Degree Of Distension Research Articles

MRI assessment of seminal vesicle involvement by prostate cancer using T2 signal intensity and volume.

Seminal vesicle involvement (SVI) in patients with newly diagnosed prostate cancer is associated with high rates of treatment failure and tumor recurrence; correct identification of SVI allows for effective management decisions and surgical planning. This single-center retrospective study analyzed MR images of the seminal vesicles from patients undergoing radical prostatectomy with confirmed T3b disease, comparing them to a control group without SVI matched for age and Gleason grade with a final stage of T2 or T3a. Seminal vesicles were segmented by an experienced uroradiologist, "raw" and bladder-normalized T2 signal intensity, as well as SV volume, were obtained. Among the 82 patients with SVI, 34 (41.6%) had unilateral invasion, and 48 (58.4%) had bilateral disease. There was no statistically significant difference in the degree of distension between normal and involved seminal vesicles (P = 0.08). Similarly, no statistically significant difference was identified in the raw SV T2 signal intensity (P = 0.09) between the groups. In the 159 patients analyzed, SVI was prospectively suspected in 10 of 82 patients (specificity, 100%; sensitivity, 12.2%). In all these cases, lesions macroscopically invaded the seminal vesicle, and the raw T2 signal intensity was significantly lower than that in the SVI and control groups (P = 0.02 and 0.01). While signal intensity measurements in T2-weighted images may provide insight into T3b disease, our findings suggest that this data alone is insufficient to reliably predict SVI, indicating the need for further investigation and complementary diagnostic approaches.

Impact of deep learning-based reconstruction and anti-peristaltic agent on the image quality and diagnostic performance of magnetic resonance enterography comparing single breath-hold single-shot fast spin echo with and without anti-peristaltic agent.

While anti-peristaltic agents are beneficial for high quality magnetic resonance enterography (MRE), their use is constrained by potential side effects and increased examination complexity. We explored the potential of deep learning-based reconstruction (DLR) to compensate for the absence of anti-peristaltic agent, improve image quality and reduce artifact. This study aimed to evaluate the need for an anti-peristaltic agent in single breath-hold single-shot fast spin-echo (SSFSE) MRE and compare the image quality and artifacts between conventional reconstruction (CR) and DLR. We included 45 patients who underwent MRE for Crohn's disease between October 2021 and September 2022. Coronal SSFSE images without fat saturation were acquired before and after anti-peristaltic agent administration. Four sets of data were generated: SSFSE CR with and without an anti-peristaltic agent (CR-A and CR-NA, respectively) and SSFSE DLR with and without an anti-peristaltic agent (DLR-A and DLR-NA, respectively). Two radiologists independently reviewed the images for overall quality and artifacts, and compared the three images with DLR-A. The degree of distension and inflammatory parameters were scored on a 5-point scale in the jejunum and ileum, respectively. Signal-to-noise ratio (SNR) levels were calculated in superior mesenteric artery (SMA) and iliac bifurcation level. In terms of overall quality, DLR-NA demonstrated no significant difference compared to DLR-A, whereas CR-NA and CR-A demonstrated significant differences (P<0.05, both readers). Regarding overall artifacts, reader 1 rated DLR-A slightly better than DLR-NA in four cases and rated them as identical in 41 cases (P=0.046), whereas reader 2 demonstrated no difference. Bowel distension was significantly different in the jejunum (Reader 1: P=0.046; Reader 2: P=0.008) but not in the ileum. Agreements between the images (Reader 1: ĸ=0.73-1.00; Reader 2: ĸ=1.00) and readers (ĸ=0.66 for all comparisons) on inflammation were considered good to excellent. The sensitivity, specificity, and accuracy in diagnosing inflammation in the terminal ileum were the same among DLR-NA, DLR-A, CR-NA and CR-A (94.42%, 81.83%, and 89.69 %; and 83.33%, 90.91%, and 86.21% for Readers 1 and 2, respectively). In both SMA and iliac bifurcation levels, SNR of DLR images exhibited no significant differences. CR images showed significantly lower SNR compared with DLR images (P<0.001). SSFSE without anti-peristaltic agents demonstrated nearly equivalent quality to that with anti-peristaltic agents. Omitting anti-peristaltic agents before SSFSE and adding DLR could improve the scanning outcomes and reduce time.

EndoFLIP Topography: Motor Patterns in an Obstructed Esophagus

EndoFLIP Topography: Motor Patterns in an Obstructed Esophagus

Comparison of laxatives used in CT colonography with full bowel preparation

Purpose. Our study aimed to identify an optimal full-cleanse bowel preparation scheme for patients undergoing CT colonography.Material and methods. The final sample included 118 patients: 81 females (68.6%), with the median age being 75 years (IQR 675-80 years). For bowel preparation 39 (33.1%) patients used PM/Ca, 36 (30.5%) – 2 L PEG + Asc, 19 (16.1%) – 3 L PEG, 24 (20.3%) – 4 L PEG. Otherwise, the preparation did not differ in all four groups. Visual assessment of residual stool, residual fluid, and distension degree was performed using a 4-point Likert scale. The patient’s subjective tolerance assessment was executed according to the survey results using a 5-point Likert scale.Results. There were no statistically significant differences in quality of bowel preparation in all four groups. Mean value of the total residual stool score in groups was 46.2 ± 2.87 for PM/Ca; 46.9 ± 2.34 for 2 L PEG + Asc; 46.5 ± 1.98 for 3 L PEG; 45.9 ± 3.18 for 4 L PEG (p &gt; 0.05). The median of the total residual fluid score in groups was 36 (33–38) for PM/Ca; 36.5 (34–39) for 2 L PEG + Asc; 37 (36–39) for 3 L PEG; 36 (34–40) for 4 L PEG (p &gt; 0.05). Mean value of the total distention degree score in groups was 43 ± 4.34 for PM/Ca; 44.6 ± 3.13 for 2 L PEG + Asc; 44.2 ± 3.98 for 3 L PEG; 43.5 ± 4.9 for 4 L PEG (p &gt; 0.05). There was a statistically significant difference in the patient tolerance total score, depending on the laxative (p = 0.001). The total preparation score was significantly lower for PM/Ca when compared with 2 L PEG + Asc. (p = 0.021), 3 L PEG (p = 0.001), and 4 L PEG (p = 0.043).Conclusion. Use of PM/Ca in CTC preparation lowers the burden of full cleanse exam preparation and can be recommended as a safe laxative choice, including senior age patients.

Functional Lumial Imaging Probe (ENDO-FLIP) for Assessment of Continence after Abdomino-Perineal Resection for Carcinoma of the Rectum Patients

AbstractBackground: Twenty per cent of patients with carcinoma of the rectum are surgically treated with Abdomino-perineal Resection even after the recent advances in surgical techniques and the introduction of staplers. Permanent iliac Colostomy impairs the quality of life of patients after APR which raised the issue for creation of Perineal colostomy as a method of total Perineal reconstruction after APR. Which later raised the issue of objective Assessment of function as regards Continence of these patients.Aim of the Study: This work is aiming at assessment of degree of Continence of patients suffering carcinoma of the rectum previously treated with APR followed by TPR and Perineal colostomy. An objective Assessment using the Endo-FLIP was used in addition to their subjective assessment.Material and Methods: Twenty patients with low rectal cancer previously treated with APR followed by a perineal colostomy were included. Patients were objectively evaluated using the Endo-FLIP system with correlation to their quality after life as regards continece.Results: Considerable degree of distensibility was noted during coughing with a mean of 22.1mm at the proximal segment of the colon versus 11.2 at the neo-sphincter level. Our patients were as well able to evacuate the catheter volun-tarily with a mean of 3.2 seconds.Conclusion: In conclusion, this new technique proved to be valuable in improving the QOL of patients with rectal cancer after APR. The procedure achieved 94% patient satis-faction.

Perioperative Gastrointestinal Care Benefits Surgical Adolescent Idiopathic Scoliosis Patients

In order to evaluate the effect of perioperative gastrointestinal care on adolescent idiopathic scoliosis (AIS) patients after correction of scoliosis surgery, 13 cases of AIS patients from January 2015 to February 2018 were treated with perioperative gastrointestinal management. The effect was compared to those 11 routine nursing surgical AIS patients from January 2008 to December 2014. Data analysis regarding the age and scoliosis degree showed no statistically significant difference between two groups (P>0.05). However, abdominal distension degree, bowel sound recovery time and anal exhaust time of the perioperative gastrointestinal care patients were better than those of normal nursing patients (P<0.05). Furthermore, evaluation of the intestinal function including fixed independent evaluation and evacuation time also was high as compared to those of normal nursing patients. In conclusion, perioperative gastrointestinal care is beneficial to surgical AIS patients.

Causes, evaluation and surgical management of mechanical small bowel obstruction

Background: Small bowel obstruction is defined as a mechanical or functional obstruction of the intestine preventing the normal transit of product of digestion. It can occur at any level distal to the duodenum and is considered to be a medical emergency. Acute intestinal obstruction has attracted wide attention and extensive research. As a consequence of experimental research, a considerable decline has been observed in the mortality of acute intestinal obstruction. The aim of this study was to observe the causes, evaluation and surgical management of small bowel obstruction among cases presenting with the same in the Department of General Surgery of Katihar Medical College. Methods: Eighty cases of small bowel obstruction were observed in this study. The cases were selected among patients visiting the outdoor clinic of General Surgery in Katihar Medical College. The selected cases belonged to different aetiology, age groups and sex. Results: Abdominal tenderness was the commonest finding during per abdomen examination. Adhesion was the commonest aetiology observed in this study followed by obstructed hernia. General trend of reporting to the hospital was observed to be on the third day of onset. Higher incidence of small bowel obstruction was observed in cases in sixth decade of life. There was predominance among the males and in cases belonging to lower socio-economic class. Conclusions: Mechanical obstruction of the small intestine due to extrinsic causes constituted a major part among the presenting cases in this study. The degree of distension has a direct relation with the duration of the symptom. Small bowel obstruction can be confirmed using a radiogram in erect posture. Mortality due to small bowel obstruction can be reduced if timely intervention is sought by the presenting cases. Early diagnosis, effective resuscitation and timely surgery are the main treatment options that should be considered.

A comparative study of degree of colorectal distention with manual air insufflation or automated CO2 insufflation at CT colonography as a preoperative examination

The purpose of this study was to compare the degree of colorectal distention between manual insufflation using room air and automatic insufflation using carbon dioxide for computed tomography colonography performed as a preoperative examination for patients with colon cancer. Participants comprised 200 patients who underwent computed tomography colonography immediately after colonoscopy from October 2011-2012. The first 100 patients were examined using manual insufflation, and the remaining 100 patients were examined using automated insufflation. Two radiologists independently assessed colorectal distention using a 4-point scale in six segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Mean scores of the two radiologists were used to analyze whether any differences existed between techniques in terms of the degree of distention per segment. Mean distention values for the colonic lumen were better using the automated technique than with the manual technique in both positions (p<0.05). In segments, distention was significantly better using the automated technique than using the manual technique in the sigmoid and descending colon for prone patients, and in all segments for supine patients. Automated carbon dioxide insufflation offered significantly improved colorectal distention scores compared to manual room air insufflation.

Assessment of annular distensibility in the aortic valve

OBJECTIVES The recent introduction of transcatheter aortic heart valves into clinical practice has driven the need to develop methodologies to size such valves without access to the annulus in the manner hitherto possible with open heart surgery. To date, sizing has largely been done according to manufacturer-supplied guidelines based on transoesophageal echocardiography or multidetector computed tomography. We sought to examine how the diameter of the aortic valve annulus stretches under typical pressures encountered in normal and diseased states. In particular, we sought to measure how the area-derived diameter, Dcsa, i.e. the diameter derived from a cross-sectional area, varies with distending pressure. METHODS We conducted testing on 14 explanted pig hearts. Placing each heart in a 37 °C bath, an EndoFLIP EF-325 catheter (Crospon, Galway, Ireland) was introduced into the aortic valve transapically. The catheter allows intra-balloon pressure and up to 16 area-derived diameters to be measured simultaneously, thus permitting the shape of a lumen to be observed. By dividing the minimum area-derived diameter by distending pressure, a measure of distensibility (mm/mmHg) could be determined. Once the balloon was centred, balloon pressure was ramped between 100 and 200 mmHg, and the area-derived diameter was calculated at each pressure. RESULTS Between 100 and 200 mmHg, the mean (SD) increase in diameter was found to be 3.0 (1.5) mm. Distensibility in the different hearts ranged from 0 to 0.05 mm/mmHg. In some cases, the diameter change over the pressure range was negligible, whereas in one case, the diameter change over the range was 5 mm. Whereas different nominal values of diameter are to be expected, a significant variation in the degree of distensibility was observed. CONCLUSIONS Distensibility of the aortic valve annulus is highly variable. Measurement of this parameter in addition to nominal annulus diameter may suggest occasions where a larger transcatheter aortic-valve implantation valve than would be suggested by annulus diameter measurement alone, could be deployed safely with an objective of reducing regurgitation where the annulus is sufficiently distensible.

Tu2027 Topography and Characterization of Anal Ultraslow Waves (AUSWs) in Patients With Proctalgia Fugax. a Study Using High-Definition Anorectal Manometry (HDM).

Ano-rectal disorders are quite common in the general population. Although they are not life threatening conditions they do represent a certain social stigma and a reduced quality of life for the sufferer. The ano-rectal region is a continuously active area integrating the effects of smooth and striated muscle sphincters. The underlying physiology of muscle function contributing to ano-rectal competence is still poorly understood and there is room for a much better understanding so that treatments can improve. In this work we inserted a cylindrically shaped, liquid filled bag (7.5 cm long), mounted on a catheter into the anus and positioned it straddling the ano-rectal region in 20 healthy volunteers (10 females). A series of volume-controlled distensions (40ml/min to 40ml) were carried out and data on 16 cross-sectional area measurements at 5 mm apart and bag pressure were recorded. Provocative tests using squeeze and cough at bag volumes of 20, 30 and 40ml were also carried out. Results indicated that the procedure was safe and well tolerated. Ramp distension showed that the female ano-rectal sphincter requires a higher pressure (mean, 11mmHg) to open than in males (mean, 5mmHg) (P 0.05). The geometric profile during distensions showed almost the same pattern in all volunteers with proximal and distal narrow bands at low degrees of distension and shortening of the narrow zone at higher degrees of distension (figure1). Interindividual differences were observed in the behaviour of the external anal sphincter and the puborectal muscle during squeeze. However, during cough their behaviour was quite similar. This distensibility technique provided an important new way of studying the anal canal and hence may have a role in testing sphincter competence in patients with incontinence and anorectal dysfunction.

Tu2026 A New Distensibility Method Using Endoflip to Determine Compliance in the Ano-Rectal Region in Healthy Controls

Ano-rectal disorders are quite common in the general population. Although they are not life threatening conditions they do represent a certain social stigma and a reduced quality of life for the sufferer. The ano-rectal region is a continuously active area integrating the effects of smooth and striated muscle sphincters. The underlying physiology of muscle function contributing to ano-rectal competence is still poorly understood and there is room for a much better understanding so that treatments can improve. In this work we inserted a cylindrically shaped, liquid filled bag (7.5 cm long), mounted on a catheter into the anus and positioned it straddling the ano-rectal region in 20 healthy volunteers (10 females). A series of volume-controlled distensions (40ml/min to 40ml) were carried out and data on 16 cross-sectional area measurements at 5 mm apart and bag pressure were recorded. Provocative tests using squeeze and cough at bag volumes of 20, 30 and 40ml were also carried out. Results indicated that the procedure was safe and well tolerated. Ramp distension showed that the female ano-rectal sphincter requires a higher pressure (mean, 11mmHg) to open than in males (mean, 5mmHg) (P 0.05). The geometric profile during distensions showed almost the same pattern in all volunteers with proximal and distal narrow bands at low degrees of distension and shortening of the narrow zone at higher degrees of distension (figure1). Interindividual differences were observed in the behaviour of the external anal sphincter and the puborectal muscle during squeeze. However, during cough their behaviour was quite similar. This distensibility technique provided an important new way of studying the anal canal and hence may have a role in testing sphincter competence in patients with incontinence and anorectal dysfunction.

Swallow induces a peristaltic wave of distension that marches in front of the peristaltic wave of contraction

Current understanding is that swallow induces simultaneous inhibition of the entire esophagus followed by a sequential wave of contraction (peristalsis). We observed a pattern of luminal distension preceding contraction which suggested that inhibition may also traverses in a peristaltic fashion. Our aim is to determine the relationship between contraction and luminal distension during bolus transport. Eight subjects using two solid-state pressure and two ultrasound (US) transducers were studied. Synchronous pressure and US images were obtained with wet swallows and after edrophonium and atropine. Luminal cross-sectional area (CSA) at 2 cm and 12 cm above the lower esophageal sphincter (LES) were recorded. Relationship between pressure and CSA at each site, propagation velocity of peak pressure and peak distension waves were determined. Fluoroscopy coupled with manometry was also performed in five normal subjects. Esophageal distension precedes contraction wave at both-recorded sites. During distension, esophageal pressure remains constant while luminal CSA increases significantly. The onset and the peak of distension wave traverses in a peristaltic fashion between both sites. A tight coupling exists between the peak distension and peak contraction waves with similar velocities (3.7 cm s(-1) and 3.6 cm s(-1)) of propagation. The degree of distension is greater at 2 cm compared to 12 cm. Atropine and edrophonium reduced and increased the contraction pressure respectively, without affecting the distension wave. Fluoroscopic study confirmed that the wave of distension traverses the esophagus in a peristaltic fashion. Distension and contraction waves are tightly coupled to each other and both traverse in a peristaltic fashion.

Parameters for successful pig islet isolation as determined using 68 specific‐pathogen‐free miniature pigs

Islet cell transplantation is a novel therapeutic modality for the cure of diabetes. Pig islet cells are an attractive substitute for human islet cells; however, they are known to be particularly difficult to isolate because of a weak islet capsule and a tendency to be fragmented during enzymatic digestion. Therefore, parameters favoring successful pig islet isolation were investigated using specific-pathogen-free (SPF) miniature pigs. Sixty-eight SPF miniature pigs were used for islet isolation. Birth weight, body weight, age, sex, pregnancy history, and the fasting blood glucose levels of each pig were determined. Each pig's general condition was assessed with regard to feeding status and physical activity. Pancreas procurement was performed by one surgical team. Anesthesia duration, operation duration, procedure quality, and perfusate type were recorded. After pancreatectomy, a biopsy was performed for islet density analysis. Decapsulation, cannulation duration, degree of distension, and cold ischemic time were assessed. During islet isolation, pancreas weight, digestion time, and digested tissue proportion were recorded. Isolation results were evaluated by total islet equivalents (IEQ), islet equivalents per gram of pancreas (IEQ/g), isolation index, islet recovery rate, purity, and visual grade. To identify the predictors of higher islet isolation yield, we performed binary logistic regression analysis with significant (P < 0.05) variables from the univariate analysis. The pigs were categorized into high (n = 34) and low yield (n = 34) groups according to the median IEQ/g or total IEQ values. Body weight and age were significantly different between the two groups. Being male or a positive history of pregnancy in females was factors favoring successful islet isolation. General condition assessments failed to estimate islet isolation results. Long anesthesia duration, which might have caused ischemic injury to the pancreas, negatively affected islet isolation results. Decapsulation, cannulation duration, and subsequent pancreas distension were significantly important in successful islet isolation. Inter-lot variability of Liberase was not observed because of screening processes performed before purchase. Isolation index and islet recovery rate correlated well with islet yields. Multivariate analysis using total IEQ and IEQ/g as outcome variables indicated that age older than 2, being male and moderate distension by Liberase injection are major determinants influencing successful islet isolation.

SERIAL GASTROINTESTINAL ULTRASONOGRAPHY FOLLOWING EXPLORATORY CELIOTOMY IN NORMAL ADULT PONIES

The objective was to characterize ultrasonographic changes in bowel wall thickness, contractility, degree of distension, luminal contents, and peritoneal fluid associated with exploratory celiotomy in normal ponies. Gastrointestinal ultrasonographic examination was performed in 14 ponies on days 1, 3, 5, and 7 after an exploratory celiotomy. Wall thickness, contractility, degree of distension, and luminal contents were recorded for the duodenum and jejunum. Stomach wall thickness and location, cecal wall thickness, and peritoneal fluid location and character were recorded. Peritoneal fluid was identified most frequently on day 1 (P = 0.0005). Duodenal wall thickness was significantly decreased on day 7 compared with days 1, 3, and 5 suggesting inflammatory thickening postoperatively (P = 0.005). Stomach wall thickness was decreased on day 1 compared with days 3, 5, and 7 (P = 0.03). All measurements, however, were within normal limits. Hypocontractile segments of jejunum were most frequently identified on day 1 (P = 0.02) and hypoechoic contents were identified most frequently in the jejunum on day 1 and the duodenum on day 3, suggesting mild functional ileus or enteritis in the early postoperative period. Our findings support that bowel handling during abdominal exploration causes minimal changes in bowel wall thickness, contractility, degree of distension, luminal contents, and peritoneal fluid. This study was performed in ponies without gastrointestinal disease and further studies are necessary in patients.

Optimizing the degree of distension and reducing discomfort in CT colonography by means of a microprocessor interface system for air insufflation

Abstract The patients’ discomfort during CT colonography determines which method is used and its frequency of use. The discomfort is largely associated with the colon’s insufflation with gas. A system for an automatic room-air insufflation has been developed that ensures a continuous and steady air insufflation and an increase in colonic pressure and enables a relatively fast decompression. This system provides constant pressure monitoring and can alert the operator, if necessary. The degree of discomfort was evaluated for 36 patients, who were subjected to manual and automated air insufflation. The degree of the colonic distension achieved by the two methods was compared. The data analysis showed a significantly lower level of discomfort in patients with automated air insufflation. The degree of colonic distension was evaluated by comparing the diameters of similar segments of the colon, as well as by the subjective opinion of the operator. The distension with automated air insufflation was higher than that with manual air insufflation. In some cases there was a significant difference (P&lt;0,05). In conclusion, the results show that the automatic insufflation of air at room temperature can be used to optimize CT colonography.

Usefulness of MDCT evaluation of the intraluminal surface of esophageal masses using only effervescent powder without injection of hypotonic agent

This study evaluated the inner surface of esophageal masses using multidetector computed tomography (MDCT) after esophageal distention with an ingested effervescent powder without inducing pharmacological esophageal hypotonia. From September 2004 to December 2005, 38 patients underwent MDCT after esophageal distention using only an effervescent powder that was ingested only 35 s after injecting the contrast agent and twice 50 s after the injection. Ten patients had a normal esophagus and twenty-eight patients had an esophageal mass detected by endoscopy. The degree of distention at three levels (upper, middle, and lower) and the intraluminal surface of the esophageal mass were evaluated. The surface between the normal and esophageal mass were analyzed using an ANOVA test. Esophageal distention in the upper and middle thirds was classified as either "good" or "fair" in 90.8% of cases. In the lower third, 81.6% of cases were either "good" or "fair". All esophageal cancers had an irregular surface but all normal lining and benign esophageal masses had a smooth surface. MDCT after esophageal distention using the effervescent powder ingested twice achieved good-to-fair distention in the esophagus, and is a useful diagnostic modality for identifying the intraluminal surface of esophageal masses.

Dark-lumen MR colonography with fecal tagging: a comparison of water enema and air methods of colonic distension for detecting colonic neoplasms

The purpose was to evaluate MR colonography (MRC) with barium fecal tagging in detecting colorectal pathology and to determine how air-based and water-based colonic distension influences MRC. We studied 83 patients with high risk of colonic neoplasms. All received oral barium sulfate for colonic preparation before unenhanced and enhanced T1-weighted gradient-echo MRC using either water (n=54) or air (n=29) for colonic distension. Fecal tagging, distension, and artifacts were recorded. All patients underwent conventional colonoscopy within 2 weeks of MRC; the techniques were compared for detection of malignant neoplasms and polyps >or=1 cm, 6-9 mm, and <or=5 mm. Fecal tagging was "good" in 76% of the colonic segments in water-distended patients and 46% of air-distended patients. The degree of distension was "good" in 90.7% of water-distended patients and 44% of air-distended patients. Severe artifacts were present in 15% air-distended patients and 0.3% of water-distended patients. Both water-distended and air-distended MRC detected all malignant neoplasms and polyps >or=1 cm, but more air-distended MRC were excluded for poor quality. MRC with fecal tagging is useful for detecting lesions >or=1 cm. Air distension was inferior to water distension in most aspects. Water-based colonic distension should be used for barium-tagging MRC.

Value of cine MRI for better visualization of the proximal small bowel in normal individuals

While enteroclysis seems to be the most efficacious method in achieving bowel distension, enterographic methods have become widespread due to the unpleasantness of enteroclysis and the radiation involved with positioning the catheter. Cine images in MRI can be done without radiation. Our aim is to see if and how cine MR imaging can improve visualization of bowel loops by capturing them while distended. Ten healthy individuals were asked to drink up to 2,000 ml of an oral solution made locally over a 60-min period. Then they underwent MRI using coronal balanced fast field echo (b-FFE) covering small bowel loops. If the initial exam revealed collapsed bowel loops an additional 50 mg of erythromycine was given intravenously with the subject still in the scanner and then cine imaging was performed. The degree of distension of different segments of the small bowel was measured before and after cine imaging and compared. The distension score was significantly higher after addition of the cine images as well, being only significant for depiction of the duodenum and jejunum. Our preliminary study suggests that cine MRI can give better image depiction of the proximal small bowel in healthy volunteers, perhaps circumventing the need for enteroclysis in some cases. There is a need for validation of these results in patients with small bowel disease.

Depiction of normal gastrointestinal anatomy with MDCT: Comparison of low- and high-attenuation oral contrast media

Purpose To compare low- and high-attenuation oral contrast media for depiction of normal gastrointestinal anatomy with multidetector-row computed tomography (MDCT). Materials and methods A prospective, randomized study of 90 consecutive patients without known or suspected gastrointestinal disease was conducted after the approval of our Institutional Review Board. All patients underwent IV contrast-enhanced abdominal and pelvic CT scans after oral administration of 900 ml of either low- or high-attenuation barium sulphate suspension. Using a five-point scale, two radiologists independently graded distention and wall visualization of stomach, duodenum, jejunum, and ileum. The degree of distention and wall visualization was compared using Mann–Whitney U-test. Results Duodenal, jejunal and ileal distention ( p < 0.05, <0.001, <0.001, respectively) and wall visualization ( p < 0.05, <0.01, <0.05, respectively) scores with low-attenuation contrast medium were significantly higher than those with high-attenuation barium sulphate preparation, for reader 1. Duodenal and jejunal wall visualization scores with low-attenuation contrast medium ( p < 0.05, <0.01, respectively) were significantly higher than those with high-attenuation contrast medium, for reader 2. Interobserver agreement was fair to good for both distention ( κ-range: 0.41–0.74) and wall visualization ( κ-range: 0.48–0.71). Conclusion MDCT with low-attenuation contrast medium provides distention and wall visualization of the GI tract that is equal or better than high-attenuation contrast medium.

Why pelvic floor surgeons should utilize ultrasound imaging

Why pelvic floor surgeons should utilize ultrasound imaging