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Diagnostic imaging advances in murine models of colitis

World Journal of Gastroenterology 2016年第3期22卷 996-1007页

作者： Markus Brückner Philipp Lenz Marcus M Mücke Faekah Gohar Peter Willeke dirk domagk Dominik Bettenworth Department of Medicine B University Hospital of MünsterAlbert-Schweitzer-Campus 1D-48149 MünsterGermany Department of Paediatric Rheumatology and Immunology University Hospital of MünsterAlbert-Schweitzer-Campus 1D-48149 MünsterGermany Department of Medicine D University Hospital of MünsterAlbert-Schweitzer-Campus 1D-48149 MünsterGermany Department of Medicine I Josephs-Hospital WarendorfAcademic Teaching HospitalUniversity of MünsterAm Krankenhaus 2D-48231 WarendorfGermany

Inflammatory bowel diseases(IBD) such as Crohn's disease and ulcerative colitis are chronic-remittent inflammatory disorders of the gastrointestinal tract still evoking challenging clinical diagnostic and therapeutic situations. Murine models of experimental colitis are a vital component of research into human IBD concerning questions of its complex pathogenesis or the evaluation of potential new drugs. To monitor the course of colitis, to the present day, classical parameters like histological tissue alterations or analysis of mucosal cytokine/chemokine expression often require euthanasia of animals. Recent advances mean revolutionary noninvasive imaging techniques for in vivo murine colitis diagnostics are increasingly available. These novel and emerging imaging techniques not only allow direct visualization of intestinal inflammation, but also enable molecular imaging and targeting of specific alterations of the inflamed murine mucosa. For the first time, in vivo imaging techniques allow for longitudinal examinations and evaluation of intra-individual therapeutic response. This review discusses the latest developments in the different fields of ultrasound, molecularly targeted contrast agent ultrasound, fluorescence endoscopy, confocal laser endomicroscopy as well as tomographic imaging with magnetic resonance imaging, computed tomography and fluorescence-mediated tomography,discussing their individual limitations and potential future diagnostic applications in the management of human patients with IBD.

关键词： confocal laser endomicroscopy contrastenhanced ultrasound Dextran Sodium Sulphate colitis experimental colitis fluorescence imaging endoscopy Imaging Inflammatory bowel disease Tomography

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Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis

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World Journal of Gastroenterology 2012年第37期18卷 5211-5218页

作者： Hauke S Heinzow Philipp Lenz Michael Khler Frank Reinecke Hansjrg Ullerich Wolfram Domschke dirk domagk Tobias Meister Department of Medicine B University of Muenster Institute of Radiology University of Muenster Department of Medicine Ⅱ Helios Albert-Schweitzer-Hospital

AIM:To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt (TIPS) implantation in cirrhotic patients. METHODS:Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implantation (bare metal) for either refractory ascites (RA) (n= 27) or variceal bleeding (VB) (n = 54). Endpoints for the study were:technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clinical records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score (MELD score), underlying disease] were retrieved. The Kaplan-Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney Utest and the χ 2 test as appropriate. RESULTS:No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient (PPG) reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg (VB) vs 22.1 ± 5.5 mmHg (RA) before TIPS to 11.8 ± 4.0 vs 11.7 ± 4.2 after TIPS implantation (P = 0.001 within each group). There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group (24 vs 6, P = 0.052). The median survival for the ascites group was 29 mo compared to > 60 mo for the bleeding group (P = 0.009). The number of radiological controls for stent patency was 6.3 for bleeders and 3.8 for ascites patients (P = 0.029). Kaplan-Meier calculation indicated that stent occlusion at first control (P = 0.027), ascites prior to TIPS implantation (P = 0.009), CHILD stage (P = 0.013), MELD score (P = 0.001) and those patients not having undergone liver

关键词： TIPS 预测因子临床疗效肝硬化患者 Cox回归模型压力梯度毫米汞柱

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Comparative analysis of ERCP,IDUS,EUS and CT in predicting malignant bile duct strictures

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World Journal of Gastroenterology 2014年第30期20卷 10495-10503页

作者： Hauke S Heinzow Sara Kammerer Carina Rammes Johannes Wessling dirk domagk Tobias Meister Department of Medicine B University of MünsterD-48149 MünsterGermany Department of Clinical Radiology University of MünsterD-48149 MünsterGermany Department of Radiology ClemenshospitalMünster University Teaching HospitalD-48153 MünsterGermany Department of Medicine Ⅱ HELIOS AlbertSchweitzer HospitalG?ttingen University Teaching HospitalD-37154 NortheimGermany

AIM:To compare endoscopic retrograde cholangio-pancreatography(ERCP),intraductal ultrasound(IDUS),endosonography(EUS),endoscopic transpapillary forceps biopsies(ETP)and computed tomography(CT)with respect to diagnosing malignant bile duct strictures.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by ERCP and IDUS,ETP,EUS,and CT.The sensitivity,specificity,and accuracy rates of the diagnostic procedures were calculated based on the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.For each of the diagnostic measures,the sensitivity,specificity,and accuracy rates were calculated.In all cases,the gold standard was the histopathologic staging of specimens or long-term follow-up of at least 12 mo.A comparison of the accuracy rates between the localization of strictures was performed by using the Mann-Whitney U-test and theχ2test as appropriate.A comparison of the accuracy rates between the diagnostic procedures was performed by using the McNemar’s test.Differences were considered statistically significant if P<0.05.RESULTS:A total of 234 patients(127 males,107 females,median age 64,range 20-90 years)with indeterminate bile duct strictures were included.A total of 161patients underwent operative exploration;thus,a surgical histopathological correlation was available for those patients.A total of 113 patients had malignant disease proven by surgery;in 48 patients,benign disease was surgically found.In these patients,the decision for surgical exploration was made due to the suspicion of malignant disease in multimodal diagnostics(ERCP,CT,or EUS).Fifty patients had a benign diagnosis and were followed by a surveillance protocol with a followup of at least 12 mo;the median follow-up was 34 mo.Twenty-three patients had extended malignant disease,and thus were considered palliative.A comparison of the different diagnostic tools for detecting bile duct malignancy resulted in accuracy rates of 91%(ERCP/IDUS),59%(ETP),92%(IDUS+ETP

关键词： Intraductal ultrasound Bile duct strictures Endoso

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Intraductal ultrasound substantiates diagnostics of bile duct strictures of uncertain etiology

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World Journal of Gastroenterology 2013年第6期19卷 874-881页

作者： Tobias Meister Hauke S Heinzow Carina Woestmeyer Philipp Lenz Josef Menzel Torsten Kucharzik Wolfram Domschke dirk domagk Department of Medicine B University of Münster Department of Medicine Ⅱ HELIOS AlbertSchweitzer University Teaching Hospital Department of MedicineⅡ Klinikum IngolstadtD-85049 IngolstadtGermany Department of Medicine University Teaching Hospital Lüneburg

AIM:To report the largest patient cohort study investigating the diagnostic yield of intraductal ultrasound (IDUS) in indeterminate strictures of the common bile duct.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by IDUS.Sensitivity,specificity and accuracy rates of IDUS were calculated relating to the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.Analysis of the endosonographic report allowed drawing conclusions with respect to the T and N staging in 147 patients.IDUS staging was compared to the postoperative histopathological staging data allowing calculation of sensitivity,specificity and accuracy rates for T and N stages.The endoscopic retrograde cholangio-pancreatography and IDUS procedures were performed under fluoroscopic guidance using a side-viewing duodenoscope (Olympus TJF 160,Olympus,Ltd.,Tokyo,Japan).All procedures were performed under conscious sedation (propofol combined with pethidine) according to the German guidelines.For IDUS,a 6 F or 8 F ultrasound miniprobe was employed with a radial scanner of 15-20 MHz at the tip of the probe (Aloka Co.,Tokyo,Japan).RESULTS:A total of 397 patients (210 males,187 females,mean age 61.43 ± 13 years) with indeterminate bile duct strictures were included.Two hundred and sixty-four patients were referred to the department of surgery for operative exploration,thus surgical histopathological correlation was available for those patients.Out of 264 patients,174 had malignant disease proven by surgery,in 90 patients benign disease was found.In these patients decision for surgical exploration was made due to suspicion for malignant disease in multimodal diagnostics (computed tomography scan,endoscopic ultrasound or magnetic resonance imaging).Twenty benign bile duct strictures were misclassified by IDUS as malignant while 14 patients with malignant strictures were initially misdiagnosed by IDUS as benign resulting in sensitivity,specificity and accuracy ratesof 93.2

关键词： Intraductal ultrasound Bile duct strictures Accuracy

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Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis

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World Journal of Gastroenterology 2014年第34期20卷 12260-12268页

作者： Philipp Lenz Franziska Eckelskemper Thomas Erichsen Tim Lankisch Alexander Dechêne Gabriele Lubritz Frank Lenze Torsten Beyna Hansjorg Ullerich Andre Schmedt dirk domagk Department of Medicine B University of MuensterD-48149 MuensterGermany Department of Gastroenterology Hepatology and EndocrinologyHannover Medical School30625 HannoverGermany Department of Gastroenterology and Hepatology University Hospital Essen45147 EssenGermany Institute of Medical Microbiology University Hospital MuensterD-48149 MuensterGermany

AIM:To develop an algorithm to improve the diagnosis and treatment of patients with biliary candidiasis.METHODS:We performed a prospective study of 127patients who underwent endoscopic retrograde cholangiopancreatography,for various biliary disorders,at 3 tertiary referral centers in Germany from July 2011through July 2012(ClinicalTrials.gov:NCT01109550).Bile,buccal,and stool samples were collected.When indicated,endoscopic transpapillary bile duct biopsies were performed to clarify the etiology of bile duct strictures and to prove invasive fungal infections.RESULTS:Candida species were detected in 38 of the 127 bile samples(29.9%).By multivariate analysis patients’age and previous endoscopic sphincterotomy were independent risk factors for biliary candidiasis(P7 d)(P=0.089)tend to be at risk for biliary candidiasis.One patient was negative in mycological culture of bile fluid but invasive biliary candidiasis was diagnosed histologically.Of Candida subspecies detected,36.7%were azole-resistant,such as C glabrata.Eight patients received anti-mycotic therapy,based on our algorithm.Of these,3 had cancer with biliary tract involvement,2had secondary sclerosing cholangitis,1 had retroperitoneal fibrosis,and 5 had septicemia.In all patients contamination was ruled out by smears of the endoscope channel.CONCLUSION:Gastroenterologists should be aware of frequent candida colonization in patients with cholangitis and biliary disorders.Our suggested algorithm facilitates the further clinical management.

关键词： Cholangitis Biliary candidiasis Invasive fungal infection Biliary obstruction

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