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Biomedical subjects

M M Morrin

Publications and source records attributed to M M Morrin.

15 recordsLinked to original sources
PubMed2001

Diverticular disease in the elderly.

Diverticular disease is common among the elderly. Because of the advanced age and muted symptoms and signs of many of those affected, diagnosis can be difficult. Consequently, great demands are placed on the physician to diagnose and treat clinically evident diverticular disease. Endoscopic, radiologic, and surgical advances have increased the availability of more definitive therapies for patients with complicated diverticular disease and diverticular hemorrhage.

Age Factors↗
PubMed2001

State-of-the-art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer.

OBJECTIVE: To compare the ability of state-of-the-art ultrasonography with that of helical computed tomography and computed tomographic angiography in detecting unresectable periampullary cancer. In most patients periampullary cancer is unresectable because of either distant metastasis or local vascular involvement. The advent of gray scale and color Doppler ultrasonography has improved the ability of ultrasonography to detect vascular involvement. METHODS: Twenty-three consecutive patients with periampullary cancer were enrolled for prospective staging of their disease by comparing helical computed tomography and computed tomographic angiography with gray scale and color Doppler ultrasonography of the abdomen. Portal vein, superior mesenteric vein, splenic vein, and superior mesenteric artery involvement was graded 0 to 4, grade 0 being no vascular involvement and grade 4 being total occlusion of the vessel. Agreement between ultrasonography and computed tomographic angiography for determining vascular involvement was measured by chi2 analysis. RESULTS: Two patients (9%) were excluded because excessive overlying bowel gas hampered the ability of ultrasonography to visualize the pancreas. For the remaining 21 patients, there was significant agreement between ultrasonography and computed tomographic angiography for detecting vascular involvement in all vessels (P < .001; portal vein, kappa = 0.67; superior mesenteric vein, kappa = 0.67; splenic vein, kappa = 0.85; and superior mesenteric artery, kappa = 0.59). Ultrasonography was in agreement with computed tomographic angiography in all cases of unresectability. Both modalities were equally poor in preoperatively showing lymphadenopathy and metastases. CONCLUSIONS: Provided that there is adequate visualization on ultrasonography of the head of the pancreas in the periampullary region, then state-of-the-art gray scale and color Doppler ultrasonography are as accurate as helical computed tomography and computed tomographic angiography for detecting the unresectability of periampullary cancer. If performed as the initial investigation and the region of the pancreatic head is clearly shown, and if vascular encasement or occlusion or distant metastasis is identified, further investigations are unnecessary.

Adult↗
PubMed2000

Role of virtual computed tomographic colonography in patients with colorectal cancers and obstructing colorectal lesions.

PURPOSE: The aim of this study was to assess the ability of computed tomographic colonography to diagnose colorectal masses, stage colorectal cancers, image the proximal colon in obstructing colorectal lesions, and evaluate the anastomoses in patients with previous colorectal surgery. METHODS: We prospectively performed computed tomographic colonography examinations in 34 patients (20 males; mean age, 64.2; range, 19-91 years): 20 patients had colorectal masses (defined at endoscopy as intraluminal masses 2 cm or larger), 7 patients had benign obstructing colorectal strictures, and 7 patients had a prior colorectal resection. Final tumor staging was available in all 16 patients who had colorectal cancers and 15 patients were referred after incomplete colonoscopy. The ability of computed tomographic colonography to stage colorectal cancers, identify synchronous lesions in patients with colorectal masses, and image the proximal colon in patients with obstructing colorectal lesions was assessed. RESULTS: Computed tomographic colonography identified all colorectal masses, but overcalled two masses in patients who were either poorly distended or poorly prepared. Computed tomographic colonography correctly staged 13 of 16 colorectal cancers (81 percent) and detected 16 of 17 (93 percent) synchronous polyps. Computed tomographic colonography over-staged two Dukes Stage A cancers and understaged one Dukes Stage C cancer. A total of 97 percent (87/90) of all colonic segments were adequately visualized at computed tomographic colonography in patients with obstructing colorectal lesions compared with 60 percent (26/42) of segments at barium enema (P < 0.01). Colonic anastomoses were visualized in all nine patients, but in one patient, computed tomographic colonography could not distinguish between local tumor recurrence and surgical changes. CONCLUSION: Computed tomographic colonography can accurately identify all colorectal masses but may overcall stool as masses in poorly distended or poorly prepared colons. Computed tomographic colonography has an overall staging accuracy of 81 percent for colorectal cancer and is superior to barium enema in visualizing colonic segments proximal to obstructing colorectal lesions.

Adult↗
PubMed2000

MR cholangiopancreatography of pancreaticobiliary diseases: comparison of single-shot RARE and multislice HASTE sequences.

AIMS: We prospectively compared two breath-hold magnetic resonance cholangiopancreatography (MRCP) sequences: single-shot rapid acquisition with relaxation enhancement (RARE) and multislice half-Fourier acquisition single-shot turbo spin echo (HASTE) in imaging the pancreaticobiliary system. PATIENTS AND METHODS: The diagnostic accuracy of single-shot RARE and multislice HASTE was studied in 34 subjects who had undergone conventional cholangiopancreatography. Overall image quality, duct conspicuity, image artifact, signal intensity and contrast-to-noise ratios were assessed independently by two radiologists who were unaware of the underlying diagnosis. RESULTS: Both sequences had comparable diagnostic accuracy regarding a normal biliary system, choledocholithiasis, extra-hepatic and intra-hepatic strictures. Single-shot RARE was superior to multislice HASTE in diagnosing a normal pancreatic system, pancreatic and intrahepatic duct strictures, while providing significantly better image quality (mean +/- SE 3.7 +/- 0.07 vs 3.3 +/- 0.08: P = 0.02) and significantly less image artifact (mean +/- SE 3.6 +/- 0.07 vs 3.2 +/- 0.08: P = 0.01). Single-shot RARE provided significantly better duct conspicuity regarding the pancreatic duct within the body (2.7 +/- 0.2 vs 2.1 +/- 0.2: P = 0.003) and tail (2.4 +/- 0.2 vs 1.6 +/- 0.2;P = 0.0001), as well as the intrahepatic ducts (3.0 +/- 0.1 vs 2.6 +/- 0.1: P = 0.004) but there was no significant difference regarding the remainder of the biliary tree. CONCLUSION: Single-shot RARE provides superior image quality, duct conspicuity with the added advantage of less image artifact and shorter acquisition time. However, volume averaging can cause common bile duct stones to be missed. Therefore, multislice HASTE sequences should still be acquired if choledocholithiasis is suspected. Larger studies are required to assess the diagnostic efficacy of single-shot RARE sequences in pancreatic duct and intra-hepatic duct disease.Morrin, M. M. (2000). Clinical Radiology55, 866-873.

Adolescent↗
PubMed2000

Utility of intravenously administered contrast material at CT colonography.

PURPOSE: To determine if intravenously administered contrast material improves overall reader confidence in the assessment of the colon, large-bowel wall conspicuity, and diagnostic accuracy in the detection of colorectal polyps and cancers at computed tomographic (CT) colonography. MATERIALS AND METHODS: Two hundred patients underwent CT colonography in both supine and prone positions. A five-point scale was used to assess the effect of contrast enhancement on overall reader confidence and bowel wall conspicuity. Eighty-one patients underwent CT colonography with complete colonoscopic or surgical correlation; diagnostic accuracy was compared in 48 patients who received contrast material and 33 who did not. RESULTS: Bowel preparation was ideal in 38 (19%) of 200 patients. Enhanced prone CT images had significantly better scores for reader confidence (4.9 +/- 0.1 vs 4.6 +/- 0.1, P: <.005) and bowel wall conspicuity (4.6 +/- 0.2 vs 4.2 +/- 0.2, P: <.005) compared with those of nonenhanced prone images despite no significant difference in bowel distention (3.8 +/- 0.2 vs 3.9 +/- 0. 1, P: =.8). Enhancement significantly improved the ability to depict medium (6-9-mm) polyps (75% vs 58%, P: <.05). Three large (10-19-mm) polyps were detected only with contrast enhancement; two remained submerged despite dual positioning. CONCLUSION: The use of intravenously administered contrast material significantly improved reader confidence in the assessment of bowel wall conspicuity and the ability of CT colonography to depict medium polyps in suboptimally prepared colons.

Adult↗
PubMed2000

Radiologic features of complications arising from dropped gallstones in laparoscopic cholecystectomy patients.

OBJECTIVE: Because laparoscopic cholecystectomy has become the accepted treatment for symptomatic cholelithiasis, radiologists frequently encounter patients who have had this surgery. Although the radiologic features of postoperative bile duct injury are well documented, the imaging features of less well-known complications remain poorly described. One such unusual complication is abscess formation caused by dropped gallstones. CONCLUSION: Although the incidence of dropped gallstones is an uncommon complication of laparoscopic cholecystectomy, it should be recognized as a potential source of both intraabdominal and intrathoracic abscess formation in any patient presenting months to years after undergoing laparoscopic cholecystectomy. These abscesses are not necessarily confined to the right upper quadrant.

Abdominal Abscess↗
PubMed1999

Bilateral facial nerve schwannomas.

Facial nerve schwannoma is an uncommon tumor and bilateral facial nerve tumors are extremely rare. A case is presented in which neuromas affecting the intra-canalicular and labyrinthine portions of both facial nerves occurred. Radiologic assessment demonstrated the origin of these tumors. Eventual tumor involvement of the sole functioning cochlea resulted in the development of total hearing loss. Management entailed symptomatic care and surgical resection. Auditory rehabilitation was attempted using cochlear implantation, but results have not been satisfactory. Genetic screening identified a mutation in the NF2 gene. It is proposed that this patient's condition should be considered a variant of neurofibromatosis 2 and that bilateral facial neuromas should be included in the clinical criteria for this condition.

Adult↗
PubMed1999

Virtual colonoscopy: a gastroenterologist's perspective.

Virtual colonoscopy is an exciting new imaging technique with potential to alter current diagnostic approaches to colonic diseases, particularly colonic neoplasms. Although colonoscopy continues to offer the highest sensitivity and specificity for evaluation of the colon, virtual colonoscopy may offer greater safety, less discomfort, and consequently greater patient acceptance. In addition, virtual colonoscopy offers shorter procedure time, more accurate lesion location, and potentially lower cost as a screening test. Limited data are currently available to define virtual colonoscopy's full clinical role. This article describes the technical considerations, current clinical status, limitations, and potential indications of this new and exciting technology which gastroenterologists should not fear but embrace.

Colonoscopy↗
PubMed1999

Endoluminal CT colonography after an incomplete endoscopic colonoscopy.

OBJECTIVE: We evaluated the clinical usefulness of endoluminal CT colonography after an incomplete colonoscopy. SUBJECTS AND METHODS: We prospectively studied 40 patients in whom the cecum could not be reached endoscopically despite adequate bowel preparation. Endoluminal CT colonography (120 kVp, 120 mA, 3-mm collimation, pitch of 2, 1.5-mm interval reconstruction) was performed within 2 hr of incomplete colonoscopy. Two-dimensional multiplanar reformatted images and three-dimensional endoluminal images were analyzed. Twenty-six patients (65%) underwent barium enema immediately after endoluminal CT colonography. We analyzed colonic distention; duration of endoluminal CT colonography; patient tolerance; number of colonic segments seen at colonoscopy, endoluminal CT colonography, and barium enema; and reasons for incomplete colonoscopy as well as colonic and extracolonic findings. RESULTS: Duration of endoluminal CT colonography was 14.2 +/- 4.6 min (mean +/- SD). Endoluminal CT colonography was better tolerated than colonoscopy or barium enema (p < .001). Probable causes for incomplete colonoscopy were identified at endoluminal CT colonography in 74% of 40 patients. Baseline colonic distention in the region of the transverse and right colon was considered adequate before additional air insufflation; however, the addition of air significantly enhanced colonic distention throughout the entire colon (p < .001). Endoluminal CT colonography adequately revealed 96% of all colonic segments; in comparison, barium enema adequately revealed 91% of all segments (p < .05). CONCLUSION: In patients with incomplete colonoscopy, endoluminal CT colonography successfully showed the previously unrevealed colon in more than 90% of patients. Endoluminal CT colonography is a rapid, well-tolerated technique that provides clinically useful colonic and extracolonic information and should be considered for all patients who undergo incomplete colonoscopy.

Adult↗
PubMedDate not supplied

Gemcitabine pulmonary toxicity: CT features.

The purpose of this case report is to describe the CT imaging features of pulmonary toxicity from gemcitabine, a relatively new chemotherapeutic agent, in three patients. CT features of gemcitabine pulmonary toxicity include ground glass opacity (n = 3), thickened septal lines (n = 3), and reticular opacities (n = 3). Distribution is diffuse and bilateral, and may be symmetric (n = 2) or asymmetric (n = 1). Clinical symptoms and imaging findings are potentially reversible with steroid therapy.

Anti-Inflammatory Agents↗