1007/s00261-022-03589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Adequate TNM-staging is important to determine prognosis and treatment planning of duodenal adenocarcinoma. Although current guidelines advise contrast-enhanced CT (CECT) for staging of duodenal adenocarcinoma, literature about diagnostic tests is sparse. METHODS In this retrospective single-center cohort study, we analyzed the real life performance of routine CECT for TNM-staging and the assessment of resectability of duodenal adenocarcinoma. Intraoperative findings and pathological staging served as reference standard for resectability, T-, and N-staging. Biopsies, 18FDG-PET-CT, and follow-up were used as the reference standard for M-staging. RESULTS Fifty-two consecutive patients with duodenal adenocarcinoma were included, 26 patients underwent resection. Half of the tumors were isodense to normal duodenum on CECT. The tumor was initially missed in 7/52 patients (13%) on CECT. The correct T-stage was assigned with CECT in 14/26 patients (54%), N-stage in 11/26 (42%), and the M-stage in 42/52 (81%). T-stage was underestimated in (27%). The sensitivity for detecting lymph node metastases was only 24%, specificity was 78%. Seventeen percent of patients had indeterminate liver or lung lesions on CECT. Surgery with curative intent was started in 32 patients, but six patients (19%) could not be resected due to unexpected local invasion or metastases. CONCLUSION Radiologists and clinicians have to be aware that routine CECT is insufficient for staging and determining resectability in patients with duodenal adenocarcinoma. CECT underestimates T-stage and N-stage, and M-stage is often unclear, resulting in futile surgery in 19% of patients. Alternative strategies are required to improve staging of duodenal adenocarcinoma. We propose to combine multiphase hypotonic duodenography CT with MRI.
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Chen J, Zhou J, Yang J, Cong R, Sun J, Xiao J, Shi J, He B. Efficiency of dual-energy computed tomography enterography in the diagnosis of Crohn's disease. BMC Med Imaging 2021; 21:185. [PMID: 34861843 PMCID: PMC8642845 DOI: 10.1186/s12880-021-00716-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background This retrospective study aimed to investigate the usefulness of the optimized kiloelectron volt (keV) for virtual monoenergetic imaging (VMI) combined with iodine map in dual-energy computed tomography enterography (DECTE) in the diagnosis of Crohn’s disease (CD).
Methods Seventy-two patients (mean age: 41.89 ± 17.28 years) with negative computed tomography enterography (CTE) were enrolled for investigating the optimized VMI keV in DECTE by comparing subjective and objective parameters of VMIs that were reconstructed from 40 to 90 keV. Moreover, 68 patients (38.27 ± 15.10 years; 35 normal and 33 CD) were included for evaluating the diagnostic efficacy of DECTE iodine map at the optimized VMI energy level and routine CTE for CD and active CD. Statistical analysis for all data was conducted.
Results Objective and subjective imaging evaluations showed the best results at 60 keV for VMIs. The CT values of the normal group, active subgroup, and CD group during the small intestinal phase at routine 120 kVp or 60 keV VMI had significant differences. The diagnostic efficacy of an iodine map was the best when NIC = 4% or fat value = 45.8% for CD, whereas NIC < 0.35 or the fat value < 0.38 for active CD. The combined routine CTE and optimized VMI improved the diagnostic efficacy (P < 0.001). Conclusions VMI at 60 keV provided the best imaging quality on DECTE. NIC and fat value provided important basis for active CD evaluation. Routine CTE combined with VMI at 60 keV improved the diagnostic efficiency for CD. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00716-y.
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Affiliation(s)
- Jinghao Chen
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong City, 226001, Jiangsu Province, China
| | - Jie Zhou
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong City, 226001, Jiangsu Province, China.,Department of Radiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou City, 213000, Jiangsu Province, China
| | - Jushun Yang
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong City, 226001, Jiangsu Province, China
| | - Ruochen Cong
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong City, 226001, Jiangsu Province, China
| | - Jinjie Sun
- Gastrointestinal Surgery, Affiliated Hospital 2 of Nantong University, Nantong City, 226001, Jiangsu Province, China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong City, 226019, Jiangsu Province, China
| | - Jianhua Shi
- Department of Biochemistry, Nantong University Medical School, Nantong City, 226019, Jiangsu Province, China
| | - Bosheng He
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong City, 226001, Jiangsu Province, China. .,Clinical Medicine Research Center, Affiliated Hospital 2 of Nantong University, Nantong City, 226001, Jiangsu Province, China.
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Refardt J, Hofland J, Wild D, Christ E. New Directions in Imaging Neuroendocrine Neoplasms. Curr Oncol Rep 2021; 23:143. [PMID: 34735669 PMCID: PMC8568754 DOI: 10.1007/s11912-021-01139-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 12/14/2022]
Abstract
Purpose of Review Accurate imaging is crucial for correct diagnosis, staging, and therapy of neuroendocrine neoplasms (NENs). The search for the optimal imaging technique has triggered rapid development in the field. This review aims at giving an overview on contemporary imaging methods and providing an outlook on current progresses. Recent Findings The discovery of molecular targets due to the overexpression of specific peptide hormone receptors on the NEN’s surface has triggered the development of multiple radionuclide imaging modalities. In addition to the established imaging technique of targeting somatostatin receptors, several alternative radioligands have been developed. Targeting the glucagon-like peptide-1 receptor by exendin-4 has a high sensitivity in localizing insulinomas. For dedifferentiated NENs, new molecular targets such as the C-X-C motif chemokine-receptor-4 have been evaluated. Other new targets involve the fibroblast activation protein and the cholecystokinin-2 receptors, where the ligand minigastrin opens new possibilities for the management of medullary thyroid carcinoma. Summary Molecular imaging is an emerging field that improves the management of NENs.
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Affiliation(s)
- Julie Refardt
- Department of Internal Medicine, Section of Endocrinology, ENETS Center of Excellence, Erasmus Medical Center, Rotterdam, the Netherlands.,ENETS Center of Excellence for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Johannes Hofland
- Department of Internal Medicine, Section of Endocrinology, ENETS Center of Excellence, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Damian Wild
- ENETS Center of Excellence for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Division of Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Emanuel Christ
- ENETS Center of Excellence for Neuroendocrine and Endocrine Tumors, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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14
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Zhou Z, Lu J, Morelli JN, Hu D, Li Z, Xiao P, Hu X, Shen Y. Utility of noncontrast MRI in the detection and risk grading of gastrointestinal stromal tumor: a comparison with contrast-enhanced CT. Quant Imaging Med Surg 2021; 11:2453-2464. [PMID: 34079715 PMCID: PMC8107337 DOI: 10.21037/qims-20-578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recently developed adjuvant therapies for gastrointestinal stromal tumor (GIST) have been shown to improve patient survival. Guidelines currently recommend contrast-enhanced computed tomography (CECT) for GIST detection and surveillance. Patients with moderate-to-high risk GISTs require more frequent surveillance due to a higher 5-year recurrence rate. Our study aimed to compare noncontrast magnetic resonance imaging (MRI) with CECT for GIST detection, and evaluate volumetric apparent diffusion coefficients (ADCs) for risk stratification of GIST. METHODS We retrospectively enrolled 83 patients with histopathologically confirmed GISTs for lesion detection efficiency analysis between noncontrast MRI and matched CECT studies. A 5-point scale was used by two independent reviewers to determine if the lesion was present or absent. Another cohort, comprising 28 patients with pathologically confirmed primary GISTs, was further screened for risk stratification, with a comparison of volumetric ADC parameters between the pathologically very-low-to-low risk and moderate-to-high risk GIST patients. RESULTS For identifying GISTs, the sensitivity and specificity of noncontrast MRI were 83.6% and 89.3% for reader 1 respectively, and 81.8% and 92.9% for reader 2 respectively; the sensitivity and specificity of CECT were 76.4% and 89.3% for reader 1 respectively, and 76.4 and 78.6% for reader 2 respectively. Tumor volumetric ADC histogram parameters, including ADCmax, ADCstdev, 90th and 95th percentiles, inhomogeneity, and entropy, were positively correlated with a higher risk grade of GIST (r=0.421-0.758). The receiver operator characteristic curve analysis showed ADCmax achieved the highest area under the curve value of 0.938 for discriminating very-low-to-low risk versus moderate-to-high risk GISTs. CONCLUSIONS Noncontrast MRI was an efficient technique for identifying GIST patients. The combination of CECT and noncontrast MRI can improve the reliability of diagnosis. For patients with contraindications to CECT, noncontrast MRI may be a comparable alternative. Volumetric ADC histogram parameters may be useful in differentiating very-low-to-low risk from moderate-to-high risk primary GISTs.
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Affiliation(s)
- Ziling Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyu Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - John N. Morelli
- Department of Radiology, St. John’s Medical Center, Tulsa, OK, USA
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Xiao
- Biomedical Engineering Department, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Morse B, Al-Toubah T, Montilla-Soler J. Anatomic and Functional Imaging of Neuroendocrine Tumors. Curr Treat Options Oncol 2020; 21:75. [PMID: 32728967 DOI: 10.1007/s11864-020-00770-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Neuroendocrine tumors (NETs) can occur in a wide variety of organs and display a spectrum of pathologic behavior. Accurate and effective imaging is paramount to the diagnosis, staging, therapy, and surveillance of patients with NET. There have been continuous advancements in the imaging of NET which includes anatomic and functional techniques.
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Affiliation(s)
- Brian Morse
- Department of Diagnostic Imaging, Moffitt Cancer Center, 12902 Magnolia Drive, WCB-RAD, Tampa, FL, 33612, USA.
| | - Taymeyah Al-Toubah
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
| | - Jaime Montilla-Soler
- Department of Diagnostic Imaging, Moffitt Cancer Center, 12902 Magnolia Drive, WCB-RAD, Tampa, FL, 33612, USA
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16
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Yu H, Wang Y, Wang Z, Li J, Lu J, Hu D. Prospective comparison of diffusion-weighted magnetic resonance enterography and contrast enhanced computed tomography enterography for the detection of ileocolonic Crohn's disease. J Gastroenterol Hepatol 2020; 35:1136-1142. [PMID: 31785602 DOI: 10.1111/jgh.14945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) is a chronic and relapsing course with various status of different segments, and there were no investigations comparing the lesion detection between magnetic resonance (MR) and computed tomography (CT) in term of the severity of CD. We aim to assess the performances of diffusion-weighted MR enterography (DW-MRE) and contrast enhanced CT enterography (CTE) for detecting different grade lesions in ileocolonic CD. METHODS Forty-one consecutive patients finally diagnosed with ileocolonic CD were included. All the patients prospectively underwent DW-MRE, contrast enhanced CTE, and ileocolonoscopy within 2 weeks. DW-MRE and CTE images were interpreted for the presence or absence of active CD segments by two experienced radiologists independently. Ileocolonic segments (terminal ileum, right colon, transverse colon, left colon, and rectum) were graded as inactive (0-2), mild (3-6), or moderate-severe (≥ 7) by the simplified endoscopic score for CD (SES-CD). Diagnostic efficiencies of DW-MRE and CTE for mild and/or moderate-severe CD segments were calculated and compared, using ileocolonoscopy as reference standard. RESULTS According to SES-CD, 190 ileocolonic segments from 41 CD patients were scored as 91 inactive, 68 mild, and 31 moderate-severe CD lesions. The sensitivity of DW-MRE for detecting active from inactive segments was higher than that of CTE, and the specificities of them had no significant differences. As for the subgroup analysis, DW-MRE was more sensitive for mild CD lesions than CTE (76.5% vs 60.3%; P = 0.019), while the sensitivities for moderate-severe CD were similar between these two modalities (96.8% for DW-MRE and 93.5% for CTE; P = 1.00). CONCLUSIONS Both DW-MRE and CTE had comparably excellent performances for moderate-severe CD detection; DW-MRE demonstrated better sensitivity in mild lesions compared with CTE and could be more suitable for the diagnosis of mild CD.
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Affiliation(s)
- Hao Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yanchun Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyu Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Masselli G, Guida M, Laghi F, Polettini E, Gualdi G. Magnetic Resonance of Small Bowel Tumors. Magn Reson Imaging Clin N Am 2019; 28:75-88. [PMID: 31753238 DOI: 10.1016/j.mric.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. 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 tumors of the small bowel. Intraluminal and extraluminal MR findings, combined with contrast enhancement and functional information, allow accurate diagnoses and consequently characterization of small bowel neoplasms. This article describes the MR findings of primary small bowel neoplasms and the MR findings for the differential diagnosis are discussed.
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Affiliation(s)
- Gabriele Masselli
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy.
| | - Marianna Guida
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesca Laghi
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Elisabetta Polettini
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
| | - Gianfranco Gualdi
- Radiology Department, Umberto I Hospital Sapienza University, Viale del Policlinico 155, Rome 00161, Italy
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18
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Khoshpouri P, Habibabadi RR, Hazhirkarzar B, Ameli S, Ghadimi M, Ghasabeh MA, Menias CO, Kim A, Li Z, Kamel IR. Imaging Features of Primary Sclerosing Cholangitis: From Diagnosis to Liver Transplant Follow-up. Radiographics 2019; 39:1938-1964. [DOI: 10.1148/rg.2019180213] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Pegah Khoshpouri
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Roya Rezvani Habibabadi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Bita Hazhirkarzar
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Sanaz Ameli
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Maryam Ghadimi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Mounes Aliyari Ghasabeh
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Christine O. Menias
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Amy Kim
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Zhiping Li
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Ihab R. Kamel
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
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Masselli G, De Vincentiis C, Aloi M, Guida M, Cao R, Cartocci G, Miele V, Grassi R. Detection of Crohn’s disease with diffusion images versus contrast-enhanced images in pediatric using MR enterography with histopathological correlation. Radiol Med 2019; 124:1306-1314. [DOI: 10.1007/s11547-019-01067-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023]
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Saade C, Nasr L, Sharara A, Barada K, Soweid A, Murad F, Tawil A, Ghieh D, Asmar K, Tamim H, Khoury NJ. Crohn's disease: A retrospective analysis between computed tomography enterography, colonoscopy, and histopathology. Radiography (Lond) 2019; 25:349-358. [PMID: 31582244 DOI: 10.1016/j.radi.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION To investigate the spectrum of computed tomography enterography (CTE) findings of active Crohn's disease (CD) in comparison to endoscopic, histopathologic and inflammatory markers. METHODS Hospital records of 197 patients with known or suspected CD who underwent CTE over a period of 5 years were reviewed. Eighty-nine patients fulfilled the inclusion criteria. Three-point severity scores for endoscopy, pathology, and haematologic inflammatory markers were recorded. The findings on CTE were identified by three readers and correlated with endoscopic, pathologic, and haematologic severity scores. Statistical analysis was carried out employing a Pearson Chi square test and Fisher exact test. Receiver operating characteristic (ROC), visual grading characteristic (VGC) and Cohens' kappa analyses were performed. RESULTS The CTE findings which were significantly correlated with the severity of active disease on endoscopy include bowel wall thickening, mucosal hyperenhancement, bilaminar stratified wall enhancement, transmural wall enhancement, and mesenteric fluid adjacent to diseased bowel (p < 0.05). Only bowel wall thickening and bilaminar stratified wall enhancement correlated with the pathological severity of active CD. ROC and VGC analysis demonstrated significantly higher areas under the curve (p < 0.0001) together with excellent inter-reader agreement (k = 0.86). CONCLUSION CTE is a reliable tool for evaluating the severity of active disease and helps in the clinical decision pathway.
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Affiliation(s)
- C Saade
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - L Nasr
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - A Sharara
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - K Barada
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - A Soweid
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - F Murad
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon.
| | - A Tawil
- Department of Pathology, American University of Beirut Medical Center, Lebanon.
| | - D Ghieh
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - K Asmar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
| | - H Tamim
- Biostatistics Unit at the Clinical Research Institute, American University of Beirut, Lebanon.
| | - N J Khoury
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Lebanon.
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Arasaradnam RP, Brown S, Forbes A, Fox MR, Hungin P, Kelman L, Major G, O'Connor M, Sanders DS, Sinha R, Smith SC, Thomas P, Walters JRF. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67:1380-1399. [PMID: 29653941 PMCID: PMC6204957 DOI: 10.1136/gutjnl-2017-315909] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/28/2018] [Accepted: 03/11/2018] [Indexed: 02/07/2023]
Abstract
Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.
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Affiliation(s)
- Ramesh P Arasaradnam
- University Hospital Coventry, Coventry, UK
- Department of Applied Biological Sciences, University of Coventry, Coventry, UK
- Clinical Sciences Research Institute, University of Warwick, Warwick, UK
| | | | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mark R Fox
- University of Zürich, Zürich, Switzerland
- Abdominal Centre, St Claraspital, Basel, Switzerland
| | - Pali Hungin
- School of Medicine, Pharmacy & Health, University of Durham, Durham, UK
| | | | - Giles Major
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | | | - Rakesh Sinha
- Department of Radiology, South Warwickshire Hospitals, Warwick, UK
| | - Stephen Charles Smith
- Department of Clinical Biochemistry, Midlands and NW Bowel Cancer Screening Hub, Rugby, UK
| | - Paul Thomas
- Department of Gastroenterology, Musgrave Park Hospital, Taunton, UK
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Feng C, Zhu D, Zou X, Li A, Hu X, Li Z, Hu D. The combination of a reduction in contrast agent dose with low tube voltage and an adaptive statistical iterative reconstruction algorithm in CT enterography: Effects on image quality and radiation dose. Medicine (Baltimore) 2018; 97:e0151. [PMID: 29561422 PMCID: PMC5895339 DOI: 10.1097/md.0000000000010151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To investigate the subjective and quantitative image quality and radiation exposure of CT enterography (CTE) examination performed at low tube voltage and low concentration of contrast agent with adaptive statistical iterative reconstruction (ASIR) algorithm, compared with conventional CTE.One hundred thirty-seven patients with suspected or proved gastrointestinal diseases underwent contrast enhanced CTE in a multidetector computed tomography (MDCT) scanner. All cases were assigned to 2 groups. Group A (n = 79) underwent CT with low tube voltage based on patient body mass index (BMI) (BMI < 23 kg/m, 80 kVp; BMI ≥ 23 kg/m, 100 kVp) and low concentration of contrast agent (270 mg I/mL), the images were reconstructed with standard filtered back projection (FBP) algorithm and 50% ASIR algorithm. Group B (n = 58) underwent conventional CTE with 120 kVp and 350 mg I/mL contrast agent, the images were reconstructed with FBP algorithm. The computed tomography dose index volume (CTDIvol), dose length product (DLP), effective dose (ED), and total iodine dosage were calculated and compared. The CT values, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of the normal bowel wall, gastrointestinal lesions, and mesenteric vessels were assessed and compared. The subjective image quality was assessed independently and blindly by 2 radiologists using a 5-point Likert scale.The differences of values for CTDIvol (8.64 ± 2.72 vs 11.55 ± 3.95, P < .001), ED (6.34 ± 2.24 vs 8.52 ± 3.02, P < .001), and DLP (422.6 ± 149.40 vs 568.30 ± 213.90, P < .001) were significant between group A and group B, with a reduction of 25.2%, 25.7%, and 25.7% in group A, respectively. The total iodine dosage in group A was reduced by 26.1%. The subjective image quality did not differ between the 2 groups (P > .05) and all image quality scores were greater than or equal to 3 (moderate). Fifty percent ASIR-A group images provided lower image noise, but similar or higher quantitative image quality in comparison with FBP-B group images.Compared with the conventional protocol, CTE performed at low tube voltage, low concentration of contrast agent with 50% ASIR algorithm produce a diagnostically acceptable image quality with a mean ED of 6.34 mSv and a total iodine dose reduction of 26.1%.
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23
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Kim JS, Park SH, Hansel S, Fletcher JG. Imaging and Screening of Cancer of the Small Bowel. Radiol Clin North Am 2017; 55:1273-1291. [DOI: 10.1016/j.rcl.2017.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Barat M, Dohan A, Dautry R, Barral M, Boudiaf M, Hoeffel C, Soyer P. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98:663-675. [PMID: 28185840 DOI: 10.1016/j.diii.2017.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.
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Affiliation(s)
- M Barat
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Dohan
- Department of Radiology, McGill University Health Centre, Montreal General and Royal Victoria Hospitals, Montreal, Canada.
| | - R Dautry
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Barral
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Boudiaf
- Pôle santé du plateau, 3/5, avenue de Villacoublay, 92360 Meudon-La-Forêt, France.
| | - C Hoeffel
- Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France.
| | - P Soyer
- Medicine department, Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
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Correlation of 18F-FDG PET/MRE Metrics with Inflammatory Biomarkers in Patients with Crohn's Disease: A Pilot Study. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:7167292. [PMID: 29097934 PMCID: PMC5625758 DOI: 10.1155/2017/7167292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/03/2017] [Indexed: 12/22/2022]
Abstract
Background To investigate the association between 18F-FDG (Fluorodeoxyglucose) PET (positron emission tomography)/MRE (magnetic resonance enterography) metrics with the inflammatory biomarkers fecal calprotectin and C-reactive protein (CRP) in patients with Crohn's disease (CD). Methods This prospective pilot study was institutional review board (IRB) approved with informed consent obtained. Consecutive CD patients were referred to 18F-FDG PET/MRE. Patients in whom colonoscopy was performed and CRP and fecal calprotectin levels were measured were included. CRP and fecal calprotectin were regarded as positive for inflammation if they were greater than 0.5 mg/dl and 150 mcg/g, respectively. Correlation of quantitative variables was performed using the Pearson's correlation coefficient. Receiver operating characteristic (ROC) curves were drawn and the area under the curve (AUC) was calculated to evaluate the accuracy of PET and MRE metrics in determining the presence of inflammation evaluated by calprotectin and CRP levels. Results Analysis of 21 patients (16 women and 5 men, 43 ± 18 years) was performed. Magnetic resonance index of activity (MaRIA) score had an AUC of 0.63 associated with fecal calprotectin and CRP. Adding apparent diffusion coefficient (ADC) and metabolic inflammatory volume (MIV) to MaRIA score resulted in an AUC of 0.92 with a cutoff value of 447 resulting in 83% and 100% sensitivity and specificity, respectively. Conclusion The addition of ADC and MIV to the MaRIA score increases the accuracy for discrimination of disease activity in patients with CD. Trial registration number is 2015062.
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Split-Bolus Injection Producing Simultaneous Late Arterial and Portal Venous Phases in CT Enterography: Preliminary Results. AJR Am J Roentgenol 2017; 209:1056-1063. [PMID: 28813197 DOI: 10.2214/ajr.17.18034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to evaluate the image quality and added value of split-bolus contrast agent injection combining late arterial and portal venous phases compared with single-bolus contrast agent injection late arterial phase CT enterography. MATERIALS AND METHODS Consecutive patients who underwent CT enterography before and after implementation of a single-bolus CT enterography protocol were included. Attenuation and contrast-to-noise ratio (CNR) were assessed by ROI measurements of the bowel wall and arterial and venous structures. Subjective enhancement of the bowel wall (1, arterial; 2, mucosal; 3, transmural; 4, transmural with mucosal hyperenhancement) and bowel abnormalities were assessed by two independent readers. MR enterography examinations, endoscopy reports, and surgery reports within 30 days after CT enterography were used to produce a composite outcome. RESULTS Sixty-six patients were included in our study: 33 (mean [± SD] age, 46.0 ± 19.8 years) who underwent split-bolus CT enterography and 33 (mean age, 49.9 ± 19.0 years) who underwent single-bolus CT enterography. Bowel wall attenuation and CNR were higher for split-bolus CT enterography than for single-bolus CT enterography at 120 kVp (enhancement, 98.7 ± 23.1 HU vs 85.1 ± 23.3 HU; CNR, 6.4 ± 2.5 vs 4.4 ± 2.3; p < 0.01). Subjective ratings of bowel wall enhancement were higher with the split-bolus CT enterography than the single-bolus CT enterography (2.6 ± 0.8 vs 2.3 ± 0.6; p < 0.001). Split-bolus CT enterography led to a higher detection rate of mucosal hyperenhancement than did single-bolus CT enterography in patients with active inflammatory bowel disease (100.0% [7/7; 95% CI, 59.0-100.0%] vs 33.3% [2/6; 95% CI, 4.3-77.7%]; p = 0.02), whereas both protocols had a specificity of 100.0% (9/9). CONCLUSION Split-bolus CT enterography led to improved CNR (47%) compared with single-bolus CT enterography and significantly increased the detection rate of mucosal hyperenhancement in patients with active inflammatory bowel disease.
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Howe JR, Cardona K, Fraker DL, Kebebew E, Untch BR, Wang YZ, Law CH, Liu EH, Kim MK, Menda Y, Morse BG, Bergsland EK, Strosberg JR, Nakakura EK, Pommier RF. The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas 2017; 46:715-731. [PMID: 28609357 PMCID: PMC5502737 DOI: 10.1097/mpa.0000000000000846] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Small bowel neuroendocrine tumors (SBNETs) have been increasing in frequency over the past decades, and are now the most common type of small bowel tumor. Consequently, general surgeons and surgical oncologists are seeing more patients with SBNETs in their practices than ever before. The management of these patients is often complex, owing to their secretion of hormones, frequent presentation with advanced disease, and difficulties with making the diagnosis of SBNETs. Despite these issues, even patients with advanced disease can have long-term survival. There are a number of scenarios which commonly arise in SBNET patients where it is difficult to determine the optimal management from the published data. To address these challenges for clinicians, a consensus conference was held assembling experts in the field to review and discuss the available literature and patterns of practice pertaining to specific management issues. This paper summarizes the important elements from these studies and the recommendations of the group for these questions regarding the management of SBNET patients.
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Affiliation(s)
- James R Howe
- From the *Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA; †Department of Surgery, Winship Cancer Institute of Emory University, Atlanta, GA; ‡Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA; §Endocrine Oncology Branch, National Cancer Institute, Bethesda, MD; ∥Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY; ¶Department of Surgery, LSU Health Sciences Center, New Orleans, LA; #Department of Surgery, University of Toronto, Sunnybrook Health Sciences Center, Toronto, Canada; **Rocky Mountain Cancer Center, Denver, CO; ††Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; ‡‡Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA; §§Department of Radiology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL; ∥∥Department of Medicine, University of California San Francisco, San Francisco, CA; ¶¶Department of Medicine, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL; ##Department of Surgery, University of California San Francisco, San Francisco, CA; and ***Department of Surgery, Oregon Health & Science University, Portland, OR
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Vasconcelos RN, Dolan SG, Barlow JM, Wells ML, Sheedy SP, Fidler JL, Hansel S, Harmsen S, Fletcher JG. Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors. Abdom Radiol (NY) 2017; 42:1365-1373. [PMID: 28058449 DOI: 10.1007/s00261-016-1033-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Our purpose is to determine the impact of CT enterography on small bowel gastrointestinal stromal tumor (GIST) detection and biologic aggressiveness, and to identify any imaging findings that correlate with biologic aggressiveness. METHODS Records of patients with histologically confirmed small bowel GISTs who underwent CT imaging were reviewed. Biologic aggressiveness was based on initial histologic grading (very low, low, intermediate, high grade; or malignant), with upgrade to malignant category if local or distant metastases developed during clinical follow-up. Imaging indications, findings, and type of CT exam were compared with the biologic aggressiveness. RESULTS 111 small bowel GISTs were identified, with suspected small bowel bleeding being the most common indication (45/111; 40.5%). While the number of malignant GISTs diagnosed by CT remained relatively constant (2-3 per year), the number of non-malignant GISTs increased substantially (mean 1.5/year, 1998-2005; 8.4/year, 2006-2013). In patients with suspected small bowel bleeding, CT enterography identified 33 GISTs (7/33, 21% malignant) compared to 12 GISTs by abdominopelvic CT (6/12, 50% malignant; p < 0.03). Tumor size (p < 0.0001), internal necrosis (p = 0.005), internal air or enteric contrast (p ≤ 0.021), and ulceration (p ≤ 0.021) were significantly associated with high-grade and malignant tumors, and irregular or invasive tumor borders (p < 0.01) was associated with malignant tumors. CONCLUSION The detection of small bowel GISTs can increase due to the use of CT enterography in patients with suspected small bowel bleeding. The large majority of small bowel GISTs detected by CT enterography are not malignant.
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Rondonotti E, Koulaouzidis A, Yung DE, Reddy SN, Georgiou J, Pennazio M. Neoplastic Diseases of the Small Bowel. Gastrointest Endosc Clin N Am 2017; 27:93-112. [PMID: 27908521 DOI: 10.1016/j.giec.2016.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The incidence of small bowel tumors is increasing over time. Until recently, their diagnosis was delayed and it was often reached only at the time of surgery. New diagnostic tools, such as capsule endoscopy, device-assisted enteroscopy, and dedicated small bowel cross-sectional imaging techniques, have been introduced recently in clinical practice. The combination of these tools allows medical practitioners to detect small bowel tumors at an early stage and to reach a definite diagnosis before surgery, thus enabling minimally invasive treatments.
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Affiliation(s)
| | - Anastasios Koulaouzidis
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Diana E Yung
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Surekha N Reddy
- Department of Radiology, Western General Hospital, Crewe Road South, 51 Little France Crescent, Edinburgh EH3 9JD, UK
| | - Julius Georgiou
- Department of Electrical and Computer Engineering, University of Cyprus, Cyprus 1 University Avenue, Aglantzia 2109, Cyprus
| | - Marco Pennazio
- Division of Gastroenterology U, San Giovanni AS University-Teaching Hospital, Via Cavour 31, Torino 10123, Italy
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Zhang M, Zhang T, Hong L, Wu Q, Lin Y, Xie M, Fan R, Wang Z, Zhou J, Zhong J. Comparison of patients' tolerance between computed tomography enterography and double-balloon enteroscopy. Patient Prefer Adherence 2017; 11:1755-1766. [PMID: 29081651 PMCID: PMC5652905 DOI: 10.2147/ppa.s145562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Computed tomography enterography (CTE) and double-balloon enteroscopy (DBE) are widely used in diagnosis of small bowel diseases. Both of these examinations bring discomfort to patients. The aim of this study was to compare patients' tolerance and preference between CTE and DBE. METHODS From August 1, 2014 to December 31, 2016, patients with suspected or known small bowel diseases who underwent both CTE and DBE were prospectively enrolled in our study. They were asked to fill out a questionnaire evaluating discomfort of the procedure after each examination. RESULTS One hundred and seven patients completed our study. Abdominal distension, painfulness, tenesmus, general discomfort, prolonged duration, difficulty in completing the test, and discomfort after the examination were significantly lower with CTE than with DBE (P<0.001, respectively). Mannitol intake (47.7%), bowel preparation (31.9%), and radiation exposure (15.0%) were regarded as the three most intolerable burdens in CTE. Painfulness (38.3%), bowel preparation (26.2%), and invasiveness (16.8%) were considered as the three most unacceptable parts of DBE. More patients (61.7%) preferred to repeat CTE rather than DBE (P<0.001). CONCLUSION Compared to DBE, CTE was a more tolerable and less burdensome examination and enjoyed higher preference by most patients.
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Affiliation(s)
- Maochen Zhang
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Tianyu Zhang
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Liwen Hong
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Qiangqiang Wu
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Yun Lin
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Mengfan Xie
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Rong Fan
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Zhengting Wang
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Jie Zhou
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
- Correspondence: Jie Zhong; Jie Zhou, Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijiner Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email ;
| | - Jie Zhong
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of China
- Correspondence: Jie Zhong; Jie Zhou, Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijiner Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email ;
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O’Malley RB, Hansen NJ, Carnell J, Afzali A, Moshiri M. Update on MR Enterography: Potentials and Pitfalls. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0172-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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