Книги по МРТ КТ на английском языке / Advanced Imaging of the Abdomen - Jovitas Skucas

formed only if the scan is positive? The primary purpose of such a policy is to increase the percentage of positive arteriograms, yet one retrospective study concluded that a prior positive bleeding scan did not increase the odds of obtaining a positive angiogram (222), a finding at odds with a number of other studies. Thus arteriography in patients with suspected acute gastrointestinal bleeding detected bleeding in 22% of studies, but after instituting a protocol requiring positive scintigraphy before performing arteriography, the positive arteriography rate increased to 53% (223).

In patients with suspected acute lower gastrointestinal bleeding, Tc-99m–red blood cell scintigraphy achieves >80% sensitivity in detecting bleeding and in those with positive scan localizes a bleeding site in about 70%.

Colonoscopy can potentially identify a colonic bleeding site. A practical limitation exists if blood and blood clots obscure adequate visualization. Also, complete colonoscopy is necessary because in up to one third of patients a bleeding site is in the cecal region.

Therapy

After mesenteric angiography identifies a bleeding site, immediate therapeutic options include arterial embolization and infusion of vasopressin. Arterial embolization is viable therapy for most acute lower gastrointestinal bleeding. The clinical success of embolization, judged by no rebleeding, is achieved in about 90% of

patients. Even hemorrhage from a large vessel can be arrested. Postembolization ischemia is rarely an issue with this technique.

One refinement is superselective microcoil embolization, with embolization performed at the vasa recta or the marginal artery of Drummond level. In one study, bleeding was arrested on a long-term basis in over 80% of patients (224). Hemostasis can be expected in all except those with a dual blood supply to the bleeding site, yet even in the latter significant reduction of bleeding is achieved. Occasional bowel ischemia, rebleeding, and even infarction are recognized complications of this procedure. At times superselective embolization includes a combination of coils, polyvinyl alcohol, and gelatin sponge particles.

Diverticular Bleeding

A typical diverticular bleed tends to be massive and arterial, and it stops spontaneously. Often little other evidence of diverticulitis is present. Past teaching was that bleeding is due to erosion of a small artery overlying the diverticulum, but whether such erosions differ from a Dieulafoy lesion is not clear.

Right-sided diverticulosis tends to present with massive rectal bleeding more often than left-sided disease, yet in general, cecal bleeding is more difficult to control than more distant bleeding.

In patients without definitive therapy, recurrent hemorrhage occurs in about 10% at 1 year.

Angiodysplasia

Among a healthy, asymptomatic population prevalence of angiodysplasia is <1%. These ectatic veins, venules, and capillaries probably develop secondary to local degeneration, especially with aging. A deficiency of collagen type IV is found in mucosal vessels in angiodysplasia. They occur in both the small and large bowel. Most, however, are smaller than 10mm and are located in the right colon. They range from single to multiple. Most manifest in the elderly, although angiodysplastic hemorrhage does occur in young patients. Earlier reports suggested an association between angiodysplasia and aortic stenosis, but more recent studies do not confirm such a link.

Unusual associations of rectal and sigmoid colon angiodysplasia-like lesions include a 12- year-old boy with Klippel-Trenaunay-Weber syndrome who developed hematochezia (225). The presence of colon angiodysplasia, small bowel lymphoma,and duodenal carcinoid in the same patient suggests a more than fortuitous association (226).

Bleeding ranges from iron-deficiency anemia to a life-threatening acute hemorrhage.

Angiodysplasia is not detected by barium enema. Angiography and colonoscopy detect only some of these flat lesions. Most angiodysplasias are intramucosal in location, although an occasional one is deeper and thus not visible. If bleeding, scintigraphy is an appropriate first imaging modality employed.

If colonoscopy detects an incidental angiodysplasia in an otherwise asymptomatic individual, therapy probably is not necessary.

Selective mesenteric angiography reveals a tuft of abnormal vessels and an early filling vein. Superselective arterial embolization is common therapy to arrest acute bleeding from angiodysplasias. In some patients, estrogen-progesterone combination therapy has been successful in preventing rebleeding from angiodysplasias (227).

Arteriovenous Malformation

Most arteriovenous malformations are intramural in location. An occasional one has a polypoid appearance. Except for very small ones,

they are detected with contrast-enhanced imaging.

Varices

Most colonic varices are associated with portal hypertension. Why only some patients develop colonic varices is not clear, although the prevalence of these varices increases in those who have had prior transection and devascularization of esophageal varices, esophageal sclerotherapy, or thrombosis of coronary and azygous drainage veins. Congenital colon varices are rare; in the absence of portal hypertension resection of such varices is curative. Varices have developed secondary to mesenteric venous obstruction and, rarely, with splenic vein thrombosis. Also rare are idiopathic colonic and mesenteric varices.

Bleeding from colorectal varices can be massive; portal hypertension needs to be excluded in these patients.

Colonic and perirectal varices can be diagnosed with contrast-enhanced CT. What is surprising is that in some patients with portal hypertension, CT detects some pararectal varices not visualized by colonoscopy and vice versa; the inferior mesenteric vein is significantly larger in patients with rectal varices than in those without.

Portal Hypertensive Colopathy

Vascular ectasia-like lesions in the colon, called portal hypertensive colopathy, develop in some patients with portal hypertension. These lesions consist of numerous irregular vessels having a hyperemic “cherry-spot” appearance.

About one third of patients with severe cirrhosis have colonic wall thickening, predominantly in the right colon (228); most patients do not have symptoms referable to the colon, and these changes presumably are related to underlying portal hypertension. Clinically these patients range from asymptomatic, to recurrent rectal bleeding, to episodes of massive hemorrhage.

Transjugular intrahepatic portosystemic shunting (TIPS) does control bleeding from portal hypertensive colopathy and, in fact, the ectasia-like colonic lesions tend to disap-

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pear. Colopathy is also corrected after liver transplantation and correction of portal hypertension.

Juvenile Polyps

Juvenile polyps persist into adulthood. Occasionally such a juvenile polyp first manifests by a massive lower gastrointestinal bleed.

Dieulafoy Lesion

A small gastric mucosal defect associated with a bleeding submucosal artery is called a Dieulafoy lesion (these lesions are discussed in more detail in Chapter 2). Since their initial detection in the stomach, similar lesions have been found in the small bowel and colon. They appear to be more common in the proximal colon. They develop in both adults and children. Dieulafoy lesions occur in diverticula, where their differentiation, if any, from a typical diverticular bleed is problematic.

Dieulafoy bleeding is often massive but intermittent. Similar to gastric Dieulafoy lesions, colonoscopic sclerotherapy has successfully arrested bleeding. Selective mesenteric angiography differentiates Dieulafoy lesions from angiodysplasias—the former consists of a small bleeding artery.

Immunosuppression (AIDS)

In patients with human immunodeficiency virus infection, superimposed opportunistic infections are common. Yet not all symptoms and lesions are due to infection; some are neoplastic and others idiopathic.

Infection

Colonic histoplasmosis is not uncommon in patients with AIDS, with the most common site being the ileocecal region. Clinically, some patients develop a palpable tumor, and imaging reveals an annular constricting lesion. At times more diffuse involvement mimics ulcerative colitis. Colonoscopy in one patient revealed volcano-like ulcers and tumors; CT identified both a colon tumor and hypodense adenopathy (229); histology and biopsy cultures and lymph

node aspirate revealed Histoplasma capsulatum, but the patient eventually developed bowel obstruction and peritonitis. At times Gomori staining of colon biopsies aids in establishing this diagnosis.

Patients with AIDS are prone to C. difficile infection. Among other predisposing factors in this population is the common use of antibiotics; clinically, symptoms of C. difficile infection in AIDS patients tend to be more severe than in non-AIDS patients.

Cytomegalovirus colitis is common in this patient population and manifests as ulcers and submucosal hemorrhage, with these ulcers ranging from aphthous to relatively deep cavities surrounded by inflammation and edema. These findings are similar to those seen in pseudomembranous colitis. In some, cytomegalovirus infection results in a focal colonic tumor. Cytomegalovirus is diagnosed by finding viral inclusion bodies in colon biopsies. These inclusions are more common in cecal biopsies rather than more distally; therefore, complete colonoscopy is necessary.

Similar to other patients, AIDS patients develop pseudomembranous colitis when treated for an infection.

It should be kept in mind that AIDS patients also develop appendicitis.

Neoplasm

Although not common, HIV infection appears to play a role in colorectal cancer development. These patients are at risk for anal squamous and cloacogenic carcinomas.

An occasional rectal Kaposi’s sarcoma is successfully treated with radiation therapy.

Complications of non-Hodgkin’s lymphoma in these patients include duodenocolic fistula and intussusception.

Other

Some AIDS patients develop pneumatosis coli. Usually a late finding, in most patients, it is benign and clears spontaneously. The right colon is involved more often than the left. Occasionally pneumatosis coli is associated either with intraperitoneal or retroperitoneal gas and suggests a perforation, although bowel perforation is not detected.

Prevalence of intussusception is increased in patients with AIDS-associated gastrointestinal disease. Crampy, intermittent abdominal pain is a typical presentation. Either CT or a barium enema is diagnostic.

A colitis mimicking ulcerative colitis can develop in an occasional AIDS patient with a low CD4 T-cell count.

Examination and

Surgical Complications

ADVANCED IMAGING OF THE ABDOMEN

Barium inspissation after a barium enema is rare. In most reports it is due to underlying constipation,poor radiographic technique resulting in the overfilling of a dilated, hypotonic colon, or the lack of post-enema hydration.

Colonoscopy

Colonoscopic complications consist of bleeding, sepsis, perforation, and transmural burn injuries, with the onset of symptoms occurring an average of 30 hours after colonoscopy. Bleeding is managed conservatively in approximately three quarters of these patients.

Barium Enema

A retrospective study of over 700,000 barium enemas performed between 1992 and 1994 in the United Kingdom found an overall mortality rate of one in 56,786 (230); only three of 30 (10%) patients with bowel perforation died, compared with nine deaths among 16 (56%) patients with cardiac arrhythmia. One death was related to vaginal intubation.

In a setting of incomplete or failed sigmoidoscopy or colonoscopy, a double-contrast barium enema can be performed the same day if no biopsy or only a superficial biopsy (using small biopsy forceps) is obtained; the risk of perforation increases if biopsies are taken from diseased mucosa. A barium enema should be postponed, however, for at least 14 days if a deep biopsy is obtained. A similar delay in performing barium enema also appears warranted if a polypectomy is performed.

Focal barium extravasation, either intramural or extrinsic to bowel, results in an exuberant fibrotic reaction around barium sulfate crystals. An experimental study in rats concluded that any effect of barium sulfate on gastrointestinal tract transmural wound healing is minimal (231). At times prior focal extravasation is unsuspected; thus in one patient a tumor in the gallbladder fossa was believed to represent an advanced gallbladder cancer, but resection revealed foreign-body barium granulomas (232).

Venous barium embolization during a barium enema is a rare but highly lethal complication. Embolization can be either into systemic veins (usually from a rectal perforation) or into portal venous system.

Disinfection Related

Colonoscopic cleansing is typically achieved with glutaraldehyde or hydrogen peroxide. Both agents produce tissue necrosis. Bloody diarrhea develops within a day or so after these agents contact colonic mucosa, mimicking ischemic or infectious colitis. Imaging in patients with glutaraldehyde-induced colitis reveals circumferential left-sided colonic wall thickening and heterogeneous wall contrast-enhancement; these findings resolve on follow-up. Ultrasonography also identifies colonic wall thickening, consisting of hypoechoic mucosa and hyperechoic submucosa.

An unusual colitis due to hydrogen peroxide developed while colonoscopy was still being performed; it consisted of opaque plaques or pseudomembranes, a condition called pseudolipomatosis by pathologists (233). To prevent such disinfectant colitis, the authors recommend an additional preprocedure rinse of colonoscopic channels.

Septicemia

Approximately 10% of patients develop transient bacteremia after colonoscopy. Septicemia is not common, although the risk of septicemia increases in immunocompromised patients.

Perforation

Three mechanisms are associated with colonoscopic perforations (234): (1) mechanical causes due to colonoscopic manipulation, (2) barotrauma from overinsufflation, and (3)

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perforation related to therapeutic procedures. In general, perforation occurring during diagnostic colonoscopy tends to result in large lacerations; those associated with polypectomy tend to be smaller. Cecal perforations tend to be due to overinsufflation; sigmoid perforations involve mostly technical problems. Some perforations are difficult to understand. Why should a jejunal or ileal perforation develop after colonoscopy? Some perforations are not diagnosed for several days.

The appearance and sequelae of colonic perforation are myriad and are related both to the extent and site of perforation and amount of peritoneal soilage. In addition to a pneumoperitoneum, some patients develop pneumothoraces, pneumopericardium, pneumomediastinum, scrotal swelling, and even subcutaneous emphysema. A tension pneumothorax can lead to acute respiratory failure.

The current trend is toward fewer surgical interventions for colonoscopic perforations; some patients with clinically and radiographically evident perforation heal under medical management. In fact, medical therapy leads to a shorter hospitalization than with comparable surgical management. In patients believed to require surgery, either primary repair or resection and anastomosis are the procedures of choice, assuming no contamination is evident.

Other

A number of splenic ruptures have been associated with colonoscopy. Acute appendicitis developed in a 69-year-old man immediately after colonoscopy (235); no signs or symptoms of appendicitis were evident prior to colonoscopy.

Transient myocardial ischemic episodes develop during colonoscopy; these appear to be associated with tachycardia and hypoxemia.

Postresection

Mostly Rectosigmoid Complications

Although colonic ischemia and anastomotic dehiscence is not uncommon after colon surgery, rectal ischemia is rare. Rectal necrosis, however, has developed after anterior resection of a rectosigmoid carcinoma; presumably inferior mesenteric artery ligation in a setting of

atherosclerosis results in an inadequate blood supply to the residual colorectum.

Extraperitoneal emphysema is not uncommon after a low anterior resection or fullthickness excision, raising the question of whether it represents benign emphysema or a postoperative leak. At times abdominal wall emphysema develops and persists for a considerable time. These entities can usually be distinguished with a contrast enema. Computed tomography findings of a leak consist of gasfluid collections adjacent to the rectum and extending along tissue planes. With resolution of a perforation these collections should gradually diminish.

Presacral space widening is common after rectosigmoid surgery.

Hartmann’s Pouch

Based on established surgical indications, either a Hartmann’s pouch or a double-barrel colostomy is created to protect an anastomosis, with surgeons in the United States favoring the former. Complications related to a Hartmann’s pouch include leaks, strictures, adhesions, and, on a more chronic basis, recurrent tumor and diversion colitis. A contrast study is often requested prior to colostomy takedown, which is generally several months or longer after the initial surgery. Occasional debate surfaces among radiologists about whether barium or a water-soluble agent should be used; I prefer barium because of its higher contrast and ability to detect more subtle detail, unless the study is being performed shortly after resection and the possibility of rupture and intraperitoneal spill are considerations. The presence of barium in a leak is not an issue—after all, if barium enters a sinus tract or cavity, so can infected colonic content, which produces more damage than inert barium sulfate. A more pertinent issue is that the enema balloon should not be inflated to the same degree as during a normal barium enema; these patients have decreased rectal pain sensation and, especially with the presence of a stricture, a major rectal perforation can occur.

Strictures in a Hartmann’s pouch are amenable to transrectal dilation. Most small leaks heal with time, although an occasional silent leak is detected by a barium study even months later.

Stricture

Benign postoperative colonic strictures are not uncommon, most being due to ischemia. These strictures are amenable to balloon catheter dilation, either via colonoscopy or, with distal colonic and rectal strictures, simply using fluoroscopic control. A preprocedure barium enema aids in defining the site and length of a stricture. Procedure complications are rare and stricture recurrence uncommon.

An occasional ischemic stricture is treated with a self-expandable metallic prosthesis, but, in general, stricture dilation is preferred even in high-risk patients.

Postlaparoscopy

Laparoscopic resections of sigmoid diverticulitis leads to a severalfold increase in operative time over open resection but a decrease in intensive care. Length of hospital stay, complications, and operating time decrease with experience.

Abdominal wall tumor recurrence at a trocarsite scar does occur after laparoscopic carcinoma resection. This complication is rare in a laparotomy scar.

Port site hernias are an uncommon complication of laparoscopic colectomy. Superior mesenteric and portal vein thrombosis occurred after a laparoscopically assisted right hemicolectomy.

References

1.Langdon DE. Radiologic barium and colon toxicity. Am J Gastroenterol 1994;89:462.

2.Harvey CJ, Halligan S, Bartram CI, Hollings N, Sahdev A, Kingston K. Evacuation proctography: a prospective study of diagnostic and therapeutic effects. Radiology 1999;211:223–227.

3.Schoenenberger AW, Debatin JF, Guldenschuh I, Hany TF, Steiner P, Krestin GP. Dynamic MR defecography with a superconducting, open-configuration MR system. Radiology 1998;206:641–646.

4.Paetzel C, Strotzer M, Furst A, Rentsch M, Lenhart M, Feuerbach S. [Dynamic MR defecography for diagnosis of combined functional disorders of the pelvic floor in proctology.] [German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001;173:410–415.

5.Maier A, Fuchsjager M, Funovics M. [Endoanal magnetic resonance tomography in fecal incontinence.] [Review] [German] Radiologe 2000;40:465–468.

ADVANCED IMAGING OF THE ABDOMEN

6.Marshall JB. Brown DN. Photodocumentation of total colonoscopy: how successful are endoscopists? Do reviewers agree? Gastrointest Endosc 1996;44:243–248.

7.Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997;112:24–28.

8.Cothren RM, Sivak MV Jr, Van Dam J, et al. Detection of dysplasia at colonoscopy using laser-induced fluorescence: a blinded study. Gastrointest Endosc 1996;44:168–176.

9.Morrin MM, Farrell RJ, Kruskal JB, Reynolds K, McGee JB, Raptopoulos V. Utility of intravenously administered contrast material at CT colonography. Radiology 2000;217:765–771.

10.Fletcher JG, Johnson CD, Welch TJ, et al. Optimization of CT colonography technique: prospective trial in 180 patients. Radiology 2000;216:704–711.

11.Kulinna C, Scheidler J, Eibel R, et al. [Diagnostic value of different rectal contrast media in the detection of colorectal diseases by multi-slice CT.] [German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2002;173:749–755.

12.Morrin MM, Kruskal JB, Farrell RJ, Goldberg SN, McGee JB, Raptopoulos V. Endoluminal CT colonography after an incomplete endoscopic colonoscopy. AJR 1999;172:913–918.

13.Pickhardt PJ. Translucency rendering in 3D endoluminal CT colonography: a useful tool for increasing polyp specificity and decreasing interpretation time. AJR 2004;183:429–436.

14.McFarland EG, Brink JA, Pilgram TK, et al. Spiral CT colonography: reader agreement and diagnostic performance with twoand three-dimensional imagedisplay techniques. Radiology 2001;218:375–383.

15.Macari M, Milano A, Lavelle M, Berman P, Megibow AJ. Comparison of time-efficient CT colonography with twoand three-dimensional colonic evaluation for detecting colorectal polyps. AJR 2000;174:1543– 1549.

16.Sosna J, Morrin MM, Kruskal JB, Lavin PT, Rosen MP, Raptopoulos V. CT colonography of colorectal polyps: a metaanalysis. AJR 2003;181:1593–1598.

17.Callstrom MR, Johnson CD, Fletcher JG, et al. Computed tomography colonography without cathartic preparation: feasibility study. Radiology 2001;219: 693–698.

18.Summers RM, Johnson CD, Pusanik LM, Malley JD, Youssef AM, Reed JE. Automated polyp detection at CT colonography: feasibility assessment in a human population. Radiology 2001;219:51–59.

19.Luboldt W, Mann C, Tryon CL, et al. Computer-aided diagnosis in contrast-enhanced CT colonography: an approach based on contrast. Eur Radiol 2002;12:2236– 2241.

20.Zalis ME, Hahn PF, Arellano RS, Gazelle GS, Mueller PR. CT colonography with teleradiology: effect of lossy wavelet compression on polyp detection—initial observations. Radiology 2001;220:387–392.

21.Hara AK, Johnson CD, MacCarty RL, Welch TJ. Incidental extracolonic findings at CT colonography. Radiology 2000;215:353–357.

22.Luboldt W, Bauerfeind P, Wildermuth S, Marincek B, Fried M, Debatin JF. Colonic masses: detection with MR colonography. Radiology 2000;216:383–388.

COLON AND RECTUM

23.Luboldt W, Frohlich JM, Schneider N, Weishaupt D, Landolt F, Debatin JF. MR colonography: optimized enema composition. Radiology 1999;212:265–269.

24.Luboldt W, Luz O,Vonthein R, et al. Three-dimensional double-contrast MR colonography: a display method simulating double-contrast barium enema. AJR 2001;176:930–932.

25.Chung JJ, Semelka RC, Martin DR, Marcos HB. Colon diseases: MR evaluation using combined T2–weighted single-shot echo train spin-echo and gadoliniumenhanced spoiled gradient-echo sequences. J Magn Reson Imaging 2000;12:297–305.

26.Lomas DJ, Sood RR, Graves MJ, Miller R, Hall NR, Dixon AK. Colon carcinoma: MR imaging with CO2 enema—pilot study. Radiology 2001;219:558–562.

27.Lauenstein T, Holtmann G, Schoenfelder D, Bosk S, Ruehm SG, Debatin JF. MR colonography without colonic cleansing: a new strategy to improve patient acceptance. AJR 2001;177:823–827.

28.Locher C, Duclos-Vallee JC, Rocher L, Blery M, Buffet

C.[Bilateral Chilaiditi’s syndrome.] [French] Presse Med 2000;29:1738.

29.Pinto A, Brunese L, Noviello D, Catalano O. [Colonic interposition between kidney and psoas muscle: anatomical variation studied with CT.] [Italian] Radiol Med 1997;94:58–60.

30.Prassopoulos P, Raissaki M, Daskalogiannaki M, Gourtsoyiannis N. Retropsoas positioned bowel: incidence and clinical relevance. J Comput Assist Tomogr 1998;22:304–307.

31.Currarino G, Coln D, Votteler T. Triad of anorectal, sacral, and presacral anomalies. AJR 1981;137:395– 398.

32.Lee SC, Chun YS, Jung SE, Park KW, Kim WK. Currarino triad: anorectal malformation, sacral bony abnormality, and presacral mass—a review of 11 cases. J Pediatr Surg 1997;32:58–61.

33.Vidiscak M, Kirnak J, Smrek M. [Results of surgery in children with congenital megacolon.] [Slovak] Rozhl Chir 2001;80:197–200.

34.Bloom DA, Buonomo C, Fishman SJ, Furuta G, Nurko

S.Allergic colitis: a mimic of Hirschsprung disease. Pediatr Radiol 1999;29:37–41.

35.Benya EC, Nussbaum-Blask AR, Selby DM. Colonic diverticulitis causing partial bowel obstruction in a child with cystic fibrosis. Pediatr Radiol 1997;27: 918–919.

36.Binkovitz LA, Allen E, Bloom D, et al. Atypical presentation of Clostridium difficile colitis in patients with cystic fibrosis. AJR 1999;172:517–521.

37.Bru C, Sans M, Defelitto MM, et al. Hydrocolonic sonography for evaluating inflammatory bowel disease. AJR 2001;177:99–105.

38.Lee BF, Chiu NT,Wu DC, et al. Use of 99mTc (V) DMSA scintigraphy in the detection and localization of intestinal inflammation: comparison of findings and colonoscopy and biopsy. Radiology 2001;220:381– 385.

39.Halme L, Edgren J, Turpeinen U, von Smitten K, Stenman UH. Urinary excretion of iohexol as a marker of disease activity in patients with inflammatory bowel disease. Scand J Gastroenterol 1997;32:148–152.

40.Lee HB, Kim JH,Yim CY, Kim DG, Ahn DS. Differences in immunophenotyping of mucosal lymphocytes

between ulcerative colitis and Crohn’s disease. Korean J Intern Med 1997;12:7–15.

41.Okada M, Maeda K, Yao T, et al. Right-sided ulcerative colitis. [Review] J Gastroenterol 1996;31:717–722.

42.Cammarota T, Bresso F, Sarno A, Astegiano M, Macchiarella V, Robotti D. [Abdominal pain and bowel dysfunction: the diagnostic role of ultrasonography.] [Italian] Radiol Med 2000;100:337–342.

43.Schunk K, Reiter S, Kern A, Orth T, Wanitschke R. [Hydro-MRI in inflammatory bowel diseases: a comparison with colonoscopy and histology.] [German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001;173:731–738.

44.Charron M, del Rosario FJ, Kocoshis SA. Pediatric inflammatory bowel disease: assessment with scintigraphy with 99mTc white blood cells. Radiology 1999; 212:507–513.

45.Lapidus A, Bernell O, Hellers G, Lofberg R. Clinical course of colorectal Crohn’s disease: a 35–year followup study of 507 patients. Gastroenterology 1998;114: 1151–1160.

46.Nordenholtz KE, Stowe SP, Stormont JM, et al. The cause of death in inflammatory bowel disease: a comparison of death certificates and hospital charts in Rochester, New York. Am J Gastroenterol 1995;90: 927–932.

47.Schunk K, Kern A, Heussel CP, et al. [Hydro-MRT with fast sequences in Crohn’s disease: a comparison with fractionated gastrointestinal passage.] [German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1999;170:338–346.

48.Ferguson A.Assessment and management of ulcerative colitis in children. [Review] Eur J Gastroenterol Hepatol 1997;9:858–863.

49.Raithel M, Winterkamp S, Pacurar A, Ulrich P, Hochberger J, Hahn EG. Release of mast cell tryptase from human colorectal mucosa in inflammatory bowel disease. Scand J Gastroenterol 2001;36:174–179.

50.Orholm M, Binder V, Sorensen TI, Rasmussen LP, Kyvik KO. Concordance of inflammatory bowel disease among Danish twins. Results of a nationwide study. Scand J Gastroenterol 2000;35:1075–1081.

51.Tzivras M, Souyioultzis S, Tsirantonaki M, Archimandritis A. Chronic granulocytic leukemia in a patient with ankylosing spondylitis and ulcerative colitis: an interesting association. [Review] J Clin Gastroenterol 1997;25:365–366.

52.Maconi G, Ardizzone S, Parente F, Bianchi Porro G. Ultrasonography in the evaluation of extension, activity, and follow-up of ulcerative colitis. Scand J Gastroenterol 1999;34:1103–1110.

53.Mirk P, Palazzoni G, Gimondo P. Doppler sonography of hemodynamic changes of the inferior mesenteric artery in inflammatory bowel disease: preliminary data. AJR 1999;173:381–387.

54.Guslandi M, Sorghi S, Polli D, Tittobello A. Measurement of rectal blood flow by laser Doppler flowmetry in inflammatory bowel disease. Hepatogastroenterology 1998;45:445–446.

55.Yamamoto T, Keighley MR. Proctocolectomy is associated with a higher complication rate but carries a lower recurrence rate than total colectomy and ileorectal anastomosis in Crohn colitis. Scand J Gastroenterol 1999;34:1212–1215.

56.Yamamoto T, Keighley MR. Long-term outcome of total colectomy and ileostomy for Crohn disease. Scand J Gastroenterol 1999;34:280–286.

57.Garcia Picazo D, Bermudez Rodriguez E, Moreno Resina JM. Acute cholecystitis after colectomy for ulcerative colitis. Rev Esp Enferm Dig 2000;92:392– 398.

58.Schmidt CM, Horton KM, Sitzmann JV, Jones B, Bayless T. Simple radiographic evaluation of ileoanal pouch volume. Dis Colon Rectum 1996;39:66–73.

59.Aitola P, Matikainen M, Mattila J, Tomminen T, Hiltunen KM. Chronic inflammatory changes in the pouch mucosa are associated with cholangitis found on perioperative liver biopsy specimens at restorative proctocolectomy for ulcerative colitis. Scand J Gastroenterol 1998;33:289–293.

60.Libicher M, Scharf J, Wunsch A, Stern J, Dux M, Kauffmann GW. MRI of pouch-related fistulas in ulcerative colitis after restorative proctocolectomy. J Comput Assist Tomogr 1998;22:664–668.

61.Wong SK, Ho YH, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum 1997;40:344–348.

62.Chintapalli KN, Chopra S, Ghiatas AA, Esola CC, Fields SF, Dodd GD 3rd. Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 1999;210:429–435.

63.Rao PM, Rhea JT. Colonic diverticulitis: evaluation of the arrowhead sign and the inflamed diverticulum for CT diagnosis. Radiology 1998;209:775–779.

64.Jang HJ, Lim HK, Lee SJ, Lee WJ, Kim EY, Kim SH.Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR 2000;174:1397–1402.

65.Blakeborough A, Chapman AH, Swift S, Culpan G, Wilson D, Sheridan MB. Strictures of the sigmoid colon: barium enema evaluation. Radiology 2001;220:343–348.

66.Miller FH, Ma JJ, Scholz FJ. Imaging features of enterohemorrhagic Escherichia coli colitis. AJR 2001;177: 619–623.

67.Satoh T, Sasatomi E, Wu L, Tokunaga O. Phlegmonous colitis: a specific and severe complication of chronic hepatic disease. Virchows Arch 2000;437:656–661.

68.Takahashi T, Gamboa-Dominguez A, Gomez-Mendez TJ, et al. Fulminant amebic colitis: analysis of 55 cases. Dis Colon Rectum 1997;40:1362–1367.

69.Sachdev GK, Dhol P. Colonic involvement in patients with amebic liver abscess: endoscopic findings. Gastrointest Endosc 1997;46:37–39.

70.Nagi B, Kochhar R, Bhasin DK, Singh K. Colorectal tuberculosis. [Review] Eur Radiol 2003;13:1907–1912.

71.Lee IJ, Ha HK, Park CM, et al. Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features. Radiology 2001;220:76–80.

72.Uchiyama N, Ishikawa T, Miyakawa K, et al. Abdominal actinomycosis: barium enema and computed tomography findings. J Gastroenterol 1997;32:89–94.

73.Kirkpatrick ID, Greenberg HM. Evaluating the CT diagnosis of Clostridium difficile colitis: should CT guide therapy? AJR 2001;176:635–639.

74.Benoit R, Grobost O, Crepeau T. [Diaphragm-like strictures of the colon from diclofenac.] [Review] [French] Presse Med 2001;30:1102–1104.

75.Pardi DS, Tremaine WJ, Rothenberg HJ, Batts KP. Melanosis coli in inflammatory bowel disease. J Clin Gastroenterol 1998;26:167–170.

76.Nusko G, Schneider B, Schneider I, Wittekind C, Hahn EG. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651–655.

77.Tomas ME, Casis B, Soto S, et al. [Salmonella osteomyelitis in a patient with collagenous colitis.] [Spanish] Rev Esp Enferm Dig 1999;91:76–77.

78.De La Riva S, Betes MT, Duque JM, Angos R, Munoz Navas MA. Collagenous colitis and lymphocytic colitis: clinical and endoscopic findings. Rev Esp Enferm Dig 2000;92:86–96.

79.Bellin MF, Darchen MA, Hoang C, et al. Rectal malacoplakia in renal transplantation: MR features. J Comput Assist Tomogr 1994;18:975–978.

80.Molik KA, West KW, Rescorla FJ, Scherer LR, Engum SA, Grosfeld JL. Portal venous air: the poor prognosis persists. J Pediatr Surg 2001;36:1143–1145.

81.Patton WL, Willmann JK, Lutz AM, Rencken IO, Gooding CA. Worsening enterocolitis in neonates: diagnosis by CT examination of urine after enteral administration of iohexol. Pediatr Radiol 1999;29: 95–99.

82.Balthazar EJ, Yen BC, Gordon RB. Ischemic colitis: CT evaluation of 54 cases. Radiology 1999;211:381–388.

83.Millward SF, Fortier M. Transient gastric emphysema caused by colonic infarction. AJR 2001;176:1331– 1332.

84.Danse EM, Van Beers BE, Jamart J, et al. Prognosis of ischemic colitis: comparison of color Doppler sonography with early clinical and laboratory findings. AJR 2000;175:1151–1154.

85.Yao T, Iwashita A, Hoashi T, et al. Phlebosclerotic colitis: value of radiography in diagnosis—report of three cases. Radiology 2000;214:188–192.

86.Shiojima K, Mitsuhashi N, Yamakawa M, Sakurai H, Niibe H. Transrectal ultrasonography in evaluation of chronic rectal complications after radiation therapy for carcinoma of the uterine cervix. Invest Radiol 1998;33:74–79.

87.Chen JH, Lai SJ, Tsai PP, Chen YF. Localized amyloidosis mimicking carcinoma of the colon. AJR 2002; 179:536–537.

88.Boudiaf M, Zidi SH, Soyer P, et al. [Primary epiploic appendicitis: CT diagnosis for conservative treatment.] [French] Presse Med 2000;29:231–236.

89.Takada A, Moriya Y, Muramatsu Y, Sagae T. A case of giant peritoneal loose bodies mimicking calcified leiomyoma originating from the rectum. Jpn J Clin Oncol 1998;28:441–442.

90.Croizet O, Moreau J, Arany Y, Delvaux M, Rumeau JL, Escourrou J. Follow-up of patients with hyperplastic polyps of the large bowel. Gastrointest Endosc 1997;46:119–123.

91.Cunnane ME, Rubesin SE, Furth EE, Levine MS, Laufer I. Small flat umbilicated tumors of the colon: radiographic and pathologic findings. AJR 2000;175: 747–749.

92.Baldisserotto M, Spolidoro JV, Bahu Mda G. Graded compression sonography of the colon in the diagnosis of polyps in pediatric patients. AJR 2002;179:201– 205.

COLON AND RECTUM

93.Chiba M, Yamano H, Fujiwara K, Abe T, Iizuka M, Watanabe S. Lymph folliculitis in ulcerative colitis. Scand J Gastroenterol 2001;36:332–336.

94.Fedele L, Bianchi S, Portuese A, Borruto F, Dorta M. Transrectal ultrasonography in the assessment of rectovaginal endometriosis. Obstet Gynecol 1998;91: 444–448.

95.Manfredi R,Valentini AL. Magnetic resonance imaging of pelvic endometriosis. Rays 1998;23:702–708.

96.Smith TR, Fine SW, Jones JG. CT appearance of some colonic villous tumors. AJR 2001;177:91–93.

97.Whitelaw SC, Murday VA, Tomlinson IP, et al. Clinical and molecular features of the hereditary mixed polyposis syndrome. Gastroenterology 1997;112:327– 334.

98.Bjork J, Akerbrant H, Iselius L, Alm T, Hultcrantz R. Epidemiology of familial adenomatous polyposis in Sweden: changes over time and differences in phenotype between males and females. Scand J Gastroenterol 1999;34:1230–1235.

99.Debinski HS, Love S, Spigelman AD, Phillips RK. Colorectal polyp counts and cancer risk in familial adenomatous polyposis. Gastroenterology 1996;110: 1028–1030.

100.Svab J, Peskova M, Jirasek V, Fried M, Krska Z. [Longterm results of ileo-rectal anastomosis in familial polyposis.] [Czech] Rozhl Chir 1999;78:150–153.

101.Parc YR, Olschwang S, Desaint B, Schmitt G, Parc RG, Tiret E. Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy. Ann Surg 2001;233:360–364.

102.Belchetz LA, Berk T, Bapat BV, Cohen Z, Gallinger S. Changing causes of mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 1996;39: 384–387.

103.Suzui M, Yoshimi N, Hara A, Morishita Y, Tanaka T, Mori H. Genetic alterations in a patient with Turcot’s syndrome. Pathol Int 1998;48:126–133.

104.Marsh DJ, Coulon V, Lunetta K, et al. Mutation spectrum and genotype-phenotype analyses in Cowden disease and Bannayan-Zonana syndrome, two hamartoma syndromes with germline PTEN mutation. Hum Mol Genet 1998;7:507–515.

105.Cho KC, Sundaram K, Sebastiano LS. Filiform polyposis of the small bowel in a patient with multiple hamartoma syndrome (Cowden disease). AJR 1999;173: 501–502.

106.Wada K, Asoh T, Imamura T, et al. Rectal carcinoid tumor associated with the Peutz-Jeghers syndrome. J Gastroenterol 1998;33:743–746.

107.Parnaud G, Corpet DE. [Colorectal cancer: controversial role of meat consumption.] [Review] [French] Bull Cancer 1997;84:899–911.

108.Potter MA, Cunliffe NA, Smith M, Miles RS, Flapan AD, Dunlop MG. A prospective controlled study of the association of Streptococcus bovis with colorectal carcinoma. J Clin Pathol 1998;51:473–474.

109.Toyoki Y, Satoh S, Morioka G, Asano M, Nomura K. Rectal cancer associated with acquired hypertrichosis lanuginosa as a possible cutaneous marker of internal malignancy. J Gastroenterol 1998;33: 575–577.

110.de la Taille A, Mariette C, Buisine MP, Biserte J, Triboulet JP. [Urothelial tumor and colonic cancer in

the context of a syndrome of hereditary predisposition to HNPCC colonic cancer.] [French] Prog Urol 2000;10:1204–1207.

111.Gafa R, Lanza G. [Expression of protein p53 in the adenoma-colorectal carcinoma sequence.][Italian] Pathologica 1998;90:351–356.

112.Vasen HF, Sanders EA, Taal BG, et al. The risk of brain tumours in hereditary non-polyposis colorectal cancer (HNPCC). Int J Cancer 1996;65:422–425.

113.Bertario L, Russo A, Sala P, et al. Risk of colorectal cancer following colonoscopic polypectomy. Tumori 1999;85:157–162.

114.Passman MA, Pommier RF, Vetto JT. Synchronous colon primaries have the same prognosis as solitary colon cancers. [Review] Dis Colon Rectum 1996;39: 329–334.

115.Conde P, Erdozain JC, Olveira A, Herrera A, Segura JM. [A patient with five synchronous adenocarcinomas of the colon.] [Spanish] Rev Esp Enferm Dig 1998;90: 124.

116.Shida H, Ban K, Matsumoto M, et al. Asymptomatic colorectal cancer detected by screening. Dis Colon Rectum 1996;39:1130–1135.

117.Macari M, Bini EJ, Jacobs SL, et al. Significance of missed polyps at CT colonography. AJR 2004; 183:127–134.

118.Nusko G, Mansmann U, Partzsch U, et al. Invasive carcinoma in colorectal adenomas: multivariate analysis of patient and adenoma characteristics. Endoscopy 1997;29:626–631.

119.Ueyama T, Kawamoto K, Iwashita I, et al. Natural history of minute sessile colonic adenomas based on radiographic findings. Is endoscopic removal of every colonic adenoma necessary? Dis Colon Rectum 1995;38:268–272.

120.Tarraga P, Garcia-Olmo D, Celada A, Garcia-Molinero Mf, Divison JA, Casado C. Colorectal cancer screening through detection of fecal occult blood in a controlled health zone. Rev Esp Enferm Dig 1999;91:335–344.

121.Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Costeffectiveness of screening for colorectal cancer in the general population. JAMA 2000;284:1954–1961.

122.Pariente A, Milan C, Lafon J, Faivre J. Colonoscopic screening in first-degree relatives of patients with ‘sporadic’ colorectal cancer: a case-control study. The Association Nationale des Gastroenterologues des Hopitaux and Registre Bourguignon des Cancers Digestifs (INSERM CRI 9505). Gastroenterology 1998;115:7–12.

123.McMahon PM, Bosch JL, Gleason S, Halpern EF, Lester JS, Gazelle GS. Cost-effectiveness of colorectal cancer screening. Radiology 2001;219:44–50.

124.Okamura S, Ohashi S, Mitake M, et al. [A case of minute IIa + IIc type early colonic cancer (5mm in size and sm 1 in invasion depth) with metachronous liver metastasis.] [Japanese] Nippon Shokakibyo Gakkai Zasshi 1998;95:890–894.

125.Garcia-Hirschfeld Garcia J, Blanes Berenguel A, Vicioso Recio L, Marquez Moreno A, Rubio Garrido J, Matilla Vicente A. Colon cancer: p53 expression and DNA ploidy. Their relation to proximal or distal tumor site. Rev Esp Enferm Dig 1999;91:481–488.

126.Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS. Relative sensitivity of colonoscopy and

barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 1997;112:17–23.

127.Strom E, Larsen JL. Colon cancer at barium enema examination and colonoscopy: a study from the county of Hordaland, Norway. Radiology 1999;211:211–214.

128.Hancock JH, Talbot RW. Accuracy of colonoscopy in localisation of colorectal cancer. Int J Colorectal Dis 1995;10:140–141.

129.Haseman JH, Lemmel GT, Rahmani EY, Rex DK. Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals. Gastrointest Endosc 1997;45:451–455.

130.Jang HJ, Lim HK, Park CK, Kim SH, Park JM, Choi YL. Segmental wall thickening in the colonic loop distal to colonic carcinoma at CT: importance and histopathologic correlation. Radiology 2000;216:712–717.

131.Oto A, Gelebek V, Oguz BS, et al. CT attenuation of colorectal polypoid lesions: evaluation of contrast enhancement in CT colonography. Eur Radiol 2003; 13:1657–1663.

132.Morrin MM, Farrell RJ, Kruskal JB, Reynolds K, McGee JB, Raptopoulos V. Utility of intravenously administered contrast material at CT colonography. Radiology 2000;217:765–771.

133.Yee J, McFarland E. How accurate is CT colonography? In: Dachman AH,ed.Atlas of Virtual Colonoscopy. New York: Springer, 2003:11–16.

134.Morra A, Meduri S, Ammar L, Ukmar M, Pozzi Mucelli R. [Colonoscopy with computed tomography with volume reconstruction. The results and a comparison with endoscopy and surgery.] [Italian] Radiol Med 1999;98:162–167.

135.Regge D, Galatola G, Martincich L, et al. [Use of virtual endoscopy with computerized tomography in the identification of colorectal neoplasms. Prospective study with symptomatic patients.] [Italian] Radiol Med 2000;99:449–455.

136.Yee J, Akerkar GA, Hung RK, Steinauer-Gebauer AM, Wall SD, McQuaid KR. Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients. Radiology 2001;219:685–692.

137.Galdino GM, Yee J. Carpet lesion on CT colonography: a potential pitfall. AJR 2003;180:1332–1334.

138.Matsui T, Yao T, Yao K, et al. Natural history of superficial depressed colorectal cancer: retrospective radiographic and histologic analysis. Radiology 1996;201:226–232.

139.Sada M, Mitomi H, Igarashi M, Katsumata T, Saigenji K, Okayasu I. Cell kinetics, p53 and bcl-2 expression, and c-Ki-ras mutations in flat-elevated tubulovillous adenomas and adenocarcinomas of the colorectum: comparison with polypoid lesions. Scand J Gastroenterol 1999;34:798–807.

140.Rubio CA, Kumagai J, Kanamori T, Yanagisawa A, Nakamura K, Kato Y. Flat adenomas and flat adenocarcinomas of the colorectal mucosa in Japanese and Swedish patients. Comparative histologic study. Dis Colon Rectum 1995;38:1075–1079.

141.Watari J, Saitoh Y, Obara T, et al. Early nonpolypoid colorectal cancer: radiographic diagnosis of depth of invasion. Radiology 1997;205:67–74.

142.Kao PF, Tzen KY, Chang PL, Chang-Chien CR, Tsai MF, You DL. Diuretic renography findings in enterovesical fistula. Br J Radiol 1997;70:421–423.

143.Alcobendas F, Jorba R, Poves I, Busquets J, Engel A, Jaurrieta E. Perforated colonic cancer. Evolution and prognosis. Rev Esp Enferm Dig 2000;92:326–333.

144.Galia M, Midiri M, Carcione A, et al. [Usefulness of CT colonography in the preoperative evaluation of patients with distal occlusive colorectal carcinoma.] [Italian] Radiol Med 2001;101:235–242.

145.Fenlon HM, McAneny DB, Nunes DP, Clarke PD, Ferrucci JT. Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon. Radiology 1999;210:423–428.

146.Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I. Malignant colorectal treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 2000;216:492–497.

147.Mainar A, De Gregorio Ariza MA, Tejero E, et al. Acute colorectal obstruction: treatment with selfexpandable metallic stents before scheduled surgery— results of a multicenter study. Radiology 1999;210: 65–69.

148.Falchi M, Cecchini G, Derchi LE. [Umbilical metastasis as first sign of cecal carcinoma in a cirrhotic patient (Sister Mary Joseph nodule). Report of a case.] [Italian] Radiol Med 1999;98:94–96.

149.Osin P, Shiloni E, Pikarsky AJ, Okon E. Metastatic adenocarcinoma in a thyroid colloid nodule: a rare presentation of colon cancer. Pathology 1996;28: 236–237.

150.Sefr R, Penka I, Oliva T. [Carcinoma of the colon invading the duodenum and pancreas.] [Czech] Rozhl Chir 2000;79:112–115.

151.Zerhouni EA, Rutter C, Hamilton SR, et al. CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II. Radiology 1996;200:443–451.

152.Sitzler PJ, Seow-Choen F, Ho YH, Leong AP. Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients. Dis Colon Rectum 1997;40:1472–1476.

153.Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 2004;232:773–783.

154.Civelli EM, Gallino G, Mariani L, et al. Double-contrast barium enema and computerised tomography in the pre-operative evaluation of rectal carcinoma: are they still useful diagnostic procedures? Tumori 2000;86: 389–392.

155.Palko A, Gyulai C, Fedinecz N, Balogh A, Nagy F. Water enema CT examination of rectum cancer by reduced amount of water. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2000;172:901–904.

156.Fuchsjager MH, Maier AG, Schima W, et al. Comparison of transrectal sonography and double-contrast MR imaging when staging rectal cancer. AJR 2003;181: 421–427.

157.Lindmark GE, Kraaz WG, Elvin PA, Glimelius BL. Rectal cancer: evaluation of staging with endosonography. Radiology 1997;204:533–538.

158.Kruskal JB, Sentovich SM, Kane RA. Staging of rectal cancer after polypectomy: usefulness of endorectal US. Radiology 1999;211:31–35.