Radiation overexposure from repeated CT scans in young adults with acute abdominal pain.

PURPOSE: The purpose of this study is to assess the dose of ionizing radiation caused by repeated CT scans performed to investigate non-traumatic acute abdominal conditions in young adults. METHODS: Over 26 months, we collected a cohort of patients aged 18 to 45 years who were subject to at least one urgent contrast-enhanced abdomen/pelvis CT. Patients affected with urolithiasis, HIV infection, tumors, and vascular and chronic inflammatory bowel diseases were excluded. All abdomen/pelvis CT scans carried out at our institution for over 6 years were retrospectively tallied, and the effective doses (EDs) were computed by multiplying the total dose-length product by the appropriate anatomic conversion factor. Examples of age- and gender-adjusted lifetime attributable cancer risks were estimated using the online calculator Radiation Risk Assessment Tool. RESULTS: Sixty-one patients (average age 34.2 years) received multiple CT scans (average 2.7 scans per patient). ED largely varied among single- and multi-phase acquisitions. Cumulative ED ranged from 14.1 mSv to a maximum of 436.6 mSv (average 70.1 mSv per person). Twenty-five patients (40.9%) received more than 50 mSv, 84% of them within year; 12 (19.7%) and 4 (6.6%) patients received more than 100 and 200 mSv, respectively. CONCLUSION: Young adults are subject to repetitive CT imaging to monitor urogenital, intestinal, hepatobiliary, and pancreatic disorders during non-operative management to detect and follow up abdominal emergencies requiring surgical intervention and to assess post-surgical complications. In this population, the risk of accruing high cumulative radiation exposure should be considered.

Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study.

PURPOSE: To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. MATERIALS AND METHODS: This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student's t, chi-squared, and Cohen's kappa tests. RESULTS: Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (k = 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (p < 0.05) predictors of OM. Nonoperative management (NOM) failed in 23 patients out of 191 (12.04%). In 75% of them, NOM failure occurred within 30 h from the trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (p < 0.05). CONCLUSION: Providing detection and characterization of parenchymal and vascular traumatic lesions, MDCT plays a crucial role for safe and appropriate guidance of ED management of splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.

Usefulness of paclitaxel-releasing high-pressure balloon associated with cutting balloon angioplasty for treatment of outflow stenoses of failing hemodialysis arteriovenous shunts.

AIM: To evaluate the technical and clinical success, primary patency (PP) and complications of angioplasty performed with paclitaxel-coated balloon (PCBs) associated with cutting balloon and for the treatment of the outflow stenoses of failing hemodialysis arteriovenous shunt. MATERIAL AND METHODS: From September 2014 to September 2015, 50 patients with 66 stenoses were registered. Vascular accesses were autogenous (n = 20) and prosthetic (n = 30). Stenosis were documented during follow-up with routine echo-color Doppler, clinical evaluation and in the remaining incidentally during fistulography. Angioplasty was performed with cutting balloon and afterward with PCB. The mean follow-up time was 8 months (range 6-15 months). Technical success, clinical success, primary patency and complications were registered. RESULTS: Technical success was 100 %. Clinical success was 94.7 %. Primary patency rate was 87.7 %; in five patients, a significant re-stenosis (≥50 %) was registered. A residual asymptomatic stenosis (<30 %) was registered in four cases (7 %). No major complications were registered. CONCLUSIONS: A short-term patency benefit may be obtained including PCB in angioplasty treatment of failing hemodialysis arteriovenous shunts.

Ethylene-vinyl alcohol copolymer as embolic agent for treatment of type II endoleak: our experience.

AIM: To evaluate safety, technical and clinical success of embolization of type II endoleak (T2 EL) using ethylene-vinyl alcohol copolymer as embolic agent alone or in combination with others materials. MATERIALS AND METHODS: From March 2007 to March 2015, 104 patients presented T2 EL during follow-up. A total of 21 patients met the criteria for treatment. T2 EL was treated with TAE (n = 18), DPSI (n = 10) or laparoscopic ligature of the inferior mesenteric artery (n = 1). DPSI was considered in case TAE was unsuccessful (8/18 patients). Ethylene-vinyl alcohol copolymer was used as embolic agent in 12 patients: alone in 5 cases, in association with glue and with glue and thrombin in 3 and 2 cases, respectively, during TAE. Onyx was injected in two cases of embolization performed with DPSI: in one case alone and in the other in combination with thrombin and glue. RESULTS: Technical success rate was 100%. Immediate clinical success was 91.7%; in one patient CEUS revealed persistent T2 EL, decreased if compared with that before the procedure. Secondary clinical success was 91.7%; until today, in one patient T2EL is persistent, nevertheless, the sac diameter remained stable. No major or minor complications were registered. CONCLUSIONS: Onyx could be an ideal embolic agent for endovascular and percutaneous embolization of T2 EL.

Evaluation of tablet ultrasound for routine abdominal interventional procedures.

AIM: The aim of the study was to establish if a novel tablet ultrasound (US) may replace a high-end US machine during routine interventional radiology activities. MATERIALS AND METHODS: Thirty consecutive patients were evaluated by two operators comparing the performance of the new US tablet system (VISIQ, Philips Healthcare) against a high-end US system (iU22, Philips Healthcare) using a curved probe (C5-2). A structured questionnaire was used to rank on a 4-point scale the ability of each system to locate a target as detected by previous examinations and visualize needles and path during an interventional procedure. Necessity for conversion from the tablet US to the high-end US system was registered; body mass index (BMI) was annotated for each patient. RESULTS: Agreement between the operators was found for every patient. Mean patient BMI was 25 (range 17-34). Image quality of the tablet US was considered insufficient in 1 case to visualize the target and in another case to visualize the needle. Mean target image quality was superior with the high-end US system, while needle visibility scored higher with the tablet US. Conversion to the high-end system was registered in 40 % of cases: in most cases (66.6 %) the decision was due to the absence of a dedicated needle guide for the tablet US. CONCLUSIONS: The novel tablet US was found to provide sufficient image quality for the majority of routine interventional procedures. Dedicated accessories and additional experience with this new generation US device may be needed to replace bulky high-end US systems.

ePTFE stent graft in non-steno-occlusive arterial disease: 2 centers retrospective study.

PURPOSE: We report our experience regarding use of Fluency stent graft (Bard, Murray Hill, NJ, USA) for the treatment of peripheral aneurysms, pseudoaneurysms, arteriovenous fistulae, dissections and arterial ruptures, lacerations or perforations. METHODS AND MATERIALS: This two-center study included 59 patients (40 M, 19 F) with a mean age of 64.37 years (range 20-91 years). In total 61 lesions were treated, so subdivided: 10 true aneurysms, 26 pseudoaneurysms, 5 iatrogenic arteriovenous fistulae, 20 arterial ruptures, lacerations or perforations. RESULTS: Immediate technical success was obtained in 60 of 61 lesions (98.3 %); in 1 case (pseudoaneurysm of hepatic artery) additional embolization of the gastroduodenal artery with microcoils was needed. Follow-up was available for 57 patients and 59 lesions; mean period was 23.52 months (range 1-60 months). At 1-year primary patency was 89.47 %, whereas secondary patency was 96.4 %. CONCLUSION: Endovascular application of Fluency stent graft seems to offer an effective, and durable less invasive alternative to standard surgical techniques for the treatment of peripheral aneurysms, pseudoaneurysms, iatrogenic arteriovenous fistulae and arterial ruptures, or penetrating injuries.

Symptomatic and complicated nonhereditary developmental liver cysts: cross-sectional imaging findings.

Commonly encountered in the general population, in the vast majority of cases nonhereditary developmental liver cysts are asymptomatic, not associated with altered hepatic function and confidently diagnosed on imaging studies, and do not require further workup, follow-up, or treatment. However, particularly in women, simple hepatic cysts may reach large sizes and cause symptoms and signs resulting from mass effect, vascular compression, and biliary obstruction. Furthermore, although rarely compared to the incidence observed in patients with adult polycystic kidney and liver disease, sporadic hepatic cysts sometimes undergo life-threatening complications such as intracystic hemorrhage, infection, or rupture, which require prompt imaging triage and appropriate interventional, laparoscopic, or open surgical treatment. This pictorial essay reviews with examples the cross-sectional imaging findings of symptomatic and complicated nonhereditary liver cysts, aiming to provide radiologists with an increased familiarity with these uncommon, challenging occurrences. Emphasis is placed on the role of MRI as a useful problem-solving modality to elucidate the complex imaging appearances resulting from intracystic bleeding and superinfection, and to differentiate complicated cysts from other hemorrhagic liver lesions and biliary cystic tumors.

Acute HIV-related gastrointestinal disorders and complications in the antiretroviral era: spectrum of cross-sectional imaging findings.

Emergency physicians and radiologists are increasingly confronted with aging HIV-positive or acquired immunodeficiency syndrome (AIDS) patients with acute abdominal symptoms, who often require immediate medical or surgical treatment. A wide spectrum of infectious and neoplastic HIV-related gastrointestinal diseases may be encountered, along with atypical presentations of common disorders. Since symptoms and physical findings are commonly nonspecific or masked by concurrent illnesses, medications, and weak immune response, prompt cross-sectional diagnostic imaging studies are needed to triage patients and choose treatment. Multidetector CT currently represents the mainstay modality to promptly investigate intra-abdominal opportunistic disorders in HIV/AIDS patients, and MRI is increasingly used to assess abnormalities involving the rectum. The spectrum of cross-sectional imaging appearances of HIV-related acute gastrointestinal disorders and complications observed in the antiretroviral era is reviewed, including acute intestinal infections, causes of right lower quadrant pain, bleeding, bowel obstruction, and perforation. State-of-the-art technology, knowledge of pertinent clinical information, and familiarity with the spectrum of opportunistic diseases are necessary to improve diagnostic confidence in the detection and characterization of gastrointestinal abnormalities on urgent cross-sectional abdominal studies performed in HIV-infected patients.

Common and unusual urogenital Crohn's disease complications: spectrum of cross-sectional imaging findings.

Involvement of the urinary tract and genital organs is not uncommon in patients affected with Crohn's disease (CD). Occurring in both sexes, uro-gynecological complications are often clinically unsuspected because of the dominant intestinal or systemic symptoms. Knowledge of their manifestations and cross-sectional imaging appearances is necessary to recognize and report them, since correct medical or surgical treatment choice with appropriate specialist consultation allows to prevent further complications. Besides uncomplicated urinary tract infections that usually do not require imaging, urolithiasis and pyelonephritis represent the most commonly encountered urinary disorders: although very useful, use of computed tomography (CT) should be avoided whenever possible, to limit lifetime radiation exposure. Hydronephrosis due to ureteral inflammatory entrapment and enterovesical fistulization may result from penetrating CD, and require precise imaging assessment with contrast-enhanced CT to ensure correct surgical planning. Representing the majority of genital complication, ano- and rectovaginal fistulas and abscesses frequently complicate perianal inflammatory CD and are comprehensively investigated with high-resolution perianal MRI acquired with phased-array coils, high-resolution T2-weighted sequences and intravenous contrast. Finally, rare gynecological manifestations including internal genital fistulas, vulvar and male genital involvement are discussed.

Nontraumatic splenic emergencies: cross-sectional imaging findings and triage.

The spleen is commonly involved in a wide spectrum of hematologic, immunologic, neoplastic, infectious, and vascular systemic disorders. Sometimes overlooked on imaging studies outside the trauma setting, the spleen may harbor severe infections, and occasionally undergoes spontaneous bleeding or rupture. This pictorial essay reviews common and unusual causes of nontraumatic acute abnormalities primarily involving the spleen, and their cross-sectional imaging appearances. Emphasis is placed on multidetector computed tomography (MDCT) imaging, which represents the modality of choice to comprehensively assess acute splenic disorders including partial or complete infarctions, vascular diseases such as venous thrombosis, abscess collections, bleeding, and rupture. State-of-the-art magnetic resonance imaging represents a problem-solving technique. Borrowing from experience with grading abdominal trauma according to the traditional American Association for the Surgery of Trauma scale, spontaneous splenic injuries are confidently detected and characterized at MDCT. Furthermore, MDCT allows to identify or exclude coexistent perisplenic and intraperitoneal hemorrhage, presence and source of active bleeding, and contained vascular injury. Occasionally idiopathic, spontaneous splenic injuries should be suspected when acute abdominal manifestations and signs of hemodynamic compromise occur in a background of acute viral infections, endocarditis or sepsis, malaria, immune suppression, hematological disorders, malignancies, coagulopathy, or therapeutic anticoagulation. These uncommon yet life-threatening conditions require prompt diagnostic evaluation that allows correct triage between conservative, medical, interventional, and surgical treatment, and may obviate splenectomy. Finally, MDCT imaging allows differentiation of splenic rupture from other rare causes of spontaneous hemoperitoneum, and reliable follow-up of nonsurgically treated patients.

Magnetic Resonance Visibility, Artifacts, and Overall Safety of the Self-Locating Peritoneal Dialysis Catheter with a Tungsten Tip.

Background: The self-locating peritoneal dialysis (PD) catheter, contains a tungsten tip. The effects of magnetic resonance (MR) on the catheter were evaluated, emphasizing its MR signal, artifacts, ferromagnetism, and possible heating production during the MR sequences. Methods: The catheter was studied in an ex vivo model using a 1.5T MR system and placed into a plastic box containing saline solution. Acquisitions on coronal and axial planes were obtained on fast gradient-echo T1-weighted and fast spin-echo T2-weighted. In vivo abdominal MR exams were also carried out. Results: Overall, the catheter had good visibility. In all sequences, an extensive paramagnetic blooming artifact was detected at the level of the tip tungsten ballast, with a circular artifact of 5 cm in diameter. The catheter showed no magnetic deflection, rotation, or movements during all MR sequences. After imaging, the temperature of the saline solution did not change compared to the basal measurement. Patients safely underwent abdominal MR. Conclusions: The results point to the possibility of safely performing MR in PD patients carrying the self-locating catheter. The self-locating PD catheter is stable when subjected to a 1.5T MR system. However, it creates some visual interference, preventing an accurate study of the tissues surrounding the tungsten tip.

Common and unusual diseases involving the iliopsoas muscle compartment: spectrum of cross-sectional imaging findings.

Although relatively uncommon, many different infectious, hemorrhagic and neoplastic disease processes may involve the iliac and psoas muscles and are increasingly diagnosed especially in referral hospitals. Furthermore, the iliopsoas compartment may become injured during trauma, percutaneous instrumentation, laparoscopic or open surgical procedures. State-of-the-art cross-sectional imaging including volumetric multidetector CT and multiplanar MRI acquisitions allows prompt detection, comprehensive visualization and confident characterization of most iliopsoas lesions, and the possibility to guide percutaneous biopsy and drainage. The pertinent regional anatomy is reviewed in correlation with disease pathways and imaging modalities. Neoplastic lesions, purulent and mycobacterial iliopsoas infections are discussed with examples. Imaging plays the key role in the differentiation of primary versus secondary abscesses due to intestinal, urinary and musculoskeletal infections, that determines medical therapy and surgical need. The iliopsoas compartment may become involved through direct extension by retroperitoneal, skeletal and pelvic tumors, and should be carefully scrutinized when reviewing oncologic imaging studies since it represents one of the preferred sites of skeletal muscle metastatization. Iliopsoas hemorrhages due to trauma, aortic aneurysms and anticoagulation are reviewed, with a special focus on determining whether the bleeding comes from aneurysmal rupture or from coagulopathy, a critical differentiation to decide about medical or surgical treatment. Postoperative complications involving the iliopsoas compartment are discussed with examples, including retroperitoneal bleeding, infections, urinary leaks and collections following various surgical or instrumentation procedures. Emphasis is placed on choosing the correct imaging modality and technique, particularly to detect active bleeding or urine leakage, and to reduce artifacts related to presence of metallic implants.

Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings.

Acute cholecystitis, which is usually associated with gallstones, is one of the commonest surgical causes of emergency hospital admission and may be further complicated by mural necrosis, perforation, and abscess formation. Magnetic resonance imaging (MRI) is increasingly available in the emergency setting. Technically improved equipment and faster acquisition protocols allow excellent tissue contrast and MRI is now an attractive modality for imaging acute abdominal disorders. The use of MRI with MR cholangiopancreatography in the emergency setting provides rapid, noninvasive, and confident diagnosis or exclusion of acute cholecystitis and of coexistent choledocholithiasis. To familiarize the reader with these cross-sectional imaging appearances, this paper reviews MRI findings consistent with uncomplicated cholecystitis. These include gallbladder distension, intraluminal sludge and gallstones, impacted stones obstructing the gallbladder neck or cystic duct, thickening of the gallbladder wall, abnormal signal intensity and edematous stratification, and pericholecystic and perihepatic fluid, plus increased enhancement of the gallbladder wall and adjacent liver parenchyma when intravenous paramagnetic contrast is used. Furthermore, MRI allows prompt detection and comprehensive visualization and characterization of cholecystitis-related complications such as gangrene, perforation, pericholecystic abscess, and intrahepatic fistulization. Some previous literature reports, and our experience, suggest that, when available, MRI should be recommended to provide prompt and efficient triage of patients with suspected cholecystitis and inconclusive clinical, laboratory, and sonographic findings. It facilitates appropriate therapeutic planning, including the timing of surgery (emergency or delayed), approach (laparoscopic or laparotomic), and need for preoperative or intraoperative removal of stone(s) in the common bile duct.

Diagnostic significance of mesenteric lymph node involvement in proximal small bowel Crohn's disease.

Background: The diagnosis of proximal small bowel involvement in Crohn's disease (CD) can be challenging at magnetic resonance enterography (MRE). The inflammatory process in CD can be associated with peri-intestinal inflammatory reactions, including the presence of inflamed mesenteric lymph nodes. Objectives: To evaluate the significance of inflamed mesenteric lymph nodes adjacent to the jejunum at MRE in CD and the association with proximal bowel disease as detected by video capsule endoscopy (VCE). Design: This retrospective study was performed in two tertiary medical centres, and included 64 patients with CD who underwent MRE as well as VCE within 1 year. Methods: Data were collected for examinations performed between August 2013 and February 2021. MRE images were independently reviewed by radiologists who were blinded to the clinical data. Association between the presence of mesenteric lymph nodes adjacent to jejunum at MRE and disease activity according to VCE Lewis scores of proximal small bowel was examined. Results: VCE detected proximal disease in 24/64 patients (37.5%). Presence of regional lymph nodes in the jejunal mesentery was significantly associated with jejunal disease as seen on VCE (p < 0.001). Of the 20 patients who had proximal mesenteric lymph nodes at MRE, 15 (75%) had jejunal disease at VCE (sensitivity, 62.5%; specificity, 87.5%; and negative and positive predictive values, 79.5 and 75%, respectively). The number of regional lymph nodes was positively correlated with jejunal disease (mean: 2.63 ± 2.90 versus 0.78 ± 2.60, p = 0.01). Other MRE features of lymph nodes were not significantly predictive of jejunal CD. Conclusion: In patients with CD, inflamed regional lymph nodes in the jejunal mesentery at MRE can be valuable to suggest proximal small bowel disease, even when bowel wall features at imaging do not suggest disease involvement. Plain language summary: The diagnosis of proximal small bowel involvement in Crohn's disease (CD) can be challenging at magnetic resonance enterography (MRE). We analysed MRE examinations in patients with CD for the presence of lymph nodes adjacent to the proximal small bowel. We included 64 patients with CD who had MRE examinations and video capsule endoscopy (VCE) examinations within 1 year. Of 64 patients, 24 had proximal small bowel disease according to VCE. We found that of 20 patients who had regional mesenteric lymph nodes in the jejunal mesentery at MRE, 15 had proximal bowel disease involvement. We also found that patients with jejunal disease had a larger number of regional lymph nodes compared to patients without jejunal disease. All but one patient had normal appearing bowel at MRE. But, using regional mesenteric lymphadenopathy at MRE as an indicator for disease, 15/24 (62.5%) patients with proximal small bowel disease were detected. We therefore conclude that regional mesenteric lymph nodes assessment at MRE can aid diagnose proximal bowel disease, even when the proximal bowel looks normal at imaging. Presence of proximal mesenteric lymph nodes at MRE in patients with CD possibly warrant further investigation of the proximal small bowel by endoscopic measures.

Ileal pouch and related complications: spectrum of imaging findings with emphasis on MRI.

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the established surgical therapy for familial adenomatous polyposis (FAP) and refractory ulcerative colitis (UC). Despite general patient satisfaction with preserved fecal continence, this procedure is associated with a significant long-term morbidity approaching 70% after 10 years, and with a non-negligible rate of pouch failure leading to removal and permanent ileostomy. Following a concise description of the surgical technique, the normal imaging appearance of the ileal "pouch" reservoir at pelvic CT and MRI is explained. Since awareness of their imaging appearances is needed for a correct diagnosis, we discuss and illustrate common and unusual pouch-related complications, including pouchitis and irritable pouch disease; anastomotic leakages and pelvic abscess collections; fistulas involving the ano-perianal region, urinary bladder, vagina, perineal skin, and subcutaneous planes; anal stenosis and small-bowel obstruction. In our experience, pelvic contrast-enhanced MRI has proven invaluable for the diagnostic assessment of patients with suspected pouch-related complications, allowing differentiation of uncomplicated pouchitis from pelvic sepsis, the latter requiring aggressive therapy and possible even in patients with normal endoscopic findings.

Elucidating vaginal fistulas on CT and MRI.

Vaginal fistulas (VF) represent abnormal communications between the vagina and either the distal portion of the digestive system or the lower urinary tract, but lack an accepted classification and standardised terminology. Regardless of the underlying cause, these uncommon disorders result in profound physical, psychological, sexual and social distress to the patients.Since diagnosis of VF is challenging at gynaecologic examination, ano-proctoscopy and urethro-cystoscopy, imaging is crucial to confirm the fistula, to visualise its site, course and involved organ, and to characterise the underlying disease. The traditional conventional radiographic studies provided limited cross-sectional information and are nowadays largely replaced by CT and MRI studies.Aiming to provide radiologists with an increased familiarity with VF, this pictorial paper summarises their clinical features, pathogenesis and therapeutic approach, and presents the appropriate CT and MRI acquisition and interpretation techniques that vary according to the anatomic site and termination of the fistula. The current role of state-of-the art CT and MRI is presented with examples regarding both entero- (involving the colon, rectum and anus) and urinary (connecting the bladder, distal ureter or urethra) VF. The resulting combined anatomic and functional cross-sectional information is crucial to allow a correct therapeutic choice and surgical planning.

A closer look at the stoma: multimodal imaging of patients with ileostomies and colostomies.

Nowadays, large numbers of ileostomies and colostomies are created during surgical management of a variety of intestinal disorders. Depending on indication, surgical technique and emergency versus elective conditions, stomas may be either temporary or permanent. As a result, patients with ileostomies and colostomies are commonly encountered in Radiology departments, particularly during perioperative hospitalisation following stoma creation or before recanalisation, and when needing CT or MRI studies for follow-up of operated tumours or chronic inflammatory bowel diseases. However, the stoma site is commonly overlooked on cross-sectional imaging.Aiming to improve radiologists' familiarity with stoma-related issues, this pictorial essay concisely reviews indications and surgical techniques for ileostomies and colostomies, and presents state-of-the art multimodal imaging in patients living with a stoma, including water-soluble contrast stomal enema (WSC-SE), CT and MRI techniques, interpretation and expected findings. Afterwards, the clinical features and imaging appearances of early and late stoma-related complications are illustrated with imaging examples, including diversion colitis.When interpreting cross-sectional imaging studies, focused attention to the stoma site and awareness of expected appearances and of possible complications are required to avoid missing significant changes requiring clinical attention. Additionally, dedicated imaging techniques such as WSC-SE and combined CT plus WSC-SE may be helpful to provide surgeons the appropriate clinical information required to direct management.

Endoscopic stenting of malignant, benign and iatrogenic colorectal disorders: a primer for radiologists.

In recent years, endoscopic placement of intraluminal stents is increasingly used to manage a widening range of colorectal disorders. Self-expanding metal stents represent an established alternative to surgery for the palliation of unresectable carcinomas and currently allow a "bridge-to-surgery" strategy to relieve large bowel obstruction and optimise the patients' clinical conditions before elective oncologic resection. Additionally, intraluminal stents represent an appealing option to manage obstructing extracolonic tumours and selected patients with benign conditions such as refractory anastomotic strictures and post-surgical leaks.This educational paper reviews the technical features and current indications of colorectal stenting and presents the expected and abnormal radiographic, CT and MRI appearances observed during the endoscopic management of malignant, benign and iatrogenic colonic disorders with stents. The aim is to provide radiologists with a thorough familiarity with stent-related issues, which is crucial for appropriate reconstruction of focused CT images, correct interpretation of early post-procedural studies and elucidation of stent-related complications such as misplacement, haemorrhage, perforation, migration and re-obstruction.

Advanced endoscopic interventions on the pancreas and pancreatic ductal system: a primer for radiologists.

In recent years, technological advancements including endoscopic ultrasound (EUS) guidance and availability of specifically designed stents further expanded the indications and possibilities of interventional endoscopy. Although technically demanding and associated with non-negligible morbidity, advanced pancreatic endoscopic techniques now provide an effective minimally invasive treatment for complications of acute and chronic pancreatitis.Aiming to provide radiologists with an adequate familiarity, this pictorial essay reviews the indications, techniques, results and pre- and post-procedural cross-sectional imaging appearances of advanced endoscopic interventions on the pancreas and pancreatic ductal system. Most of the emphasis is placed on multidetector CT and MRI findings before and after internal drainage of pseudocysts and walled-off necrosis via EUS-guided endoscopic cystostomy, and on stent placement to relieve strictures or disruption of the main pancreatic duct, respectively in patients with chronic pancreatitis and disconnected pancreatic duct syndrome.

Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion.

Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation.The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.