What’s New in Gastrointestinal Imaging – January 2022

4 months ago

Gastrointestinal Imaging – Dane Eskildsen

Revisiting the Spleen—An Imaging Review of the Common and Uncommon Splenic Pathology – M Nadeed et al.

This article gives attention to the spleen and many of the common and uncommon pathologies that affect it. The authors first give a summary of splenic anatomy, the normal imaging characteristics of the spleen and expound on several common splenic anatomical variants. The authors divide splenic pathologies into 4 categories. The first is trauma, in which the imaging characteristics of many traumatic injuries to the spleen (contusion, rupture, laceration) are described. The second is vascular pathology, including splenic artery aneurysm/pseudoaneurysms, splenic vein thrombosis, splenic infarction, and spontaneous rupture of the spleen. Third, is infection and inflammation which includes abscess, hydatid cyst and sarcoidosis. The article is rounded off with benign and malignant masses, from cysts to angiosarcoma.

Evaluation of celiac disease with uniphasic and multiphasic dynamic MDCT imaging – C. Goya et al.

Past studies have indicated that dynamic contrast-enhanced magnetic resonance imaging (MRI) provides useful information about the inflammatory processes in Crohn’s and celiac disease (CD). This study aims to determine if this also rings true for dynamic multidetector CT imaging. This study is a retrospective analysis of patients divided into 4 groups: patients with positive symptoms and serologies who had imaging done for other abdominal complaints before treatment (untreated), patients with a diagnosis of CD who got better with treatment (treated), patients who were resistant to treatment (incompatible), and patients without CD who had imaging done (control). The authors found that the contrast curves observed in the treated patients differed significantly from the contrast curves observed in untreated/noncompliant patients. There were also similarities between the contrast curves between the treated group and the control group. As mentioned by the authors, this study suggests that dynamic MDCT may be useful in the follow-up of dietary therapy and in evaluating the response to anti-inflammatory drugs in patients with CD.

Overview of serum and tissue markers in colorectal cancer: a primer for radiologists – A. Bonde et al.

Serum and tissue biomarkers play a significant role in the diagnosis and personalized management of colorectal cancer patients, with consistently increased utilization in recent years. Two main types of biomarkers are used in clinical practice: serological markers (CEA, CA 19-9, CA- 125, etc.) and tissue markers (KRAS, BRAF, HER2, etc.). These tumor markers can be used to screen, aid in early diagnosis, determine treatment response, recurrence, and aid in prognosis. For colon cancer specifically, the authors report that any serial elevation of CEA should prompt further workup, including imaging. They suggest that the radiologist should consider patients’ tumor markers when monitoring response to chemotherapy and contend that the use of markers in conjunction with imaging findings improves prognostication of colorectal cancer with early detection of recurrence and metastatic disease. The authors also describe some imaging biomarkers which are being investigated to determine characteristics of colon cancer, predict prognosis, and aid in targeted treatments.

Body mass index as a predictor of sonographic visualization of the pediatric appendix – C Pfeifer et al.

Ultrasound is used as first-line imaging for appendicitis in pediatric patients. Increased Body mass index (BMI) above 25 has been cited as a limitation to the sensitivity of this study. This study aimed to compare BMI with rates of successful visualization of the appendix on ultrasound. Patients’ BMI was calculated and converted to an age/sex-adjusted Z score. 500 patients met the inclusion criteria and were used in the study, roughly half being male and half female. The authors found that there was an inverse linear relationship between BMI Z-score and visualization of the appendix. That is, as BMI Z- score increases, appendix visualization decreases. Thinner children (Z-score of < -2) were 4.41 times more likely to have visualization of the appendix when compared to average-weight children. Overweight children (Z-scores of 1-2 and >2) were 33% and 66% less likely to have a visualized appendix. Interestingly, appendix visualization was higher for male patients than female patients at all BMI Z-scores.

Radiology of anal and lower rectal cancers – M Hemachandran et al.

Lower rectal and anal cancers are distinct from neoplasms involving the rest of the rectum. This review article delves into the pertinent anatomy and normal imaging characteristics of the anal canal and lower rectum, including extremely important structures such as the anal sphincters. The authors then define and categorize tumors of the anal canal and lower rectal region and briefly describe the risk factors and clinical features of these entities. They also discuss the role of imaging, including the use of contrast-enhanced CT and FDG positron emission tomography as anal cancers are FDG avid. MRI use or the use of endoanal ultrasound if MRI is not available is also explored. The authors spend a lot of the article then discussing MRI technique and MRI features of lower rectal and anal cancers. Treatment of these cancers including post-treatment imaging is briefly discussed. Lastly, the future directions of the imaging and treatment of anal and lower rectal cancers are touched upon.

 

References:

  1. Revisiting the Spleen—An Imaging Review of the Common and Uncommon Splenic Pathology. Nadeem, Meshaal ; Tiwari, Hina Arif ; Jambhekar, Kedar ; Shah, Hemendra ; Ram, Roopa Journal of Gastrointestinal and Abdominal Radiology, 2021-07, Vol.4 (2), p.127-138
  2. Evaluation of celiac disease with uniphasic and multiphasic dynamic MDCT imaging. Göya, Cemil; Dündar, İlyas Özgökçe, Mesut; Türkoğlu, Saim; Türko, Ensar; Özkaçmaz, Sercan; Aydoğdu, Güly; Almalı, Necat. Abdominal radiology (New York), 2021-08-20, Vol.46 (12), p.5564-5573
  3. Overview of serum and tissue markers in colorectal cancer: a primer for radiologists Bonde, Apurva; Smith, Daniel A; Kikano, Elias; Yoest, Jennifer M; Tirumani, Sree H; Ramaiya, Nikhil H. Abdominal radiology (New York), 2021-08-20, Vol.46 (12), p.5521-5535
  4. Radiology of anal and lower rectal cancers. Hemachandran, N ; Goyal, A ; Bhattacharjee, H.K ; Sharma, R. Clinical radiology, 2021-12, Vol.76 (12), p.871-878
  5. Body mass index as a predictor of sonographic visualization of the pediatric appendix. Pfeifer, Cory M ; Xie, Luyu ; Atem, Folefac D ; Mathew, M. Sunil ; Schiess, Desi M ; Messiah, Sarah E. Pediatric radiology, 2021-09-15, Vol.52 (1), p.42-49

 

 

 

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