AIM: To determine the prevalence and association of mesenteric panniculitis (MP) in a group of patients with non-Hodgkin's lymphoma (NHL) compared to control group.MATERIALS AND METHODS: We retrospectively evaluated computed tomography (CT) and combined positron-emission tomography (PET) with CT examinations of a total of 166 patients who were diagnosed with NHL over a period of 5 years (2008-2013). The control group consisted of 332 subjects who were matched for gender and age at the time period the examinations were performed on the study group. A combination of radiological signs and absence of 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG)-uptake was used to establish the diagnosis of MP and distinguish it from the involvement of mesentery by lymphoma.RESULTS: MP was identified in three patients (prevalence 1.8%) from the study group as compared to seven subjects out of 332 (2.1%) in the control group (p=0.556). During the course of follow-up no changes in the imaging features of MP were seen in either group. Additionally, 27 (16.2%) patients from the study group were found to have changes in the mesentery, which were attributed to the involvement of the mesentery in the primary disease.CONCLUSION: The prevalence of MP among patients with NHL was found to be 1.8%, which corresponds to the range of its prevalence in the general population. This is contrary to the proposition that MP is associated with NHL. (C) 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

PURPOSE:To compare the effective doses of needle biopsies based on dose measurements and simulations using adult and pediatric phantoms, between cone beam c-arm CT (CBCT) and CT.METHOD:Effective doses were calculated and compared based on measurements and Monte Carlo simulations of CT- and CBCT-guided biopsy procedures of the lungs, liver, and kidney using pediatric and adult phantoms.RESULTS:The effective doses for pediatric and adult phantoms, using our standard protocols for upper, middle and lower lungs, liver, and kidney biopsies, were significantly lower under CBCT guidance than CT. The average effective dose for a 5-year old for these five biopsies was 0.36 ± 0.05 mSv with the standard CBCT exposure protocols and 2.13 ± 0.26 mSv with CT. The adult average effective dose for the five biopsies was 1.63 ± 0.22 mSv with the standard CBCT protocols and 8.22 ± 1.02 mSv using CT. The CT effective dose was higher than CBCT protocols for child and adult phantoms by 803 and 590% for upper lung, 639 and 525% for mid-lung, and 461 and 251% for lower lung, respectively. Similarly, the effective dose was higher by 691 and 762% for liver and 513 and 608% for kidney biopsies.CONCLUSIONS:Based on measurements and simulations with pediatric and adult phantoms, radiation effective doses during image-guided needle biopsies of the lung, liver, and kidney are significantly lower with CBCT than with CT.

AIM:To evaluate the outcome of percutaneous cholecystostomy in critically ill patients with acute cholecystitis. MATERIALS AND METHODS:The study group included critically ill patients who underwent percutaneous cholecystostomy for acute cholecystitis at a tertiary medical centre in 2007-2011. Data on complications, morbidities, surgical outcome, and imaging findings were collected from the medical files and radiology information system. RESULTS:There were 48 women (59.3%) and 33 men (40.7%), with a median age of 82 years (range 47-99 years). Seventy-one (88%) had calculous cholecystitis and 10 (12%), acalculous cholecystitis. The drain was successfully inserted in all cases with no immediate major procedural complications. Fifteen patients (18.5%) died in-hospital within 30 days, mainly (93%) due to septic shock (14/15), another 20 patients (24.7%) died during the study period of unrelated co-morbidities. Of the remaining 46 patients, 36 (78.2%) had surgical cholecystectomies. In patients with acalculous cholecystitis, the drain was removed after cessation of symptoms. Transcystic cholangiography identified five patients with additional stones in the common bile duct. They were managed by pushing the stones into the duodenum via the cystostomy access, sparing them the need for surgical exploration. CONCLUSIONS:Early percutaneous gallbladder drainage is safe and effective in critically ill patients in the acute phase of cholecystitis, with a high technical success rate. Surgical results in survivors are better than reported in patients treated surgically without drainage. Bile duct stones can be eliminated without creating an additional access.

Full-thickness rectal prolapse in frail elderly patients is often treated by a perineal approach with considerable attendant morbidity. We report our preliminary results of the perineal stapled prolapse resection (PSPR) technique for resection of full-thickness external rectal prolapse using a new reloadable Contour® Transtar™ stapler (Ethicon Endo-Surgery) device.

Biliary complications after liver transplantation remain a serious cause of morbidity and mortality. Direct invasive cholangiographic techniques, endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), have procedure-related complications. Magnetic resonance cholangiopancreatography (MRCP) is non-invasive, safe, and accurate. The aim of this study was to evaluate MRCP in detecting biliary complications following liver transplantation and comparing findings with ERCP and PTC. Twenty-seven consecutive liver transplant recipients who presented with clinical and biochemical, ultrasonographic, or histological evidence of biliary complications were evaluated with MRCP. Patients were followed up for a median period of 36 months. The presence of a biliary complication was confirmed in 18 patients (66.6%): anastomotic biliary stricture in 12 (66.6%); diffuse intrahepatic biliary stricture in 5 (27.7%): ischemic (n = 3), recurrence of primary sclerosing cholangitis (n = 2), and choledocholithiasis in one. In nine patients (33.3%), MRCP was normal. Six patients underwent ERCP, and eight PTC. There was a statistically significant correlation between the MRCP and both ERCP and PTC (p = 0.01) findings. The sensitivity and specificity of the MRCP were 94.4% and 88.9%, respectively, and the positive and negative predictive values, 94.4% and 89.9%, respectively. MRCP is an accurate imaging tool for the assessment of biliary complications after liver transplantation. We recommend that MRCP be the diagnostic imaging modality of choice in this setting, reserving direct cholangiography for therapeutic procedures.

OBJECTIVEStudies have suggested that rheumatoid arthritis (RA) and osteoarthritis (OA) share common characteristics. The highly selective A(3) adenosine receptor agonist CF101 was recently defined as a potent antiinflammatory agent for the treatment of RA. The purpose of this study was to examine the effects of CF101 on the clinical and pathologic manifestations of OA in an experimental animal model.METHODSOA was induced in rats by monosodium iodoacetate, and upon disease onset, oral treatment with CF101 (100 microg/kg given twice daily) was initiated. The A(3) adenosine receptor antagonist MRS1220 (100 microg/kg given twice daily) was administered orally, 30 minutes before CF101 treatment. The OA clinical score was monitored by knee diameter measurements and by radiographic analyses. Histologic analyses were performed following staining with hematoxylin and eosin, Safranin O-fast green, or toluidine blue, and histologic changes were scored according to a modified Mankin system. Signaling proteins were assayed by Western blotting; apoptosis was detected via immunohistochemistry and TUNEL analyses.RESULTSCF101 induced a marked decrease in knee diameter and improved the changes noted on radiographs. Administration of MRS1220 counteracted the effects of CF101. CF101 prevented cartilage damage, osteoclast/osteophyte formation, and bone destruction. In addition, CF101 markedly reduced pannus formation and lymphocyte infiltration. Mechanistically, CF101 induced deregulation of the NF-kappaB signaling pathway, resulting in down-regulation of tumor necrosis factor alpha. Consequently, CF101 induced apoptosis of inflammatory cells that had infiltrated the knee joints; however, it prevented apoptosis of chondrocytes.CONCLUSIONCF101 deregulated the NF-kappaB signaling pathway involved in the pathogenesis of OA. CF101 induced apoptosis of inflammatory cells and acted as a cartilage protective agent, which suggests that it would be a suitable candidate drug for the treatment of OA.

Verification of catheter tip location in the venous system necessitates use of x-ray. Our aim was to build an algorithm to detect the catheter tip position and its distance from the right atrium based only on non invasive technology without radiation. In 5 pigs, through the right internal jugular vein and the right axillary vein, under fluoroscopic monitoring, central venous catheters were inserted towards the right atrium. The catheters that were connected to pressure monitors were gradually withdrawn at 2.5 cm intervals for about 30 seconds of breath holding and one minute of normal breath in every stop. Pressure waves, ECG and breath monitoring were simultaneously recorded. 50 sets of measurements in each stop from the right atrium to the puncture site were obtained and analyzed. Two types of pressure waves from the catheter tip emitted due to valves closure and opening and right atrium cycle were detected. The first signal propagates through fluid and biological tissue as a regular acoustic wave at a velocity of about 1540 m/sec or travels a 20 cm distance in about 130 microseconds. The other is a propagating pressure wave generated due to the emptying, filling and the contraction of the right atrium. This procedure requires actual displacement of fluid and is therefore dependent on the compliance of the blood vessel, the viscosity of the blood and its mass. This waveform propagates backward along the vein at about 2 m/sec or it travels 20 cm in about 100 milliseconds which is about a 1000 times slower than the acoustic wave. Based on these data, that were found to be consistent, a primary algorithm to identify location of catheter tip in the venous system was built. We also found that by neglecting the delay of the acoustic wave sound and use the time between these two waves, we can estimate the distance between the right atrium and the catheter tip without x-ray guidance.

PURPOSE:To report our experience with the Angioseal vascular closure device for hemostasis of distal brachial artery puncture.METHODS:Between September 2003 and August 2005, 64 Angioseal vascular closure devices were inserted in 64 patients (40 men, 24 women; mean age 65 years) immediately after diagnostic or therapeutic arterial angiographies performed through a 5 Fr to 7 Fr sheath via the distal brachial artery. Ultrasound examination of the brachial artery preceded the angiography in all cases and only arteries wider than 4 mm were closed by the Angioseal. In cases of a sonographically evident thin subcutaneous space of the cubital fossa, tissue tumescence, using 1% Lidocaine, was performed prior to the arterial closure.RESULTS:The deployment success rate was 100%. No major complications were encountered; only 2 patients developed puncture site hematoma, and these were followed conservatively.CONCLUSIONS:Closure of low brachial artery punctures with the Angioseal is simple and safe. No additional manual compression is required. We recommend its use after brachial artery access interventions, through appropriately wide arteries, to improve early patient ambulation and potentially reduce possible puncture site complications.

OBJECTIVE:The purpose of this study was to evaluate the effects and applicability of use of the American College of Radiology (ACR) Appropriateness Criteria by nonradiologist physicians in an MRI preauthorization center.MATERIALS AND METHODS:All MRI requests received at our preauthorization center during a 19-month period were included in the study. The study period was divided into preintervention and postintervention phases, indicating before and after introduction of the ACR criteria to the general practitioners staffing our center. ACR appropriateness values were classified into three groups: appropriate, indeterminate, and inappropriate. Requests for which a matching ACR value could not be assigned were labeled ACR-noncodable. Multiple parameters evaluated and compared for the two phases included rate of request receipt, total approval and denial rates, and approval and denial rates according to the ACR Appropriateness Criteria and by anatomic region to be evaluated.RESULTS:There was no significant change in rate of request receipt and total approval and denial rates. However, there was an increase in the rate of approval of appropriate requests (phase 1, 71/96 [74%]; phase 2, 74/76 [97%]; p < 0.001) and the rate of denial of inappropriate requests (phase 1, 0/12 [0%]; phase 2, 9/13 [69%]; p < 0.001). More than 40% of requests were marked "ACR-noncodable" because of a lack of a matching clinical condition or variant.CONCLUSION:Introduction of the ACR Appropriateness Criteria resulted in an increase in the rate of performance of appropriate MRI examinations and a decrease in the rate of performance of inappropriate MRI examinations. ACR Appropriateness Criteria were applicable to approximately 50% of MRI requests.

OBJECTIVE. The aim of the study was to establish the feasibility of using MR angiography as the sole imaging technique before endovascular repair of abdominal or thoracic aortic aneurysms and to compare preprocedural measurements by MR angiography and digital subtraction angiography in patients with impaired renal function.CONCLUSION. MR angiography appears to be effective and reliable for use as the sole imaging method before endovascular repair of aortic aneurysms in patients with renal impairment.

Objective: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. Design: Retrospective study of angiographic and clinical files in selected group. Materials and methods: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. Results: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). Conclusions: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Celiac trunk aneurysm is a rare finding and, like other visceral aneurysms, is usually detected incidentally. If the aneurysm is wider than 2 cm, treatment is warranted to avoid catastrophic rupture. Embolization of these aneurysms is the accepted method of treatment to replace surgical options. Endovascular treatment using a stent graft is a known therapy for aneurysms, but it is not used in a celiac artery aneurysm.

OBJECTIVE:To determine whether the size of the extrahepatic bile duct increases with age in adults.METHODS:We prospectively collected data on 251 patients aged 20 years or older who underwent abdominal sonography. None of the patients had a history of liver, gallbladder, biliary, or pancreatic disease or surgery. The extrahepatic bile duct was measured at 3 locations: in the porta hepatis, in the most distal aspect of the head of the pancreas, and midway between these points. Least squares linear regression was used to correlate patient age and the size of the extrahepatic bile duct.RESULTS:There were 126 men and 125 women aged 20 to 94 years (mean +/- SD, 52.5 +/- 17.63 years). Twelve percent of the study population were younger than 30 years, and 12% were older than 80 years. The mean diameters of the common bile duct in the 3 locations were as follows: proximal, 3.39 +/- 1.14 mm; middle, 3.72 +/- 1.28 mm; and distal, 4.28 +/- 1.18 mm. The overall mean for all measures was 3.66 +/- 1.15 mm. The width of the common bile duct ranged from 1.0 to 8.6 mm. There was a significant correlation between common bile duct size and age (r = 0.535; P < .001). Mean common bile duct sizes were 3.128 +/- 0.862 mm in the patients younger than 50 years and 4.19 +/- 1.15 mm in the patients older than 50 years (P < .001 by independent t test for equality of means). We have found that the duct gradually dilated 0.04 mm/y.CONCLUSIONS:This study revealed an age-dependent change in the diameter of the extrahepatic bile duct. We suggest that the upper normal limit of the duct in elderly persons be set at 8.5 mm.

BACKGROUND:Ovarian vein embolization was recently suggested as the preferred treatment for chronic pelvic pain syndrome.OBJECTIVE:To evaluate the technical feasibility, complications and early clinical and radiographic results of ovarian vein embolization in women with pelvic pain syndrome.METHODS:Percutaneous transcatheter ovarian vein embolization with coils was performed in six patients aged 27-53 years who presented with pelvic pain syndrome. All had lower abdominal pain, and pelvic varicosities were found on Doppler ultrasound and retrograde ovarian vein venography. Embolization was done unilaterally in three patients (on the left side) and bilaterally in three. Mean follow-up by telephone questionnaire was 7.3 months.RESULTS:The procedure was technically successful in all patients. Two patients reported partial relief of symptoms (33.3%) and three had complete relief (50%), for a total of 5 patients (83.3%) with some measure of improvement. There were no complications following the procedure.CONCLUSIONS:Percutaneous transcatheter ovarian vein embolization seems to be safe and feasible for the treatment of pelvic pain syndrome. The procedure is performed on an outpatient basis and is well tolerated by patients.

OBJECTIVE. Kidney donation is associated with ligation of the ovarian vein and is comparable to ovarian vein embolization. We evaluated the incidence, morbidity, and clinical outcome of ovarian varices in healthy female kidney donors before and 6 months after nephrectomy.MATERIALS AND METHODS. Between 1994 and 2001, 273 healthy female kidney donors underwent preoperative abdominal aortography. The study group consisted of 27 women (9.9%) in whom retrograde flow in an incompetent left ovarian vein was noted during the venous phase of imaging. All patients underwent left nephrectomy with left ovarian vein ligation. Only women with retrograde flow in the left ovarian vein were asked to complete a questionnaire about the incidence and intensity of pelvic pain before and 6 months after nephrectomy.RESULTS. Twenty-two of the 27 left-kidney donors with retrograde flow in the ovarian vein were available for follow-up. Thirteen (59%) of those 22 reported chronic pelvic pain. After nephrectomy, the pelvic pain completely resolved in seven (54%), improved in three (23%), and persisted in three (23%).CONCLUSION. Our study found a 9.9% prevalence of ovarian varices in the general population. Our findings suggest that more than half (59%) the patients with ovarian varices have pelvic congestion syndrome and that most (77%) of them might benefit from ovarian vein embolization or ligation.

To evaluate the abdominal CT features of reactive amyloidosis, abdominal CT scans of 20patients with amyloidosis of familial Mediterranean fever (FMF) were reviewed and compared with abdominal CT scans of2 control groups: 22 patients with chronic renal failure (CRF) due to non-amyloidotic kidney diseases and 40 patients with normal kidney function. The kidney size of patients with amyloidosis of FMF were found to vary during the course of the disease from normal or slightly larger than normal at the proteinuric phase, to smaller than normal and comparable to kidney size in CRF, at the uremic stage. Compared to kidney disease of other causes, more patients with FMF-amyloidosis had dense kidneys with coarse parenchymal calcification and calcification in other abdominal organs. Patients with FMF-amyloidosis had fewer aortic calcifications than patients with non-amyloidotic kidney disease. These findings suggest that kidney disease of reactive amyloidosis may have abdominal CT findings distinguishing it from other types of kidney diseases.