Staging of colorectal cancer.
CT, MR, and TRUS play complementary roles in staging CRC. Further improvements in these techniques will improve the accuracy of preoperative staging and thereby help optimize patient treatment and outcome.
Colon↗
Biomedical subjects
R M Gore
Publications and source records attributed to R M Gore.
Helical CT in the evaluation of the acute abdomen.
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Abdomen, Acute↗
The great escape: interfascial decompression planes of the retroperitoneum.
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Aged↗
Acquired immunodeficiency syndrome (AIDS) of the abdominal organs: imaging features.
The liver, spleen, biliary tract, pancreas, and kidneys are commonly affected by opportunistic infection, malignancy, and inflammatory disorders during the course of human immunodeficiency virus (HIV) infection. Clinical manifestations of solid abdominal visceral involvement are protean and usually nonspecific, but it is important to establish a specific diagnosis promptly in these often critically ill patients. This presentation reviews the cross-sectional imaging spectrum of HIV-associated lesions of these organs.
AIDS-Associated Nephropathy↗
Use of single percutaneous endoscopic gastrostomy in management of gastric volvulus in three patients.
Gastric volvulus is a rare condition that occurs when the stomach twists either in an organoaxial or mesenteroaxial direction. In patients with recurrent episodes of volvulus, standard therapy is surgical correction. Many patients, however, are not candidates for surgical therapy because of comorbid conditions or advanced age. Our aim was to determine if the insertion of a single percutaneous gastrostomy tube placement would assist in management of gastric volvulus in patients not able to undergo surgical therapy. The alpha-loop maneuver was used to reduce gastric volvulus in three elderly patients. A percutaneous endoscopic gastrostomy tube was then inserted to prevent recurrent volvulus. Single percutaneous gastrostomy tube placement was successful in managing volvulus in these three patients. Single percutaneous endoscopic gastrostomy tube placement is a useful treatment alternative to surgery in patients requiring therapy of gastric volvulus.
Aged↗
Using triphasic helical CT to detect focal hepatic lesions in patients with neoplasms.
OBJECTIVE: Our purpose was to determine the value of triphasic helical CT (unenhanced, hepatic arterial, and portal venous phases) in the detection and characterization of focal hepatic lesions due to hepatomas or metastases. MATERIALS AND METHODS: One hundred two patients with known or suspected hepatomas or liver metastases underwent triphasic CT. The number and conspicuity of lesions were evaluated on each phase. RESULTS: Five hundred eighty-four lesions were detected in 102 patients. Patients with hypovascular malignancies had more lesions detected on the portal venous phase with increased conspicuity than on the other phases. Patients with hypervascular malignancies had lesions best detected on the hepatic arterial phase, which revealed small lesions that were not seen on the other phases in seven (21%) of the 33 patients with hypervascular metastases and hepatomas. No lesions were detected on the unenhanced phase that were not seen on the other phases. However, arterial phase images introduced new diagnostic dilemmas because not all lesions seen on the arterial phase alone were caused by hepatomas or metastases, even in patients with known malignancies; several lesions represented benign abnormalities that included focal nodular hyperplasia. CONCLUSION: The unenhanced phase is not routinely necessary for the detection of metastases or hepatomas. Hypovascular malignancies are best evaluated during the portal venous phase. Small lesions due to hypervascular metastases and hepatomas are best evaluated and may be detected only during the hepatic arterial phase, which should be used routinely in these patients. New dilemmas may develop from the increased sensitivity of the hepatic arterial phase for lesions. However, the hepatic arterial phase is of limited value with hypovascular malignancies.
Carcinoma, Hepatocellular↗
Esophageal cancer. Clinical and pathologic features.
Carcinoma of the esophagus remains one of the most lethal of all cancers. In the past, squamous cell carcinomas accounted for over 95% of esophageal malignancies. Over the past two decades, however, there has been a dramatic increase in the incidence of adenocarcinoma arising in columnar cell-lined Barrett's mucosa, accounting for up to 34% of all esophageal cancers in some areas. This article discusses the different demographic, pathologic, therapeutic, and prognostic features of squamous cell and adenocarcinoma of the esophagus.
Adenocarcinoma↗
Gastric cancer. Clinical and pathologic features.
Gastric cancer is one of the leading causes of cancer mortality worldwide. Very little progress has been made in improving the dismal cure rate of gastric cancer over the last 30 years in the United States. Unless major breakthroughs develop in chemotherapy or radiation therapy, the only way to improve survival rates rests with earlier recognition and prevention.
Adenocarcinoma↗
Gastric cancer. Radiologic diagnosis.
The development and refinement of double-contrast barium techniques over the past two decades have dramatically improved the radiologist's ability to detect gastric cancer and characterize gastric ulcers. This article presents the radiologic findings of both early and advanced gastric cancer and offers guidelines for differentiating benign versus malignant gastric ulcers.
Barium Sulfate↗
Gastric cancer. Radiologic staging.
CT scan and EUS play complementary roles in staging gastric cancer. CT scan is initially performed to detect local and distant metastases. Depending on institutional expertise, EUS may be considered for local staging. Laparoscopic staging may also be helpful in select patients. It is hoped that further improvements in these techniques will improve the ability to stage gastric cancer and thereby optimize patient treatment and outcome.
Combined Modality Therapy↗
Small bowel cancer. Clinical and pathologic features.
Although the small bowel constitutes over 75% of the length and 90% of the mucosal surface of the alimentary tract, it is the site of only 1% of gastrointestinal cancers. Despite their rarity, it is important to diagnose small bowel tumors early to maximize patient survival. This article focuses on the clinical and pathologic findings of small bowel adenocarcinomas and carcinoids.
Adenocarcinoma↗
Colorectal cancer. Clinical and pathologic features.
Despite an improved understanding of the pathogenesis of colorectal cancer and the technical ability to alter its natural history in a large proportion of average and high-risk patients, this cancer remains deadly. There has been no significant change in incidence or survival rates over the past 40 years. This indicates a continued need for earlier detection of polyps and cancers, aggressive surgery for the primary tumor, and improved multimodality treatment for metastatic disease.
Colorectal Neoplasms↗
Upper urinary tract abnormalities in multiple sclerosis patients with urinary symptoms.
OBJECTIVE: To determine the prevalence of upper urinary tract complications in multiple sclerosis (MS) patients with urinary symptoms, and to determine if an association exists between degree of physical impairment and upper urinary tract complications. DESIGN AND SETTING: A cohort study of MS patients seeking treatment at a freestanding, university-affiliated rehabilitation hospital. PARTICIPANTS: A referred sample of 48 patients with MS, exacerbation-free for 6 months with symptoms of neurogenic bladder dysfunction. For each patient, demographic data, disease characteristics, and urologic history was obtained. Using the Kurtzke Expanded Disability Status Scale (EDSS), participants were divided into a control (EDSS < 7) and study (EDSS >/= 7) group. INTERVENTION: Ultrasound examination of the upper urinary tract. MAIN OUTCOME MEASURE: Significant MS-related abnormalities of the upper respiratory tract. RESULTS: Ten of 48 patients (21%) had significant MS-related upper urinary tract abnormalities, which were evenly distributed between control and study groups. In the more disabled study group, abnormalities were associated with the symptom of urinary hesitancy (p < .05) and form of bladder management (p < .05). CONCLUSIONS: Routine screening for upper urinary tract complications appears indicated in a select group of MS patients with urinary symptoms.
Activities of Daily Living↗
Crohn's esophagitis: a unique cause of esophageal polyposis.
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Adult↗
Pancreaticobiliary manifestations of AIDS.
The pancreas and the biliary tract are frequent sites of infectious, Inflammatory, and neoplastic disease in patients with HIV infection. However, the symptoms of pancreaticobiliary involvement may be relatively mild so that the prevalence of these disorders is probably underestimated. An appreciation of the imaging findings of HIV-associated pancreaticobiliary disorders is important because involvement of these organs may be the only criterion that establishes the diagnosis of AIDS (Table 1).
AIDS-Related Opportunistic Infections↗
CT features of ulcerative colitis and Crohn's disease.
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Colitis, Ulcerative↗
Radiologic investigation of acute inflammatory and infectious bowel disease.
Definitive diagnosis of infectious or idiopathic inflammatory bowel disease ultimately rests on histologic and bacteriologic documentation. Nevertheless, radiologic studies play an important role in the evaluation and management of patients with acute enterocolitis. Plain abdominal films can give a gross estimate of disease extent in the colon and detect complications, such as perforation or toxic megacolon. Double-contrast barium enema allows visualization of the mucosal pattern and the overall configuration of the bowel, which are important for determining the extent and severity of disease and its most likely cause. Cross-sectional imaging depicts the mural and mesenteric involvement as well as intraperitoneal complications of inflammatory bowel disease, thus providing a critically important perspective that complements the information afforded by endoscopic and conventional radiographic techniques.
Acute Disease↗
Colitis: use of CT findings in differential diagnosis.
PURPOSE: To determine whether colitides can be differentiated based on computed tomographic (CT) features. MATERIALS AND METHODS: The CT scans of 117 patients with documented colitis and colon wall thickening were reviewed. Features evaluated included mural thickness and homogeneity, distribution of bowel involvement, and associated mesenteric and small bowel disease. RESULTS: The mean colon wall thickness in Crohn colitis (11.0 mm +/- 5.1) was significantly greater than in ulcerative colitis (7.8 mm +/- 1.9) (P < .002). Submucosal fat deposition, not observed in the acute colitides, was present significantly more often in ulcerative (61%) than in Crohn colitis (8%) (P = .0001). Exclusive involvement of the right colon and small bowel was most frequent with Crohn and infectious colitis. Abscess was associated almost exclusively with Crohn colitis (35%) but was seen in one patient with radiation colitis. CONCLUSION: Although many CT findings in patients with colitis are nonspecific, some features are helpful in suggesting a specific diagnosis.
Adolescent↗