Acute Jejunoileal Diverticulitis: Multicenter Descriptive Study of 33 Patients.

OBJECTIVE: Acute jejunoileal diverticulitis is a very rare and potentially serious disease affecting mostly elderly patients. The diagnosis is based on imaging but remains underrecognized. The purpose of this study is to describe the clinical and CT features and the outcomes of patients with acute jejunoileal diverticulitis. MATERIALS AND METHODS: Cases of acute jejunoileal diverticulitis managed at three French hospitals November 2005 through January 2015 were identified retrospectively. The final diagnosis relied either on a clinical and radiologic data review by a panel of experts or on surgical findings. Demographic, clinical, laboratory, and 18-month outcome data were collected. CT scans were reviewed by two radiologists who reached a consensus about the presence of an inflammatory diverticulum, evidence of complications, and presence of other bowel diverticula. RESULTS: We identified 33 cases of acute jejunoileal diverticulitis in 33 patients with a median age of 78 years, including 30 (91%) patients in whom an inflammatory diverticulum was identified at the jejunum (n = 26, 87%) or ileum (n = 4, 13%). Extraintestinal gas was seen in 10 (30%) patients and extraintestinal fluid in 11 (33%) patients. Other small-bowel diverticula were visible in all 33 patients. The diverticulitis was mild and resolved with nonoperative treatment in 22 (67%) patients and was severe in the remaining 11 (33%) patients, eight of whom required emergent surgery. CONCLUSION: Acute jejunoileal diverticulitis is a rare and usually nonserious condition that chiefly involves the jejunum. A detailed CT assessment may allow nonoperative treatment.

Altered signal intensity of active enhancing inflammatory lesions using post-contrast double inversion recovery MR sequence.

OBJECTIVES: We aimed at establishing the impact upon gadolinium administration on the conspicuity of active enhancing multiple sclerosis (MS) lesions using double inversion recovery (DIR) at 3T. METHODS: 15 consecutive patients with MS (n=8) or a clinically isolated syndrome (n=7) underwent pre and post-contrast DIR in addition to T2-weighted, FLAIR, pre and post-contrast T1-weighted sequences. First, two neuroradiologists located and marked all the enhancing MS lesions visible in consensus. Second, two other neuroradiologists, blinded to other sequences than DIR, independently assessed the SI changes from pre to post-contrast DIR images for each enhancing lesion, according to a 4-point-scale: increased SI (grade 1), absence of change (grade 2), lesion being partially (grade 3) or completely masked on post-contrast DIR images (grade 4). RESULTS: 246 MS lesions were detected including 26 enhancing on post-contrast T1-weighted images in 9 patients. The two blinded readers concluded to a decreased signal-intensity on post-contrast DIR images for all the 26 enhancing MS lesions (14 of grade 3 and 12 of grade 4). Inter-observer agreement was excellent, Kappa=0.85 (0.75 - 0.94). Using DIR post-contrast leads to altered signal-intensity of enhancing active MS lesions, ranging from partial to complete signal-loss. CONCLUSION: Our study strongly suggests the use of DIR before gadolinium administration. KEY POINTS: • DIR has gained widespread use in MS. • MRI protocols for MS patients usually contain several post-contrast sequences. • Signal-intensity of enhancing MS lesions is altered using DIR post-contrast. • Our study strongly suggests the use of DIR before gadolinium administration.

Pneumatosis intestinalis and portal venous gas in mechanical small bowel obstruction: Is it worrisome?

PURPOSE: The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference. MATERIALS AND METHODS: Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59±19 (SD) (range: 25-93 years). CT examinations were reviewed by two radiologists to confirm the diagnosis of mechanical SBO and make a description of PI. Interobserver agreement was calculated. The reference standard was intraoperative appearance of the bowel wall (10/14; 71%) or the recovery of a normal bowel function in patients who were managed conservatively (4/14; 29%). RESULTS: Among the 10 patients who underwent surgery, a normal appearance of the bowel in association with PI on CT was found intraoperatively in 8/10 (80%) patients and a reversible ischemia in the remaining 2/10 (20%) patients. The four patients who were managed conservatively recovered normal bowel function. Two patients died within two weeks following SBO. CONCLUSION: PI and PVG are not specific signs of bowel necrosis in mechanical SBO.

Accuracy of cardiac magnetic resonance imaging to rule out significant coronary artery disease in patients with systolic heart failure of unknown aetiology: Single-centre experience and comprehensive meta-analysis.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of systolic heart failure (HF). Cardiac magnetic resonance imaging (CMR) is a non-invasive technique that detects a myocardial infarction scar as subendocardial or transmural late gadolinium enhancement (st-LGE). AIM: We sought to evaluate whether a lack of st-LGE could rule out CAD in new-onset systolic HF of unknown aetiology. METHODS: We included 232 consecutive patients with new-onset HF and left ventricular ejection fraction ≤35% who underwent both coronary angiography and CMR to assess HF aetiology. CAD was defined as the presence of coronary artery stenosis≥50% on a coronary angiogram. We assessed sensitivity, specificity, and positive and negative likelihood ratios (PLR and NLR) of the presence of st-LGE to detect underlying CAD. A complementary meta-analysis of 11 studies (including ours) was also performed. RESULTS: In our study, 49 (21.1%) patients had CAD. The sensitivity and specificity of the presence of st-LGE to detect CAD were 69 and 92%, respectively. PLR and NLR were 8.47 and 0.33, respectively. In the meta-analysis, 1227 patients were included, and the prevalence of CAD ranged from 19.2 to 68.3%. Sensitivity, specificity, PLR and NLR were 87% (95% confidence interval [CI] 0.80-0.92), 93% (95% CI 0.89-0.96), 12.91 (95% CI 7.70-21.64) and 0.14 (95% CI 0.09-0.22), respectively. Altogether, 55 patients presented CAD with no st-LGE; inversely, 75 patients presented st-LGE with no CAD. CONCLUSION: With a CMR specificity of 93%, the absence of st-LGE rules out significant underlying CAD in patients with systolic HF of unknown aetiology in most cases.