There is good agreement between MR enterography and bowel ultrasound with regards to disease location and activity in paediatric inflammatory bowel disease.

AIM: To investigate concordance of bowel ultrasound and magnetic resonance enterography (MRE) in identifying active disease in children with inflammatory bowel disease. MATERIALS AND METHODS: The imaging of children with inflammatory bowel disease who had undergone bowel ultrasound and MRE within 30 days were retrospectively reviewed, from January 2009 to November 2015. Ultrasound was without oral contrast medium; MRI was conducted with patients unsedated with oral contrast medium and gadolinium. Imaging data included bowel thickness, markers of activity, and complications. Endoscopy and biopsy reports were also reviewed. RESULTS: Forty-nine patients (median age 14 years, 33 male) met the inclusion criteria, and 31 children also had endoscopy within 30 days. Active inflammation was seen in 17.6% of bowel segments at ultrasound and 17.3% at MRE. There was good agreement between ultrasound and MRE on the location and activity of disease (Cohen's kappa 0.75, 95% confidence interval [CI]: 0.66-0.83). One patient had an inflammatory phlegmon detected at MRE only; there was no other significant discrepancy in identifying complications. In patients with histopathology, MRE, and ultrasound demonstrated high specificity 85.1% (77.9-90.6) and 86.6% (79.6-91.8) at the bowel segment level. Technical difficulties, including poor tolerance of oral contrast medium and movement, were more common in MRE. CONCLUSION: There was good concordance between MRE and ultrasound for disease location and activity, and fewer technical difficulties with ultrasound. Bowel ultrasound is useful in children, and its use is advocated.

Applied peritoneal anatomy.

The peritoneal cavity is a complex anatomical structure with multiple attachments and connections. These are better understood with reference to the embryological development of this region. Armed with this knowledge, the diagnosis and assessment of a wide range of common intra-abdominal diseases becomes straightforward. This article will review and simplify the terminology, complex embryological development, and anatomy of the peritoneum, peritoneal attachments, and the reflections forming the peritoneal boundaries. Normal anatomy will be described using schematic diagrams with corresponding computed tomography (CT) and magnetic resonance imaging (MRI) images, including CT peritoneograms. The relevance of intra- and extra-peritoneal anatomy to common pathological processes will be demonstrated.

Detection of neuroendocrine liver metastases with MnDPDP-enhanced MRI.

PURPOSE: The sensitivity of computerised tomography (CT) in detecting neuroendocrine liver metastases is variable and three-phase imaging is advocated. However, patients are often young and may require prolonged follow-up, thus a technique that avoids radiation exposure would be desirable. Our purpose was to assess the diagnostic performance of MRI, before and after administration of mangafodipir trisodium (MnDPDP), in the detection of neuroendocrine liver metastases. METHODS: Patients who had undergone single-phase or multi-phase contrast-enhanced MD-CT for neuroendocrine liver metastases were invited to have MRI. Two independent observers made quantitative measurements (number and size of lesions). All measurements were made on each available CT phase and all MRI sequences independently, and repeated after an interval to assess reproducibility. The final number of lesions was agreed on by consensus of three observers. A qualitative assessment (contrast and spatial resolution) and preferred modality were agreed on by consensus. RESULTS: 265 lesions were detected by consensus in 11 patients. Non-contrast CT was available in 4/11, arterial phase in 6/11 and portal phase in 10/11 patients. When compared with the consensus number of lesions, MD-CT identified 17% on non-contrast, 44% on arterial and 43% on portal venous imaging. Lesion detection on MRI was 48% on T(1)W, 52% on T(2)W and 92% on MnDPDP-MRI. The number of lesions detected on MnDPDP-MRI was closest to the final consensus reading (variance = 0.994, p = 0.0027). The reproducibility of lesion size measurements was best on MnDPDP-MRI (variance = 0.033, p = 0.0021). The preferred modality subjectively was MnDPDP-MRI in 9/11 cases and T(2)W MRI in 2/11. CONCLUSION: MRI is a robust technique in the demonstration of neuroendocrine liver metastases. It is highly reproducible in both detecting the number and measuring the size of lesions. We recommend T(2)W MRI and MnDPDP-MRI in detection and follow-up of neuroendocrine liver metastases.

Breast imaging in the new era.

In the last decade,there have been huge advances in the field of breast imaging.Full field digital mammography systems optimise lesion to background contrast with resultant improvement in the sensitivity of the technique for cancer detection, facilitated by computer-aided detection.Though mammography remains the only established modality for population-based screening, preliminary results from several large studies indicate that magnetic resonance imaging(MRI) has a role in high-risk patients.On the other hand, advances in ultrasound, MRI and nuclear medicine have the potential to greatly improve the specificity of breast imaging with regard to cancer detection and lesion characterisation.A number of new and experimental techniques are being developed which may have great impact in this area and these will be discussed. Though MRI now has an established place in the diagnosis of breast cancer, it is becoming clear that it can directly affect surgical and medical management by enabling assessment of response to chemotherapy and endocrine therapy, and facilitating choice of the most appropriate surgery.Just as the role of MRI has evolved,so too the place of nuclear medicine, particularly positron emission tomography and radio-immunoscintigraphy should become clearer in the next few years.