Aoife Kilcoyne

Inflammatory bowel disease imaging: Current practice and future directions

The purpose of this paper is to evaluate the role of imaging in inflammatory bowel disease (IBD), including detection of extraluminal complications and extraintestinal manifestations of IBD, assessment of disease activity and treatment response, and discrimination of inflammatory from fibrotic strictures. IBD is a chronic idiopathic disease affecting the gastrointestinal tract that is comprised of two separate, but related intestinal disorders; Crohns disease and ulcerative colitis. The paper discusses, in detail the pros and cons of the different IBD imaging modalities that need to be considered in order to optimize the imaging and clinical evaluation of patients with IBD. Historically, IBD evaluation of the bowel has included imaging to assess the portions of the small bowel that are inaccessible to optical endoscopic visualization. This traditionally was performed using barium fluoroscopic techniques; however, cross-sectional imaging techniques (computed tomography and magnetic resonance imaging) are being increasingly utilized for IBD evaluation because they can simultaneously assess mural and extramural IBD manifestations. Recent advances in imaging technology, that continue to improve the ability of imaging to noninvasively follow disease activity and treatment response, are also discussed. This review article summarizes the current imaging approach in inflammatory bowel disease as well as the role of emerging imaging modalities.

Impact of magnetic resonance enterography in the management of small bowel Crohn's disease.

Introduction Magnetic resonance enterography (MRE) is a relatively new imaging modality that involves small bowel distension with orally administered fluid. Few studies have assessed its impact on patient management. Aim The aim of this study was to determine whether MRE influenced the management of patients with established small bowel Crohn’s disease (CD). Materials and methods From a prospectively maintained database of patients with inflammatory bowel disease, we identified patients with small bowel CD who underwent MRE between January 2007 and December 2010. The results of the MRE and subsequent changes in patient management within 1 month were evaluated. Results Thirty women and 27 men with CD were included. Seven patients (12%) had a normal MRE. Forty-two of 57 (74%) patients had a change in management, and 41/50 (82%) patients with an abnormal MRE had changes in management (P<0.0008). After MRE, 20/42 (47%) patients had surgery and 22/42 (53%) had changes in medical treatment. Patients with stricturing disease had more surgical intervention (P=0.02), and patients with active disease on MRE had more medical intervention (P=0.0001). Patients with two or more abnormalities on MRE had more surgery compared with medical therapy (P=0.02). Conclusion The majority of patients with small bowel CD had a change in management as a result of the MRE. Because of its high clinical impact on patient management, MRE should become one of the preferred methods of small bowel evaluation in CD. Specific MRE findings may help to stratify treatment options, however, further work is required to validate this.

Supramolecular Metallo-Bioadhesive for Minimally Invasive Use.

A novel metallo-bioadhesive to be used as tissue sealant in minimally invasive procedures is reported. Metal complexation can be used to render gelatin derivatives adhesive, which occurs in minutes, is efficient, and fully biodegradable within weeks.

Computational imaging reveals mitochondrial morphology as a biomarker of cancer phenotype and drug response

Mitochondria, which are essential organelles in resting and replicating cells, can vary in number, mass and shape. Past research has primarily focused on short-term molecular mechanisms underlying fission/fusion. Less is known about longer-term mitochondrial behavior such as the overall makeup of cell populations’ morphological patterns and whether these patterns can be used as biomarkers of drug response in human cells. We developed an image-based analytical technique to phenotype mitochondrial morphology in different cancers, including cancer cell lines and patient-derived cancer cells. We demonstrate that (i) cancer cells of different origins, including patient-derived xenografts, express highly diverse mitochondrial phenotypes; (ii) a given phenotype is characteristic of a cell population and fairly constant over time; (iii) mitochondrial patterns correlate with cell metabolic measurements and (iv) therapeutic interventions can alter mitochondrial phenotypes in drug-sensitive cancers as measured in pre- versus post-treatment fine needle aspirates in mice. These observations shed light on the role of mitochondrial dynamics in the biology and drug response of cancer cells. On the basis of these findings, we propose that image-based mitochondrial phenotyping can provide biomarkers for assessing cancer phenotype and drug response.

Ivacaftor Imaging Response in Cystic Fibrosis

A 27-year-old Irish adult with cystic fibrosis (CF; DF508/G551D genotype) was commenced on ivacaftor in January 2011. Ivacaftor addresses the underlying cause of CF in individuals with the G551D genotype by increasing chloride transport through cell surface CF transmembrane conductance regulator. Before this, he suffered two to three respiratory exacerbations per year, none requiring hospital admission. Sputum was positive for Staphylococcus aureus and Pseudomonas aeruginosa. After 2 years of treatment, the patient’s FEV1 increased from 79% predicted to 95% predicted, and he was completely free of respiratory exacerbations during this time. A previous chest computed tomography scan (CT) in 2011 showed mild diffuse bilateral upper lobe bronchiectasis (Figure 1A, arrowhead), mild diffuse airway wall thickening (straight arrows) and diffuse mucus plugging (curved arrows). A follow-up chest CT in 2013 showed stabilization of bronchiectasis (Figure 1B, arrowhead), marked improvement in airway wall thickening (straight arrows), and extensive clearing of mucus plugging (curved arrows). The stabilization of bronchiectasis and reduction in airway thickening and mucus plugging demonstrated by CT in this patient correlate with his improvement in lung function and are likely a result of chronic therapy with ivacaftor. High-resolution CT imagingmay be a useful tool to gauge response to therapy with ivacaftor for patients with CF with the G551D mutation. n

Cholangiocarcinoma: classification, diagnosis, staging, imaging features, and management

Cholangiocarcinoma is a relatively uncommon malignant neoplasm with poor prognosis. The distinction between extrahepatic and intrahepatic subtypes is important as epidemiological features, biologic and pathologic characteristics, and clinical course are different for both entities. This review study focuses on the role imaging plays in the diagnosis, classification, staging, and post-treatment assessment of cholangiocarcinoma.

MRI of Placenta Accreta, Placenta Increta, and Placenta Percreta: Pearls and Pitfalls

OBJECTIVE The purpose of this article is to provide a primer for radiologists performing MRI for suspected placenta accreta, illustrating normal and abnormal findings and diagnostic pitfalls. Appropriate examination indications and recommendations for optimizing image acquisition and interpretation are summarized. CONCLUSION MRI increases the accuracy of the workup of high-risk patients and aids in multidisciplinary delivery planning to improve maternal outcome. Reader accuracy and confidence require adherence to examination performance, image interpretation criteria, and awareness of common pitfalls.

Prostate Cancer Imaging and Therapy: Potential Role of Nanoparticles

Over the last 2 decades, the use of nanoparticle imaging has been investigated extensively for both diagnosis and therapy of prostate cancer. This review discusses the various classes of nanoparticles currently in clinical use or at the advanced preclinical stage. In particular, we focus on the unique properties of nanoparticles, as a group, that make them suitable for imaging and therapy. The characteristics of each nanoparticle are detailed. Iron oxide nanoparticles, extensively used for MRI of prostate cancer, are discussed in depth.

Kidney, Ureter, and Bladder Biopsy

Percutaneous urologic biopsy is a safe and effective technique and can comprise a significant proportion of the daily workload of the interventional radiologist. This article discusses the indications and rationale for the performance of renal, ureter, and bladder biopsy as well as the approach to performing such biopsies, pitfalls, and potential complications.

Interventional oncology: pictorial review of post-ablation imaging of liver and renal tumors

Percutaneous image-guided ablation is now commonly performed in many institutions for the treatment of hepatocellular carcinoma, liver metastases, and renal cell carcinoma in select patients. Accurate interpretation of post-ablation imaging is of supreme importance because treatment algorithms for these diseases rely heavily on imaging to guide management decisions. The purpose of this pictorial essay is to provide abdominal imagers with a review of the indications for percutaneous ablation in the abdomen, a basic overview of ablation modalities in clinical use today, the expected post-ablation imaging findings in the liver and kidney, and potential complications of hepatic and renal ablation procedures.