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The use of MRCP in the detection of pancreatic injuries after blunt trauma

From January 2000 to November 2001, five consecutive, hemodynamically stable trauma patients (age range 8–69 years, mean age 34 years) with parenchymal injurieswere evaluated by magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). One patient also underwent a MRCP-facilitated secretin test. MRI depicted pancreatic laceration in two patients, ductal disruption and a post-traumatic intraparenchymal pseudocyst in one, migrating pancreatic fluid collection in the mediastinal space with disruption in another, and main pancreatic duct rupture and dilatation in the patient evaluated with MRCP following secretin administration. MRI with MRCP is an effective noninvasive test for detecting and managing pancreatic injuries after blunt trauma. Secretin administration improves ductal visualization, particularly of nondilated ducts. Finally, MRI was useful in the follow-up studies of parenchymal damage and minor ductal injuries, providing high-quality images of the pancreatic duct and biliary tract.

Three-dimensional anal endosonography in depicting anal-canal anatomy.

PurposeThis report describes the advantages of 3D anal endosonography in depicting the normal anatomy of the anal canal in relation to sex and age.Materials and methodsA retrospective study was performed of 85 patients, 33 men and 52 women, previously examined with 3D anal ultrasound (US) for clinically suspected anorectal disease but found to be negative. The examinations were performed with a Bruel and Kjaer US system with a 2050 transducer, scanning from the anorectal junction to the subcutaneous portion of the external anal sphincter (EAS). The 3D reconstructions provided an estimation of sphincter length in the anterior and posterior planes, and axial 2D images enabled calculation of the thickness of the internal anal sphincter (IAS) and EAS in the anterior, posterior and lateral transverse planes.ResultsDistribution of the sphincter complex is asymmetric in both sexes: the EAS and IAS are significantly shorter in females, especially in the anterior longitudinal plane (p=0.005 and p<0.001, respectively). EAS and IAS thickness increases with age, especially the lateral IAS (R2=0.37, p<0.001) and the posterior EAS (R2=0.29, p=0.01).ConclusionsA good knowledge of anal-canal anatomy is essential to detect sphincter abnormalities when assessing pelvic floor dysfunction.RiassuntoObiettivoScopo del presente lavoro è stato documentare la rappresentazione anatomica normale del canale anale attraverso l’ultrasonografia (US) endoanale 3D, in relazione al sesso e all’età.Materiali e metodiIn uno studio retrospettivo sono stati selezionati 85 soggetti, di cui 33 maschi e 52 femmine, sottoposti precedentemente ad US endoanale 3D per sospetto clinico di patologia dell’ano-retto distale ma risultati essere tutti negativi all’esame ultrasonografico. Gli esami sono stati eseguiti con apparecchio dedicato Bruel e Kjaer, con trasduttore tipo 2050 e scansioni dalla giunzione ano-rettale alla porzione più superficiale dello sfintere anale esterno (SAE). Nell’immediato postprocessing sono stati stimati la lunghezza degli sfinteri nei piani anteriore e posteriore e lo spessore anteriore, laterale e posteriore dello sfintere anale interno (SAI) e del SAE.RisultatiLa distribuzione della muscolatura del canale anale risulta asimmetrica in entrambi i sessi: la lunghezza di SAI e SAE è significativamente più breve nelle donne, specie lungo il piano longitudinale mediano anteriore (p=0,005 e p<0,001, rispettivamente). Inoltre, lo spessore di entrambi gli sfinteri presenta una tendenza all’accrescimento proporzionale all’età del paziente, soprattutto nella porzione laterale per il SAI (R2=0,37, p<0,001) e posteriore per il SAE (R2=0,29, p=0,01).ConclusioniLa conoscenza precisa delle componenti anatomiche muscolo-legamentose del canale anale è alla base della identificazione delle alterazioni sfinteriali utili alla comprensione dei disturbi del pavimento pelvico.

The role of nasoenteric intubation in the MR study of patients with Crohn’s disease: our experience and literature review

PurposeThe aim of this study was to compare magnetic resonance (MR) enteroclysis with MR enterography to verify whether nasoenteric intubation in patients affected by Crohn’s disease can provide supplementary information to that afforded by MR study of the small bowel.Materials and methodsIn a 12-month period, 40 patients (28 women and 12 men, mean age 35 years) affected by Crohn’s disease underwent MR imaging. Distension of the small-bowel loops was obtained by administering polyethylene glycol: 15 patients were given the mixture by mouth (MR enterography), whereas the remaining 25 received it via nasoenteric intubation (MR enteroclysis). Our study protocol included morphological sequences taken before and after intravenous injection of contrast medium and real-time functional sequences. Accuracy criteria for the execution of the examinations were designed according to 11 bands.ResultsComplete distension of the small-bowel loops was obtained in the 25 patients who underwent MR enteroclysis, with the additional advantage of a suitable assessment of those segments involved in the pathological process. This was not the case for the 15 patients who underwent MR enterography, because both the jejunum and the small-bowel loops appeared partially collapsed.ConclusionsMR enteroclysis is the most effective technique for studying the small bowel in Crohn’s disease, as it not only provides a suitable morphological assessment but also supplies functional information.RiassuntoObiettivoLo scopo di questo lavoro è quello di confrontare la resa della risonanza magnetica (RM) con somministrazione di mezzo di contrasto tramite sondino naso-enterico (MR-e) piuttosto che per via orale (MR-os), allo scopo di valutare se l’intubazione naso-enterica nei pazienti con morbo di Crohn fornisca un valore aggiunto alla RM dell’intestino tenue.Materiali e metodiIn un periodo di 12 mesi, 40 pazienti con morbo di Crohn (28 femmine e 12 maschi; età media 35 anni) sono stati sottoposti ad esame RM. La distensione delle anse dell’intestino tenue è stata ottenuta con polietilen glicole (PEG): 15 pazienti hanno assunto per os la miscela (MR-os), mentre a 25 pazienti è stata iniettata tramite sondino naso-enterico (MR-e). Il protocollo di studio ha incluso sequenze pre- e post-contrastografiche morfologiche e per la MR-e sono state effettuate sequenze funzionali real-time. I criteri di correttezza dell’esecuzione degli esami erano basati sulla valutazione di 11 parametri.RisultatiNei 25 pazienti sottoposti ad MR-e si è ottenuta una completa distensione di tutte le anse dell’intestino tenue con un’adeguata valutazione dei tratti interessati dal processo patologico, così non è stato nei 15 sottoposti ad MR-os poiché le anse del digiuno e del tenue prossimale sono risultate parzialmente collabite.ConclusioniLa MR-e è la tecnica più efficace nello studio dell’intestino tenue nei pazienti affetti da morbo di Crohn, fornendo un’adeguata valutazione morfologica, ma anche informazioni funzionali.

Thoracic CT findings at hypovolemic shock

Purpose: To describe and discuss the thoracic CT features of hypovolemic shock. Material and Methods: From a group of 18 patients with signs of hypovolemia on contrast-enhanced abdominal CT, 11 were selected for our study as having also undergone a complete chest examination. Pulse rate, blood pressure, trauma score value, Glasgow coma scale value, surgical result, and final outcome were retrospectively evaluated. The CT features analyzed were: decreased cardiac volume, reduced caliber of the thoracic aorta, aortic branches and caval venous system, increased enhancement of the aorta, and increased enhancement of the pulmonary collapses/contusions. Results: All 11 subjects presented severe injuries and hemodynamic instability; 7 were stable enough to undergo surgery; only 1 of the 11 survived. Two patients showed none of the features of thoracic hypovolemia. All the other patients presented at least two signs: reduced caliber of the thoracic aorta in 7 cases; decreased volume of the cardiac chambers and increased aortic enhancement in 6; decreased caliber of the aortic vessels in 4; decreased caliber of the caval veins in 3; and increased enhancement of the pulmonary collapses/contusions in 3. Conclusions: In patients with hypovolemia, CT may show several thoracic findings in addition to abdominal ones. Knowledge of these features is important for distinguishing them from traumatic injuries.

ABDOMINAL COMPUTED TOMOGRAPHIC FINDINGS IN ADULTS WITH HYPOVOLEMIC SHOCK

The clinical charts and contrast mediumenhanced computed tomographic (CT) examinations of 15 adults with a history of serious shock and resuscitation were reviewed. Several hypovolemia-related abnormalities were recognizable and were variably associated with each other. Diminished caliber of the abdominal vessels with intense vascular contrast medium enhancement and renal abnormalities were the most common findings; decreased and/or increased enhancement of the abdominal organs and other hypovolemic changes were also present.Most of the series in the radiologic literature describe findings in pediatric subjects, but the various vascular and extravascular CT findings with regard to shock in adults may be different from those reported in children. Although the diagnosis of shock is based on clinical signs, hypovolemia-related CT abnormalities must be distinguished from organic lesions. CT may also identify a previously unsuspected shock state.

Suspected adverse reactions to contrast media in Campania Region (Italy): results from 14 years of post-marketing surveillance.

Objective: During the last years in Italy, contrast media (CM) use increased. An increase of monitoring activities on CM-induced adverse drug reaction (ADR) is necessary, also in our regional territory. The main aim of this study was to give a preliminary evaluation of all Spontaneous Reports of ADRs (SRA) attributed to CM sent to Campania Pharmacovigilance Regional Center (CRFVC) from 01 January 2001 to 31 October 2014. Research design and methods: For each SRA we evaluated: frequency and source, ADRs onset (time to event, seriousness and outcome), socio-demographic characteristics and risk factors of cases, the most reported CM (checking for pharmacodynamic and pharmacokinetic interactions). Results: A total of 111 SRA were sent to CRFVC; specialist in radiology was the main source of reports. Ninety-seven SRA (87.3%) were referable to hypersensitivity reactions. Thirty-four SRA (30.6%) reported serious ADRs. The most reported CM were iopamidol, gadobenic acid and gadoteric acid. We identified two SRA induced by pharmacokinetic and/or pharmacodynamic interactions. Conclusions: During 14 years of post-marketing surveillance, only few SRA concerning CM-induced ADRs were sent to CRFVC probably due to underreporting. We aim to improve monitoring activity on CM-induced ADRs especially in hospitals. Most reported ADR and CM were in line with current body of literature.