Lameris, J.S.

Describing peripancreatic collections in severe acute pancreatitis using morphologic terms: An international interobserver agreement study (Article)

2008-10-01T00:00:00Z

Background/Aims: The current terminology for describing peripancreatic collections in acute pancreatitis (AP) derived from the Atlanta Symposium (e.g. pseudocyst, pancreatic abscess) has shown a very poor interobserver agreement, creating the potential for patient mismanagement. A study was undertaken to determine the interobserver agreement for a new set of morphologic terms to describe peripancreatic collections in AP. Methods: An international, interobserver agreement study was performed: 7 gastrointestinal surgeons, 2 gastroenterologists and 8 radiologists in 3 US and 5 European tertiary referral hospitals independently evaluated 55 computed tomography (CT) scans of patients with predicted severe AP. The percentage agreement [median, interquartile range (IQR)] for 9 clinically relevant morphologic terms was calculated among all reviewers, and separately among radiologists and clinicians. The percentage agreement was defined as poor (<0.50), moderate (0.51-0.70), good (0.71-0.90), and excellent (0.91-1.00). Results: Overall agreement was good to excellent for the terms collection (percentage agreement = 1; IQR 0.68-1), relation with pancreas (1; 0.68-1), content (0.88; 0.87-1), shape (1; 0.78-1), mass effect (0.78; 0.62-1), loculated gas bubbles (1; 1-1), and air-fluid levels (1; 1-1). Overall agreement was moderate for extent of pancreatic nonenhancement (0.60; 0.46-0.88) and encapsulation (0.56; 0.48-0.69). The percentage agreement was greater among radiologists than clinicians for extent of pancreatic nonenhancement (0.75 vs. 0.57, p = 0.008), encapsulation (0.67 vs. 0.46, p = 0.001), and content (1 vs. 0.78, p = 0.008). Conclusion: Interobserver agreement for the new set of morphologic terms to describe peripancreatic collections in AP is good to excellent. Therefore, we recommend that current clinically based definitions for CT findings in AP (e.g. pancreatic abscess) should no longer be used.

Transjugular intrahepatic portosystemic shunts: long-term patency and clinical results in a patient cohort observed for 3-9 years. (Article)

2004-05-01T00:00:00Z

PURPOSE: To retrospectively assess the outcome of transjugular intrahepatic portosystemic shunt (TIPS) placement in a nonselected group of consecutive patients. MATERIALS AND METHODS: TIPS placement was attempted in 82 patients. Patients were followed up for at least 3 years according to a standard protocol that included repeated shunt evaluations. Fifty-four patients underwent TIPS placement for variceal bleeding, 24 for refractory ascites, and four for other indications. Recurrent bleeding, effect on ascites, long-term patency, development of encephalopathy, and survival and complication rates were evaluated with Kaplan-Meier survival analysis and Cox multivariate analysis. RESULTS: TIPS placement was successful in 75 patients (91%). Mean follow-up lasted 29.4 months. Primary patency was 22% and 12%, primary-assisted patency was 67% and 46%, and secondary patency was 91% and 91% at 1- and 5-year follow-up, respectively. Nonalcoholic liver disease (P =.007) and increasing platelet counts (P =.006) independently predicted development of shunt insufficiency. The 1- and 5-year rates of recurrent variceal bleeding were 21% and 27%, respectively. In the majority of patients with refractory ascites, a beneficial effect of TIPS placement was observed. The risk for encephalopathy was 25% at 1-month follow-up and 52% at 3-year follow-up. The risk for chronic or severe intermittent encephalopathy was 15% at 1-year follow-up and 20% at 3-year follow-up. Serum creatinine levels (P =.001) and age (P =.02) were independent risk factors. Overall survival rate was 61%, 49%, and 42% at 1-, 3-, and 5-year follow-up, respectively. Age (P =.03), serum albumin level (P =.02), and serum creatinine level (P <.001) were independently related to mortality. CONCLUSION: The risk for definitive loss of shunt function was 17% at 5-year follow-up, indicating that surveillance with shunt revision-when indicated-results in excellent long-term TIPS patency. TIPS placement effectively protects against recurrent bleeding.

Prospective comparative study of spiral computer tomography and magnetic resonance imaging for detection of hepatocellular carcinoma (Article)

2002-01-01T00:00:00Z

BACKGROUND: Hepatocellular carcinoma (HCC) is often detected at a relatively late stage when tumour size prohibits curative surgery. Screening to detect HCC at an early stage is performed for patients at risk. AIM: The aim of this study was to compare prospectively the diagnostic accuracy and classification for management of the two state of the art secondline imaging techniques: triphasic spiral computer tomography (CT) and super paramagnetic iron oxide (SPIO) enhanced magnetic resonance imaging (MRI). PATIENTS: Sixty one patients were evaluated between January 1996 and January 1998. Patients underwent CT and MRI within a mean interval of 6.75 days. METHODS: CT and MRI were evaluated blindly for the presence and number of lesions, characterisation of these lesions, and classification for management. For comparison of the data on characterisation, the CT and MRI findings were compared with histopathological studies of the surgical specimens and/or follow up imaging. Data of patients not lost to follow up were available to January 2001. RESULTS: SPIO enhanced MRI detected more lesions and overall smaller lesions than triphasic spiral CT (number of lesions 189 v 124; median diameter 1.0 v 1.8 cm; Spearman rank's correlation coefficient 0.63, p<0.001). There was no significant difference in accuracy between CT and MRI for lesion characterisation. The agreement in classification for management was very good (weighted kappa 0.91, 95% CI 0.83-0.99). CONCLUSION: SPIO enhanced MRI detects more and smaller lesions, but both techniques are comparable in terms of classification for management. SPIO enhanced MRI may be preferred as there is no exposure to ionising radiation.

Sonography for hip joint effusion in adults with hip pain (Article)

2000-01-01T00:00:00Z

OBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a standardised examination. The distance between the ventral capsule and the femoral neck, an increase in which represents joint effusion, was measured sonographically. Joint effusion was defined in three different ways: "effusion" according to Koski's definition, "major effusion", and "asymmetrical effusion" based on only individual side differences. RESULTS: "Effusion" was present in 80 (38%), "major effusion" in 20 (9%), and "asymmetrical effusion" in 47 (22%) patients. Pain in the groin or medial thigh, pain aggravated by lying on the side, decreased extension/internal rotation/abduction/flexion, painful external rotation, and pain on palpation in the groin showed a significant relation (adjusted for age and radiological osteoarthritis of the hip) with ultrasonic hip joint effusion. "Major effusion" showed a significant relation with an increased ESR. When patients with bilateral pain and increased ESR were excluded, a side difference in the range of motion of extension of the hip was shown to be a good predictor for "asymmetrical effusion" (positive predictive value: 71%, negative predictive value: 80%). CONCLUSION: This study showed a relatively high prevalence of ultrasonic joint effusion in adults with hip pain in general practice. Furthermore the results indicate a relation between joint effusion and clinical signs.

Endoluminal MR imaging of the rectum and anus: technique, applications, and pitfalls (Article)

1999-01-01T00:00:00Z

Anorectal diseases (e.g., fecal incontinence, perianal and anovaginal fistulas, anorectal tumors) require imaging for proper case management. Endoluminal magnetic resonance (MR) imaging has become an important part of diagnostic work-up in such cases. Optimal endoluminal MR imaging requires careful attention to patient preparation, imaging protocols, and potential pitfalls in interpretation. Comfortable positioning and the use of an antiperistaltic drug are vital for adequate patient preparation. Selected sequences and imaging planes are used in imaging protocols tailored for specific diseases. In fecal incontinence, three-dimensional sequences allow detailed demonstration of the anal anatomy and related defects. In perianal and anovaginal fistulas, longitudinal imaging planes help determine the superior extent of the abnormality. In anorectal tumors, T1-weighted turbo spin-echo MR imaging can help detect extension into the perirectal fat and T2-weighted turbo spin-echo MR imaging is used to optimize contrast between tumor and the rectal wall. Off-axis and radial imaging planes are used in all anorectal diseases to minimize partial volume effects. Potential pitfalls include various parts of the normal anal anatomy mimicking sphincter defects, veins and hemorrhoids mimicking fistulas and abscesses, and overhanging tumor mimicking more extensive tumor. Adequate patient preparation combined with proper technique and a knowledge of potential pitfalls will allow optimal endoluminal MR imaging of the rectum and anus.

Fecal incontinence: endoanal US versus endoanal MR imaging (Article)

1999-01-01T00:00:00Z

PURPOSE: To assess endoanal ultrasonography (US) and endoanal magnetic resonance (MR) imaging for mapping of anal sphincter defects that have been validated at surgery in patients with fecal incontinence. MATERIALS AND METHODS: US, MR imaging, and surgical findings in 22 women with fecal incontinence who underwent sphincter repair were retrospectively reviewed. US and MR imaging had been performed before surgery. The findings were evaluated separately and validated with surgical results. RESULTS: Endoanal MR imaging findings showed better agreement with surgical results than did endoanal US findings for diagnosis of lesions of the external sphincter (kappa value, 0.85 vs 0.53) and of the internal sphincter (kappa value, 0.64 vs 0.49). Endoanal US could not accurately demonstrate thinning of the external sphincter. MR imaging results correlated moderately with US results (kappa = 0.39). If endoanal MR images alone had been considered, the correct surgical decision would have been made in 21 (95%) patients; if endoanal US images alone had been considered, the correct decision would have been made in 17 (77%) patients. CONCLUSION: MR imaging is more accurate than US for demonstration of sphincter lesions. MR imaging provides higher spatial resolution and better inherent image contrast for lesion characterization. Endoanal MR imaging allows more precise description of the extent and structure of complex lesions and is superior for help in decisions about optimal therapy.

Pulmonary hypertension after transjugular intrahepatic portosystemic shunt (TIPS) (Article)

1996-01-01T00:00:00Z

We reported the case of a patient in whom severe, and ultimately fatal, pulmonary hypertension developed 1.5 yrs after transjugular intrahepatic portosystemic shunt (TIPS). Pulmonary artery pressures were not affected by 100% oxygen, prostacyclin or nifedipine. Postmortem examinations showed pulmonary and vascular abnormalities typical of pulmonary hypertension. Pulmonary artery pressures should be measured in each patient with otherwise not readily explained dyspnoea following transjugular intrahepatic portosystemic shunt.

Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology (Article)

1996-01-01T00:00:00Z

The purpose of this study was to correlate the in vivo endoanal MRI findings of the anal sphincter with the cross-sectional anatomy and histology. Fourteen patients with rectal tumours were examined with a rigid endoanal MR coil before undergoing abdominoperineal resection. In addition, 12 cadavers were used to obtain cross-sectional anatomical sections. The images were correlated with the histology and anatomy of the resected rectal specimens as well as with the cross-sectional anatomical sections of the 12 cadavers. The findings in 8 patients, 11 rectal preparations, and 10 cadavers, could be compared. In these cases, there was an excellent correlation between endoanal MRI and the cross-sectional cadaver anatomy and histology. With endoanal MRI, all muscle layers of the anal canal wall, comprising the internal anal sphincter, longitudinal muscle, the external anal sphincter and the puborectalis muscle were clearly visible. The levator ani muscle and ligamentous attachments were also well demonstrated. The perianal anatomical spaces, containing multiple septae, were clearly visible. In conclusion, endoanal MRI is excellent for visualising the anal sphincter complex and the findings show a good correlation with the cross-sectional anatomy and histology.

Over het oog, de naald en de draad (Inaugural Lecture)

1994-11-11T00:00:00Z