Imaging features in management of laparoscopic mini/one anastomosis gastric bypass post-surgical complications.

Obesity is a widespread pathology among the population related to an increase in mortality and morbidity of patients. Bariatric surgery provides several forms of treatment for obese patients. Laparoscopic mini/one anastomosis gastric bypass (MGB/OAGB) is a recent low risk bariatric surgical procedure common in a large number of countries in the treatment of severe obesity. MGB/OAGB, compared to other bariatric surgery techniques, offers the significant technical improvement of requiring only one anastomosis in place of two. In this scenario, diagnostic imaging takes a significant role in the postoperative period, to evaluate the outcomes of surgical treatment and to detect possible complications both in early and late postoperative period. The prevalent radiological procedure to investigate suspicions of clinical post-operative complications is Computed tomography (CT) with oral and intravenous contrast administration. This pictorial essay aims to illustrate and identify normal radiological aspects of MGB/OAGB and post-surgery complication imaging features. We think that this article will serve to familiarize all the specialists with the diagnostic imaging of MGB/OAGB.

Cystic Interstitial Lung Diseases: A Pictorial Review and a Practical Guide for the Radiologist.

A cyst is a round circumscribed area of low attenuation, surrounded by epithelial or fibrous wall. Cysts can frequently occur on chest computed tomography (CT) and high-resolution computed tomography (HRCT); multiple parenchymal cysts of the lungs are the most typical feature of cystic lung interstitial diseases, characterizing a wide spectrum of diseases-ranging from isolated lung disorders up to diffuse pulmonary diseases. The aim of this review is to analyze scientific literature about cystic lung interstitial diseases and to provide a practical guide for radiologists, focusing on the main morphological features of pulmonary cysts: size, shape, borders, wall, location, and distribution. These features are shown on free-hand drawings and related to HRCT images, in order to help radiologists pursue the correct differential diagnosis between similar conditions.

Laparoscopic mini/one anastomosis gastric bypass: anatomic features, imaging, efficacy and postoperative complications.

Laparoscopic mini/one anastomosis gastric bypass (MGB/OAGB) is an increasingly used bariatric surgical procedure. This surgical technique is effective in terms of both weight loss and the resolution of comorbidities, but it is not without complications. To report our experience in MGB/OAGB, assessing comorbidities and complications, and to illustrate post-surgical anatomy and radiological appearance of complications, a single-centre retrospective study of 953 patients undergoing MGB/OAGB between January 2005 and September 2018 was done. The inclusion criteria: body mass index (BMI) of 40 kg/m2 or higher or BMI between 35 and 40 kg/m2 with significant comorbidities not responsive to medical therapies. In the postoperative period, all patients were evaluated with clinical and laboratory tests and radiological examinations (upper gastrointestinal series, computed tomography and magnetic resonance imaging). Median weight was 126.69 kg and mean BMI was 49.4 kg/m2. Regarding comorbidities, 37.2%, 52.8%, 46.7% and 43.2% of patients presented with preoperatively diagnosed type 2 diabetes mellitus (T2DM), hypertensive disease, dyslipidaemia and obstructive sleep apnoea syndrome (OSAS), respectively. Median excess weight loss at 6, 12, 24 and 60 months after surgery was 33.45%, 53.81%, 68.75% and 68.80%, respectively. The remission of comorbidities was 91.4% for T2DM, 93.7% for hypertensive disease, 90.3% for dyslipidemia and 93.4% for OSAS. Early and late complication rates identified with radiological examinations were 1.5% and 1.6%, respectively. MGB/OAGB was effective for weight loss and comorbidities remission. Complications occurred at lower rate than with other surgical procedures were identified with imaging; CT was the main radiological technique.

Diffusion-MR in kidney transplant recipients: is diuretic stimulation a useful diagnostic tool for improving differentiation between functioning and non-functioning kidneys?

OBJECTIVES: To evaluate the effects of diuretic stimulation on Diffusion Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI) techniques in transplanted kidneys. METHODS: 33 transplanted kidney recipients underwent DWI and DTI sequences before and after furosemide. Cortical and medullary Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) values were calculated in transplanted kidneys. Patients were divided into two groups according to their estimated glomerular rate filtration (Group A ≥ 60 ml/min and Group B < 60 ml/min). Wilcoxon matched pairs signed rank test was applied to compare pre- and post-furosemide values. ADC and FA values were compared between the 2 groups using a Mann-Whitney U test. Receiver Operating Curves (ROC) analysis was performed to predict normal renal function. RESULTS: Wilcoxon test revealed a statistically significant difference for all pre- and post- ADC and FA values in group B. For group A, a significant difference was found comparing pre- and post-medullary ADC and FA values (p = 0.0151 and p = 0.0054). In the comparison between group A and group B, cortical and medullary mean ADC values were significantly different before and after furosemide. With regard to medullary FA values, a significant difference was found between groups before and after diuretic stimulation (p respectively of 0.004 and 0.042). Comparing cortical FA mean values, no statistical difference was observed between groups before and after furosemide. The highest Area Under Curve values were reported for cortical ADC (0.878) and medullary ADC (0.863) before diuretic bolus. CONCLUSIONS: In transplanted kidneys, furosemide did not improve the differentiation between normal and reduced function.

Eagle's syndrome: a case report and CT pictorial review.

Eagle's syndrome (ES) refers to symptomatic elongation of the ossified styloid process. A styloid process greater than 2.5 cm in length should be considered abnormal; however, an elongated styloid process is not sufficient for a diagnosis of ES; only an abnormal styloid process in association with symptoms can confirm the syndrome. In this case report, we discuss a 54-year-old man who has come to our attention with various symptoms: dysphagia to both solids and liquids, difficulty swallowing, neck pain, and a foreign body sensation during bilateral neck rotation and mouth opening. The diagnosis is performed radiologically because conventional radiographs have many potential disadvantages, whereas, computed tomography (CT) scans and reconstructions allow the length and angulation of the styloid process to be measured and the relationship between the elongated styloid processes and adjacent anatomical structures to be evaluated. Moreover, CT allows for differential diagnosis and provides detailed information needed for surgical planning.

Change in kidney volume after kidney transplantation in patients with autosomal polycystic kidney disease.

BACKGROUND: The indication to bilateral nephrectomy in patients with autosomal dominant polycystic kidney scheduled for kidney transplantation is controversial. Indeed, the progressive enlargement of cysts may increase the risk of complications and the need for nephrectomy. However, very few studies investigated the change in kidney volume after kidney transplantation. MATERIAL AND METHODS: In this prospective cohort study, the change in native kidney volume in polycystic patients was evaluated with magnetic resonance imaging. Forty patients were included in the study. Kidney diameters and total kidney volume were evaluated with magnetic resonance imaging in patients who underwent simultaneous nephrectomy and kidney transplantation and in patients with kidney transplant alone, before transplantation and 1 year after transplantation. RESULTS: There was a significant reduction of kidney volume after transplantation, with a mean degree of kidney diameters reduction varying from 12.24% to 14.43%. Mean total kidney volume of the 55 kidney considered in the analysis significantly reduced from 1617.94 ± 833.42 ml to 1381.42 ± 1005.73 ml (P<0.05), with a mean rate of 16.44% of volume decrease. More than 80% of patients had a volume reduction in both groups. CONCLUSIONS: Polycystic kidneys volume significantly reduces after kidney transplantation, and this would reduce the need for prophylactic bilateral nephrectomy in asymptomatic patients.

Clinical and radiological features of extra-pulmonary sarcoidosis: a pictorial essay.

UNLABELLED: The aim of this manuscript is to describe radiological findings of extra-pulmonary sarcoidosis. Sarcoidosis is an immune-mediated systemic disease of unknown origin, characterized by non-caseating epitheliod granulomas. Ninety percent of patients show granulomas located in the lungs or in the related lymph nodes. However, lesions can affect any organ. Typical imaging features of liver and spleen sarcoidosis include visceromegaly, with multiple nodules hypodense on CT images and hypointense on T2-weighted MRI acquisitions. Main clinical and radiological manifestations of renal sarcoidosis are nephrolithiasis, nephrocalcinosis, and acute interstitial nephritis. Brain sarcoidosis shows multiple or solitary parenchymal nodules on MRI that enhance with a ring-like appearance after gadolinium. In spinal cord localization, MRI demonstrates enlargement and hyperintensity of spinal cord, with hypointense lesions on T2-weighted images. Skeletal involvement is mostly located in small bone, showing many lytic lesions; less frequently, bone lesions have a sclerotic appearance. Ocular involvement includes uveitis, conjunctivitis, optical nerve disease, chorioretinis. Erythema nodosum and lupus pernio represent the most common cutaneous manifestations encountered. Sarcoidosis in various organs can be very insidious for radiologists, showing different imaging features, often non-specific. Awareness of these imaging features helps radiologists to obtain the correct diagnosis. TEACHING POINTS: • Systemic sarcoidosis can exhibit abdominal, neural, skeletal, ocular, and cutaneous manifestations. • T2 signal intensity of hepatosplenic nodules may reflect the disease activity. • Heerfordt's syndrome includes facial nerve palsy, fever, parotid swelling, and uveitis. • In the vertebrae, osteolytic and/or diffuse sclerotic lesions can be found. • Erythema nodosum and lupus pernio represent the most common cutaneous manifestations.