Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms.

BACKGROUND: Computed tomographic colonography (CTC) is now an established method for imaging the colon and rectum in the screening and symptomatic setting. Additional benefit of CTC is the ability to assess for extracolonic findings especially in patients presenting with colorectal symptoms. PURPOSE: To determine prevalence of extracolonic findings (ECF) in symptomatic patients undergoing CTC and determine accuracy of CTC for exclusion of significant abdominal disease and extracolonic malignancy (ECM). MATERIAL AND METHODS: A total of 1359 unenhanced prone and postcontrast supine CTC studies were performed between March 2002 and December 2007. ECF were retrospectively classified according to C-RADS criteria into E1 to E4 findings. For ECM, a gold standard of clinical and/or radiological follow-up supplemented with data from the regional cancer registry with a median follow-up of 42 months was created. Sensitivity and negative predictive values for ECM was calculated. RESULTS: Following exclusions, 1177 CTCs were analyzed. Of 1423 extracolonic findings reported, 328/1423 (23%) E3 and 100/1423 (7%) E4 (including six eventual FP studies) findings were identified. Thirty-two ECMs were confirmed following further investigations. Seven further small ECMs were detected during the entire follow-up, of which two were potentially visible in retrospect (false-negative studies). Additional tests were generated from 55/1177 (4.7%) studies. Sensitivity and negative predictive value for ECM was 94.1% (95% CI 78.9-98.9%) and 99.8% (95% CI 99.3-99.9%), respectively. CONCLUSION: One in 37 patients were found to have an ECM. Two potentially detectable cancers were missed. Only a small proportion of patients underwent additional work-up.

CT Colonography to exclude colorectal cancer in symptomatic patients.

OBJECTIVES: CT Colonography (CTC) is being increasingly used for the radiological evaluation of colorectal symptoms. Aim of this study was to assess the role of CTC in excluding a colorectal cancer (CRC) in older symptomatic patients. METHODS: 1,359 CTC studies performed between March 2002 and December 2007 were analysed retrospectively. Gold standard was an endoscopic examination within 1 year and/or clinical, endoscopic and/or radiological follow-up until the time of data analysis. Patients not diagnosed as having a CRC on CTC were assumed as true-negatives if the gold standard was negative and did not feature on the regional cancer registry (at least 18 months post-CTC). Sensitivity, specificity, positive and negative predictive values were calculated for detection of colorectal cancer. RESULTS: After exclusions, 1,177 CTC studies were included. These were undertaken in 463 men and 714 women. Median age of patients undergoing CTC was 71 (range, 27-96) years. 59 invasive CRC were detected. Median follow-up was 34.5 (range 18-84) months. Three small colorectal cancers were missed. Sensitivity and negative predictive value for CRC were 94.9% (95% CI:84.9%-98.7%) and 99.7% (95% CI:99.1%-99.9%) respectively. CONCLUSIONS: CTC has a high sensitivity and negative predictive value in excluding a CRC in patients with colorectal symptoms.

Role of CT colonography in symptomatic assessment, surveillance and screening.

INTRODUCTION: When 'whole colonic imaging' is indicated, clinicians must decide between optical colonoscopy, barium enema and CT colonography (CTC). CTC is a relatively new technique which has become increasingly accessible in the UK over the past 5 years. As radiologists have gained experience and scanning parameters have standardised, there have been substantial improvements in both the accuracy and safety of CTC. METHODS: We review evidence from observational studies and randomised trials, and draw on expert opinion, to provide a comprehensive discussion of the current role of CTC in both symptomatic and asymptomatic individuals. CONCLUSIONS: The emergence of CTC could soon entirely obviate the need for barium enema. CTC now has a complementary role alongside colonoscopy in symptomatic patients and a possible future role in colorectal cancer screening in the UK.

Utility of chest radiography on admission for initial triaging of COVID-19 in symptomatic patients.

A Likert score based on chest radiography of symptomatic patients of #COVID19 can be used as a diagnostic and triaging tool in the emergency room to help physicians identify patients with likelihood of COVID-19 and triage them appropriately https://bit.ly/3gDxzDK.

Radiological imaging of the GI tract after bariatric surgery.

BACKGROUND: Obesity is becoming epidemic in proportion and is leading to considerable morbidity and mortality in the community. Bariatric surgery offers one tested solution to sustained weight loss and comorbidity reduction. However, it is associated with a significant number of complications. OBJECTIVE: The objective of this article is to review the utility of radiological techniques in the diagnosis of surgical complications after bariatric surgery. DESIGN: Literature-based review and pictorial illustration in the use of imaging techniques in the diagnosis of complications after bariatric surgery. CONCLUSIONS: Radiology plays a critical role in the diagnosis of complications after bariatric surgery. Upper GI contrast study and CT are the most commonly used imaging modalities in this regard. They are complementary in their diagnostic abilities and should be used in concert for the complete evaluation of symptomatic patients. All other radiological imaging modalities are also used in the diagnosis of complications after bariatric surgery, but much less commonly.

Direct erosion and prolapse of esophageal stents into the tracheobronchial tree leading to life-threatening airway compromise.

Covered or uncovered self-expanding metal stents are currently used for the palliative treatment of neoplastic esophageal obstructions or compressions and malignant esophageal leaks or fistulas. This small series, from three different European hospitals, highlights the unusual but significant complication of esophageal stent perforation followed by erosion and prolapse of the endoprosthesis into the tracheobronchial tree causing acute airway compromise or aspiration. Possible causal mechanisms and means of treatment are discussed to raise physician awareness of this life-threatening complication.

More than meets the eye: subtle but important CT findings in Bouveret's syndrome.

OBJECTIVE: Gallstones are a rare cause of duodenal or gastric outlet obstruction and therefore are not commonly suspected. Rigler's radiographic triad of pneumobilia, bowel obstruction, and an ectopic gallstone is seen in few of these patients. The symptoms are insidious and nonspecific, and the diagnosis is usually made radiologically. Although CT scans are far more sensitive, 25% of cases are still missed, often because the size of the offending gallstone is underestimated. CONCLUSION: Better assessment of stone size, and therefore higher accuracy of diagnosis, could be achieved if attention is paid to more subtle but nonetheless important signs. These include compressed air in dependent areas of the duodenal lumen, an area of soft-tissue rather than fluid density surrounding the calcified rim of the stone, and a faint radiolucency in or beyond this soft-tissue area that could represent laminations of fat or air in the stone.

Relative threshold of detection of active arterial bleeding: in vitro comparison of MDCT and digital subtraction angiography.

OBJECTIVE: The objective of our study was to determine the relative sensitivity and the lowest threshold of bleeding detectable with digital subtraction angiography (DSA) and with MDCT using an in vitro physiologic system. MATERIALS AND METHODS: A closed pulsatile cardiopulmonary bypass circuit was connected to tubes traversing a water bath to simulate the abdominal aorta and inferior vena cava. Three smaller interconnecting acrylic plastic tubes were connected as branches to the aortic tubing to simulate branch vessels. One of the three tubes, the control, had no holes in it, one had a 100-microm hole, and one had a 280-microm hole. The leakage rates were predetermined with a cardiac output of 2 and 4 L/min and with a mean arterial pressure (MAP) ranging from 30 to 100 mm Hg for each hole size. The following studies were performed for each of the predetermined leakage rates. For study 1, 16-MDCT was performed using bolus tracking after 35 mL of contrast medium had been injected into a simulated peripheral vein. For study 2, DSA was performed using a 4-French straight catheter placed 10 cm proximal to the holes (selective first aortic branch cannulation). For study 3, DSA was performed with a catheter placed in the small branch at the site of the hole (highly superselective). For study 4, 16-MDCT was performed with a catheter placed as in study 2, 10 cm proximal to the holes, for the detection of lower leakage rates. Cine loops of MDCT and DSA images were examined by two blinded observers to detect extravasation from the holes in the tubes (i.e., the branch arteries). Interobserver agreement was studied using Cohen's kappa statistic. RESULTS: The threshold to detect bleeding was as follows for each study: For IV contrast-enhanced MDCT (study 1), it was 0.35 mL/min; DSA with a catheter 10 cm proximal to the holes (study 2), 0.96 mL/min; DSA with a catheter at the holes (study 3), 0.05 mL/min [corrected] or lower; and intraarterial selective MDCT (study 4), 0.05 mL/min [corrected] or lower. The ease of detection improved with increasing MAPs and larger volumes of leakage. Interobserver correlation was excellent. CONCLUSION: In vitro, i.v. contrast-enhanced MDCT is more sensitive than first-order aortic branch-selective DSA in detecting active hemorrhage unless the catheter position is highly superselective and is close to the bleeding artery. These results suggest that MDCT can be used as the initial imaging technique in the diagnosis of active hemorrhage if the clinical condition of the patient allows.

Anaesthetic management of previously non-diagnosed phaeochromocytoma: Clinical vigilance, the ultimate saviour of anaesthesiologist.

A 39-year-old male, post nephrectomy and adrenalectomy (right), was planned for adrenalectomy (left) and radiofrequency ablation of left renal mass. Clinical evaluation indicated a possibility of phaeochromocytoma, whereas biochemical parameters were found to be within normal limits. Intraoperatively, massive fluctuations in haemodynamic parameters were noticed while the tumour was being handled. Patient was stabilised with inotropes, vasopressors, fluids and careful titration of anaesthetic agents. Preoperatively diagnosed coronary disease could have complicated anaesthetic care. Optimum and modern anaesthetic care leads to safe execution of surgery.

Management of renal tumors by image-guided radiofrequency ablation: experience in 105 tumors.

AIMS: In this article we present our experience with radiofrequency ablation (RFA) in the treatment of 105 renal tumors. MATERIALS AND METHODS: RFA was performed on 105 renal tumors in 97 patients, with a mean tumor size of 32 mm (11-68 mm). The mean patient age was 71.7 years (range, 36-89 years). The ablations were carried out under ultrasound (n = 43) or CT (n = 62) guidance. Imaging follow-up was by contrast-enhanced CT within 10 days and then at 6-monthly intervals. Multivariate analysis was performed to determine variables associated with procedural outcome. RESULTS: Eighty-three tumors were completely treated at a single sitting (79%). Twelve of the remaining tumors were successfully re-treated and a clinical decision was made not to re-treat seven patients. A patient with a small residual crescent of tumor is under follow-up and may require further treatment. In another patient, re-treatment was abandoned due to complicating pneumothorax and difficult access. One patient is awaiting further re-treatment. The overall technical success rate was 90.5%. Multivariate analysis revealed tumor size to be the only significant variable affecting procedural outcome. (p = 0.007, Pearson chi(2)) Five patients had complications. There have been no local recurrences. CONCLUSION: Our experience to date suggests that RFA is a safe and effective, minimally invasive treatment for small renal tumors.

Early experience with percutaneous radiofrequency ablation of small solid renal masses.

OBJECTIVE: Incidental small renal-cell masses are often seen in elderly patients with significant comorbidity who are unfit to undergo major surgery. This study was conducted to determine the safety and efficacy of percutaneous imaging-guided radiofrequency ablation in the management of small solid renal masses, almost all of which are renal cell cancers. CONCLUSION: Early experience suggests that radiofrequency ablation is a safe, well-tolerated, and minimally invasive therapy for patients with solid renal masses. In the era of nephron-sparing surgery, radiofrequency ablation may have a role in the management of small problematic renal masses.