Fructuoso Delgado

Crohn Disease: Correlation of Findings at Contrast-enhanced US with Severity at Endoscopy

PURPOSE To evaluate the effectiveness of visualization of vascularization at contrast material-enhanced ultrasonography (US) for assessment of the activity of Crohn disease, with severity grade determined at endoscopy as the reference standard. MATERIALS AND METHODS Ethics committee approval and written informed consent were obtained. Sixty-one patients (age range, 21-67 years; median age, 36 years) who had Crohn disease underwent both colonoscopy and US, including color Doppler and contrast-enhanced US, prospectively. To assess the vascularization of the involved bowel loop in a region expected to be seen at colonoscopy, the contrast agent uptake was measured by using quantitative analysis of the enhancement in regions of interest. Measurement of contrast enhancement was assessed as the increase in wall brightness with respect to the baseline brightness. Results were compared with the severity grade determined at endoscopy by using the area under the receiver operating characteristic curve and logistic regression analysis. RESULTS Colonoscopy showed inflammatory lesions in 53 patients (mild disease, seven; moderate disease, 12; and severe disease, 34). Bowel wall thickness and grade at color Doppler US (P = .019 and .002, respectively) correlated with severity grade at endoscopy. Mural contrast enhancement in patients with active disease at endoscopy was markedly increased in comparison with enhancement in patients with inactive disease (P < .001). Multivariate logistic regression analysis revealed that an increase in wall brightness was a significant and independent variable predictive of severity grade at endoscopy. A threshold brightness value of percentage of increase of 46% had a sensitivity and specificity of 96% and 73%, respectively, in the prediction of moderate or severe grade for inflammation at endoscopy. CONCLUSION Quantitative measurements of bowel enhancement obtained by using contrast-enhanced US correlate with severity grade determined at endoscopy. Contrast-enhanced US could be a useful technique to monitor the activity of Crohn disease. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2531082269/-/DC1.

Contrast-enhanced ultrasonography: Usefulness in the assessment of postoperative recurrence of Crohn's disease

AIM The aim of this study was to assess whether the contrast-enhanced ultrasonography (CEUS) can increase the value of the ultrasonography in the study of postoperative recurrence of Crohns disease (CD). MATERIALS AND METHODS 60 patients with CD who had previously undergone ileocolic resection underwent prospectively both CEUS and colonoscopy within a 3-day period. The sonographic examination included evaluation of bowel wall thickness, transmural complications, colour Doppler grade and contrast-enhanced US. In addition a sonographic score was established. The capacity of CEUS to diagnose endoscopic recurrence, as well as its severity, was assessed by calculating the sensitivity, specificity and positive and negative predictive values, accuracy and odds ratio, with their respective 95% confidence intervals. The areas under the receiver operating characteristic (ROC) curves were also calculated. RESULTS 49 out of 60 patients showed endoscopic postoperative recurrence. Severe endoscopic recurrence was present in 34 patients (57%). Classic ultrasound parameters (wall thickness >3mm and colour Doppler flow) revealed an accuracy of 88.3% for the diagnosis of recurrence. Sonographic score 2, including thickness >5mm or contrast enhancement >46%, improved the results with a sensitivity, specificity and accuracy of 98%, 100% and 98.3%, respectively, in the diagnosis of endoscopic recurrence. The area under the ROC curve was 0.99, in remarkable agreement with endoscopy (k: 0.946). Sonographic score 3, including thickness >5mm, contrast enhancement >70% or fistula identified 32 out of 34 (94.1%) severe endoscopic recurrences. The area under the ROC curve was 0.836, in good agreement with endoscopy (k: 0.688). CONCLUSION CEUS shows excellent sensitivity and specificity for the diagnosis of postoperative recurrence in CD and can also detect severe recurrences.

Usefulness of abdominal ultrasonography in the analysis of endoscopic activity in patients with Crohn's disease: Changes following treatment with immunomodulators and/or anti-TNF antibodies

OBJECTIVE The objective of this study was to analyze the accuracy of abdominal ultrasonography (AUS) in the assessment of mucosal healing in patients with Crohns disease (CD) receiving immunomodulators and/or biological treatment, with ileocolonoscopy as the reference standard. MATERIALS AND METHODS Thirty patients were included in a prospective longitudinal study. All patients underwent ileocolonoscopy and AUS before and after a minimum of one year of treatment. The Crohns Disease Endoscopic Inflammatory Index of Severity (CDEIS) was used for endoscopic assessment whereas AUS was analyzed by means of bowel wall thickness, color Doppler grade and percentage of increase of parietal enhancement after contrast injection. RESULTS In the segmental analysis, endoscopic healing was found in 71.2% of the segments and AUS findings were normalized in 62.8%, with a significant correlation between the two techniques (κ=0.76, p<0.001). In the overall assessment performed after treatment, 18 (60%) patients exhibited endoscopic remission (CDEIS <6 points); of these patients, 15 (83.3%) had normalized sonographic findings, with a good correlation between endoscopic remission and sonographic normalization (κ=0.73, p<0.001). Of the three variables assessed by AUS, parietal thickness was the best variable to predict mucosal healing in both analyses, segmental and global. CONCLUSION Abdominal ultrasonography is a useful and reliable technique for the assessment of the endoscopic response to treatment with immunomodulators and/or biological drugs in Crohns disease. AUS is a highly accurate technique for evaluating the healing of the intestinal mucosa.

Contrast-enhanced ultrasound (CEUS) in Crohn’s disease: technique, image interpretation and clinical applications

BackgroundRecent meta-analysis has demonstrated no significant differences in diagnostic accuracy among different imaging techniques (US, MRI and CT) in the evaluation of Crohn’s disease (CD). High-resolution bowel ultrasound has emerged as an alternative imaging technique for the diagnosis and follow-up of patients with CD, being as accurate as CT and MR for detecting intramural and extramural extension of the disease. B-Mode US can evaluate the localization and length of the affected intestinal segments and allow identification of transmural complications, stenosis and intestinal obstruction. Doppler techniques are tools that visualize and quantify bowel vascularization. Contrast-enhanced ultrasound (CEUS) is a new technique that involves IV administration of an ultrasound contrast agent with real-time examination, providing an accurate depiction of the bowel wall microvascularization and the perienteric tissues. The introduction of imaging quantification techniques enables an objective quantitative measurement of the enhancement.Method and resultsThe article reviews the technique, sonographic findings, advantages and limitations, and clinical applications of contrast-enhanced US in the evaluation of Cohn’s disease. Current CEUS applications in CD are: CD activity assessment, evaluation of inflammatory masses, distinguishing phlegmons from abscesses, characterization of stenosis by differentiating fibrosis from inflammation, monitoring the efficacy of drug treatments and improving the detection of disease recurrence.ConclusionCEUS is an emerging technique that is part of the entire sonographic evaluation, with a role in the diagnosis and follow-up of CD, thus improving therapy planning and monitoring of the efficacy of treatment.

Estudio de la grasa abdominal mediante resonancia magnética: comparación con parámetros antropométricos y de riesgo cardiovascular

Fundamento La obesidad se asocia a numerosas complicaciones. En la frecuencia e intensidad de las mismas parece influir el deposito de grasa intraabdominal. La resonancia magnetica es una tecnica con una gran resolucion espacial y capacidad de discriminacion tisular. El objetivo del presente trabajo es estudiar el deposito graso abdominal y cuantificar su distribucion relativa en un grupo de pacientes obesos, relacionando los hallazgos con la presencia de marcadores clinicos y analiticos de riesgo cardiovascular. Pacientes y metodo A todos los pacientes se les realizo un estudio de resonancia magnetica abdominal, adquiriendose imagenes axiales potenciadas en T1. Mediante el empleo de un programa de tratamiento de imagenes (ASYMED 3.0, Valencia) se cuantifico la distribucion de la grasa en los compartimientos subcutaneo e intraabdominal. Se compararon los resultados de la resonancia magnetica con los valores medios de diferentes marcadores de riesgo cardiovascular mediante la prueba de la t de Student para datos no apareados. Se fijo el nivel de significacion en p Resultados El 12% de los pacientes presentaban una acumulacion grasa de predominio intraabdominal. Se detectaron diferencias significativas en las cifras medias de edad, indice de cintura-cadera, y los valores de colesterol total, lipoproteinas de baja y muy baja densidad, trigliceridos y apoproteinas B entre los grupos determinados por esta. Conclusion Mediante la resonancia magnetica se obtuvieron imagenes adecuadas para calcular la distribucion de grasa abdominal. Existe una relacion estadisticamente significativa entre una mayor proporcion de grasa intraabdominal y un perfil lipidico mas aterogenico.

Ecografía y TC del mucocele apendicular: hallazgos que sugieren etiología maligna

Objetivo Describir los hallazgos del mucocele apendicular en ecografia y tomografia computarizada (TC), valorando los signos que ayu-den a predecir el origen maligno del mismo. Material y metodos Se revisaron los hallazgos clinicos y radiolo-gicos de 17 pacientes diagnosticados de mucocele apendicular en nuestro hospital en los ultimos 10 anos (seis cistoadenocarcinomas, ocho mucoceles de retencion, dos cistoadenomas y un adenoma vello-so). Resultados La ecografia mostro masas quisticas en la teorica loca-lizacion del apendice, con estructura de capas en la pared, de ecogeni-cidad interna variable, mostrando en siete casos calcificacion parietal. La TC mostro tumoraciones quisticas de baja atenuacion en el area pericecal, con realce parietal, siendo nodular en cuatro casos (tres cis-toadenocarcinomas y un adenoma velloso). Ninguno de los cistoade-nocarcinomas presento calcio en la pared. En cuatro pacientes se ob-servo la presencia de seudomixoma peritoneal (tres cistoadenocarcino-mas y un mucocele de retencion). Conclusiones El mucocele apendicular tiene unos hallazgos eco-graficos y en TC caracteristicos. La presencia en la TC de un realce nodular en la pared del mucocele es un hallazgo que sugiere un origen maligno. La ausencia de calcio parietal y la existencia de seudomixo-ma peritoneal asociado tambien sugieren malignidad, aunque ambos signos pueden aparecer en mucoceles benignos.

Tissue harmonic sonography in the diagnosis of common bile duct stones: a comparison with endoscopic retrograde cholangiography.

To revisit the diagnostic accuracy of sonography in the detection of choledocholithiasis using modern equipment with tissue harmonic imaging (THI) and endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy as the gold standard.

Diverticulitis de Meckel: hallazgos en ecografía y TC

espanolPresentamos los hallazgos radiologicos en ecografia y en TC de cuatro casos de diverticulitis de Meckel. La imagen tipica visualizada es similar a la del apendice inflamado, y para su diferenciacion es util su localizacion mas medial y la no dependencia del ciego. En dos de los casos, la obtencion de reconstrucciones multiplanares permitio llegar a un diagnostico preoperatorio. EnglishWe present echographic and CT findings in 4 cases of Meckels diverticulitis. The image usually observed is that of an inflamed appendix, the differentiation being made chiefly through its more medial location and apparent unrelatedness to the cecum. In two cases, the obtaining of multiplanar reconstructions permitted preoperative diagnoses to be made.

Estudios hepáticos con RM tras la administración de Teslascan® en bolo*

® was ad- ministered by rapid intravenous infusion (≈ 1 ml/s), and the GE se- quence was repeated and completed by an STIR sequence. Correla- tions between presence of cirrhosis and enhancement pattern of hepatic parenchyma, number of lesions detected before and after bolus administration, as well as lesion histology and degree of enhancement were all analyzed. Adverse clinical reactions as reported by patients were also noted. Results: Cirrhotic liver was found in 49% of the patients. Enhan- cement was mainly heterogeneous with hypointense areas and hete- rogeneous with hypointense areas together with more greatly enhan- ced regenerative nodules. Enhancement of cirrhotic livers was homo- geneous in a third of the cases. Non-cirrhotic patients exhibited a homogeneous hepatic mass in most cases, with only one liver sho- wing heterogeneous enhancement containing hypointense bands cau- sed by necrotic debris having resulted from treated metastases. En- hancement pattern differences between cirrhotic and non-cirrhotic patients were statistically significant (p = 0.001). In 20 of the 31 pa- tients, solid focal lesions were detected. Sequences performed after bolus administration of contrast media detected more lesions than did those before administration. Combination of both post-administration sequences (T1 and STIR) detected the most lesions, with differences between it and pre-administration sequences being statistically signi- ficant (p = 0.014). There was observed a varying degree of lesion en- hancement. Such variability was associated with the nature of the le- sion, with those containing hepatocytes being enhanced. Most pa- tients exhibited a sensation of hot flashes (28 of 31, 90%) and no discomfort in the area of injection. No other adverse reactions were reported.

TC helicoidal del sector vascular aortoilíaco: optimación del retraso en la adquisición mediante el método del bolo de prueba*

Resumen Objetivos Optimar el tiempo de retraso en la adquisicion de estu-dios de tomografia computarizada (TC) helicoidal del sector vascular aortoiliaco utilizando el metodo del bolo de prueba. Material y Metodos Se estudiaron 90 pacientes consecutivos remi-tidos para evaluacion del sector vascular aortoiliaco. En todos se calcu-lo el tiempo de llegada del contraste a la aorta (T 0 pico) de acuerdo con un protocolo predefinido utilizando el metodo del bolo de prueba, apli-candose distintos retrasos en la adquisicion de la helice. Se midieron los valores de atenuacion en tres zonas de la aorta abdominal de todos los pacientes. Los resultados de captacion por zonas y tiempos de re-traso se compararon mediante la prueba ANOVA y Student-Newman-Keuls. El nivel de significacion se fijo en p Resultados: El tiempo medio de llegada del contraste fue de 22,3 segundos (intervalo, 13-40). La captacion media para las regiones ini-cial, central y distal de la aorta fue de 231, 260, y 254 UH en los gru-pos con retraso de T 0 pico +5 segundos; de 275, 287 y 287 UH para un retraso de T 0 pico + 10 segundos; y de 266, 259 y 276 UH para un re-traso de T 0 pico + 15 segundos, respectivamente. Conclusiones La aplicacion del metodo del bolo de prueba en la optimacion de la captacion intravascular en el sector vascular aortoilia-co permite lograr un elevado grado de realce. Cuando se utiliza un re-traso de T 0 pico + 10 segundos la opacificacion vascular es homogenea en toda la aorta abdominal y mayor que con otras formulaciones.