Value of diffusion-weighted and gadolinium-enhanced MRI for the diagnosis of pelvic recurrence from colorectal cancer.

PURPOSE: To prospectively assess the added value of gadolinium-enhanced and diffusion-weighted (DWI) MRI for the diagnosis of pelvic recurrence from colorectal cancer (CRC). MATERIALS AND METHODS: Fifty-two patients with suspected pelvic recurrence from CRC underwent pelvic MRI with T2-weighted ("T2"), gadolinium-enhanced fat-suppressed T1-weighted ("gadolinium") and DWI MR sequences. Three readers (senior radiologist: R1, two residents: R2, R3) scored the likelihood of recurrence on "T2," "T2 + DWI," and "T2 + Gadolinium." RESULTS: Twenty-seven patients had 42 sites of pelvic recurrence. On "T2," R1 achieved AUC of .95, sensitivity 88.4%, specificity 95.2%. For R2, these figures were .89, 81.4%, 90.5%, for R3 .90, 83.7%, 76%. Both Gadolinium injection and DWI significantly improved AUCs for residents but not for the senior radiologist: up to .988 (R2, P = 0.006) and to .98 (R3, P = 0.01) with DWI and to .96 (R2, P = 0.04), .98 (R3, P = 0.01) after gadolinium. All readers achieved slightly better AUCs with "T2 + DWI" than with "T2+Gadolinium" but not significantly (P = 0.68, P = 0.11, P = 0.3; respectively). CONCLUSION: For diagnosis of pelvic recurrence from CRC, both DWI and gadolinium-enhanced MRI significantly increase diagnostic performances compared with "T2" MRI for residents. DWI may be helpful in patients with contra-indications to intravenous administration of gadolinium.

Association between hidradenitis suppurativa and spondyloarthritis.

OBJECTIVES: We aimed to investigate the existence of an association between hidrosadenitis suppurativa and spondyloarthritis. METHODS: We performed a single-centre, cross-sectional study in patients with hidrosadenitis suppurativa followed in a tertiary care center, and in healthy volunteers without dermatological disease, matched for age (±5years) and gender. For each subject included, clinical examinations, HLA-B27 testing and sacro-iliac MRI were performed in order to diagnose spondyloarthritis according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. RESULTS: In total, 39 subjects were included in each group (70% women in each group, mean age 35.6±11.1 in the hidrosadenitis suppurativa group and 36.0±11.1 in the control group). Eleven (28.2%) patients in the hidrosadenitis suppurativa group were diagnosed with spondyloarthritis (in 4 of these, spondyloarthritis was already previously documented), and in 1 (2.6%) subject in the control group (OR 11.0; 95% CI 4.1-83.3; P=0.02). Axial spondyloarthritis was the most common form of spondyloarthritis, observed in 9/11 patients in the hidrosadenitis suppurativa group, the remainder were peripheral spondyloarthritis. In the hidrosadenitis suppurativa group, only HLA B27 was found to be associated with a diagnosis of spondyloarthritis. CONCLUSIONS: Our results indicate that hidrosadenitis suppurativa is significantly associated with an increased risk of spondyloarthritis, independently of age and sex. Patients with hidrosadenitis suppurativa presenting osteoarticular symptoms, specially low back pain or dactylitis, should be monitored for spondyloarthritis.

Management of large incisional hernias with loss of domain: A prospective series of patients prepared by progressive preoperative pneumoperitoneum.

BACKGROUND: The surgical treatment of giant incisional hernias with loss of domain is challenging due to the possibility of intra-abdominal hypertension after the herniated content is returned to the peritoneal cavity. Progressive preoperative pneumoperitoneum has been described before repair of the hernia, although its efficacy has not been demonstrated clearly. Our aim was to evaluate the efficacy of preoperative progressive pneumoperitoneum in expanding the volume of the peritoneal cavity and the outcomes after surgical treatment of incisional hernias with loss of domain. METHODS: All consecutive patients with incisional hernias with loss of domain undergoing preoperative progressive pneumoperitoneum and operative repair were included in a prospective observational study. All patients had pre- and postoperative progressive pneumoperitoneum computed tomography of the abdomen. Open incisional hernias with loss of domain repair consisted of anatomic reconstruction of the abdominal wall by complete closure of the defect and reinforcement with a sublay synthetic mesh, whenever possible. RESULTS: The cohort was composed of 45 patients (mean age, 60.5 years). Before the preoperative progressive pneumoperitoneum, the mean volume of the herniated content was 38% of the total peritoneal volume. The mean abdominal volume increased by 53% after the preoperative progressive pneumoperitoneum. One patient died during preoperative progressive pneumoperitoneum, but the postoperative mortality was zero, giving a mortality rate of 2% to the treatment using preoperative progressive pneumoperitoneum. Complete reduction of the herniated content intraperitoneally with primary closure of the fascia was achieved in 42 out of 45 patients (94%). Reinforcement by a synthetic mesh was possible in 37 patients (84%). Overall, surgical complications related directly to the operative procedure occured in 48% of cases. The rates of overall and severe morbidity were 75 and 34%, respectively. At a mean follow-up of 18.6 months, the recurrence rate was 8% (3 out of 37 patients) with non-absorbable meshes and 57% (4 out of 7 patients) with absorbable mesh. CONCLUSION: Preoperative progressive pneumoperitoneum increased the volume of the abdominal cavity in patients with incisional hernias with loss of domain, allowing complete reduction of the herniated content and primary fascial closure in 94% of patients, with acceptable overall morbidity.