CT angiography of the hepatic and pancreatic circulation.

Multidetector computed tomography angiography (MDCTA) is an established, noninvasive, and effective imaging method to evaluate the liver and the pancreas primarily for neoplasm staging and presurgical planning. However, its role has also extended into a variety of other clinical indications. Technological advances in MDCT scanners and post processing now offer new opportunities with CTA, but the challenges of protocol optimization should be confronted appropriately to meet the new expectations. In this review, we focus on the technical details with MDCTA protocols for liver and pancreas and briefly discuss the common pathologic conditions where CTA is now considered integral to patient management.

Debate: diminutive polyps noted at CT colonography need not be reported.

Colorectal polyps less than 6 mm in size pose a negligible risk to the development of colorectal carcinoma. The sensitivity and specificity for detection of diminutive lesions on all available examinations including CT colonography (CTC) and optical colonoscopy (OC) is relatively low. In the context of regular screening, the low clinical significance and slow to negligible growth of diminutive polyps, as well as the low detection performance of CTC and OC for these lesions, would contribute to wasted health care resource and excess morbidity if each diminutive polyp were referred for potential resection. Respect for patient safety, attention to proper use of resources, and appropriate focus on larger, clinically significant polyps lead the authors to the conclusion that colonic polyps of less than 6 mm should not be separately reported.

MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections.

OBJECTIVE: The objective of our study was to describe the occurrence of local complications and the fate of fluid collections in milder forms of acute nonnecrotizing pancreatitis. MATERIALS AND METHODS: Initial MDCT studies of 169 consecutive patients with mild acute pancreatitis and 203 follow-up CT examinations were reviewed. The fate of peripancreatic fluid collections was investigated, and the incidence and type of local complications were recorded and correlated to the CT grading system (A-E). RESULTS: Complications developed in nine of 169 patients, for an incidence of 5.3%. All morbidity occurred in the subgroup of 73 patients with initial fluid collections, for an incidence of 12.3%. Follow-up CT examinations available in 51 of these 73 patients documented rapid fluid resolution in 35 cases (68.6%) and persistence of fluid more than 2 weeks from onset in seven asymptomatic patients (13.7%). Acute, life-threatening complications (hemorrhage, infection, perforation) occurred in five patients, for an incidence of 6.8% among the 73 patients with initial fluid collections, or 3.0% in the entire group of 169 patients. Five patients developed acute pseudocysts. Long-term follow-up studies discovered two patients with chronic pancreatitis and one with groove pancreatitis. CONCLUSION: A small number of acute, life-threatening abdominal complications and chronic complications are expected to occur in patients with milder forms of acute nonnecrotizing pancreatitis presenting with fluid collections. In these patients, clinical monitoring and repeated imaging studies are recommended to document the resolution of fluid or the development of complications.