Deep learning reconstruction vs standard reconstruction for abdominal CT: the influence of BMI.

OBJECTIVE: This study aimed to evaluate the image quality and lesion conspicuity of the deep learning image reconstruction (DLIR) algorithm compared with standard image reconstruction algorithms on abdominal enhanced computed tomography (CT) scanning with a wide range of body mass indexes (BMIs). METHODS: A total of 112 participants who underwent contrast-enhanced abdominal CT scans were divided into three groups according to BMIs: the 80-kVp group (BMI ≤ 23.9 kg/m2), 100-kVp group (BMI 24-28.9 kg/m2), and 120-kVp group (BMI ≥ 29 kg/m2). All images were reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction-V of 50% level (IR), and DLIR at low, medium, and high levels (DL, DM, and DH, respectively). Subjective noise, artifact, overall image quality, and low- and high-contrast hepatic lesion conspicuity were all graded on a 5-point scale. The CT attenuation value (in HU), image noise, and contrast-to-noise ratio (CNR) were quantified and compared. RESULTS: DM and DH improved the qualitative and quantitative parameters compared with FBP and IR for all three BMI groups. DH had the lowest image noise and highest CNR value, while DM had the highest subjective overall image quality and low- and high-contrast lesion conspicuity scores for the three BMI groups. Based on the FBP, the improvement in image quality and lesion conspicuity of DM and DH images was greater in the 80-kVp group than in the 100-kVp and 120-kVp groups. CONCLUSION: For all BMIs, DLIR improves both image quality and hepatic lesion conspicuity, of which DM would be the best choice to balance both. CLINICAL RELEVANCE STATEMENT: The study suggests that utilizing DLIR, particularly at the medium level, can significantly enhance image quality and lesion visibility on abdominal CT scans across a wide range of BMIs. KEY POINTS: • DLIR improved the image quality and lesion conspicuity across a wide range of BMIs. • DLIR at medium level had the highest subjective parameters and lesion conspicuity scores among all reconstruction levels. • On the basis of the FBP, the 80-kVp group had improved image quality and lesion conspicuity more than the 100-kVp and 120-kVp groups.

Utilidad de la radiografía de abdomen en el diagnóstico de la intoxicación medicamentosa: reporte de un caso pediátrico / Use of abdominal X-ray in drug intoxication: a pediatric case report

Las intoxicaciones medicamentosas son un motivo de consulta frecuente en pediatría, además de una de las principales causas externas de mortalidad en adolescentes. El diagnóstico y tratamiento tempranos son fundamentales para el manejo adecuado de estos casos. Se presenta una niña de 13 años que, luego de ingerir un fármaco desconocido, muestra decaimiento y manifestaciones clínicas gastrointestinales. Por sospecha de intoxicación con hierro y la imposibilidad de determinar los niveles de sideremia de manera urgente, se realiza radiografía de abdomen, que confirma el diagnóstico y permite el tratamiento adecuado de la paciente. En este caso, se destaca la utilidad de la radiología para el diagnóstico en la sospecha de intoxicación con hierro, gracias a la radiopacidad de sus sales

Drug intoxication is a common reason for pediatric emergency department (ED) visits and one of the leading causes of death among teenagers. Early diagnosis and treatment are essential for a proper management of these patients. We present a 13-year-old girl attended at the ED showing excessive sleepiness and gastrointestinal symptoms after taking an unknown drug. Due to suspected iron overdose and the impossibility of measuring urgent iron levels, an abdominal X-ray was performed, which confirmed the diagnosis. We highlight the utility of radiology in the diagnosis of iron poisoning, which is possible due to its radiopacity.

[Use of abdominal X-ray in drug intoxication: a pediatric case report]. / Utilidad de la radiografía de abdomen en el diagnóstico de la intoxicación medicamentosa: reporte de un caso pediátrico.

Drug intoxication is a common reason for pediatric emergency department (ED) visits and one of the leading causes of death among teenagers. Early diagnosis and treatment are essential for a proper management of these patients. We present a 13-year-old girl attended at the ED showing excessive sleepiness and gastrointestinal symptoms after taking an unknown drug. Due to suspected iron overdose and the impossibility of measuring urgent iron levels, an abdominal X-ray was performed, which confirmed the diagnosis. We highlight the utility of radiology in the diagnosis of iron poisoning, which is possible due to its radiopacity.

Las intoxicaciones medicamentosas son un motivo de consulta frecuente en pediatría, además de una de las principales causas externas de mortalidad en adolescentes. El diagnóstico y tratamiento tempranos son fundamentales para el manejo adecuado de estos casos. Se presenta una niña de 13 años que, luego de ingerir un fármaco desconocido, muestra decaimiento y manifestaciones clínicas gastrointestinales. Por sospecha de intoxicación con hierro y la imposibilidad de determinar los niveles de sideremia de manera urgente, se realiza radiografía de abdomen, que confirma el diagnóstico y permite el tratamiento adecuado de la paciente. En este caso, se destaca la utilidad de la radiología para el diagnóstico en la sospecha de intoxicación con hierro, gracias a la radiopacidad de sus sales.

Abdominal Digital Radiography with a Novel Post-Processing Technique: Phantom and Patient Studies.

Purpose: The aim of this study was to evaluate the diagnostic image quality of low dose abdominal digital radiography processed with a new post-processing technique. Materials and Methods: Abdominal radiographs from phantom pilot studies were post-processed by the novel and conventional post-processing methods of our institution; the proper dose for the subsequent patient study of 49 subjects was determined by comparing image quality of the two preceding studies. Two radiographs of each patient were taken using the conventional and derived dose protocols with the proposed post-processing method. The image details and quality were evaluated by two radiologists. Results: The radiation dose for the patient study was derived to be half of the conventional method. Overall half-dose image quality with the proposed method was significantly higher than that of the conventional method (p < 0.05) with moderate inter-rater agreement (κ = 0.60, 0.47). Conclusion: By applying the new post-processing technique, half-dose abdominal digital radiography can demonstrate feasible image quality compared to the full-dose images.

Divertículo colónico gigante: Dos nuevos casos en la literatura / Giant Colonic Diverticulum: Two New Cases in Literature / Divertículo gigante de colom: Dois novos casos na literatura

Introducción: El divertículo colónico gigante es una presentación rara de la enfermedad diverticular del colon descrita por primera vez en la literatura francesa en 1946; se define cuando su diámetro es mayor a 4cm. Objetivo: Adicionar a la literatura dos casos diagnosticados en la Fundación Oftalmológica de Santander, Colombia debido al bajo número de casos reportados en la actualidad; además, mencionar los principales datos encontrados en la literatura en cuanto a la epidemiología, la presentación clínica, los diagnósticos diferenciales, las herramientas diagnósticas más importantes a tener en cuenta y la diferencia de los esquemas de tratamiento. Presentación de los casos: Se presentan dos casos de pacientes con clínica de dolor abdominal para los cuales se solicitaron estudios imagenológicos que permitieron realizar un adecuado diagnóstico de divertículo colónico gigante; el primero fue manejado de manera conservadora con antibiótico-terapia y el segundo de forma quirúrgica con resección de colon transverso con anastomosis primaria. Conclusiones: El divertículo colónico gigante es una entidad poco frecuente y por tanto escasamente descrita en la literatura asociada en su mayoría con la diverticulosis. Se presenta con una clínica muy diversa, sugestiva de múltiples patologías abdominales que deben ser descartadas para poder realizar un adecuado diagnóstico por medio de técnicas de imagen como la radiografía, el colon por enema y la tomografía axial computarizada que representan las principales herramientas diagnósticas de esta entidad. El tratamiento de elección es la intervención quirúrgica, sin embargo, en contextos determinados como pacientes ancianos, asintomáticos y con alto riesgo quirúrgico puede manejarse de manera conservadora. Su importancia a pesar de la baja prevalencia radica en la necesidad del diagnóstico oportuno para evitar una alta tasa de complicaciones. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo colónico gigante: Dos nuevos casos en la literatura MedUNAB 2017; 20(2): 235-243].

Introduction: The giant colonic diverticulum is a rare presentation of the diverticular disease of the colon described for the first time in French literature in 1946 and it is defined when its diameter is greater than 4cm. Objective: To add to the literature two more cases diagnosed in the Ophthalmological Foundation of Santander, Colombia due to the low number of cases reported today; in addition, to mention the main data found in the literature in terms of epidemiology, clinical presentation, differential diagnoses, the most important diagnostic tools to consider and the difference of treatment schemes for it. Presentation of the cases: Two cases of patients with abdominal pain clinic for whom imaging studies were requested that allowed an adequate diagnosis of giant colonic diverticulum are presented. The first one was managed conservatively with antibiotic therapy and the second one was surgically treated with a transverse colon resection with primary anastomosis. Conclusions: The giant colonic diverticulum is a rare entity and therefore poorly described in the literature associated mostly with diverticulosis. It is presented with a very diverse clinic, suggestive of multiple abdominal pathologies that must be discarded in order to perform an adequate diagnosis by means of imaging techniques such as x-rays, colon by enema and computerized axial tomography scan which represent the main diagnostic tools for this entity. The treatment of choice is surgery; however, in determined contexts such as with elderly patients who are asymptomatic and with a high surgical risk can be managed conservatively. Its importance despite its low prevalence lies in the need for timely diagnosis to avoid a high rate of complications. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Giant Colonic Diverticulum: Two New Cases in Literature. MedUNAB 2017; 20(2): 235-243].

Introdução: O divertículo colônico gigante é uma apresentação rara da doença diverticular do cólon descrita pela primeira vez na literatura francesa em 1946; é definido quando seu diâmetro é maior que 4cm. Objetivo: Adicionar à literatura dois casos diagnosticados na Fundação Oftalmológica de Santander, Colômbia devido ao baixo número de casos relatados no presente; Além disso, mencionar os principais dados encontrados na literatura em termos de epidemiologia, apresentação clínica, diagnósticos diferenciais, as ferramentas de diagnóstico mais importantes a serem consideradas e a diferença de esquemas de tratamento. Apresentação dos casos: Foram apresentados dois casos de pacientes com clínica de dor abdominal para os quais foram solicitados estudos de imagem que permitiram um diagnóstico adequado de divertículo colônico gigante; O primeiro foi administrado de forma conservadora com terapia antibiótica e o segundo foi tratado cirurgicamente com ressecção do colo cruzado com anastomose primária. Conclusões: Divertículo colônico gigante é uma entidade rara e, portanto, pouco descrita na literatura associada principalmente à diverticulose. É apresentado um quadro clínico muito diverso, sugestivo de múltiplas patologias abdominais que devem ser descartadas para poder fazer um diagnóstico adequado por meio de técnicas da imagem como a radiografia, o cólon por enema e tomografia axial computorizada que representam as principais ferramentas Diagnóstico desta entidade. O tratamento a escolher é a cirurgia, no entanto, em determinados casos como é a dos pacientes idosos, assintomáticos e com alto risco cirúrgico podem ser tratados de forma tradicional. Sua importância, apesar da baixa prevalência, reside na necessidade de um diagnóstico oportuno para evitar uma alta taxa de complicações. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo gigante de colom: Dois novos casos na literatura. MedUNAB 2017; 20(2): 235-243].

Imaging manifestations of 92 cases of congenital intestinal malrotation / 中华围产医学杂志

Objective To investigate the imaging manifestations of congenital intestinal malrotation. Methods The clinical data of 92 infants with congenital intestinal malrotation admitted from January 1993 to December 2012 were studied retrospectively. All the 92 cases enrolled in this study were diagnosed based on imaging examinations and confirmed surgically. The imaging features of four examinations including plain abdominal radiography, upper gastrointestinal radiography, lower gastrointestinal angiography and ultrasound examination were analyzed. Results The percentage of the infants who presented with the initial clinical symptoms of vomit, blood stool and abdominal dilatation was 87.0%(80/92), 3.3%(3/92) and 1.1%(1/92), respectively, and eight cases [8.7%(8/92)] received prenatal ultrasound, which showed intestinal malrotation. Clinical examination showed no abdominal abnormalities in 68 (73.9%) cases. Seventy-seven cases underwent plain abdominal radiography, revealing intestinal obstruction in 31 cases. Thirty-six cases underwent upper gastrointestinal radiography, which revealed malrotation in 14 cases, and duodenal complete/incomplete obstruction or stenosis in 19 cases. Twenty-two cases underwent lower gastrointestinal angiography, and all of them were diagnosed as malrotation. Seventy-nine cases were examined with abdominal ultrasonography, and 58 cases were diagnosed as malrotation. Conclusions Rational selection of imaging examinations can improve the preoperative diagnosis. When congenital intestinal malrotation is suspected, abdominal ultrasound should be done as the first optional examination. At the same time, plain abdominal radiography should be selected accordingly. When intestinal malrotation with or without midgut volvulus is suggested, surgery should be performed as early as possible. When the diagnosis is not clear, upper or lower gastrointestinal radiography should be done.

Diagnostic value of different imaging methods for cholangiocarcinoma / 中华全科医师杂志

Cholangiocarcinoma is a malignant tumor that occurs in the bile duct epithelium,it is the second most common malignant tumor of the liver and bile duct after hepatocellular carcinoma.Imaging examination is an important method to detect bile duct cancer;the purpose of imaging is to determine the location of the tumor,and the extent of invasion and distant metastasis.Different imaging methods have their advantages and disadvantages,so they should be chosen based on the condition of patients,or be optimized as the combined detection.

Complementory Value of Sonography in Early Evaluation of Necrotizing Enterocolitis.

BACKGROUND: Despite the widespread use of plain films to detect necrotizing enterocolitis (NEC), it is considered a time-consuming method, which exposes patients to radiation. We aimed to assess changes in ultrasonographic variables and to compare sonograhy and chest radiography in detecting early stages of NEC in suspected premature infants. MATERIAL/METHODS: This case-control study was carried out in the years 2012-2013. We enrolled 67 premature neonates using a simple sampling method and divided them into the study and control groups. All patients underwent plain abdominal radiography, gray-scale and color Doppler sonography. RESULTS: 34 and 33 neonates were assigned to the study and control groups. No significant gender differences were found between the two groups (P=0.549). The mean bowel wall thickness ranged from 1.2 to 3.2 mm in the control group (132 abdominal quadrants) and 1-3.3 mm in the study group (136 abdominal quadrants, P=0.502). Intra-mural echogenic dots were seen in one neonate in the study group in favour of pneumatosis intestinalis. The mean ±SD bowel wall perfusion in the study and control groups were 3.117±0.975 and 2.878±0.538 dots or lines/cm(2), respectively (P=0.218). One neonate in the study group showed internal echoes within the mild amount of free fluid. Twelve neonates in the control group had minimal amounts of intra-abdominal free fluid. CONCLUSIONS: The two groups differed regarding bowel wall thickness, echogenicity, and perfusion in sonograhy and color Doppler evaluation. Although those differences were not statistically significant, considering the time-consuming nature of abdominal X-ray, the use of sonograhy and color Doppler can improve diagnosis and treatment of NEC as a triage method.

Necrotic bowel induces takotsubo-like myocardial injury.

Although chest pain in association with ST-segment electrocardiographic deviation is often indicative of cardiac ischemia, it has also been associated with noncardiac conditions. The case of a 63-year-old woman that we report here is extraordinary because her presentation of "acute abdomen" did not appear severe enough to warrant urgent surgical intervention, whereas the chest pain and electrocardiographic changes (supported by rising troponin levels) created strong clinical suspicion of acute coronary syndrome. Was the evidence of cardiac ischemia a primary event, or was it a sequela of an acute surgical condition? Noncardiac surgical cases associated with evidence of myocardial injury can be extremely challenging from a diagnostic and management perspective. We believe that the accuracy of the clinical diagnosis is crucial to a well-considered approach.

Body packing and its radiologic manifestations: a review article.

Body packing is described as using the abdominal or pelvic cavity for concealing illegal drugs. Leakage from the packets may cause catastrophic effects on smugglers and medical history is not reliable in these patients. Moreover, new sophisticated smuggling techniques make it imperative that radiologists and emergency physicians understand and familiarize themselves with the different radiological manifestations of ingested drug packets. Currently, there is no gold standard for imaging patients suspected of body packing; nevertheless, computed tomography (CT) seems to be the best modality for packet detection and unenhanced CT without bowel preparation is a reliable technique for detection of ingested packets. On abdominal radiography, packets may be visualized as oval or round radiopaque foreign bodies surrounded by a gas halo. In the literature, sensitivity of abdominal radiography is reported from 74% to 100%. Visualization of the drug packets may be strikingly hampered by administration of oral or intravenous contrast medium in abdomino-pelvic CT; hence, contrast-enhanced CT does not seem to be a suitable modality for searching the ingested packets in suspicious smugglers.

Radiographic study of patients submitted to total gastrectomy using Safatle reconstruction technique / Estudo radiológico em doentes submetidos a gastrectomia total com reconstrução à Safatle

BACKGROUND: Ever since the first total gastrectomy, there has always been a great concern in increasing the survival of patients, and with the advance of techniques, in improving the quality of life of these patients. The most common reconstruction technique of the gastrointestinal transit is the Roux-en-Y. The reposition of a functional pouch in place of the resected stomach was proposed to minimize the postprandial symptoms, improve the nutritional grade and consequently, the quality of life. The Safatle reconstruction of the gastrointestinal transit technique consists of, in short, in the association of the interposition of the jejunal loop with partial transit through the duodenum, with an inverted Roux-en-Y and with the creation of a pouch which resembles the dynamics of the stomach, achieved by duodenojejunal segment which has an antiperistalsis emptying. AIM: To assess, by radiographic means, the emptying of the duodenojejunal pouch in patients submitted to total gastrectomy using the Safatle reconstruction technique. METHOD: Twelve patients submitted to total gastrectomy using the Safatle technique due to gastric cancer were studied. They were summoned to perform contrasted radiographies of the esophagus-duodenum-jejunum by the videofluoroscopic method during the months of July and August, 2005. RESULTS: All the patients presented satisfactory movement of the duodenojejunal pouch and an adequate emptying in antiperistalsis without food stasis. There has been an average 25-minute drainage time of the duodenojejunal pouch. CONCLUSION: The duodenojejunal pouch, in the patients submitted to total gastrectomy using the Safatle reconstruction, presented adequate emptying and movement.

RACIONAL: Desde a primeira gastrectomia total, houve sempre a preocupação em aumentar a sobrevida e, com o aprimoramento das técnicas, de melhorar a qualidade de vida. A técnica mais aceita para a reconstrução do trânsito intestinal após gastrectomia total é a em Y-de-Roux. A reposição de um reservatório funcional no lugar do estômago ressecado foi proposta para minimizar os sintomas pós-prandiais, melhorar o grau nutricional e, conseqüentemente, a qualidade de vida. A técnica de reconstrução do trânsito intestinal pós-gastrectomia à Safatle consiste, em síntese, numa associação da interposição de alça jejunal com trânsito parcial pelo duodeno, com o Y-de-Roux invertido, e com a criação de um reservatório que se aproxima da dinâmica do estômago, obtido à custa de um segmento duodenojejunal com esvaziamento em antiperistalse. OBJETIVO: Avaliar, por método radiológico, o esvaziamento da bolsa duodenojejunal em doentes submetidos a gastrectomia total com reconstrução à Safatle. MÉTODO: Foram estudados 12 doentes submetidos a gastrectomia total por câncer gástrico com reconstrução à Safatle, convocados para realizar radiografias contrastadas de esôfago-duodeno-jejuno pelo método videofluoroscópico nos meses de julho a agosto de 2005. RESULTADOS: Todos os doentes apresentaram motricidade satisfatória da bolsa duodenojejunal com adequado esvaziamento em antiperistalse sem estase alimentar. O tempo de esvaziamento da bolsa duodenojejunal foi de 25 minutos em média. CONCLUSÃO: A bolsa duodenojejunal, nos doentes submetidos a gastrectomia total com reconstrução à Safatle, apresentou adequado esvaziamento e motricidade.

Evaluation of ligamentum teres hepatis with multi-slice spiral CT:an initial experience / 中国普通外科杂志

Objective To recognize the features of the ligamentum teres hepatic(LTH) in multi-slice spiral CT,and to preliminarily explore its clinical value.Methods A total of 130 patients without liver disease underwent abdominal scanning with a 16-slice spiral CT scanner.LTHs,as focused points,were observed by using postprocessing techniques such as multi-planar reformation(MPR),slab maximum intensity projection(slab-MIP) and slab volume rendering(slab-VR).Results The LTH was detected by multi-slice spiral CT in 90.8%(118/130).On these oblique-sagittal MPR,slab-MIP and slab-VR images,LTH presentedas slightly high density smooth cord-like structure in accordance with its anatomical morphology and position.The mean diameter of fissure portion of normal LTH was(5.44?0.96) mm(range 3.2-7.2 mm) measured at its middle region,and that of free portion of normal LTH was(3.43?0.91) mm(range 1.6-6.0 mm).Conclusions Multi-slice spiral CT demonstrates the LTH clearly,and has a potentialto evaluate the LTH before abdominal operation in which the LTH is to be used as an autogenous repairmaterial.

Neonatal intestinal obstruction

We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure of conservative treatment. There were more males than females and the age range was 12 hours-26 days. Imperforate anus was the main cause of the obstruction [27.8%] followed by duodenal atresia [13.9%] and colonic atresia and meconium ileus [11.1% each]. There were 8 deaths following surgery [22% mortality rate], the main causes being aspiration pneumonia, septicaemia and hypothermia