Objective. There may be advantages in using magnetic resonance imaging (MRI) in small- bowel disease. The aims of this study were to optimize the MRI examination technique and to evaluate the capabilities of MRI compa...Objective. There may be advantages in using magnetic resonance imaging (MRI) in small- bowel disease. The aims of this study were to optimize the MRI examination technique and to evaluate the capabilities of MRI compared with those of conventional enteroclysis (CE). Material and methods. MRI and CE were performed in 36 patients suspected of Crohn’ s disease. Based on 26 pilot studies optimal oral administration of plum juice and bulk fibre laxative was found. T2- weighted and gadolinium enhanced T1- weighted images were obtained using a breath- holding technique and butylscopolamine. Virtual endoscopy was performed. Conventional enteroclysis entailed duodenal intubation and administration of barium and air. Two radiologists evaluated the examinations independently. Finally, each patient scored the degree of discomfort, and preference for either MRI or CE was found. Results. The MRI technique ensured sufficient distension of the small bowel and small- bowel changes were found in 12 patients. In 3 patients this was not seen on conventional enteroclysis, which did not reveal any pathology that was not already seen on MRI. Pathological abdominal changes were found in 70% more patients during MRI than during conventional enteroclysis (p < 0.001). Endoscopic examination corresponded with the MRI findings. The examination quality decreased with increasing age (p = 0.002) and the interobserver agreement of the pathological changes was high (p < 0.001). Virtual endoscopy resulted in excellent demonstration of the mucosal surface. The examination discomfort scores obtained during the MRI were lower than those during conventional enteroclysis (p< 0.001). Conclusions. MRI using the current technique is preferable to conventional enteroclysis because of superior demonstration of the entire small- bowel pathology, low level of patient discomfort and absence of radiation exposure.展开更多
Background and study aims: The aim of the present study was to analyze the reasons for false findings on computed tomographic (CT) colonography. Patients and methods: A total of 100 consecutive CT colonography examina...Background and study aims: The aim of the present study was to analyze the reasons for false findings on computed tomographic (CT) colonography. Patients and methods: A total of 100 consecutive CT colonography examinations were carried out before conventional colonoscopies scheduled on the same day. Before the study, an experienced radiologist received training in analyzing CT colonographies. The radiologists and endoscopists were blinded to each others findings. The patients received standard polyethylene glycol bowel preparation and were scanned in the prone and supine positions using a helical CT scanner and commercially available software for image analysis. Each pair of examinations was later followed by an unblinded analysis, comparing the CT colonographies with video recordings of the conventional colonographies in order to determine the reasons for tumors being missed or false- positive diagnoses arising on CT colonography. Results: Ninety polyps were detected in 41 patients. For patients with tumors ≥ 5 mm and ≥ 10mm, the sensitivity was 67% and 75% , respectively, and the specificity was 84% and 95% , respectively. The most important reasons for the 38 false findings of tumors ≥ 5 mm were perception errors (21 of 38) and misinterpretation of flat lesions in particular, including a high- grade dysplasia and a flat elevated Dukes A carcinoma. Residual stool was frequently the reason for misinterpreting lesions ≥ 10 mm (four of 10). Conclusions: Perception errors were the main reason for false findings of lesions ≥ 5 mm, including one flat malignant lesion. Residual stool caused four of 10 false findings for lesions ≥ 10 mm. Reading CT colonographies requires a high level of expertise, and conventional colonography is still regarded as the gold standard for detecting colorectal lesions.展开更多
文摘Objective. There may be advantages in using magnetic resonance imaging (MRI) in small- bowel disease. The aims of this study were to optimize the MRI examination technique and to evaluate the capabilities of MRI compared with those of conventional enteroclysis (CE). Material and methods. MRI and CE were performed in 36 patients suspected of Crohn’ s disease. Based on 26 pilot studies optimal oral administration of plum juice and bulk fibre laxative was found. T2- weighted and gadolinium enhanced T1- weighted images were obtained using a breath- holding technique and butylscopolamine. Virtual endoscopy was performed. Conventional enteroclysis entailed duodenal intubation and administration of barium and air. Two radiologists evaluated the examinations independently. Finally, each patient scored the degree of discomfort, and preference for either MRI or CE was found. Results. The MRI technique ensured sufficient distension of the small bowel and small- bowel changes were found in 12 patients. In 3 patients this was not seen on conventional enteroclysis, which did not reveal any pathology that was not already seen on MRI. Pathological abdominal changes were found in 70% more patients during MRI than during conventional enteroclysis (p < 0.001). Endoscopic examination corresponded with the MRI findings. The examination quality decreased with increasing age (p = 0.002) and the interobserver agreement of the pathological changes was high (p < 0.001). Virtual endoscopy resulted in excellent demonstration of the mucosal surface. The examination discomfort scores obtained during the MRI were lower than those during conventional enteroclysis (p< 0.001). Conclusions. MRI using the current technique is preferable to conventional enteroclysis because of superior demonstration of the entire small- bowel pathology, low level of patient discomfort and absence of radiation exposure.
文摘Background and study aims: The aim of the present study was to analyze the reasons for false findings on computed tomographic (CT) colonography. Patients and methods: A total of 100 consecutive CT colonography examinations were carried out before conventional colonoscopies scheduled on the same day. Before the study, an experienced radiologist received training in analyzing CT colonographies. The radiologists and endoscopists were blinded to each others findings. The patients received standard polyethylene glycol bowel preparation and were scanned in the prone and supine positions using a helical CT scanner and commercially available software for image analysis. Each pair of examinations was later followed by an unblinded analysis, comparing the CT colonographies with video recordings of the conventional colonographies in order to determine the reasons for tumors being missed or false- positive diagnoses arising on CT colonography. Results: Ninety polyps were detected in 41 patients. For patients with tumors ≥ 5 mm and ≥ 10mm, the sensitivity was 67% and 75% , respectively, and the specificity was 84% and 95% , respectively. The most important reasons for the 38 false findings of tumors ≥ 5 mm were perception errors (21 of 38) and misinterpretation of flat lesions in particular, including a high- grade dysplasia and a flat elevated Dukes A carcinoma. Residual stool was frequently the reason for misinterpreting lesions ≥ 10 mm (four of 10). Conclusions: Perception errors were the main reason for false findings of lesions ≥ 5 mm, including one flat malignant lesion. Residual stool caused four of 10 false findings for lesions ≥ 10 mm. Reading CT colonographies requires a high level of expertise, and conventional colonography is still regarded as the gold standard for detecting colorectal lesions.
