What’s New in Gastrointestinal Imaging? – April 2023

1 year ago

Preoperative cross‑sectional imaging findings in patients with surgically complex ileocolic Crohn’s disease.

Dane B, Remzi FH, Grleco M, et al. Abdominal Radiology (2023) 48:486-493


Many patients with Crohn’s disease will require surgical management of their disease, and surgery can be more complex in patients with features such as fistulas, phlegmon, abscess or difficult mesentery. Pre-operative identification of these features through imaging studies can improve surgical planning and operative outcomes. The authors of this study retrospectively classified patients with Crohn’s disease who underwent surgery as complex or not complex using operative findings following surgery. The diagnostic performance of preoperative imaging was then compared between the two groups. 60.9% of patients were found to have surgically complex ileocolic Crohn’s disease. Penetrating disease, complex fistulas, and mesenteric abscess/inflammatory masses were more common in patients with complex Crohn’s disease. Estimated blood loss, conversion to open surgery, and diversion were also more common in patients with complex Crohn’s disease. These findings demonstrate the value of pre-operative imaging and some of the important findings in surgical planning for Crohn’s disease.


Prognostic value of preoperative CT features for disease‑free survival in patients with primary gastric gastrointestinal stromal tumors after resection.

Chen XS, Yuan W, Xu ZH, et al. Abdominal Radiology (2023) 48:494-501.


Resection is the mainstay of treatment for gastrointestinal stromal tumors, and recurrence is a feared complication. Previous studies have explored the influence of tumor necrosis, tumor size, and other factors on prognosis. These prior studies have examined tumor size without specifically assessing the effects of enhancing tumor tissue volume on prognosis. The authors of this study retrospectively studied patients with primary gastric GIST who underwent pre-operative contrast enhanced CT prior to resection, and explored the prognostic implications of the enhancing tissue volume, growth pattern, serosal invasion, organ invasion, and other imaging findings. The study found that serosal invasion and enhancing tissue volume are independent risk factors for predicting disease free survival after curative resection of primary gastric GIST.


Prognostic value of free air under the diaphragm on chest radiographs in correlation with peritoneal soiling intraoperatively.

Abosayed AK, Dayem AYA, Shafik I, et al. Emergency Radiology (2023) 30:99-106.


Gastrointestinal tract perforation can be a fatal result of peptic ulcers or trauma, among other causes, and leakage of alimentary contents into the peritoneal cavity can further complicate a patients clinical status and treatment. Pneumoperitoneum is an early imaging finding to suggest gastric perforation, and is commonly seen on plain film radiographs given the wide availability in emergency and primary care settings. The authors in this study aimed to use the height of the air column under the diaphragm to estimate the extent of peritoneal contamination in patients with bowel perforations. The authors studied patients who presented with free air under the diaphragm and required surgical intervention for viscus perforation. The results show that there is a statistical correlation between the amount of air under the diaphragm and the size of perforation, the amount of peritoneal soiling, and patient mortality.


Traumatic abdominal wall hernias in the pediatric population: a 13-year institutional review.

VanNess G, Wanner MR, Chong ST, et al. Emergency Radiology (2023) 30:51-61.


This study examined the incidence of pediatric traumatic abdominal wall hernias and their cause and associated findings. The authors retrospectively examined cohorts from two large level 1 trauma centers over a span of 13 years who underwent abdominopelvic CT imaging. Despite their classic association with bicycle handlebars, the authors found that the most common mechanism of injury was motor vehicle collision, followed by bicycle accidents. The mean age was 10.6 years old, and 89.5% had associated injuries including intestinal injuries, pelvic fractures, femur fractures, splenic injuries and lumbar spine Chance fractures in decreasing order of incidence.


MRI remains highly accurate in the diagnosis of appendicitis in pregnancy when read by radiologists of mixed specialty training and experience.

Buckley B, Delaney F, Welaratne I, et al. Emergency Radiology (2023) 30: 85-91.


Appendicitis is the most common surgical complication of pregnancy, and 25% of operations during pregnancy are due to appendicitis. Normal physiologic changes during pregnancy can complicate the clinical diagnosis, and the use of CT is very limited in pregnancy. The authors of this study examined the accuracy of MRI in the diagnosis of appendicitis in pregnant patients when read by radiologists of varying experience and specialty training. MRI reports for 45 pregnant women, read by 18 radiologists were retrospectively reviewed. 62% of the studies were read by abdominal or emergency radiology specialists with the remainder read by general radiologists. The accuracy of diagnoses was 99.8%, sensitivity was 80%, and specificity was 100%. Right iliac fossa fat stranding or free fluid was significantly associated with appendicitis. There were no false-positives in specialty trained or general radiologist groups, and there were two false-negatives, one in each group. These findings demonstrate that MRI is a highly accurate diagnostic study in pregnant patients when read by specialty and non-specialty radiologists.


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