Double-contrast Radiography Research Articles

Preoperative Staging Diagnosis of Colorectal Cancer Based on Multi-Row Spiral CT

Colorectal cancer is a common malignant tumor of digestive tract, and its incidence has increased significantly in recent years. The 5-year survival rate of patients with early local colorectal cancer is more than 90%, with local invasion of about 68%, and distant metastasis of less than 10%. Therefore, early diagnosis and early treatment is an effective means for the prevention and treatment of colorectal cancer. At present, X-ray air-barium double contrast radiography and fiberoptic endoscope are most commonly used in the examination of colorectal tumors in the world. These two methods have the advantages of simple operation, intuition and low cost. However, it is limited to judge the depth of tumor invasion, whether to break through the serosa, lymphatic metastasis, and distant metastasis. In this work, it can be confirmed that the measurement of preoperative tumor vascular volume reconstruction density is feasible in the preoperative evaluation of colorectal cancer, it will provide clinicians with more valuable information about preoperative tumor staging. Besides, multi-slice spiral CT has the advantages of less trauma, high speed, and clear image. It can not only judge the location of the tumor, the depth, and extent of tumor invasion, and show distant organ metastasis, but also has good application value in tumor staging. In this paper, the clinical data and MSCT imaging data of patients with colorectal cancer were analyzed retrospectively, and the value of MSCT in the diagnosis of colorectal cancer was discussed.

Colon cancer: risk factors and screening

Colon and rectal cancers are usually combined under the same term "colorectal cancer". It should be noted that the lesion of the colon is much more common. Colorectal cancer ranks fourth in the overall structure of oncological pathology in terms of prevalence, and in some countries even comes third after lung and stomach cancer. Risk factors that contribute to the development of colorectal cancer include bowel polyps, ulcerative colitis and Crohn's disease, and a genetic predisposition. Most often, neoplastic transformation occurs at the site of an adenoma or dysplastic lesion of the intestinal mucosa. Due to the high risk of neoplastic process in a sufficiently large number of elderly people, it is recommended that every person over the age of 50 should undergo compulsory screening to detect latent cancer. The simplest, but at the same time insufficiently informative method is a blood culture test - analysis for the presence of blood in the feces. Method of total colonoscopy and double-contrast radiography is distinguished by a higher information content, but at the same time a higher cost. It is recommended to have these examinations every three to five years after the age of 50 years without clinical manifestations, and after the age of 40 for those at risk for colorectal cancer.

Radiological evaluation on invasive extent of adenocarcin-oma of esophagogastric junction

The accurate judgement of the upper and lower borders of the adenocarcinoma of esophagogastric junction (AEG) by radiology can facilitate the decisions on surgical approach and staging criteria. X-ray double contrast radiography, CT and MRI are the common modalities. The accuracy of X-ray double contrast radiography in determining the invasion length of esophagus and the central point of gastric infiltration can be improved by standardized pretreatment, combination of multiple contrast methods such as double contrast and flow-coating procedure, and combination of multi-angle observations such as conventional frontal, left /right anterior oblique and supine right posterior oblique position. Abdominal enhanced CT is the imaging method recommended by clinical guidelines for the radiological examination of AEG. The relative position of the central point of the tumor from 2 cm line can be determined through the combination of measurement and formula calculation on multi-planar reconstructed CT images. The "three-layer four-type" classification can provide reference for the selection of abdominothoracic incision. The direct demonstration of the tumor extension can be achieved through the CT curved planar reconstruction by drawing lines along esophagus to stomach. The combination of multiple sequences of MRI is helpful to determine the extension of the lesions. In the future, more radiological studies are needed to establish criteria with high accuracy, repeatability and convenient operation,and to assist clinical evaluation of AEG invasion.

Abstract No. 526 A rabbit model of gastric cancer established by injecting VX2 tumor pieces through left gastric artery catheterization

To establish gastric cancer in rabbits by injecting VX2 tumor pieces through left gastric artery catheterization. VX2 tumor pieces of size 0.5 × 0.5 mm were implanted into the left gastric artery under the guidance of the digital subtraction angiography (DSA) in 12 New Zealand rabbits. One week after the implantation, DSA and air barium double contrast radiography were performed to evaluate the growth of the tumors. Three rabbits were then sacrificed for histopathological analysis of the tumors immediately and survival time was observed in the other nine rabbits. The left gastric artery catheterization was successfully achieved in all rabbits. All animals survived one week after the implantation. Gastric tumors were demonstrated with DSA and the air barium double contrast radiography. The masses, ulcers and mucous membrane edema could be found in the stomachs of the three rabbits, one week after the implantation of VX2 tumor pieces. Gastric tumors with remarkable perforations were confirmed in the other nine animals. The median survival time of the VX2 gastric cancer rabbits was 12 days in the current study. The implantation of VX2 tumor pieces into the left gastric artery is feasible to establish gastric cancer in rabbits, a promising animal model for the researchers on interventional oncology, radiology, and surgery.

Sensitivity of urolithiasis detection using urinary, radiography and ultrasound parameters

Although many information has been published regarding canine urolithiasis, sensitivity of radiography, ultrasound and urinary parameters have been poorly correlated with number, size, and composition of the stones. One hundred and thirteen clinical files of dogs with diagnosis of urolithiasis were retrospectively selected. Information regarding number, appearance, location, size, and composition of the stones were noted after surgical removed. Urolithiasis data was compared with radiographs and ultrasound images and urinalysis parameters. Pure struvite was found in 42.4% and calcium oxalate in 35.6%. Survey radiographs enabled the detection of radiopaque stones and when an ultrasound examination was also performed, the sensitivity was increased. Double contrast radiography enabled identification in 100% of radiolucent stones, and allowed for size measurement and number counts in 76.9% of radiolucent stones. Crystalluria had low sensitivity (31.5%) and specificity (58.8%). Hematuria (96.3%) and leukocyturia (61.1%) were the most common parameters found. We concluded that double contrast radiography can be considered the method of choice for detection of radiolucent stones. Crystalluria is not a good parameter to detect or predict type of stone. Hematuria and leukocyturia, although non-specific findings, can be used as triage for investigation of urolithiasis.

The Japanese Viewpoint on the Histopathology of Early Gastric Cancer.

Japanese histopathologists have traditionally had greater opportunity to study the histology and clinical course of early gastric cancer because of technological developments including double contrast radiography and endoscopy systems, combined with the higher incidence of gastric cancer in the general population in Japan. Endoscopic resection is now considered best practice for treatment of early gastric cancers with a negligible risk of lymph node metastasis. Histopathologic evaluation plays a critical role in assessing the likelihood of lymph node metastasis on endoscopically resected specimens. There remains disparity between Western and Japanese histopathologists in the conceptual approach to the histopathologic evaluation of neoplastic lesions in the upper gastrointestinal tract, in particular regarding lesions straddling the borderline between noninvasive and invasive disease. Although in routine practice, the clinical impact of these conceptual differences is small, this disparity does complicate international exchange of datasets and the development of globally applicable formal definitions. Here we review the current practice in histological diagnosis of early gastric cancer in Japan and discuss some of the conceptual differences between Japanese and Western histopathological assessment of lesions in the neoplastic stomach.

Clinical and Diagnostic Significance of Enteroclysis Through Nasointestinal Decompression Intubation

To study the clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation, thirty-five patients with small bowel obstruction were enrolled. A nasointestinal catheter of 300 cm was placed through the nasal cavity then pushed to the upper jejunum under X-ray realtime monitoring. The patients underwent intra-small-intestinal suction therapy reducing or relieving the obstruction after 3 days. As the catheter reached the lesions, we conducted selective imaging. Using fluoroscopy, we injected 20-100 ml meglumine diatrizoate 76 % and 50-200 ml air via the decompression suction port to produce a double-contrast radiography. The catheter was then retrieved to the upper jejunum, and the X-ray of the small intestine was obtained. All 35 patients had successful intubations. The decompression treatment resolved symptoms in 20 cases and alleviated symptoms in 15 cases. Ten cases underwent surgery. The images obtained by infusing meglumine diatrizoate through the decompression catheter were of good quality. Among the 35 cases, six were absent of any distinct abnormal signs on the X-ray, 15 had adhesive ileus, four had small bowel tumor (three metastatic tumor, one small bowel cancer), three had Crohn's disease, three had radiation enteritis (one of the three was mistaken for small bowel metastatic tumor), two had enteric intussusception, one had a polyp in the small intestine, one had ascending colon cancer. The nasointestinal decompression intubation under X-ray monitoring serves a dual function for patients with intestine obstruction, by decompressing the small bowel and examining the small intestinal radiographically. The X-rays can confirm the obstruction and provide guidelines for surgery.

Strategies for eliminating death from gastric cancer in Japan.

In Japan, efforts have been directed toward improving the detection of early gastric cancer by double contrast radiography and endoscopy, since early cancer has a good prognosis, resulting in Japan having the world’s best diagnostic system for early gastric cancer. The 5-year survival rate of gastric cancer patients in Japan is much higher than in Western countries by the development of endoscopic treatment for early gastric cancer. In February 2013, Japanese national health insurance cover for H. pylori eradication therapy was expanded to patients with H. pylori-associated gastritis, a type of chronic gastritis. H. pylori-associated gastritis causes gastric and duodenal ulcers and gastric polyps, therefore, providing treatment for this gastritis is likely to substantially decrease the prevalence of both gastric and duodenal ulcer and gastric cancer. Patients with gastritis are tested for H. pylori infection and those who are positive receive eradication therapy followed by periodic endoscopic surveillance. If such an approach is pursued further in Japan, gastric cancer deaths will show a dramatic decline after 10–20 years.

The Clinical and imaging analysis of ulcerative colitis

Objective To study the clinical and imaging features of Ulcerative Colitis(UC).Methods The clinical,imagins,colonoscopy and pathological data of 35 cases of UC were studied retrospectively.Resuits 35 cases' lesions were located at the left colon,12 cage6 of mucosal thickening disorder,9 cases ofdouble taxation,13 cases of intestinal deformed,16 cases of inflammatory polyps.Conclusion Combination of clinical,X-ray air-barium double contrast radiography and endoscopy,UC can be diagnosed. Key words: Colitis; Ulcerative; Diagnosis; Differential

The diagnose value of hypotonic double contrast examination in gastric precancerous lesions

Objective To investigate diagnose value and lesions image features of the hypotonic double contrast examination in gastric percancancerous lesions. Methods Apply the low tension medicines make double contrast to radiography stomach, assisted by the (helicobacter pylori HP)13C urea breath test;There is again gastroscope and pathologic biopsy of gastroscopce unden taken sample to live check for choose 45 cases suspect that yes gastric precancerous lesions patient;Comparative Analysis to will the double contrast radiography see with the result of gastroscope and pathology. Results (1)41 cases confirmed (coincidence rate about 91%),double contrast radiography results with gastroscope and pathology results the majority accords. (2)It the main x-ray findings for lesion area gastric area irregular increasa, crown now, deformity;gastric grooves broadening and unequal;submucosal nodular hyperplasia; gastric reduced distensibility a series of signs. Conclu-sions (1)The key of diagnosis are the change of clear display gastric area. (2)assisted by the HP measuring can raises the diagnosis rate apparently. (3)There is certain characteristic native in x-ray findings of gastric lesions precancerous, good double contrast radiograpby all righe diagnose most pathological changes preliminarily. Key words: Astric; Precancerous lesions; Double contrast radiography; Image diagnose

Cine Magnetic Resonance Imaging Evaluation of Peristalsis of Small Bowel With Longitudinal Ulcer in Crohn Disease

To evaluate peristalsis of the small bowel with a longitudinal ulcer in Crohn disease using cine magnetic resonance imaging (MRI). Fifteen patients with suspected or diagnosed Crohn disease were examined by cine MRI using a multislice and multiphase method. Inclusion criteria were pathological evidence of Crohn disease and confirmation of longitudinal ulceration in the small bowel by ileocolonoscopy, single- or double-contrast radiography of the small bowel, or surgery. Six of these patients were included in this study. Cine MRI findings of the small bowels were retrospectively reviewed by 2 radiologists. Asymmetric involvement or mesenteric rigidity with antimesenteric flexibility was seen in all patients by cine MRI. This finding was not seen in normal small bowel segments. A combination of ileocolonoscopy and contrast radiography detected longitudinal ulcers in 5 of the 6 patients, and surgery revealed ulceration in the remaining patient. Cine MRI was a feasible approach for detecting a longitudinal ulcer in small-bowel Crohn disease.

Usefulness and Limitation of Double Balloon Enteroscopy in Inflammatory Small Bowel Disease

Background and Aim: Diagnostic ability for inflammatory small bowel disease by double balloon enteroscopy (DBE) and conventional double contrast radiography (DCR) of the small intestine were compared. Subjects: From 2003 June to 2005 May we have examined 97 patients with various complaints by DBE. 44 patients with inflammatory small intestinal diseases underwent both DBE and DCR studies. The subjects of the present study were 26 patients with Crohn's disease (CD), 7 with intestinal tuberculosis, 8 with NSAIDs enteropathy and 3 with non-specific multiple ulcer of the small intestine (NMUSI, Matsumoto, J Clin Pathol 2004). Method: DCR (using per nasal tubing method, 70 percent barium, 250 ml) and DBE study (per anal approach, Fujinon-Toshiba EN-450T5 and EN-450P5/20 scope with Yamamoto's method) were made in all patients prospectively. Comparisons of diagnosability (range of insertion and/or observation, evaluation of lesion activity) of the two studies in the small intestinal lesions were made. Results: It was hard to observe intestinal lesions fully by DBE in CD and NMUSI (average insertion range from ileocecal valve was 111 cm in CD, and 50 cm in NMUSI) because these diseases had stenoses which made full insertion of DBE difficult. In contrast, it was possible to observe even subtle lesions (aphthoid or shallow ulcers) by DBE in intestinal tuberculosis and in NAIDS enteropathy because there were few stenosis in these diseases (average insertion range from ileocecal valve was 339 cm in NSAIDs enteropathy, and 269 cm in tuberculosis). Rate of cases with better diagnosability of DBE than DCR in cases with tuberculosis or NSAIDs enteropathy group was higher than that in CD or NMUSI group (p < 0.0001, Table). However, we have succeeded in dilating multiple stenoses of the small intestine in a patient with Crohn's disease. Conclusion: From theses observation, it was concluded that stenotic lesions and adhesions of the small intestine in CD or NMUSI were hazard to full study by DBE and that conventional radiography would be beneficial to study intestinal lesions in these cases. In contrast, DBE was very useful in NSAIDs enteropathy and in tuberculosis without stenosis. DBE might be useful to dilate stenotic lesion of the Crohn's ileitis.

Partial resection of the second portion of the duodenum for gastrointestinal stromal tumor after effective transarterial embolization

We report herein the case of 64-year-old man with gastrointestinal stromal tumor (GIST), who was treated by partial resection of the duodenum after preoperative transarterial embolization. He presented to our hospital with a history of tarry stools, dizziness, and severe anemia (hemoglobin, 7.5 g/dl). Gastroduodenal endoscopy revealed the presence of a submucosal tumor in the second portion of the duodenum. The presence of the tumor was subsequently confirmed by double-contrast gastrointestinal radiography and abdominal computed tomography. Super-selective angiography showed tumor staining fed from the anterior and posterior superior pancreaticoduodenal arteries, and the inferior pancreaticoduodenal artery. Two weeks after transarterial embolization through these vessels, the tumor size was found to have shrunk to 40% of its original size. Partial resection of the duodenum was performed and absence of tumor cells at the surgical margin was confirmed by intraoperative frozen-section examination. Histopathological examination revealed that the duodenal submucosal tumor consisted of spindle cells, and immunohistochemical analysis revealed positive tumor staining for c-kit protein, CD34 and alpha-smooth muscle actin (SMA), and negative staining for desmin and S-100; the positivity rate for MIB-1 staining was 2.2%. Based on these findings, the tumor was diagnosed as a GIST of low-grade malignancy, classified as the muscular type. It is considered that preoperative treatment of duodenal GISTs, such as transarterial embolization, may be useful for reducing the extent of resection, from pancreaticoduodenenctomy to a partial resection.

Ileocolic intussusception

A 73-year-old woman was referred for evaluation of severe anemia. Double (air/barium) contrast radiography of the colon demonstrated a huge polypoid tumor that appeared to prolapse from the ileum into the cecum, suggesting an ileocolic intussusception (A).Amultinodular tumor approximately 40mm in diameter with superficial ulcerations was noted at colonoscopy (B). Chromoendoscopy indicated that it was covered by normal mucosa, and biopsy specimens did not reveal any specific finding. By EUS, the tumor was homogeneous and hyperechoic (C). Based on these findings, an ileal lipoma was suspected. Because of the bleeding and the obstructive nature of the ileal tumor, it was resected surgically. Macroscopically, the resection specimen consisted of a semipedunculated submucosa tumor (55 × 50 mm) arising in the ileum. The cut surface was homogeneousand yellow. Histopathologically, the tumor was a lipoma that was thought to have originated from the subserosal layer (D; H&E, orig. mag. ×1).

Helicobacter pylori-induced enlarged-fold gastritis is associated with increased mutagenicity of gastric juice, increased oxidative DNA damage, and an increased risk of gastric carcinoma.

The severe inflammation, increased cell proliferation and marked acid inhibition observed in subjects with Helicobacter pylori-associated enlarged-fold gastritis suggest that enlarged-fold gastritis may be a risk factor for gastric carcinoma. The purpose of the present study was to determine whether a relationship exists between enlarged-fold gastritis and gastric carcinoma. One hundred and thirty-five H. pylori-positive patients with early gastric carcinoma and 141 age- and sex-matched H. pylori-positive controls without gastric carcinoma were involved in the study. The widths of gastric body folds were measured by double-contrast radiographs. The mutagenicity of gastric juice was assayed using the Ames test and Salmonella typhimurium TA-98 or TA-100 with S9-mix. Levels of 8-hydroxydeoxyguanosine (8-OHdG) in gastric mucosa were examined using high-performance liquid chromatographic-electrochemical detection. An upward shift in the distribution of gastric fold widths in H. pylori-positive patients with early gastric carcinoma was found. Enlarged-fold gastritis (fold width >/=5 mm) was observed in 81% of the patients with gastric carcinoma, compared with 46% of H. pylori-positive controls. The odds ratio for gastric carcinoma increased with increasing fold width to a maximum of 35.5 in persons with fold width >/=7 mm. The prevalence of diffuse-type early gastric carcinoma in the body region increased with increasing fold width. The mutagenicity of gastric juice from the patients with enlarged-fold gastritis was significantly higher than that in H. pylori-negative controls and H. pylori-positive patients without enlarged folds. Mucosal 8-OHdG levels in the body region of patients with enlarged-fold gastritis were significantly higher than in H. pylori-negative controls and H. pylori-positive patients without enlarged-fold gastritis. Eradication of H. pylori significantly decreased the mutagenicity of gastric juice and 8-OHdG levels in the gastric mucosa from patients with enlarged-fold gastritis. A significant association is suggested between enlarged-fold gastritis and gastric carcinoma.

Synchronous and metachronous small bowel adenocarcinomas in a patient with celiac disease

Synchronous and metachronous small bowel adenocarcinomas in a patient with celiac disease

Radiographic findings of primary B-cell lymphoma of the stomach: low-grade versus high-grade malignancy in relation to the mucosa-associated lymphoid tissue concept.

We undertook this study to assess how well double-contrast radiography and CT allow radiologists to differentiate low-grade from high-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach. We retrospectively reviewed the upper gastrointestinal radiographs and contrast-enhanced CT scans of 57 patients with pathologically proven primary gastric lymphoma (low-grade [n = 29] and high-grade [n = 28] MALT lymphoma). On upper gastrointestinal radiography, ulceration (39%) was the most common finding in low-grade lymphoma, whereas polypoid appearance (38%) was the most common in high-grade lymphoma. In the 29 patients (33 lesions) with low-grade MALT lymphoma, upper gastrointestinal radiography revealed 13 ulcerative lesions (39%), 10 nodular lesions (30%), four infiltrative lesions (12%), two polypoid lesions (6%), and four combined lesions (12%). In the 28 patients (29 lesions) with high-grade lymphoma, upper gastrointestinal radiography revealed 11 polypoid lesions (38%), nine infiltrative lesions (31%), six ulcerative lesions (20%), one nodular lesion (3%), and two combined lesions (7%). On CT, thickening of the gastric wall in low-grade lymphoma (range, 0.3-2.5 cm; mean, 0.8 cm) was much less than that in high-grade lymphoma (range, 0.7-8.0 cm; mean, 2.5 cm). Abdominal lymphadenopathy was less frequent in low-grade lymphoma (14%) than in high-grade lymphoma (75%). Most low-grade lymphomas show superficial spreading lesions, such as mucosal nodularity, shallow ulcer, and minimal fold thickening, on upper gastrointestinal radiography, whereas most high-grade lymphomas show mass-forming lesions or severe fold thickening.

Report based on fiscal 2000 diagnostic x-ray equipment questionnaire survey(conditions of radiography)

X-ray equipment has seen advances in inverters and the digitalization of reception systems. The X-ray Systems Study Group, in order to examine changes in the conditions of radiography, including pediatric radiography, variations in shortest irradiation time, and standardization of the conditions of radiography, carried out investigative research using a questionnaire survey that was sent to 400 facilities. The recovery rate was 33%. In terms of the reception system, half of the general radiography systems were using computed radiography (CR). Seventy percent of respondents used an intensifying screen and film(S EF)in stomach double-contrast radiography. About 80% used digital radiography (DR) and digital subtraction angiography (DSA) in aorta abdominalis angiography. At least 70% of high-voltage generators were of the inverter type. The conditions of radiography were not greatly influenced by changes in reception systems and X-ray equipment. Many pediatric radiographies were carried out by radiological technologists. We consider it useful to conduct such survey investigations.

Proximal Crohn's disease: review of the clinicopathologic features and therapy.

Crohn's disease in the proximal region of the digestive tract is uncommon. Better diagnostically procedures and more careful histologic examination has led to a higher detection of proximal Crohn's disease. The diagnosis is based on symptoms, endoscopy with serial sections, or double contrast radiography. The most common histologic finding for this diagnosis are granulomas in the mucosa in Helicobacter pylori-negative patients, but the granulomas are not always frequently detected. Endoscopic lesions in the proximal regions look like the lesions that could be found in the distal regions. Notching in the duodenal folds could be a strong indication for Crohn's desease. Radiological lesions are not always characteristic, but should be used in combination with endoscopy. Stenosis is an important complication, but fistula formation and pseudodiverticular formation is possible. There is no uniform medical therapy, but the regular anti-inflammatory management for Crohn's disease is most often used. Sometimes surgery is needed.

Visualization of three-dimensional stomach shapes for virtual observation

Double contrast radiography provides a detailed information of stomach inner-fold patterns that are very important to diagnose stomach. Taking a good quality of this radiograph is difficult because radiologists have to control many things during inspection time. We propose a virtualized stomach and its deformation method based on the approximation of physical features around the stomach. We use both X-ray TV images and external appearances of the subject while taking X-ray images, to transform the shapes of virtualized stomach. Several types of simulated results are presented.