Magnetic Resonance Imaging Of Abdomen Research Articles

Differentiation of confluent hepatic fibrosis and infiltrative hepatocellular carcinoma on MR imaging.

To identify reliable magnetic resonance imaging (MRI) features that can differentiate confluent fibrosis (CF) from infiltrative hepatocellular carcinoma (HCC). A retrospective analysis was conducted on Twenty CF patients and 28 infiltrative HCC patients who underwent upper abdomen MRI scans. The imaging features of lesions were analyzed, and the apparent diffusion coefficient (ADC) of lesions were measured. Accuracy, sensitivity and specificity for the diagnosis of CF were calculated for each category individually and combined. Compared to infiltrative HCC, hepatic capsular retraction at the site of lesion, hepatic volume loss at the site of lesion and "nodular surround sign" were more common in patients with CF (all P < 0.001). Hepatic volume loss at the site of lesion, no or mild enhancement in arterial phase, and hyper-enhancing in delayed phase to the background parenchyma showed superior diagnostic accuracy (83.3%, 85.4%, 97.9%, respectively). When the lesion exhibited hepatic volume loss at the site of lesion or no or mild enhancement in arterial phase or hyper-enhancing in delayed phase, a sensitivity of 100.0% for the diagnosis of CF was achieved. When the lesion was positive for any two of three categories, or positive for all three categories, a specificity of 100.0% was achieved. The ADC values of CF were higher than those of infiltrative HCC (P < 0.001). The combination of the hepatic volume loss at the site of lesion, no or mild enhancement in arterial phase, and hyper-enhancing in delayed phase to the background parenchyma can be considered reliable MR features for the diagnosis of CF, as they allow differentiation from infiltrative HCC.

A review of self-supervised, generative, and few-shot deep learning methods for data-limited magnetic resonance imaging segmentation.

Magnetic resonance imaging (MRI) is a ubiquitous medical imaging technology with applications in disease diagnostics, intervention, and treatment planning. Accurate MRI segmentation is critical for diagnosing abnormalities, monitoring diseases, and deciding on a course of treatment. With the advent of advanced deep learning frameworks, fully automated and accurate MRI segmentation is advancing. Traditional supervised deep learning techniques have advanced tremendously, reaching clinical-level accuracy in the field of segmentation. However, these algorithms still require a large amount of annotated data, which is oftentimes unavailable or impractical. One way to circumvent this issue is to utilize algorithms that exploit a limited amount of labeled data. This paper aims to review such state-of-the-art algorithms that use a limited number of annotated samples. We explain the fundamental principles of self-supervised learning, generative models, few-shot learning, and semi-supervised learning and summarize their applications in cardiac, abdomen, and brain MRI segmentation. Throughout this review, we highlight algorithms that can be employed based on the quantity of annotated data available. We also present a comprehensive list of notable publicly available MRI segmentation datasets. To conclude, we discuss possible future directions of the field-including emerging algorithms, such as contrastive language-image pretraining, and potential combinations across the methods discussed-that can further increase the efficacy of image segmentation with limited labels.

A Rare Case of "Periportal Cuffing" as an Incidental Finding on 18F-FDG PET/CT.

A 7-year-old boy with known diagnosis of hereditary spherocytosis and ulcerative colitis was referred for 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography after detection of a 28 mm lesion suspicious for malignancy in spleen on upper abdomen magnetic resonance imaging (MRI). As an incidental finding, a moderately increased uptake of 18F-FDG was observed in periportal region with no definable mass. MRI revealed compatible findings with "periportal cuffing" as described on ultrasonography.

Multidisciplinary discussion and management of synchronous colorectal liver metastases: A single center study in China.

The multidisciplinary team (MDT) has been carried out in many large hospitals now. However, given the costs of time and money and with little strong evidence of MDT effectiveness being reported, critiques of MDTs persist. To evaluate the effects of MDTs on patients with synchronous colorectal liver metastases and share our opinion on management of synchronous colorectal liver metastases. In this study we collected clinical data of patients with synchronous colorectal liver metastases from February 2014 to February 2017 in the Chinese People's Liberation Army General Hospital and subsequently divided them into an MDT+ group and an MDT- group. In total, 93 patients in MDT+ group and 169 patients in MDT- group were included totally. Statistical increases in the rate of chest computed tomography examination (P = 0.001), abdomen magnetic resonance imaging examination (P = 0.000), and preoperative image staging (P = 0.0000) were observed in patients in MDT+ group. Additionally, the proportion of patients receiving chemotherapy (P = 0.019) and curative resection (P = 0.042) was also higher in MDT+ group. Multivariable analysis showed that the population of patients assessed by MDT meetings had higher 1-year [hazard ratio (HR) = 0.608, 95% confidence interval (CI): 0.398-0.931, P = 0.022] and 5-year (HR = 0.694, 95%CI: 0.515-0.937, P = 0.017) overall survival. These results proved that MDT management did bring patients with synchronous colorectal liver metastases more opportunities for comprehensive examination and treatment, resulting in better outcomes.

Weak correlation between total psoas muscle area and sarcopenia index for children with brain tumor.

The aim of this study is to determine whether the sarcopenia index (SI) is a viable measure of muscle mass in pediatric patients with brain tumors. Retrospectively enrolled patients (1-16 years) who had serum creatinine (Cr) and cystatin C (CysC) levels evaluated within 28 days of an abdomen magnetic resonance imaging scan for the lumbar vertebrae 3-4 total psoas muscle area (tPMA) were studied. Variables were compared using their z scores calculated from age- and sex-dependent reference. We hypothesized that a low SI indicated less skeletal muscle, and therefore potentially indicated sarcopenia. The SI z score had no correlation with tPMA z score (r = 0.004). Both Cr and CysC levels were positively correlated with tPMA in z scores (r = 0.249 and 0.320). tPMA strongly correlated with body mass index in z scores (r = 0.582). The z scores of tPMA, Cr and CysC decreased with elevated World Health Organization grades of tumor, but the z scores of SI showed no significant dependence on WHO grades. The correlation of SI to muscle mass is very weak in our sample of pediatric patients with brain tumor. Its viability as biomarker for sarcopenia needs more study.

Pancreatic tumor with hepatic metastases secreting vasoactive intestinal polypeptide: Treatment options and long-term follow-up results

Abstract Introduction Vasoactive intestinal polypeptide secreting tumor (VIPoma) are rare neuroendocrine tumors (NETs) and there isn't any robust recommendation for management. In here, we present a metastatic VIPoma case which is managed by multidisciplinary approach. Clinical Case A 64-year-old male patient presented with profuse watery, bloodless and mucous diarrhea and weight loss. In the laboratories analyzes, creatinine:1.02 mg/dL, sodium:136 mmol/L, potassium:2.9 mmol/L, chlorine:115 mmol/L, phosphorus:1.4 mg/dL, calcium:9.8 mg/dL were detected. Infectious and inflammatory causes of diarrhea were excluded. In abdomen magnetic resonance imaging (MRI), there were a 25×23×33 mm lesion in the tail of the pancreas and multiple metastatic liver lesions. Metastatic liver lesion biopsy revealed a NET. Plasma VIP level was 199 ng/L (23–63). Multidisciplinary committee was decided to distal pancreatectomy and metastatic liver lesions’ chemoembolization (TACE). Octreotide LAR 20 mg/month was started. Distal pancreatectomy revealed a 35 mm, grade 1 NET. TACE was done for metastatic liver lesions. At the 3rd month follow-up, the patient's symptoms had improved and he had gained 6 kg. Metastatic liver lesions’ size reduced and plasma VIP level was detected &amp;lt;20 ng/L. At 18th months, abdominal MRI revealed progression of liver metastases. Multidisciplinary committee was decided to re-TACE and octreotide LAR dose increased to 30 mg. At the 3rd month follow-up, it was found that the size of the liver lesions decreased and the VIP level was &amp;lt;20 ng/L. One year later, progression of liver metastases was detected. Plasma VIP level was 168 ng/L. Ga-68 DOTA-TATE PET/CT showed increased uptake in metastatic liver lesions. Peptide receptor radionuclide therapy (PRRT) was decided by the multidisciplinary committee. The patient received 8 cycles of Lu-177 treatment. However, PET/CT control revealed a newly developed metastatic lesion in liver. During this period, the patient applied to the emergency department with the complaint of fever. Hgb: 8.1 g/dL, thrombocyte: 60.1 10^3/uL, WBC: 11.3 10^3/uL were found. A leukoerythroblastic picture was observed in the peripheral blood smear. In bone marrow aspiration biopsy, 3.28% blasts were detected. The patient was evaluated as MDS secondary to PRRT with current results. EPO treatment was started. Since the monocyte count remained above 1000 10^3/uL for more than 6 months during the follow-up of the patient, chronic myelomonocytic leukemia was accepted and azacitidine treatment was started. However, the patient died at the end of the first cycle due to sepsis. CONCLUSION: VIPomas are rare NETs with characteristic symptoms; however, they are often detected with unresectable metastatic disease. Therefore, it is important to keep NETs in mind when evaluating watery diarrhea. Due to the rarity of these tumors, there is no consensus to guide treatment. Therefore, multidisciplinary management of the disease will be more effective.

Type 2 Autoimmune Pancreatitis and Ulcerative Colitis an Uncommon Association: About One Case

Autoimmune pancreatitis is one of the less recognised associations and remains poorly understood. The overall reported prevalence of autoimmune pancreatitis in inflammatory bowel disease patients is 0.4% [5, 6] considering the only two studies in the literature specifically examining this issue, and that concern Asian populations. Autoimmune pancreatitis in the setting of inflammatory bowel disease is challenging to diagnose but a clinically important entity to recognize and treat. Here we report a case of a 43-year-old women followed for ulcerative colitis, presented with epigastric pain and dyspepsia symptoms associeted to steatorrhea and 12 kg weight loss in 2 months. Laboratory tests found fasting plasma glucose at 1.27 g/l. HbA1c was 8%, IgG4 Levels were normal and the fecal elastase level was low. Magnetic resonance imaging of abdomen revealed a swollen pancreas especially in the uncus. The Bilio-pancreatic endoscopic ultrasound showed heterogeneous hypoechoic lesion of the pancreas head. And the biopsy of the pancreas revealed signs compatible with autoimmune pancreatitis type 2. A final diagnosis of ulceratice colitis associated autoimmune pancreatitis type 2 was made and the patient was treated with corticosteroids, with impressive improvement during his follow-up. In the context of inflammatory bowel disease, autoimmune pancreatitis is a rare and challenging to identify condition. The creation of clear guidelines and diagnostic standards for autoimmune pancreatitis is anticipated to improve awareness of the condition and result in a rise in the number of confirmed cases during the ensuing years.

FDG PET-CT as an important diagnostic tool and prognostic marker in suspected recurrent cervical carcinoma after radiotherapy: comparison with MRI.

Recurrent disease in post-irradiation patients with cervical cancer is often difficult to delineate on magnetic resonance imaging (MRI), because posttreatment changes can have a similar appearance, and further evaluation is often required. The aims of the study were to evaluate positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG PET-CT) diagnostic role in suspected recurrent cervical cancer after radiotherapy, compare it to MRI, and assess their prognostic impact in these patients. This cohort retrospective study included patients previously treated with radiotherapy for carcinoma of uterine cervix with suspected recurrence, who had undergone MRI of abdomen and pelvis, and were subsequently evaluated on FDG PET-CT, with minimum follow-up period of 12 months. In the total of 84 patients included in analysis, MRI vs. FDG PET-CT showed sensitivity, specificity and accuracy of 80.1%, 52.4% and 66.7%, vs. 97.6%, 61.9% and 79.8%, respectively. Patients with positive findings on MRI (Log Rank, p = 0.003) and PET-CT (Log Rank, p < 0.001) had shorter progression-free survival (PFS) than those with negative results. In univariate Cox regression models, MRI and FDG PET-CT results were found to be related to PFS (p = 0.005 and p < 0.001, respectively). However, multivariate analysis proved only FDG PET-CT to be independent prognostic factor, where patients with positive FDG PET-CT results had almost nine times higher risk of progression (p < 0.001). FDG PET-CT represents useful diagnostic tool in suspected recurrent cervical cancer after radiotherapy, showing high sensitivity in its detection. In addition, it is an independent factor in predicting progression-free survival in these patients.

Laparoscopic Myomectomy of Vaginal Leiomyoma: A Video Case Report

<h3>Study Objective</h3> To demonstrate the surgical steps of a laparoscopic excision of a vaginal leiomyoma. <h3>Design</h3> We present a video of laparoscopic excision of a vaginal myoma. <h3>Setting</h3> Private hospital in Curitiba, Paraná, Brazil. <h3>Patients or Participants</h3> A 45 years-old woman, G2 P2, was referred to our outpatient clinic with a complaint of abdominal pain, frequent urination and nocturia over five months. She underwent vaginal hysterectomy one year earlier due to uterine myoma. On digital examination a round and firm mass was palpable in the left vaginal wall. Magnetic resonance imaging of abdomen and pelvis reported a solid tumor in the left side of vaginal fornix measuring 28 × 26 mm, located 2mm from ureter. The patient underwent a laparoscopic excision of the vaginal tumor. The post-operative histopathology confirmed leiomyoma. <h3>Interventions</h3> A laparoscopic myomectomy was recorded and presented in the video. <h3>Measurements and Main Results</h3> We described the main steps of laparoscopic myomectomy of vaginal leiomyoma. Step 1: Exposure of the operation field. Step 2: Incision and dissection with ultrasonic instrument of visceral peritoneum over the vaginal fornix and towards the rectovaginal space. Step 3: Vaginal opening and excision. Step 4: Dissection towards the leiomyoma to reach the cleavage plane. Step 5: Grasping and traction of the leiomyoma with a traumatic forceps to its enucleation and excision. Step 6: Extraction of leiomyoma through the vagina. Step 7: Vaginal closure with intracorporeal suturing in two layers: first with continuous suture, followed by a second layer with three X stitches of zero poliglecaprone 25. Step 8: Bipolar hemostasis. <h3>Conclusion</h3> The laparoscopic myomectomy of vaginal leiomyoma presented can be an effective and safe treatment due to the advantages of minimally invasive surgery. Our patient was previously hysterectomized, but laparoscopy is a prudent approach as well when necessary to undergo myomectomy of vaginal and uterine fibroids concomitantly.

Design and construction of an 8-channel transceiver coil array for rat imaging at 9.4 T

Ultra-high field (UHF) small animal magnetic resonance imaging (MRI) is a crucial tool permitting investigation of metabolic diseases and identification of imaging biomarkers suitable for clinical diagnosis and translation. Radiofrequency (RF) coils are critical components in enabling acquisition of high-quality rat abdomen MRI data. However, efficient RF coils with high-channel count, capable of sensitive and accelerated rat abdomen imaging at 9.4 T, are not available commercially. The SNR of the commonly-used 9.4 T birdcage coil is relatively weak, particularly in the peripheral area of the subject. In addition, the birdcage is not readily to perform parallel imaging due to unavailability of the required multiple channels. Consequently, the extended scanning duration may cause unnecessary hazards to the rat. In this work, an 8-channel transceiver coil array was designed and constructed to provide good image quality and large coverage for rat abdomen imaging at 9.4 T. The structure and the performance of the developed array was optimized and evaluated by numerical electromagnetic simulations and bench tests, respectively. The MR imaging experiments in phantoms and rat models were also performed on a Bruker 9.4 T preclinical MRI system to validate the feasibility of the proposed design. The coil array supports a one-dimensional acceleration factor up to R = 4, providing good parallel imaging capabilities. These results demonstrated that the proposed 8-channel transceiver coil array for rat imaging has the ability to obtain high spatial resolution of rat abdomen anatomical structure images at 9.4 T.

Indian Data on the Response of Positive Pelvic Lymph Nodes in Carcinoma Cervix Patients Treated with Simultaneous Integrated Boost Using Volumetric Modulated Arc Radiation Therapy

Abstract Background The percentage of pelvic lymph node (LN) positivity in cervical cancer patients varies from 19% in early stages to 68% in advanced cases. Thirty-three percent of patients will develop recurrence within 2 years following therapy, and 5-year relative survival for patients with affected regional LNs is 57%. Hence, pelvic LNs need to be included in the definitive plan of radiation treatment for better disease control and longer survival. With conventional radiation therapy, dose escalation was not possible because of small bowel constraints. With higher conformity of intensity-modulated radiotherapy technique, doses to pelvic and abdominal organs can be minimized. The added advantage of simultaneous integrated boost (SIB) is that high dose per fraction is delivered to the gross disease and low dose to the microscopic disease, thereby reducing the total treatment time and improving the therapeutic ratio. Materials and Methods Forty-one patients presenting to the Department of Radiation Oncology, between January 2016 and June 2017, with newly biopsy-proven carcinoma cervix Stage IB to IVA were enrolled in the study, and all the investigations were performed. The radiation dose was delivered using volumetric modulated arc therapy plan according to the dose of 5,000 cGy in 25 fractions to the whole pelvis and 5,500 cGy in 25 fractions to the involved nodes at 220 cGy per fraction using SIB along with weekly cisplatin at 40 mg/m2. After completion of external beam radiation, all the patients received three fractions of brachytherapy to a total dose of 21 Gy. Acute toxicities were assessed using Radiation Therapy Oncology Group criteria. At 3 months after completion of treatment, all the patients were followed up with diffusion-weighted magnetic resonance imaging of abdomen and pelvis to assess the response after 3 months. Results Of 41 carcinoma cervix patients with significantly positive LNs treated with SIB VMAT, 9.8% of the patients (4 patients) had residual nodal disease and 87.8% of the patients (36 patients) had a complete response, and 19.5% (8 patients) had residual disease of primary and 78% (32 patients) had a complete response at 3 months after completion of treatment with only grade I and grade II toxicities. Conclusion Treatment with SIB VMAT in carcinoma cervix patients with significant pelvic LNs shows a very good response with acceptable acute toxicities. But longer follow-up period is required to see if this response translates into better disease-free survival and overall survival.

Diagnostic Accuracy of Magnetic Resonance Imaging in Carcinoma of Cervix Taking Histopathology as Gold Standard

The crucial factor that plays important role in diagnosis and prompt treatment management of cervical cancer is staging. To stage cervical carcinoma Magnetic Resonance Imaging (MRI) is considered to be the most accurate and gold standard diagnostic tool. Objective: The aim of the present study was to elaborate the diagnostic accuracy of MRI in correlation with Histopathological Examination (HPE). Methods: The 53 patients diagnosed with cervical carcinoma attending the gynecology department of hospital from May 2021 to April 2022 were included in the study. Those patients who had undergone the abdomen and pelvis MRI fulfilled the inclusion criteria. The MRI and histopathological examination not only help in staging of cancer but also consider valuable in tracking tumor location, size and extension. The retroperitoneal lymphadenopathy, and involvement of the tumor to the adjacent areas was also evaluated by the study. Staging of all patient was done according to the International Federation of Gynecology and Obstetrics FIGO standards. Findings of MRI and HPE were assessed. For statistical evaluation of data, the SPSS version 22.0 was used. For quantitative variables the values were represented as mean with standard deviations. Results: The 54.46±9.29 years was the calculated mean age. Squamous cell carcinoma was diagnosed in almost 46 patients (87.5% cases). Stage IB carcinoma was diagnosed in almost 47.91% cases. Pelvic lymphadenopathy was observed in 8.34% cases, while metastasis of pelvic nodal lymph was observed in 4.16% cases on the HPE. Conclusion: Malignant diseases require early and accurate tool for their diagnosis. For identification of cancer stage and better planning of treatment of cervical carcinoma the highly non-invasive modality MRI can be used. With the advents in MR imaging, it is considered as gold standard diagnostic tool with better sensitivity, specificity and high accuracy for cervical carcinoma.

Enhancement patterns of adrenal nodules on magnetic resonance imaging.

ABSTRACTObjective:To compare enhancement patterns of typical adrenal adenomas, lipid-poor adenomas, and non-adenomas on magnetic resonance imaging (MRI).Materials and Methods:Evaluation of adrenal nodules larger than 1.0 cm, with at least 2-year follow-up, evaluated on MRI in January 2007 and December 2016. Two different protocols were included - upper abdomen MRI (delayed phase after 3 minutes) and abdomen and pelvis MRI (delayed phase after 7 minutes) – and nodules were divided in typical adenomas (characterized on out-of-phase MRI sequence), lipid-poor adenomas (based on follow-up imaging stability) and non-adenomas (based on pathological finding or follow-up imaging). T2-weighted and enhancement features were analyzed (absolute and relative washout and enhancement curve pattern), similarly to classic computed tomography equations.Results:Final cohort was composed of 123 nodules in 116 patients (mean diameter of 1.8 cm and mean follow up time of 4 years and 3 months). Of them, 98 (79%) nodules had features of typical adenomas by quantitative chemical shift imaging, and demonstrated type 3 curve pattern in 77%, mean absolute and relative washout of 29% and 16%, respectively. Size, oncologic history and T2-weighted features showed statistically significant differences among groups. Also, a threshold greater than 11.75% for absolute washout on MRI achieved sensitivity of 71.4% and specificity of 70.0%, in differentiating typical adenomas from non-adenomas.Conclusion:Calculating absolute washout of adrenal nodules on MRI may help identifying proportion of non-adenomas.

Accuracy of Inflow Inversion Recovery (IFIR) for Upper Abdominal Arteries Evaluation: Comparison with Contrast-Enhanced MR and CTA.

Background: Inflow-sensitive inversion recovery (IFIR) is a recently introduced technique to perform unenhanced magnetic resonance angiography (MRA). The purpose of our study is to determine the accuracy of IFIR-MRA in the evaluation of upper abdominal arteries, compared to standard MRA and computed tomography angiography (CTA). Materials and Methods: Seventy patients undergoing upper abdomen Magnetic Resonance Imaging (MRI) in different clinical settings were enrolled. The MRI protocol included an IFIR-MRA sequence that was intra-individually compared by using a qualitative 4-point scale in the same patients who underwent concomitant or close MRA (n = 65) and/or CTA (n = 44). Celiac trunk (CA), common-proper-left-right hepatic artery (C-P-L-R-HA), left gastric artery (LGA), gastroduodenal artery (GDA), splenic artery (SA), renal arteries (RA) and superior mesenteric artery (SMA) were assessed. Results: IFIR-MRA images were better rated in comparison with MRA. Particularly, all arteries obtained a statistically significant higher qualitative rating value (all p < 0.05). IFIR-MRA and MRA exhibited acceptable intraclass correlation coefficients (ICC) values for CA, C-L-R-HA, and SMA (ICC 0.507, 0.591, 0.615, 0.570, 0.525). IFIR-MRA and CTA showed significant correlations in C-P-L-R-HA (τ = 0.362, 0.261, 0.308, 0.307, respectively; p < 0.05), and in RA (τ = 0.279, p < 0.05). Conclusions: Compared to MRA, IFIR-MRA demonstrated a higher image quality in the majority of upper abdomen arterial vessels assessment. LHA and RHA branches could be better visualized with IFIR sequences, when visualizable. Based on these findings, we suggest to routinely integrate IFIR sequences in upper abdomen MRI studies.

A Case of Acute Pancreatitis Following Computed-Tomography Scan

Introduction:&#x0D; Acute pancreatitis is a common cause of hospitalization among gastrointestinal disorders and its frequency has been rising in the past few years. The majority of cases are due to alcohol use, gallstones and hypertriglyceridemia. However, there still remain a significant number of cases in which no causative factor can be found and therefore called idiopathic. Contrast-induced pancreatitis is a rare cause pancreatitis and there are only a few cases reported so far. Here we present a case of mild acute pancreatitis following iodinated contrast exposure.&#x0D; &#x0D; Case Presentation:&#x0D; A 42-year-old female patient with a history of lymphoma was admitted to our clinic with severe abdominal pain and nausea. Her blood tests revealed elevated pancreatic enzyme levels and mildly elevated liver function tests. Upper abdomen magnetic resonance imaging revealed pancreatic inflammation without any sign of necrosis. Since her complaints began after a computed-tomography scan that she had earlier that day for the evaluation of lymphoma and no other cause could be found, iodinated contrast was thought to be the cause of acute pancreatitis in this patient.&#x0D; &#x0D; Conclusion:&#x0D; Contrast agents seem to be a rare cause of acute pancreatitis, however taking the increasing availability of procedures involving radiocontrast agents into consideration, it is important to keep in mind that clinicians may come across more cases of contrast-induced acute pancreatitis in the future.

Idiopathic bilateral adrenal hemorrhage presenting as acute abdomen in a 61-year-old male: A case report with review of literature

Introduction: Adrenal haemorrhage (AH) is a rare, life-threatening condition that requires prompt diagnosis and management. Case Report: A 61-year-old male presented with sudden-onset central abdominal pain, distended abdomen, and nausea. There was no history of trauma or any other predisposing factor for AH. The blood pressure was raised, while other vitals were normal. The patient was managed with intravenous Diclofenac, Tablet Amlodipine, and Ryle's tube insertion. Initial abdominal ultrasound revealed bilateral adrenal enlargement. However, non-contrast computed tomography of abdomen revealed changes suggestive of bilateral AH. These findings were confirmed on magnetic resonance imaging of abdomen. Though the serum cortisol and adrenocorticotropic hormone levels were normal, and the patients were not symptomatic of adrenal insufficiency, intravenous Methylprednisolone was initiated to prevent deterioration of adrenal function. All the known causes of AH were excluded, and a diagnosis of idiopathic bilateral AH was reached. On Day 7, an abdominal ultrasound revealed a non-progressive size of the bilateral adrenal lesions and the patient was discharged with well-controlled blood pressure. Conclusion: Idiopathic AH, in patients without any predisposing factors, should be included in the differential diagnosis of a patient with vague abdominal pain.

The clinical utility of inpatient MRI following an abdominopelvic CT.

The purpose of this study was to assess the diagnostic yield of abdomen magnetic resonance imaging (MRI) in the inpatient setting following a computed tomography (CT). All inpatient abdominopelvic MRIs performed on patients for a 1-year period were identified and medical records were retrospectively reviewed for the following information. Only MRIs with a preceding CT were included in the study. A total of 221 MRIs were included. Forty exams were deemed technically inadequate due to motion, while 9 more patients did not tolerate a full examination. The most common indications were focal liver lesion (n = 101), pancreaticobiliary ductal dilatation (n = 39), abnormal liver function tests (n = 26), acute pancreatitis (n = 14), abdominal pain (n = 10), and fever/sepsis (n = 10). 83 MRIs were recommended on CT and 138 were requests from the care team. In 63 cases, MRI offered new information over CT. Thirty-two MRIs recommended by radiologists affected patient management, while only 31 MRIs recommended by the care team affected management. Of these 63 MRIs, 29 cases changed immediate inpatient management, requiring further intervention. In these cases, MRI identified abscesses, choledocholithiasis, or made other diagnoses such as cholecystitis, which were not diagnosed on CT. Patient LOS increased in 24 patients in order to receive an MRI. Average costs of outpatient CTs and MRIs are typically 20% less than inpatient costs. Inpatient abdomen MRIs have limited impact on patient care following a CECT and entail higher cost, utilize more resources, scanner time, and increase patient LOS. Therefore, it should be reserved for select clinical indications.

Crohn disease-like enterocolitis remission after empagliflozin treatment in a child with glycogen storage disease type Ib: a case report

BackgroundBesides major clinical/biochemical features, neutropenia and inflammatory bowel disease (IBD) constitute common complications of Glycogen storage disease type Ib (GSD Ib). However, their management is still challenging. Although previous reports have shown benefit of empagliflozin administration on neutropenia, no follow-up data on bowel (macro/microscopic) morphology are available. We herein present for the first time longitudinal assessment of bowel morphology in a GSD Ib child suffering from Crohn disease-like enterocolitis treated with empagliflozin.Case presentationA 14-year-old boy with GSD Ib and severe IBD was (off-label) treated with empagliflozin (20 mg/day) after informed oral and written consent was obtained from the patient’s parents. No adverse events were noted. Clinical symptoms and stool frequency improved within the first week of treatment. Pediatric Crohn disease activity index (PCDAI) normalised within the first month of treatment. Abdomen magnetic resonance imaging (MRI) performed 3 months after treatment initiation showed dramatic decrease in disease activity and length. Similar findings were reported on histology at 5.5 months. At 7.5 months hemoglobin levels normalised and fecal calprotectin almost normalised. Improved neutrophil count, metabolic control and quality of life were also noted. G-CSF dose was decreased by 33% and the patient was partly weaned from tube feeding.ConclusionsThis is the first report presenting extensive gastrointestinal morphology follow-up in a GSD Ib patient receiving empagliflozin. The present case suggests that empagliflozin can be safe and effective in inducing IBD remission in GSD Ib patients and can even postpone surgery. Future studies are required to confirm its effect over time and assess its benefit in various disease stages. The development of an international collaborating networks for systematic data collection is worthy.

Association between MRI Findings and Histopathological Examination in Carcinoma Cervix: A Retrospective Study

Introduction: Staging of cervical cancer plays a major role in the treatment and prognosis of the patients. Preoperative Magnetic Resonance Imaging (MRI) is widely reviewed as a method to stage cervical cancer. Aim: To evaluate the role of MRI in the staging of cervical cancer in correlation with Histopathological Examination (HPE). Materials and Methods: A retrospective observational hospital- based study was done on 48 patients with Carcinoma Cervix attending the Velammal Medical College Hospital and Research Institute, Madurai, Tamilnadu. The patients, who had undergone MRI (on 1.5 Tesla Unit) of abdomen and pelvis from June 2018 to July 2019 were included in the study. Tumour location, size, vaginal, parametrial extension, pelvic sidewall involvement, pelvic and retroperitoneal lymphadenopathy, spread to adjacent pelvic organs and distant organs following retroperitoneal lymphadenopathy were reviewed from reports, and histopathology reports were analysed. International Federation of Gynaecology and Obstetrics (FIGO) staging was done for all the cases. HPE findings and MRI findings were assessed for correlation. IBM SPSS version 22.0 was used for statistical analysis. Descriptive analysis was carried out, and values were represented as mean with standard deviation for quantitative variables, frequency and proportion for categorical variables. Results: The mean age was 54.46±9.29 years. The majority 42 (87.5%) of the patients had Squamous cell carcinoma of the cervix on HPE. The majority 23 (47.91%) of the patients had stage IB carcinoma of the cervix. MRI revealed pelvic lymphadenopathy in 04 (8.33%) of cases, pelvic lymph nodal metastasis was seen in 02 (4.16%) of the HPE cases. Conclusion: MRI is useful in staging of Carcinoma cervix in stage IB or greater and for planning of treatment. Hence, MRI has the potential to be used as a one-stop-shop diagnostic tool for cervical cancer.

S2107 Successful Management of Refractory Esophageal Variceal Bleeding Secondary to Chronic Portal Vein Thrombosis by Transsplenic Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt

INTRODUCTION: Trans-jugular intrahepatic portosystemic shunt (TIPS) becomes challenging in the presence of portal vein thrombus (PVT). We describe a case of successful management of refractory esophageal variceal bleeding secondary to chronic PVT and splenic vein thrombosis (SVT) by portal vein recanalization – TIPS through transsplenic and transhepatic approach. CASE DESCRIPTION/METHODS: A 29-year-old male with a history of homozygous methylenetetrahydrofolate reductase mutation with normal homocysteine levels on warfarin presented with acute hematemesis. He underwent emergent endoscopic band ligation of esophageal and GOV1 gastric varices. He had a history of chronic PVT with prior mechanical thrombectomy and thrombolysis two years ago, and received band ligation for bleeding esophageal varices in the last year, but did not follow up for surveillance. MRI of abdomen and pelvis revealed chronic PVT with cavernous transformation (Fig A) and chronic SVT. No further bleeding was reported after endoscopy. Liver biopsy one year ago showed benign liver tissue with focal mild congestion and sinusoidal dilation. There was a normal hepatic venous pressure gradient. Given concerns about his compliance and risk of re-bleeding, multidisciplinary team discussion led to consideration of a high-risk TIPS with splenic vein recanalization and stenting. Under ultrasound and fluoroscopic guidance, TIPS was placed using two snare targets. One snare was placed in the occluded portal vein via splenic vein access, and another was placed in the middle hepatic vein via internal jugular vein access. Using the gun-sight technique, a 21-gauge Chiba needle was advanced transhepatically through both the loop snares and then a guidewire was advanced until it could be captured by both the above snares (Fig B). With this newly obtained access, TIPS and splenic stents were successfully deployed (Fig C). Pressure gradient across TIPS was lowered to 6 mm Hg from 16 mm Hg. As varices did not fill on post TIPS portogram, embolization was not performed. He was started on aspirin in addition to his warfarin. Repeat CTA at 3 months demonstrated patent TIPS and splenic stent, and no further episodes of hematemesis were reported. DISCUSSION: In our patient, the gunsight TIPS approach helped decompress portal hypertension and prevent recurrent variceal bleeding when other alternatives including Sugiura surgery carried high morbidity and were not amenable. Post TIPS re-stenosis is a known complication, and may be prevented by aspirin and warfarin use.Figure 1.: Magnetic resonance imaging (MRI) of the abdomen and pelvis showing chronic portal vein thrombosis with cavernous transformation.Figure 2.: Fluoroscopic image showing gun-sight technique: Guide-wire is captured by the first snare in the presumed right portal vein and second snare in the middle hepatic vein.Figure 3.: Fluoroscopic image showing successful deployment of TIPS.