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Postoperative biliary adverse events following orthotopic liver transplantation: Assessment with magnetic resonance cholangiography

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World Journal of Gastroenterology 2014年第32期20卷 11080-11094页

作者： piero boraschi Francescamaria Donati 2nd Unit of Radiology Department of Diagnostic Radiology Vascular and Interventional Radiology and Nuclear Medicine Pisa University Hospital56124 Pisa Italy

Biliary adverse events following orthotopic liver transplantation (OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these adverse events is heavily influenced by the type of anastomosis during surgery. The low specificity of clinical and biologic findings makes the diagnosis challenging. Moreover, direct cholangiographic procedures such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography present an inadmissible rate of adverse events to be utilized in clinically low suspected patients. Magnetic resonance (MR) maging with MR cholangiopancreatography is crucial in assessing abnormalities in the biliary system after liver surgery, including liver transplant. MR cholangiopancreatography is a safe, rapid, non-invasive, and effective diagnostic procedure for the evaluation of biliary adverse events after liver transplantation, since it plays an increasingly important role in the diagnosis and management of these events. On the basis of a recent systematic review of the literature the summary estimates of sensitivity and specificity of MR cholangiopancreatography for diagnosis of biliary adverse events following OLT were 0.95 and 0.92, respectively. It can provide a non-invasive method of imaging surgical reconstruction of the biliary anastomoses as well as adverse events including anastomotic and non-anastomotic strictures, biliary lithiasis and sphincter of Oddi dysfunction in liver transplant recipients. Nevertheless, conventional T2-weighted MR cholangiography can be implemented with T1-weighted contrast-enhanced MR cholangiography using hepatobiliary contrast agents (in particular using Gd-EOB-DTPA) in order to improve the diagnostic accuracy in the adverse events’ detection such as bile leakage and strictures, especially in selected patients with biliary-enteric anastomosis.

关键词： Liver transplantation Bile ducts Biliary adverse events Magnetic resonance cholangiography Contrast-enhanced magnetic resonance cholangiography

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Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful?

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World Journal of Gastroenterology 2021年第26期27卷 4143-4159页

作者： piero boraschi Luigi Giugliano Giuseppe Mercogliano Francescamaria Donati Stefania Romano Emanuele Neri Department of Diagnostic Imaging Second Division of RadiologyAzienda Ospedaliero-Universitaria Pisana-University of PisaPisa 56124Italy Department of Radiology University of Naples“Federico II”Naples 80131Italy Department of Diagnostic Imaging Santa Maria delle Grazie HospitalNaples 80078Italy Diagnostic and Interventional Radiology Department of Translational Research and of New Surgical and Medical TechnologiesUniversity of PisaPisa 56126Italy

Coronavirus disease 2019(COVID-19)can be considered a systemic disease with a specific tropism for the vascular system,in which the alterations of the microcirculation have an important pathogenetic *** lungs are the main organ involved in COVID-19,and severe progressive respiratory failure is the leading cause of death in the affected patients;however,many other organs can be involved with variable clinical *** abdominal manifestations,the gastrointestinal tract and the hepatobiliary system are mainly affected,although the pancreas,urinary tract and spleen may also be *** most common gastrointestinal symptoms are loss of appetite,followed by nausea and vomiting,diarrhea and abdominal *** imaging findings include bowel wall thickening,sometimes associated with hyperemia and mesenteric thickening,fluid-filled segments of the large bowel and rarely intestinal pneumatosis and *** involvement manifests as an increase in the enzymatic levels of alanine aminotransferase,aspartate aminotransferase,serum bilirubin andγ-glutamyl transferase with clinical manifestations in most cases mild and *** most frequent radiological features are hepatic steatosis,biliary sludge and *** acute pancreatitis,kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in ***,splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge shaped or even rounded morphology,with irregular or smooth *** summary,the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the *** and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and *** radiological signs are not specific of abdom

关键词： COVID-19 SARS-CoV-2 Abdominal findings Gastrointestinal findings Computed tomography Ultrasound

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Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging

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World Journal of Gastroenterology 2019年第18期25卷 2217-2228页

作者： Luca Morelli Simone Guadagni Valerio Borrelli Roberta Pisano Gregorio Di Franco Matteo Palmeri Niccolò Furbetta Dario Gambaccini Santino Marchi piero boraschi Luca Bastiani Alessandro Campatelli Franco Mosca Giulio Di Candio General Surgery Unit Department of Surgery Translational and New Technologies in Medicine University of Pisa EndoCAS (Center for Computer Assisted Surgery) University of Pisa Diagnostic and Interventional Ultrasound in Transplants Unit Azienda Ospedaliero-Universitaria Pisana Gastroenterology Unit University of Pisa 2~(nd) Radiology Unit Department of Diagnostic Imaging Azienda Ospedaliero-Universitaria Pisana Institute of Clinical Physiology National Council of Research

BACKGROUND Patients with pancreatic cystic neoplasms(PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime imagebased surveillance follow-up. In these patients, the current European evidencedbased guidelines advise magnetic resonance imaging(MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound(US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by *** To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of *** We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US *** this communication, we reported the clinical results of this alternative followup, and the results of a comparative cost-analysis between our surveillance protocol(abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance *** In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients(1%) because of the appearance of suspicious features at imaging(with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN

关键词： Ultrasound Pancreatic cystic neoplasms Magnetic resonance imaging Surveillance

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