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Background. MDCT currently frequently represents the first choice modality for imaging in acute or subacute abdominal conditions implicating the small bowel. As a consequence, the MDCT features of intestinal carcinoid tumors and of their peculiar metastatic spread have to be known by abdominal radiologists. Patients and methods:These features are described and illustrated in the retrospective review of seven proven cases of small intestine carcinoids diagnosed and treated in our institution. The findings are described and correlated with gross anatomy specimens. Results:The primary tumour clearly appeared as a contrast-enhancing intraluminal lesion in all cases except in one case in which the primary lesion remained unlocalized and in another in which the primary tumour finally appeared infracted at gross anatomy. The maximal tumoral enhancement was obtained in 3 patients imaged during the acute arterial phase. The diameter of the primary tumour ranged from 1 to 3 cm and all masses were ileal comprising one lesion in the proximal ileum, two in the medium ileum and three in the distal ileum. 6/7 patients had multiple prominent mesenteric nodal metastases, all also appearing as hypervascularised enhancing masses. In 4/7 patients the nodal metastases represented the major finding being much prominent and larger than the primary tumour. Signs of retractile mesenteritis with soft tissue stranding, retraction and stellate pattern of the mesentery were found around the mesenteric metastases in 5/7 patients and direct incarceration of vessels were found in 3 cases. Conclusion: The analysis of the arterial phase of MDCT study appears primordial to detect the sometimes very small but intensively enhancing primary tumor and to delineate encasement or direct obstruction of mesenteric vessels frequently caused by enhancing nodal metastases which volume often exceeds that of the primary tumor. Secondary retractile mesenteritis, deformation or ischemia of bowel loops, and hypervas

The concept of "abdominal tuberculosis" in this review refers to peritoneum and its reflections, gastrointestinal tract, abdominal lymphatic system, and solid visceral organs, as they are subject to varying degrees of involvement alone or in combination. Some features, including free or loculated ascites with thin-mobile septa, smooth peritoneal thickening and enhancement, misty mesentery with large lymph nodes. smudged omental involvement, and advanced ileocecal changes demonstrated by US, CT. or gastrointestinal series are deemed suggestive radiological findings. The diagnosis still requires a high index of suspicion, once the suggestive features have been demonstrated by imaging modalities.

The aim of this study was to analyze the color Doppler sonographic findings in primary epiploic appendagitis. Color Doppler sonographic findings of ten patients with primary epiploic appendagitis were reviewed. The following sonographic features were analyzed: identification of a mass adjacent to the colonic wall; identification of spotty color areas with arterial flow in this mass and detection of abnormalities of the colonic wall adjacent to the infiltrated fatty tissue. A well-delineated hyperechoic mass adjacent to the colonic wall was detected in each patient with sonography. No colonic wall abnormalities were observed nor color Doppler signal in and around the hyperechoic area. Absence of flow at color Doppler sonography is an additional feature of epiploic appendagitis.

Superwarfarins have progressively replaced warfarin as rodenticides as they are more potent and have a longer anticoagulant activity. Human exposure may be complicated by spontaneous haemorrhage in various sites. We report the case of a 51-year-old woman who was admitted with spontaneous haemoperitoneum and intramural haematoma along the small intestine. After the evidence of a deficit of vitamin K1-dependent clotting factors (II, VII, IX, X), the patient admitted that she was chronically ingesting difenacoum. She was successfully treated with fresh frozen plasma and vitamin K1. Follow-up was not accepted.

To analyze the optimal timing strategy for the detection of hypervascular liver tumors during the arterial phase of magnetic resonance (MR) imaging, a test examination after injection of 2 mL of gadopentetate dimeglumine was performed in 47 patients. The time course of the tumor-to-liver contrast-to-noise ratio (CNR) for all studies together was determined relative to the start of injection, the time of peak aortic enhancement, and the time of peak enhancement in the tumor. All studies were grouped together and the highest CNR was transiently observed at the time of peak tumor enhancement. This CNR was significantly higher than those observed at fixed delays after peak aortic enhancement. However, the CNRs at peak tumor enhancement+/-1.5 seconds did not differ significantly from those obtained after peak aortic enhancement. Finally, the CNRs obtained at fixed delays after the start of injection remained significantly lower. In hypervascular liver tumors, a higher CNR can be obtained during the arterial phase when the MR imaging delay is determined relative to the time of peak enhancement in the tumor or the aorta rather than being fixed after the start of contrast material injection. Timing based on the enhancement profile in the tumor rather than in the aorta should be performed only if rapid MR imaging is available with a time resolution of about 1.5 seconds to image the whole liver.

Emergency medicine has emerged as a specific medical specialty for 30 years. To be efficient, the emergency clinician frequently needs the contribution of radiological examinations. This is the reason why emergency radiology has emerged as a new radiologic subspecialty. The aim of this paper is to review the recent history of emergency medicine and to summarize the present state of the radiological organisation for emergency care in the Western countries.

RATIONALE AND OBJECTIVES: The authors compare the potential value of unenhanced and gadoxetate disodium-enhanced spin-echo images for the detection of hepatocellular carcinoma in a rat model. METHODS: Eleven rats with chemically induced hepatocellular carcinoma underwent unenhanced T2-weighted fast spin-echo imaging followed by T1-weighted spin-echo imaging before and at 5 minutes, 30 minutes, 3 hours, 1 day, and 3 days after intravenous administration of 60 micromol/kg gadoxetate disodium at 4.7 tesla. Tumor and liver enhancement, and tumor-to-liver contrast-to-noise (C/N) ratio were calculated. RESULTS: After gadoxetate disodium administration, the tumors showed less enhancement than the liver. Tumor-to-liver C/N ratio increased from 5.5 +/- 0.8% on unenhanced T1-weighted images to 12.9 +/- 2.4% on gadoxetate-enhanced T1-weighted images (P = 0.02). However, the C/N ratio on unenhanced T2-weighted images (23.5 +/- 3.6%) remained higher than that on gadoxetate-enhanced T1-weighted images, a difference that is statistically significant (P < 0.01). CONCLUSIONS: In the experimental setting of our study, the higher tumor-to-liver C/N ratio on unenhanced T2-weighted spin-echo images suggests that unenhanced T2-weighted spin-echo images are superior to gadoxetate disodium-enhanced T1-weighted spin-echo images for the detection of hepatocellular carcinoma.

Various acute intestinal diseases can be imaged with ultrasound and in particular intestinal occlusion, acute ischemia and inflammatory diseases such as appendicitis and diverticulitis. We review the contribution and limitations of ultrasound to these diagnoses.

Inflammatory pseudotumor of the liver is a rare benign mass that is often misdiagnosed as hepatocellular carcinoma at preoperative imaging. We report a case of inflammatory pseudotumor of the liver with special emphasis on the appearance at MRI after administration of mangafodipir trisodium. On T1-weighted images the lesion was slightly hypointense relative to the liver, and on T2-weighted images it was isointense with a hyperintense capsule. No tumor enhancement was seen on T1-weighted images after administration of mangafodipir trisodium. MRI with mangafodipir trisodium might help to distinguish inflammatory pseudotumor of the liver from hepatocellular carcinoma.

The aim of this study was to evaluate the contribution of colour Doppler sonography in the diagnosis of acute intestinal ischaemia. In a two years experience, all patients admitted for acute abdominal pain in our emergency department were evaluated with colour Doppler sonography of the abdomen. The final diagnosis based on clinical evolution, endoscopic or surgical findings and further radiological investigations was compared to the sonographic results. Therapy and final outcome of the patients with acute intestinal ischaemia were also evaluated. In twenty-one patients a final diagnosis of acute intestinal ischaemia (mesenteric ischaemia (n = 13) and ischaemic colitis (n = 8)) was made. Intestinal ischaemia was correctly diagnosed by initial clinical and biological data and further confirmed by sonography in eight cases (mesenteric ischaemia (n = 2) and ischaemic colitis (n = 6)). Eleven other cases were detected by suggestive colour Doppler sonography features (mesenteric ischaemic (n = 10) and ischaemic colitis (n = 1)). Sixteen of the 21 patients had a final favourable outcome (mesenteric ischaemia (10/ 13) and ischaemic colitis (6/8)). We conclude that sonography has a place in the diagnosis of acute intestinal ischaemia and has to be integrated in the diagnostic algorithm of this acute condition. By this way, this diagnosis may be suspected earlier and may allow a prompt and adapted treatment with possible improvement in survival rate.

OBJECTIVE: The aim of this study was to evaluate the immediate and long-term results in a retrospective series of patients with highly symptomatic adult polycystic liver disease (APLD) treated by extensive fenestration techniques. A classification of APLD was developed as a stratification scheme to help surgeons conceptualize which operation to offer to patients with APLD. SUMMARY BACKGROUND DATA: Treatment options for APLD remain controversial, with partisans of fenestration techniques or combined liver resection-fenestration. METHODS: Clinical symptoms, performance status, liver volume measurement by computed tomography (CT), and morbidity were recorded before surgery and after surgery. Adult polycystic liver disease was classified according to the number, size, and location of liver cysts and the amount of remaining liver parenchyma. Follow-up was obtained by clinical and CT examinations in all patients. RESULTS: Ten patients with highly symptomatic APLD were operated on using an extensive fenestration technique (by laparotomy in 8 patients and by laparoscopy in 2 patients, 1 of whom conversion to laparotomy was required). The mean preoperative liver volume was 7761 cm3. There was no mortality. Postoperative morbidity occurred in 50%, mainly from biliary complications, requiring reintervention in two cases. Massive intraoperative hemorrhage occurred in one patient. During a mean follow-up time of 71 months (range, 17 to 239 months), all patients were improved clinically according to their estimated performance status. The mean postoperative liver volume was 4596 cm3, which represents a mean liver volume reduction rate of 43%. However, in type III APLD, despite absence of clinical symptoms, a significant increase in liver volume was observed in 40% of the patients. CONCLUSIONS: Extensive fenestration is effective in relieving symptoms in patients with APLD. Hemorrhage and biliary complications are possible consequences of such an aggressive attempt to reduce liver

Various MR contrast agents have been developed to improve the detection and characterization of tumors and nontumours diseases of the liver. The clinical effect of these MR contrast agents is determined not only by their contrast-enhancing properties, but also by their biodistribution. According to their biodistribution, the MR contrast agents can be classified as extracellular fluid space agents, reticuloendothelial, hepatocyte-direct, blood pool, and “tumor-specific” agents. Extracellular fluid space agents are small-molecular-weight hydrophilic gadolinium chelates such as Gd-DTPA. They distribute in the extracellular space and are rapidly eliminated by the kidneys through glomerular filtration. Reticuloendothelial agents are particles that are mainly taken up by Kupffer cells in the liver and macrophages in the spleen. Orin oxide particles with superparamagnetic properties have mainly by used. Hepatocyte-directed agents include derivatives of extracellular fluid space gadolinium chelates, a manganese chelate (Mn-DPDP), and hepatocyte-directed iron oxide particles. Amphipathic derivatives of extracellular fluid space gadolinium chelates such as Gd-EOB-DTPA are taken up in the hepatocyte and excreted in the bile by organic anion carriers that are involved in the transport of bilirubin and sulfobromophthalein. In contrast, the uptake of Mn-DPDP does not depend on the pyridoxine transporter. Hepatocyte-directed iron oxide particles are taken up in the hepatocytes by receptor mediated endocytosis. Blood pool agents are mainly macromolecular derivatives of Gd-DTPA and small iron oxide particles with prolonged blood retention. “Tumor-specific” agents include monoclonal antibodies attached to Gd-DTPA derivatives or iron oxide particles, and metalloporphyrins. The tumor-specific of these compounds is questionable. Only extracellular fluid space agents, hepatobiliary agents, and iron oxide particles of different sizes acting as reticuloendothelial, Thèse d'agrégation de l'enseignement supérieur (faculté de médecine) -- UCL, 1997

The authors report a case of liver trauma with hematoma complicated with a pseudoaneurysm. The latter was suspected on day 7, with a monophasic helical CT and was demonstrated with helical CT angiography. Arteriography confirmed the lesion and showed an associated arteriovenous fistula, unsuspected on helical CT. The pseudoaneurysm was managed with transcatheter embolization, completed with percutaneous embolization because of vascular spasm.

The purpose of this study was to evaluate the diagnostic value of the “whirlpool sign” detected at color Doppler sonography in adults complaining of acute abdominal pain. During a 2-year period, the whirlpool sign was systematically looked for with color Doppler sonography in all patients admitted in the emergency room for acute abdominal pain. The whirlpool sign was observed in 13 patients: 2 cases of surgically proven primary volvulus of the small bowel, 10 cases of proven or suspected small bowel obstruction secondary to adhesions, and 1 case of acute leukemia with enlarged mesenteric lymph nodes. In the first 12 cases, the whirlpool sign was associated with radiologic (N=9) and sonographic (N=12) signs of small bowel obstruction. In the last case, no sign of obstruction was observed. In patients who had the whirlpool sign and who underwent operations (N=6), primary or secondary volvulus was present in 3 cases but was absent in the other 3 cases. The whirlpool configuration detected with color Doppler sonography has to be considered as a sign of limited value, because it may be observed in various conditions, including primary or secondary volvulus, postsurgical adhesions without volvulus, and acute abdominal diseases without obstruction.

We report a case of gastric pneumatosis with findings of air in the retroperitoneal and mediastinal spaces demonstrated by plain radiographs and computed tomography. Pneumatosis was considered to be due to gastric distention caused by involvement of the gastric outlet by disseminated hepatocellular carcinoma and was possibly promoted by intake of steroids and local radiotherapy.

The purpose of this study was to correlate the MRI features of the anal canal with histologic findings. T1- and T2-weighted MR images of nine anal canals were obtained after fixation in 10% formalin. In three specimens, imaging was repeated after removal of histologic layers with a dissecting microscope. Corresponding histologic slices were stained with hematoxylin-eosin, Masson trichrome, and periodic acid-Schiff. Four layers were visualized on T2-weighted images. An inner layer of high signal intensity and a second layer of low signal intensity corresponded to the mucosa as well as mucous secretions and to the submucosa. The high signal intensity layer vanished at the distal part of the anal canal in accordance with the lack of mucus-secreting epithelium below the level of the dentate line. A third layer of intermediate signal intensity corresponded to the internal sphincter. A fourth layer of low signal intensity corresponded to the longitudinal muscle and external sphincter. T2-weighted MRI is capable of showing the internal architecture of the wall of the anal canal. In particular, the internal sphincter can be differentiated from the external sphincter and longitudinal muscle.

The aim of our study was to assess the feasibility of using Doppler sonography for the detection of acute intestinal ischemia due to occlusion of the superior mesenteric artery. Between September 1993 and March 1995, abdominal sonography with Doppler imaging of the mesenteric vessels was performed in 770 patients with emergency admissions for acute abdominal pain. In six cases, the diagnosis, based on surgery or arteriography and computed tomography, was acute intestinal ischemia due to complete or localized occlusion of the superior mesenteric artery. Five cases of occlusion of the superior mesenteric artery were correctly detected by Doppler sonography. These results suggest that Doppler sonography may be a feasible method for detecting acute intestinal ischemia due to proximal superior mesenteric artery occlusion.

Detection of acute intestinal ischemia is a diagnostic challenge. Color Doppler sonography of the abdomen may contribute to its diagnosis by showing lesions of the gut wall associated with occlusion or stenosis of the mesenteric vessels. Our overview of the sonographic findings of acute intestinal ischemia is presented as well as a proposition of algorithm for the working up to the diagnosis based on recent clinical experience.

PURPOSE: To compare the small bowel distribution and safety of a fast ingestion procedure of ferristene to those of the standard ingestion procedure. MATERIAL AND METHODS: Sixty-four patients received 0.5 g/l ferristene in 800 ml water. Thirty-four patients of the fast ingestion group ingested ferristene with 20 mg of oral metoclopramide during the course of 30 min before MR imaging and received an i.v. injection of an antiperistaltic agent during the MR study. Thirty patients of the standard group ingested ferristene during the course of 2 h, without additional drugs. Ferristene distribution was assessed by 2 reviewers and adverse events were recorded. RESULTS: More than 50% of the small bowel segments analyzed were filled with ferristene in 30 patients in the fast ingestion group and in 28 patients in the standard ingestion group. One patient in each group experienced nausea and/or vomiting. Some bloating or sensation of fullness was reported by 2 patients in the fast ingestion group and by 3 patients in the standard ingestion group. CONCLUSION: The distribution of ferristene in the small bowel and the safety of the procedure were thus similar in the 2 groups using either a fast ingestion procedure with oral metoclopramide or the more time-consuming standard ingestion procedure.

BACKGROUND: Open surgery is the standard approach for splenectomy in hematologic disorders, but a few cases of successful laparoscopic splenectomy have been reported. METHODS: Thirty-one patients (18 adults, group 1; and 13 children, group 2) underwent laparoscopic splenectomy. Indications for surgery included idiopathic thrombocytopenic purpura (25 patients), congenital spherocytosis (4 patients), and hemolytic anemia (2 patients). In 97% of the patients the diameter of the spleen was less than 15 cm.RESULTS: Laparoscopic splenectomy was successful in 94% of the patients; conversion to open surgery was mainly related to hemorrhage. Accessory spleen was found in 39% in group 1 and 8% in group 2. Two adults received intraoperative autotransfusion. Postoperative morbidity was minimal. The median postoperative stay was 3 days (range, 2 to 12 days) in group 1 and 2 days (range, 2 to 5 days) in group 2. CONCLUSIONS: Laparoscopic splenectomy is safe in both adults and children. Adequate selection of patients (small-size spleen, splenic destruction on preoperative scanning of platelets), appropriate preparation in patients with idiopathic thrombocytopenic purpura (immunoglobulin G), and meticulous surgical technique (with routine opening of the gastrocolic ligament to search for accessory spleen) are key factors in obtaining the same long-term results as with open surgery.

Intraductal papillary-mucinous tumours are rare epithelial tumours with all intermediate types occurring from papillary to mucin-hypersecreting forms. They affects generally old men and recurring pancreatitis is the main clinical feature. Endoscopic Retrograde Pancreatography is the best diagnostic method, showing large dilatation of the ducts and filling defects due to mucin's plugs or papillary tumour. IPMT are slow-growing and have low malignant potential; as to far, surgical resection is considered mandatory, however, better distinction between benign and malignant evolution will probably select cases in which conservative follow-up may be proposed.

Objective : The aim of our study was to assess the value of sonography in the diagnosis of acute intestinal occlusion. Material and Methods : Sonographic findings were reviewed in 50 cases of intestinal occlusion (39 small bowel and 11 colonic occlusions). The final diagnosis was based on surgical findings (n = 40) or clinical course and further imaging findings (n = 10). Results : Occlusion was correctly detected with sonography in 48 cases (96%). The location was correctly established with sonography in 43 cases (86%). The precise cause was suggested with sonography in 21 cases (42%). Commentary : These results confirm the value of sonography for the diagnosis of intestinal occlusion and the identification of its level and its cause.

To detect reperfused ischemia of the rat intestine, T-2-weighted spin-echo images were acquired, followed by T-1-weighted images before and after administration of polylysine-Gd-DTPA or Gd-DTPA, Before administration of the contrast agent, the reperfused intestine was hyperintense on T-2-weighted images, and to a lesser extent on T-2-weighted images, After administration of polylysine-Gd-DTPA, the reperfused intestine enhanced more than the normal one, giving a significantly better contrast-to-noise (CNR) ratio than on unenhanced images, Gd-DTPA induced the same enhancement of the reperfused and the normal intestine and the CNR was lower than on unenhanced T-2-weighted images, Reperfused intestinal ischemia could thus be better detected on polylysine-Gd-DTPA-enhanced MR images than on unenhanced images or on Gd-DTPA-enhanced images.