Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity.

PURPOSE: To quantitatively assess microvascular activation in the thickened ileal walls of patients with Crohn disease (CD) by using contrast-enhanced ultrasonography (US) and evaluate its correlation with widely used indexes of CD activity. MATERIALS AND METHODS: This prospective study was approved by the ethics committee, and written informed consent was obtained from all patients. The authors examined 54 consecutively enrolled patients (mean age, 35.29 years; age range, 18-69 years; 39 men, 15 women) with endoscopically confirmed CD of the terminal ileum. Ileal wall segments thicker than 3 mm were examined with low-mechanical-index contrast-enhanced US and a second-generation US contrast agent. The authors analyzed software-plotted time-enhancement intensity curves to determine the maximum peak intensity (MPI) and wash-in slope coefficient (ß) and evaluated their correlation with (a) the composite index of CD activity (CICDA), (b) the CD activity index (CDAI), and (c) the simplified endoscopic score for CD (SES-CD, evaluated in 37 patients) for the terminal ileum. Statistical analysis was performed with the Mann-Whitney test, Spearman rank test, and receiver operating characteristic (ROC) analysis. RESULTS: MPI and ß coefficients were significantly increased in the 36 patients with a CICDA indicative of active disease (P<.0001 for both), the 33 patients with a CDAI of at least 150 (P<.032 and P<.0074, respectively), and the 26 patients with an SES-CD of at least 1 (P<.0001 and P<.002, respectively). ROC analysis revealed accurate identification (compared with CICDA) of active CD with an MPI threshold of 24 video intensity (VI) (sensitivity, 97%; specificity, 83%) and a ß coefficient of 4.5 VI/sec (sensitivity, 86%; specificity, 83%). CONCLUSION: Contrast-enhanced US of the ileal wall is a promising method for objective, reproducible assessment of disease activity in patients with ileal CD.

Ileal Crohn's disease: CEUS determination of activity.

Transabdominal ultrasound is currently accepted as a clinical first-line tool in the assessment of Crohn's disease activity. During recent years, great improvements have been achieved in ultrasound examination with the introduction of high-frequency transducers, ultrasonographic microbubble contrast agents, and dedicated contrast-specific ultrasound software. Therefore, contrast-enhanced ultrasonography (CEUS) is emerging as one of the most important imaging techniques in the diagnosis and follow-up of patients with ileal Crohn's disease. It is non-invasive and non-ionizing, easily repeatable, well-tolerated by patients and has significant diagnostic accuracy. Moreover, the possibility to monitor response to therapies, describing, and quantifying contrast enhancement behavior by specific software, represents an interesting aspect of its utilization, considering the still open questions about the correct use of immunosuppressive and biological agents. The aim of our review is to provide an updated overview of the role of CEUS in the patients who have an ileal localization of Crohn's disease, defining its qualitative and quantitative features.

Malabsorption syndromes.

Malabsorption syndromes are divided according to the underlying cause: maldigestion; bacterial contamination; mucosal abnormalities. One of the main causes of maldigestion are surgical resections. Malabsorption from bacterial contamination is due to a lower effectiveness of one or more of the factors that normally inhibit the growth of pathogens. The most common malabsorption syndrome from mucosal abnormalities is celiac disease for which, with small bowel enteroclysis a specific radiographic pattern has been identified. The gold standard in the diagnosis of diseases associated to malabsorption is represented by mucosal biopsy and histology though some patterns are similar and create difficulties in the differential diagnosis. Among radiologic examinations, small bowel enteroclysis is highly predictive; hopefully, novel diagnostic methods will support radiology.

Imaging of small bowel tumors.

Small bowel tumors represent less than 25% of all gastrointestinal tumors and 1-2% of malignant tumors in general. However for their nonspecific clinical presentation, diagnosis is often late, because of the patient delay to contact the doctor and especially the doctor difficulty to advance the clinical suspicion and request the suitable clinicoinstrumental diagnostic tests. The radiologist plays a major role in early diagnosis, treatment and prognosis. In the last decade diagnostic imaging (US, CT, MRI) has supported conventional barium studies: the diagnostic accuracy has been enhanced in terms of identification, characterization and evaluation of the degree of severity of these diseases. The choice of the most suitable technique should be based on the diagnostic skills acquired in the field and on the awareness of the limits and indications of each method. In this article, the contribution of imaging to the diagnosis of small bowel tumors, is analyzed.

Facial nerve outcome after vestibular schwannoma surgery: our experience.

In this study we evaluate the postoperative facial nerve function after vestibular schwannoma (VS) surgery and analyze the factors that cause it. We included 97 consecutive patients undergoing surgical excision of sporadic unilateral VS. Patient and tumor characteristics, surgical approaches, facial nerve function, extent of tumor removal, perioperative complications are all analyzed through standardized systems. Four different surgical approaches are used: translabyrinthine, retrolabyrinthine, retrosigmoid, and middle cranial fossa. Anatomic preservation of the facial nerve is achieved in 97% of patients. The incidence of postoperative facial palsy is found to be statistically correlated to tumor size, but not to the surgical approach used and to extent of tumor penetration in the internal auditory canal. A significant improvement of the short-term facial nerve outcome is detected in patients undergone simultaneous intraoperative electromyography (EMG) and pneumatic facial nerve monitoring. Complete tumor excision is achieved in 94% of cases. Complication rates are excellent and no deaths are reported. Short- and long-term facial nerve outcome is good and comparable with those of other series reported in literature. In VS surgery both EMG and pneumatic facial nerve monitors should be simultaneously used. Further investigations are desirable to improve the facial outcome respecting the oncological radicality.

Isolated fracture of the malleus handle: a video clip.

Isolated malleus fracture is a rare clinical entity, and usually the handle of the malleus is involved. We report a video, to our knowledge the first in the literature, of a diagnostic otoscopy of a malleus fracture showing the movement of a left fractured malleus handle during a Valsalva maneuver (see the video online at www.laryngoscope.com).