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Gastrointestinal Endoscopy Clinics of... Apr 2010Computed tomographic colonography (CTC) has emerged as an alternative screening tool for colorectal cancer due to the potential to provide good efficacy combined with... (Review)
Review
Computed tomographic colonography (CTC) has emerged as an alternative screening tool for colorectal cancer due to the potential to provide good efficacy combined with greater acceptability than optical colonoscopy or fecal occult blood testing. However, some organizations have raised concerns about the potential harms, including perforation rates and radiation-related cancer risks, and have not recommended that it currently be used as a screening tool in the general population in the US. In this article the authors review the current evidence for these potential harms from CTC and compare them to the potential harms from the alternatives including colonoscopy and double-contrast barium enema.
Topics: Colon; Colonography, Computed Tomographic; Colorectal Neoplasms; Humans; Incidence; Intestinal Perforation; Radiation Injuries; Risk Factors; Rupture; United States
PubMed: 20451817
DOI: 10.1016/j.giec.2010.02.003 -
Annals of Translational Medicine Jul 2019Primary colorectal lymphoma (PCL) is a rare disorder, the accurate imaging diagnosis of which remains a clinical challenge. This study aimed to characterize the imaging...
BACKGROUND
Primary colorectal lymphoma (PCL) is a rare disorder, the accurate imaging diagnosis of which remains a clinical challenge. This study aimed to characterize the imaging features of PCL by double-contrast barium enema (DCBE) examination and computed tomography (CT) and correlate them with histopathological findings.
METHODS
DCBE (n=6) and CT (n=19) findings for 19 pathologically proven PCLs were evaluated and compared with histopathological findings in this retrospective analysis.
RESULTS
Non-Hodgkin lymphoma was present in all patients, and the most common histological type was diffuse large B-cell lymphoma (63.2%, 12/19). The most common site was the ileocecum (84.2%, 16/19). CT revealed circumferential infiltrative lesions (68.4%, 13/19), polypoid masses (26.3%, 5/19) and ulcerative lesions (5.3%, 1/19). Most (94.7%, 18/19) lesions appeared as moderate enhancements. Fourteen (73.7%, 14/19) patients had serous membrane infiltration presenting as a poorly defined serous membrane and focal opacities in the pericolonic fat. Regional lymph node involvement was observed in twelve (63.2%, 12/19) patients who presented with aggregated nodules or masses. Frequent findings of the DCBE exam included a filling defect and niche with slight mucosal destruction, mild luminal narrowing and preserved peristalsis. The imaging appearance reflected the gross pathological findings well, although the preoperative diagnostic accuracy was low.
CONCLUSIONS
The imaging features of PCL have a relatively characteristic appearance but are still, at times, hardly differentiated from carcinoma. Familiarity with the radiological features of PCL on DCBE and CT can help ensure a correct diagnosis.
PubMed: 31475178
DOI: 10.21037/atm.2019.06.32 -
Arquivos Brasileiros de Cirurgia... 2016Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis.
BACKGROUND
Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis.
AIM
To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of Hirschsprung in patients underwent barium enema.
METHODS
This cross sectional study was carried out in Imam Khomeini Hospital for one year starting from 2012, April. Sixty patients were enrolled. Inclusion criteria were: neonates with failure to pass meconium, abdominal distention, and refractory constipation who failed to respond with medical treatment. Transitional zone, delay in barium evacuation after 24 h, rectosigmoid index (maximum with of the rectum divided by maximum with of the sigmoid; abnormal if <1), and irregularity of mucosa (jejunization) were evaluated in barium enema. Biopsy was obtained at three locations apart above dentate line. PPV, NPV, specificity , and sensitivity was calculated for each finding.
RESULTS
Mean age of the cases with Hirschsprung's disease and without was 17.90±18.29 months and 17.8±18.34 months respectively (p=0.983). It was confirmed in 30 (M=20, F=10) of cases. Failure to pass meconium was found in 21(70%) cases. Sensitivity, specificity, PPV, and NPV were 90%, 80%, 81.8% and 88.8% respectively for transitional zone in barium enema. Sensitivity, specificity, PPV, and NPV were 76.7%, 83.3%, 78.1% and 82.1% respectively for rectosigmoid index .Sensitivity, specificity, PPV, and NPV were 46.7%, 100%, 100% and 65.2% respectively for irregular contraction detected in barium enema. Sensitivity, specificity, PPV, and NPV were 23.3%, 100%, 100% and 56.6% respectively for mucosal irregularity in barium enema.
CONCLUSION
The most sensitive finding was transitional zone. The most specific findings were irregular contraction, mucosal irregularity, and followed by cobblestone appearance.
Topics: Barium Enema; Child, Preschool; Cross-Sectional Studies; Female; Hirschsprung Disease; Humans; Infant; Male; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity
PubMed: 27759777
DOI: 10.1590/0102-6720201600030007 -
Endoscopic Ultrasound Apr 2012The widespread use of endoscopic ultrasound has facilitated the evaluation of subepithelial and surrounding lesions of the gastrointestinal tract. Deep pelvic... (Review)
Review
The widespread use of endoscopic ultrasound has facilitated the evaluation of subepithelial and surrounding lesions of the gastrointestinal tract. Deep pelvic endometriosis, with or without infiltration of the intestinal wall, is a frequent disease that can be observed in women in their fertile age. Patients of this disease may present nonspecific signs and symptoms or be completely asymptomatic. Laparoscopic surgical resection of endometriotic lesions is the treatment of choice in symptomatic patients. An accurate preoperative evaluation is indispensable for therapeutic decisions mainly in the suspicion of intestinal wall and/or urinary tract infiltration, and also in cases where we need to establish histological diagnosis or to rule out malignant disease. Diagnostic tools, including transrectal ultrasound, magnetic resonance image, transvaginal ultrasound, barium enema, and colonoscopy, play significant roles in determining the presence, depth, histology, and other relevant data about the extension of the disease. Diagnostic algorithm depends on the clinical presentation, the expertise of the medical team, and the technology available at each institution. This article reviews and discusses relevant clinical points in endometriosis, including techniques and outcomes of the study of the disease through transrectal ultrasound and fine-needle aspiration.
PubMed: 24949332
DOI: 10.7178/eus.01.005 -
Cureus May 2023Intestinal intussusception rarely occurs in adults and is challenging to diagnose in the emergency department due to its associated nonspecific symptom of abdominal...
Intestinal intussusception rarely occurs in adults and is challenging to diagnose in the emergency department due to its associated nonspecific symptom of abdominal pain. Most of these incidences are caused by a neoplasm within the bowel acting as a lead point. Lipomas are benign fatty tumors that rarely develop in the colon and are very infrequently a precursor lesion to intussusception. Our present report describes a case of lipoma-associated intussusception in the transverse colon in an adult who presented with complaints of abdominal pain and acutely worsened chronic constipation. Computerized tomography (CT) imaging and barium enema revealed colocolonic intussusception with a lipomatous lead point and complete obstruction. The patient was admitted for same-day intervention and underwent a successful colectomy with no complications.
PubMed: 37288201
DOI: 10.7759/cureus.38671 -
British Medical Journal May 1948
Topics: Animals; Barium; Barium Compounds; Coleoptera; Enema; Humans; Intestines; Intussusception; Radiography, Abdominal
PubMed: 18938483
DOI: 10.1136/bmj.1.4558.955-a -
Korean Journal of Radiology 2012To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. (Comparative Study)
Comparative Study
OBJECTIVE
To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency.
MATERIALS AND METHODS
Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean ± SD in age, 51 ± 6.4 years) and CTC (n = 176; 50 ± 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of ≥ 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups.
RESULTS
Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups.
CONCLUSION
In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.
Topics: Analysis of Variance; Barium Sulfate; Colonic Polyps; Colonography, Computed Tomographic; Colorectal Neoplasms; Contrast Media; Enema; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Renal Insufficiency; Risk Factors; Sensitivity and Specificity
PubMed: 22563266
DOI: 10.3348/kjr.2012.13.3.290 -
Health Science Reports Jan 2024Hirschsprung's disease (HSD) remains a common cause of pediatric intestinal obstruction. Barium contrast enema (BE) is the primary imaging modality for the evaluation of...
Diagnostic accuracy of barium enema versus full-thickness rectal biopsy in children with clinically suspected Hirschsprung's disease: A comparative cross-sectional study.
BACKGROUND AND AIMS
Hirschsprung's disease (HSD) remains a common cause of pediatric intestinal obstruction. Barium contrast enema (BE) is the primary imaging modality for the evaluation of clinically suspected cases. Here, we aimed to assess the diagnostic accuracy of BE in children with clinically suspected HSD when compared to a gold standard full-thickness rectal biopsy (FTRB).
METHODS
We recruited and consecutively enrolled children with clinically suspected HSD at two tertiary teaching hospitals. Participants underwent BE imaging and two radiologists interpreted the findings independently. Participants further underwent FTRB by pediatric surgeons as the confirmatory test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC) with the area under the curve (AUC) were calculated on Stata version 14.2, taking FTRB as the standard.
RESULTS
We enrolled 55 cases, of which 49 completed the evaluation and were included in the final analysis. The median age was 9.4 months (interquartile range: 2-24], with a male-to-female ratio of 4.4:1. The sensitivity, specificity, PPV, and NPV of BE were 0.95 (95% confidence interval [CI] [0.81-0.99]), 0.73 (95% CI [0.39-0.94]), 0.92 (95% CI [0.82-0.97]), and 0.80 (95% CI [0.50-0.94]), respectively. On AUC, the diagnostic accuracy of BE compared to the confirmatory FTRB was 0.84 (95% CI [0.69-0.98]). The diagnostic accuracy was higher in neonates (ROC: 1.00) when compared to infants (ROC: 0.83) or those above 1 year of age (ROC: 0.798). HSD-suggestive BE findings were associated with absence of ganglion cells on FTRB ( = 23.301, < 0.001). Inverted rectosigmoid ratio and transition zone were more sensitive in detecting HSD of 0.92 (95% CI [0.74-0.98]) and 0.81 (95% CI [0.63-0.92]), respectively.
CONCLUSION
BE is sufficiently accurate in the diagnosis of children with HSD, suggesting BE would likely be used to inform surgical management in settings where confirmatory biopsy is lacking. However, clinical judgment is warranted in interpreting negative BE findings.
PubMed: 38196566
DOI: 10.1002/hsr2.1798 -
Cancer Imaging : the Official... Dec 2021The indication for endoscopic resection for submucosally invasive colorectal cancer (T1-CRC) depends on the preoperative diagnosis of invasion depth. The aim of this...
BACKGROUND
The indication for endoscopic resection for submucosally invasive colorectal cancer (T1-CRC) depends on the preoperative diagnosis of invasion depth. The aim of this investigation was to evaluate the association between barium enema examination (BE) profile views and depth of submucosal (SM) invasion in CRCs.
METHODS
We reviewed the radiographic and endoscopic findings of 145 T1-CRCs diagnosed from 2008 to 2019. We measured the widths of horizontal and vertical rigidity under a BE profile view corresponding to CRC and compared the values with SM invasion depth. Horizontal rigidity was defined as the horizontal length and vertical rigidity as the vertical width of the barium defect corresponding to each target lesion. The most appropriate cut-off values for predicting SM invasion ≥1.8 mm were calculated by receiver operating characteristic curve analysis.
RESULTS
Values of horizontal rigidity (r = 0.626, P < 0.05) and vertical rigidity (r = 0.482, P < 0.05) correlated significantly with SM invasion depth. The most appropriate cut-off values for the prediction of SM invasion depth ≥ 1.8 mm were 4.5 mm for horizontal rigidity, with an accuracy of 80.7%; and 0.7 mm for vertical rigidity, with an accuracy of 77.9%. The prevalence of lympho-vascular invasion was significantly different when those cut-off values were applied (43.2% vs. 17.5% for horizontal rigidity, P < 0.005).
CONCLUSIONS
In T1-CRC, values of horizontal and vertical rigidities under a BE profile view were correlated with SM invasion depth. While the accuracy of the rigidities for the prediction of SM invasion depth ≥ 1.8 mm was not high, horizontal rigidity may be predictive of lympho-vascular invasion, thus aiding in therapeutic decision-making.
Topics: Barium Enema; Colorectal Neoplasms; Humans; Neoplasm Invasiveness; ROC Curve
PubMed: 34876222
DOI: 10.1186/s40644-021-00437-z -
California Medicine Oct 1968Three cases of intussusception in adults were observed within a period of six months in a small general hospital. All the patients were over 65 years old and all were...
Three cases of intussusception in adults were observed within a period of six months in a small general hospital. All the patients were over 65 years old and all were admitted to hospital with intermittent cramping abdominal pains. None appeared to be in acute distress. In all three, body temperature, pulse rate and hemogram were within normal limits. Diagnosis was made preoperatively after barium enema studies. Bowel resection with end-to-end anastomosis was done in all three cases, in two because of gangrenous bowel. The site of intussusception was jejunojejunal in one case, ileocecal in another and colorectal in the third; and the cause in all cases was tumor, benign in two cases, malignant in one. The patients recovered uneventfully except for incisional abscess and diarrhea of seven days' duration in one. In a review of literature it was found that the clinical features in these three cases closely paralleled those of other cases of adult intussusception reported in this country.
Topics: Aged; Female; Humans; Intussusception; Male
PubMed: 5696558
DOI: No ID Found