Richard M. Gore

Gastrointestinal complications of spinal cord injury.

The incidence, nature, and radiographic features of gastrointestinal complications encountered in a group of 567 consecutive spinal-cord-injury patients are reported. Eighty-seven episodes of gastrointestinal complications developed in 63 (11%) patients. During the first month post injury, these complications consisted of ileus, gastric dilatation, the body cast syndrome, peptic ulcer disease, and pancreatitis. More chronically these patients presented with fecal impactions, peptic ulcer disease, the superior mesenteric artery syndrome, hepatitis, amyloidosis, and the precocious appearance of diverticulosis, hiatus hernia, and gastroesophageal reflux. Radiographic findings were diagnostic in the majority of cases and aided in the early diagnosis of these potentially life-threatening complications.

Imaging benign and malignant disease of the gallbladder

This article reviews the imaging of various benign and malignant diseases of the gallbladder. Clinical findings and imaging features using ultrasound, CT, and MR for the detection and evaluation of gallstones, acute cholecystitis, xanthogranulomatous cholecystitis, adenomyomatosis, and carcinoma of the gallbladder among other disorders are discussed.

Magnetic resonance imaging of the pancreas at 3.0 tesla: qualitative and quantitative comparison with 1.5 tesla.

Objectives:We sought to perform a preliminary comparison of signal-to-noise ratio (SNR) and image quality for magnetic resonance imaging (MRI) of the pancreas at 1.5 and 3 T. Materials and Methods:Two imaging cohorts were studied using a T2-weighted, single-shot fast spin-echo pulse sequence and a T1-weighted, fat-suppressed 3D gradient-echo pulse sequence. In the first cohort, 4 subjects were imaged using identical imaging parameters before and after contrast administration at 1.5 and 3.0 T. The SNR was quantified for the pancreas as well as for the liver, spleen, and muscle. In a second cohort of 12 subjects in whom the receiver bandwidth was adjusted for field strength, SNR measurements and qualitative rankings of image quality were performed. Results:In the study cohort using identical imaging parameters at both magnetic field strengths, the mean (SD) ratios of SNR at 3.0 to 1.5 T of the single-shot fast spin-echo images for the pancreas, liver, spleen, and muscle were 1.63 (0.39), 1.82 (0.39), 1.45 (0.18), 2.01 (0.16), respectively. For the precontrast fat-suppressed 3D gradient-echo sequence, the corresponding ratios were 1.28 (0.29), 1.26 (0.30), 1.16 (0.27), and 1.76 (0.45), respectively; for the arterial phase, the corresponding ratios were 2.02 (0.28), 1.60 (0.42), 1.47 (0.26), and 1.94 (0.32), respectively; and for the delayed postcontrast phase, the corresponding ratios were 1.63 (0.51), 2.01 (0.25), 1.66 (0.06), and 2.31 (0.47), respectively. The SNR benefit of 3.0 T was significantly greater on contrast-enhanced as compared with noncontrast T1-weighted 3D gradient-echo images. In the second study cohort, SNR was superior at 3.0 T, although the use of a reduced readout bandwidth at 1.5 T substantially diminished the advantage of the higher field system. With qualitative comparison of images obtained at the 2 magnetic field strengths, the fat-suppressed 3D gradient-echo images obtained at 3.0 T were preferred, whereas the single shot fast spin-echo images obtained at 1.5 T were preferred because of better signal homogeneity. Conclusions:Our results in a small cohort of volunteers and patients demonstrate a marked improvement in SNR at 3.0 T compared with 1.5 T (by a factor of 2 in some cases) when identical imaging parameters were used. The SNR advantage at 3.0 T is diminished but persists when the receiver bandwidth is adjusted for magnetic field strength. The results suggest that 3.0 T may offer promise for improved body MRI, although further technical development to optimize SNR and improve signal homogeneity will be needed before its full potential can be achieved.

Esophageal manifestations of Crohn's disease.

Two patients with concurrent esophagitis and ileocolitis due to Crohns disease are presented. The initial feature of esophageal involvement was dysphagia caused by severe inflammation of the distal esophagus with mucosal ulcerations and polypoid folds. Long-term observation of both cases revealed a gradually progressive course leading to development of rigid esophageal stricture, intramural sinus tract, and esophagobronchial or esophagogastric fistulas. The clinical and radiographic manifestations of Crohns esophagitis in these 2 patients and in 18 previously reported cases are reviewed.

Diagnosis and staging of small bowel tumours

Small bowel neoplasms comprise only 1% of gastrointestinal neoplasms. Despite their rarity, it is important to diagnose small bowel tumours early to maximize patient survival.

Upper urinary tract abnormalities in multiple sclerosis patients with urinary symptoms.

OBJECTIVE To determine the prevalence of upper urinary tract complications in multiple sclerosis (MS) patients with urinary symptoms, and to determine if an association exists between degree of physical impairment and upper urinary tract complications. DESIGN AND SETTING A cohort study of MS patients seeking treatment at a freestanding, university-affiliated rehabilitation hospital. PARTICIPANTS A referred sample of 48 patients with MS, exacerbation-free for 6 months with symptoms of neurogenic bladder dysfunction. For each patient, demographic data, disease characteristics, and urologic history was obtained. Using the Kurtzke Expanded Disability Status Scale (EDSS), participants were divided into a control (EDSS < 7) and study (EDSS >/= 7) group. INTERVENTION Ultrasound examination of the upper urinary tract. MAIN OUTCOME MEASURE Significant MS-related abnormalities of the upper respiratory tract. RESULTS Ten of 48 patients (21%) had significant MS-related upper urinary tract abnormalities, which were evenly distributed between control and study groups. In the more disabled study group, abnormalities were associated with the symptom of urinary hesitancy (p < .05) and form of bladder management (p < .05). CONCLUSIONS Routine screening for upper urinary tract complications appears indicated in a select group of MS patients with urinary symptoms.

Ct diagnosis of a mycotic aneurysm of the thoracoabdominal aorta

The CT appearance of a mycotic aneurysm involving the thoracoabdominal aorta with adjacent vertebral osteomyelitis is presented. Specific CT features of the aneurysm, such as lack of intimal calcification and adjacent bone destruction or abscess, may allow the diagnosis to be made in the appropriate clinical setting.

Comprehensive review of the diagnosis and treatment of biliary tract cancer 2012. PART I: Diagnosis‐clinical staging and pathology

Biliary tract cancers (gallbladder cancer, intra‐ and extra‐hepatic cholangiocarcinoma, and selected periampullary cancers) accounted for 12,760 new cases of cancer in the USA in 2010. These tumors have a dismal prognosis with most patients presenting with advanced disease. Early, accurate diagnosis is essential, both for potential cure where possible and for optimal palliative therapy in all others. This review examines the currently available and emerging technologies for diagnosis and treatment of this group of diseases. J. Surg. Oncol. 2012; 106:332–338.

Imaging of cystic diseases of the pancreas

Although the majority of cystic lesions of the pancreas seen in clinical practice represent postinflammatory pseudocysts, it is important for the radiologist to be knowledgeable of the wide spectrum of cystic masses of the pancreas and the variable prognoses they possess. As a result of similarities in the imaging features of these lesions, a definitive diagnosis is often not possible. By combining imaging features with clinical history, a reasonable differential diagnosis can be offered to the referring physician. In some cases, biopsy or fluid aspiration may be required prior to surgery. In a patient without the appropriate history of pancreatitis and the presence of a cystic pancreatic mass, it is incumbent upon the radiologist to offer alternative diagnoses of cystic neoplasms of the pancreas.

The Incidental Pancreatic Cyst

The discovery of a pancreatic cyst in an asymptomatic patient presents an immediate challenge to the interpreting radiologist, the clinician who manages the patient, and patients themselves. When a cyst is discovered on imaging in a patient without symptoms directly referable to the pancreas, the following questions are immediately raised: can the lesion be accurately diagnosed or is the appropriate management clear from the examination, is the best management approach to suggest watchful waiting with follow-up imaging, what is the best method for imaging follow-up, and what is the optimal frequency of follow-up? This article recommends an approach to analyzing patients with incidental pancreatic cysts.