- Email: [email protected]
A comparison of magnetic resonance imaging and plain abbominal radiography in neonatal necrotising enterocolitis
T1728
intestine by tissue harmonic imaging (THI) mode, and from the obtained ultrasonic dislocation pictures, the US-VE image was created. After the colonoscopy, we compared the USVE images with endoscopic images. RESULTS: 3 of 8 colonic polyps and 3 of 5 cancers were detected by US-VE One malignant 1}r and one ulcerative colitis could also be diagnosed by US-VE (8/15, 54%). On the other hand, in 20 patients who had not previously been examined by colonoseopy, 13 polyps were found by colonoscopic examination, hut small polyps less than 5ram in diameter were not detected by US-VE, except one ascending colon cancer. CONCLUSIONS: US-VE is useful to diagnose large intestinal diseases. But more irnprovement in preparation or use of other procedures is necessary.
Increased Serum Levels and Epithelial Expression of Macrophage Migration Inhibitor),' Factor in Gastric Cancer Xing Xang He, ttarry H. X. Xia, Yi 'fang, Shiu Kum/.am, Marie C. M Lin, Wai Man Wong, Hsiang Fu Kung, Suet Yi I~ung, Sin "Is.an Yuen, Ymg Heng Zhao, Benjamin C, Y, Wong Background: Macrophage migration inhibitory factor (MID plays a pivotal role in inflammatory' and immune diseases, and is also implicated in carcinogenesis, This study aimed to determine if serum levels and gastric epithelial MIF expression are associated with gastric precancerons lesions and cancer, and to determine MIF expression in non-maligIlant and mahgnant gastric ceils in vitro Methods: Ninety patients (ivb']:, 54136, age, 56 +/-16 years), 15 with normal gastric mucosa, 15 with H. pylori-associated chronic antral gastritis, 20 with intestinal metaplasia in the antrum, and 40 with antml adenocarcinoma, were included in this study, immunohistochemistry was used to determine MIF expression in gastric epithelial ceils, and enzyme-linked immunosorbent assay (ELISA) was used to measure serum MIF. Five gastric cancer cell lines (AGS, MKN-45, MKN-28, MGC-803 and SGC790i) and one non-tnalignant gastric cell line (GES-1) were cultured for 24 hours. MIF protein in the supernatant was measured by ELISA, and MIF mRNA in cultured cells was determined by reverse transcription-polymerase chain reaction. Results: The average labeling index of MIF expression in epithdial cells was 12% in normal mucosa, but increased in gastritis (52%), intestinal metaplasia (66%) and gastric cancer (96%) (P<0.001, ANOVA). Serum M1F level was also increased with the pathologmal changes (576+/-82 pg/ml in normal mucosa, 2100 +/-349 pg/ml in gastritis, 4498+/-253 pg/ml in intestinal metaplasia and 9737 +/-1249 pgtml in gastric cancer, P<0.001, ANOVA). There was a significant correlation between epithelial MIF expression and serum MiP level (R= 0,776, P
T1731 A PROSPECTIVE BLINDED COMPARISON OF POWER DOPPLER SONOGRAPHY AND ILEOCOLONOSCOPY IN THE EVALUATION OF ACTIVITY IN PATIENTS WITH CROHN'S DISEASE Holger Neye, Winfried Voderholzer, Jutta Wirth, Jutta Weber, Guido Schachschal, Sascha Murrer, Jaqueline Beinhoelzl, Wolfram Wermke, Herbert LocKs Background: Data on the clinical value of power Doppler sonography in Cmhn's disease are rare. The aim of this prospective study was to determine the accuracy of power Doppler sonography in the evaluation of activity in different bowel segments as compared '~dth ileocolonoscopy in patients with Crohn's disease. Patients and methods: Thirty-four patients ,oath confirmed Cmhn's disease were prospectively investigated with B-mode and power Doppler sonography (HDI 5000, Philips Ultrasound) and ileocolonoseopy. Sonography was performed within 3 days before endoscopy. All investigations were done by experienced examiners who were blinded to the clinical data and results of other examinations. Previously defined criteria were used to deternrine actMty for ultrasound (bowel wall thickness, vascularization pattern) and colonoscopy (pattern, extent of typical lesions), respectively. The degree of activity was scored from 1 (none) to 4 (high). For each patient the bmvel segments presented at the table were investigated. For statistical analysis, the Weighted Kappa Test was used (StatXact, software). Resuhs: See table. There is a high concordance between the results of ultrasound andileocolonoseopy. However, best results were found in the descending colon and terminal ileum. Conclusions: A combination of B-mode and power Doppler sonography has a high accuracy in the evaluation of activity in patients with Cmhn's disease as compared to ileocolonoscopy. Therefore, ultrasound may be recommended tor Mlowup examinations in patients with crohn's disease.
T1729 Tele-Hepatitis: Validation of Desktop Videoteleconferencing (VTC) System at 384 kb Connectivity for the Evaluation of Patients with Chronic Liver Disease Inku Hwang, Thomas R. Boal, Sean D. Kennedy, Ronald K, Poropatich, Kent C. Holtzmufier
Rnults of power D o p ~ sonographyIn comparisonto ileocolonoscopy. Bowel segment
PURPOSE: Te/emedicine has been embraced by psychiatry,, dermatology, and ophthalmology with consistently positive patient and physician acceptance. However, it has not yet been used by gastrtmnterology and bepatology. The goal of this study was to validate the use of VTC uinng a low-cost desktop system at 384 kb connection for the evaluation of patients with chronic liver disease, METHODS: Adult patients with chromc liver disease referred to our hepatology clinic were prospectively enrolled. Patients were randomized to be seen by 1 of 2 gastroenterologists, first in-person, then by the other physiiaan ~la ~TC on the same day. Thirty-six exam criteria pertinent to liver disease were scored as present, not present or not applicable. Then, subjects filled out a patient questionnaire The physical exam criteria were compared for concordance between tbe in-person and \TC resuhs RESULTS: Thus far, 31 of 110 projected patients have been completed. Median age was 43 (range 20-79), Nineteen were Caucasian, 7 African-American, I Hispanic, 1 Asian, and 3 other, In-person examinstion detected 209 abnormal physical findings and VTC 189, If non-visnal criteria were exchaded, in-person examination fuund 188 and VTC saw 180 abnormalities, The overall sensitivity and specificity of *vqC in detectiug abnormalities seen by the in-person examination were 82,3% and 98.1% (87,8% and 98.0%, ~ith exclusion of non-visual criteria) Positive and negative predictive values were 91.0% and 95.9% (91.7% and 96.9% w~th exclusmn ot nonwiaual cnteria). Overall accuracy was 95.0% with Cohen's kappa = 0 8 3 4 1 ( p < 0 0 0 0 1 ) , and 95.9% with exclusion of non-visual criteria (kappa = 08713, p<0.0001). C,ynecomastia and rash were overcalled by the VTC, and the sensitivity of detecting scleral ictems and skin iaundice were only 71.4 and 50.0% Patients consistently scored the VTC experience positivdy, and 25/31 (80.6% with 95% C[: 0.630.93) would choose to be seen via "~q-C near their home vs. traveling 2 hours to see the bepatologist in person. CONCLUSIONS: Physical exanrs using VTC appear to strongly agree with in-person examinatirms with high kappa agreement scores. Patients positively rated the experience, and the majority preferred VTC to traveling long distances to see the physicians. Findings that require depth pemepuon (e.g, gynecomastia), fine detail (eg. rash) and those requiring subtle color discnmation (e.g. jaundice) may be difficult to detect consiatently by VTC,
Kap,pa
Sigmold Descending Transverse Ascending Cecum Terminal colon , colon colon colon Ileum
0,80
0,90
0,81
0,79
0,81
0,86
Kappa~ i e r R : range0-1, a highervalue is combinedwith a higherconcordance,
T1732 A Comparison of Magnetic Resonance Imaging and Plain Abdominal Radiography in Neonatal Necrotising Enterocolitis Andrew A. Fagbemi, Anna Thornton, Ella Maaloul, Philip Duggan. David Edwards, Graeme Bydder, Kokila Lakhoo BACKGROUND AND OBJECTIVE. The aim of the study was to establish the value of nmgoetic resonance (MR) imaging and abdominal radiography in predicting surgical findings in infants suspected of suffenirg from Necrotismg Entemcolins (NEC). METHODS. Fifieen preterm infants with suspected NEC were examined by abdominal MR imaging and plain radiograph}, using a 1-Tesla MR (Marconi Medical) located within the neortatal intensive care unit. The MR and X rays images were evaluated by two observers for boy/el wail thickness, dilatation of bowel loops, (small and large bowel differentiation), presence of fluid filled bowel, fi'ee peritoneal fluid, mesenteric oedema, intramural and portal venous gas) and the results compared with fndings at surgery" Six weight and age matched infants were imaged with abdominal distension but no NEC to provide comparison data RESULTS Thirteen of the study preterm infants, had the diagnosis of NEC confirmed at surgery, tF.e remaining two were found to have volvulus, MR imaging is more sensitive tot detection of intramural gas with sensitivity = (0.67), portal venous gas sensitivity, = (0.4), mesenteric oedema sensitivity = (0.73) and free fluid sensitB,"W =(0.6), these compared with similar X ray features of intramural gas sensitivity = (0.27), portal venous gas sensitivity =(0.07), abdominal wall oedema sensitivity = (0.07) and free gas sensitivity = (0.07). MRI intramural gas and ti'ee fluid had a specificity of 0.5 and all other features had specifcity of 1 CONCLUSION Both plain radiography and MR imaging can show features of NEC, but MRI is more sensitive and specific. No test is particularly successful.
r1730 T1733
The Usefulness of Virtual Endoscopy by Ultrasonography in the Diagnosis of the Large Intestinal Disease Tsuguo Kamioka, Yasumasa Niwa, Yoshiki Hirooka, Naoki Ohmiya, Akihiro ito, Seniu Hashimoto, Nobuhiro Ando, Yoji Sasald, Ryqi Miyahara, Akira Ohashi, Hidemi Goto
A Comparison of MRI Based Colonography with Conventional Colonoscopy in Patients with Inflammatory Bowel Disease AndI~as G. Schreyer, Johamres Seitz
BACKGROUND: Ultrasonic examination has become increasingly important in the diagnosis of gastrointestinal tract diseases. In ueoplastic diseases of the large intestine, however, the diagnostic value of conventional tmnsabdominal sonography is limited. 1he aim of this study is to assess the usefufrmss of virtual endoseopy by transabdommal uhrasonography (US&*E) in the diagnosis of large intestinal diseases. SUBJECTS: From March 2000 to October 2002, we pertbnned US&"E on 35 patients, 15 who had already been examined by colonoscopy and diagnosed at other hospitals, and 20 who were introduced to our hospital because of positive fecal occult blood. METHODS: Patients received a routine bowel preparation m the morning and transabdominal US ,,','as accomplished using the ATL HDI5000 scanner with 2-5 MHz convex transducer, and employing Silicon Graphic Advanced 3DI as 3-dinlensional picture analysis equipnmnt. We carried out the scan of the large
AGA Abstracts
Purpose: To compare conventional colonoscopy with MRI based colonography including virtual flights in disease assessment for patients with inflammatory bowd disease. Methods: In 16 consecutive patients with known inflammatory bowel disease (1BD) conventmnal colonoscopy (CC) and MRI based colonography (MRC) was performed the same day. After bowel cleansing approximately 1.5 1 of a gadolinium/water mixture ',','as applied rectally 3D FLASH sequences were acqnired m prone and supine position. 2D FLASH was performed before and after iv gadolinium application. MR images were assessed by two radiologists and a gastroemerologist in consensus. The colon was subdivided in 7 parts (sigma, descending colon, right flexure, transverse colon, left flexure, ascending colon, coecum), imaging quaIity and diagnosis of each part was assessed. Additionally a volume rendered virtual colonoscopy of the bowel was performed. Results were compared with the findings of the video taped
A-556
intestine by tissue harmonic imaging (THI) mode, and from the obtained ultrasonic dislocation pictures, the US-VE image was created. After the colonoscopy, we compared the USVE images with endoscopic images. RESULTS: 3 of 8 colonic polyps and 3 of 5 cancers were detected by US-VE One malignant 1}r and one ulcerative colitis could also be diagnosed by US-VE (8/15, 54%). On the other hand, in 20 patients who had not previously been examined by colonoseopy, 13 polyps were found by colonoscopic examination, hut small polyps less than 5ram in diameter were not detected by US-VE, except one ascending colon cancer. CONCLUSIONS: US-VE is useful to diagnose large intestinal diseases. But more irnprovement in preparation or use of other procedures is necessary.
Increased Serum Levels and Epithelial Expression of Macrophage Migration Inhibitor),' Factor in Gastric Cancer Xing Xang He, ttarry H. X. Xia, Yi 'fang, Shiu Kum/.am, Marie C. M Lin, Wai Man Wong, Hsiang Fu Kung, Suet Yi I~ung, Sin "Is.an Yuen, Ymg Heng Zhao, Benjamin C, Y, Wong Background: Macrophage migration inhibitory factor (MID plays a pivotal role in inflammatory' and immune diseases, and is also implicated in carcinogenesis, This study aimed to determine if serum levels and gastric epithelial MIF expression are associated with gastric precancerons lesions and cancer, and to determine MIF expression in non-maligIlant and mahgnant gastric ceils in vitro Methods: Ninety patients (ivb']:, 54136, age, 56 +/-16 years), 15 with normal gastric mucosa, 15 with H. pylori-associated chronic antral gastritis, 20 with intestinal metaplasia in the antrum, and 40 with antml adenocarcinoma, were included in this study, immunohistochemistry was used to determine MIF expression in gastric epithelial ceils, and enzyme-linked immunosorbent assay (ELISA) was used to measure serum MIF. Five gastric cancer cell lines (AGS, MKN-45, MKN-28, MGC-803 and SGC790i) and one non-tnalignant gastric cell line (GES-1) were cultured for 24 hours. MIF protein in the supernatant was measured by ELISA, and MIF mRNA in cultured cells was determined by reverse transcription-polymerase chain reaction. Results: The average labeling index of MIF expression in epithdial cells was 12% in normal mucosa, but increased in gastritis (52%), intestinal metaplasia (66%) and gastric cancer (96%) (P<0.001, ANOVA). Serum M1F level was also increased with the pathologmal changes (576+/-82 pg/ml in normal mucosa, 2100 +/-349 pg/ml in gastritis, 4498+/-253 pg/ml in intestinal metaplasia and 9737 +/-1249 pgtml in gastric cancer, P<0.001, ANOVA). There was a significant correlation between epithelial MIF expression and serum MiP level (R= 0,776, P
T1731 A PROSPECTIVE BLINDED COMPARISON OF POWER DOPPLER SONOGRAPHY AND ILEOCOLONOSCOPY IN THE EVALUATION OF ACTIVITY IN PATIENTS WITH CROHN'S DISEASE Holger Neye, Winfried Voderholzer, Jutta Wirth, Jutta Weber, Guido Schachschal, Sascha Murrer, Jaqueline Beinhoelzl, Wolfram Wermke, Herbert LocKs Background: Data on the clinical value of power Doppler sonography in Cmhn's disease are rare. The aim of this prospective study was to determine the accuracy of power Doppler sonography in the evaluation of activity in different bowel segments as compared '~dth ileocolonoscopy in patients with Crohn's disease. Patients and methods: Thirty-four patients ,oath confirmed Cmhn's disease were prospectively investigated with B-mode and power Doppler sonography (HDI 5000, Philips Ultrasound) and ileocolonoseopy. Sonography was performed within 3 days before endoscopy. All investigations were done by experienced examiners who were blinded to the clinical data and results of other examinations. Previously defined criteria were used to deternrine actMty for ultrasound (bowel wall thickness, vascularization pattern) and colonoscopy (pattern, extent of typical lesions), respectively. The degree of activity was scored from 1 (none) to 4 (high). For each patient the bmvel segments presented at the table were investigated. For statistical analysis, the Weighted Kappa Test was used (StatXact, software). Resuhs: See table. There is a high concordance between the results of ultrasound andileocolonoseopy. However, best results were found in the descending colon and terminal ileum. Conclusions: A combination of B-mode and power Doppler sonography has a high accuracy in the evaluation of activity in patients with Cmhn's disease as compared to ileocolonoscopy. Therefore, ultrasound may be recommended tor Mlowup examinations in patients with crohn's disease.
T1729 Tele-Hepatitis: Validation of Desktop Videoteleconferencing (VTC) System at 384 kb Connectivity for the Evaluation of Patients with Chronic Liver Disease Inku Hwang, Thomas R. Boal, Sean D. Kennedy, Ronald K, Poropatich, Kent C. Holtzmufier
Rnults of power D o p ~ sonographyIn comparisonto ileocolonoscopy. Bowel segment
PURPOSE: Te/emedicine has been embraced by psychiatry,, dermatology, and ophthalmology with consistently positive patient and physician acceptance. However, it has not yet been used by gastrtmnterology and bepatology. The goal of this study was to validate the use of VTC uinng a low-cost desktop system at 384 kb connection for the evaluation of patients with chronic liver disease, METHODS: Adult patients with chromc liver disease referred to our hepatology clinic were prospectively enrolled. Patients were randomized to be seen by 1 of 2 gastroenterologists, first in-person, then by the other physiiaan ~la ~TC on the same day. Thirty-six exam criteria pertinent to liver disease were scored as present, not present or not applicable. Then, subjects filled out a patient questionnaire The physical exam criteria were compared for concordance between tbe in-person and \TC resuhs RESULTS: Thus far, 31 of 110 projected patients have been completed. Median age was 43 (range 20-79), Nineteen were Caucasian, 7 African-American, I Hispanic, 1 Asian, and 3 other, In-person examinstion detected 209 abnormal physical findings and VTC 189, If non-visnal criteria were exchaded, in-person examination fuund 188 and VTC saw 180 abnormalities, The overall sensitivity and specificity of *vqC in detectiug abnormalities seen by the in-person examination were 82,3% and 98.1% (87,8% and 98.0%, ~ith exclusion of non-visual criteria) Positive and negative predictive values were 91.0% and 95.9% (91.7% and 96.9% w~th exclusmn ot nonwiaual cnteria). Overall accuracy was 95.0% with Cohen's kappa = 0 8 3 4 1 ( p < 0 0 0 0 1 ) , and 95.9% with exclusion of non-visual criteria (kappa = 08713, p<0.0001). C,ynecomastia and rash were overcalled by the VTC, and the sensitivity of detecting scleral ictems and skin iaundice were only 71.4 and 50.0% Patients consistently scored the VTC experience positivdy, and 25/31 (80.6% with 95% C[: 0.630.93) would choose to be seen via "~q-C near their home vs. traveling 2 hours to see the bepatologist in person. CONCLUSIONS: Physical exanrs using VTC appear to strongly agree with in-person examinatirms with high kappa agreement scores. Patients positively rated the experience, and the majority preferred VTC to traveling long distances to see the physicians. Findings that require depth pemepuon (e.g, gynecomastia), fine detail (eg. rash) and those requiring subtle color discnmation (e.g. jaundice) may be difficult to detect consiatently by VTC,
Kap,pa
Sigmold Descending Transverse Ascending Cecum Terminal colon , colon colon colon Ileum
0,80
0,90
0,81
0,79
0,81
0,86
Kappa~ i e r R : range0-1, a highervalue is combinedwith a higherconcordance,
T1732 A Comparison of Magnetic Resonance Imaging and Plain Abdominal Radiography in Neonatal Necrotising Enterocolitis Andrew A. Fagbemi, Anna Thornton, Ella Maaloul, Philip Duggan. David Edwards, Graeme Bydder, Kokila Lakhoo BACKGROUND AND OBJECTIVE. The aim of the study was to establish the value of nmgoetic resonance (MR) imaging and abdominal radiography in predicting surgical findings in infants suspected of suffenirg from Necrotismg Entemcolins (NEC). METHODS. Fifieen preterm infants with suspected NEC were examined by abdominal MR imaging and plain radiograph}, using a 1-Tesla MR (Marconi Medical) located within the neortatal intensive care unit. The MR and X rays images were evaluated by two observers for boy/el wail thickness, dilatation of bowel loops, (small and large bowel differentiation), presence of fluid filled bowel, fi'ee peritoneal fluid, mesenteric oedema, intramural and portal venous gas) and the results compared with fndings at surgery" Six weight and age matched infants were imaged with abdominal distension but no NEC to provide comparison data RESULTS Thirteen of the study preterm infants, had the diagnosis of NEC confirmed at surgery, tF.e remaining two were found to have volvulus, MR imaging is more sensitive tot detection of intramural gas with sensitivity = (0.67), portal venous gas sensitivity, = (0.4), mesenteric oedema sensitivity = (0.73) and free fluid sensitB,"W =(0.6), these compared with similar X ray features of intramural gas sensitivity = (0.27), portal venous gas sensitivity =(0.07), abdominal wall oedema sensitivity = (0.07) and free gas sensitivity = (0.07). MRI intramural gas and ti'ee fluid had a specificity of 0.5 and all other features had specifcity of 1 CONCLUSION Both plain radiography and MR imaging can show features of NEC, but MRI is more sensitive and specific. No test is particularly successful.
r1730 T1733
The Usefulness of Virtual Endoscopy by Ultrasonography in the Diagnosis of the Large Intestinal Disease Tsuguo Kamioka, Yasumasa Niwa, Yoshiki Hirooka, Naoki Ohmiya, Akihiro ito, Seniu Hashimoto, Nobuhiro Ando, Yoji Sasald, Ryqi Miyahara, Akira Ohashi, Hidemi Goto
A Comparison of MRI Based Colonography with Conventional Colonoscopy in Patients with Inflammatory Bowel Disease AndI~as G. Schreyer, Johamres Seitz
BACKGROUND: Ultrasonic examination has become increasingly important in the diagnosis of gastrointestinal tract diseases. In ueoplastic diseases of the large intestine, however, the diagnostic value of conventional tmnsabdominal sonography is limited. 1he aim of this study is to assess the usefufrmss of virtual endoseopy by transabdommal uhrasonography (US&*E) in the diagnosis of large intestinal diseases. SUBJECTS: From March 2000 to October 2002, we pertbnned US&"E on 35 patients, 15 who had already been examined by colonoscopy and diagnosed at other hospitals, and 20 who were introduced to our hospital because of positive fecal occult blood. METHODS: Patients received a routine bowel preparation m the morning and transabdominal US ,,','as accomplished using the ATL HDI5000 scanner with 2-5 MHz convex transducer, and employing Silicon Graphic Advanced 3DI as 3-dinlensional picture analysis equipnmnt. We carried out the scan of the large
AGA Abstracts
Purpose: To compare conventional colonoscopy with MRI based colonography including virtual flights in disease assessment for patients with inflammatory bowd disease. Methods: In 16 consecutive patients with known inflammatory bowel disease (1BD) conventmnal colonoscopy (CC) and MRI based colonography (MRC) was performed the same day. After bowel cleansing approximately 1.5 1 of a gadolinium/water mixture ',','as applied rectally 3D FLASH sequences were acqnired m prone and supine position. 2D FLASH was performed before and after iv gadolinium application. MR images were assessed by two radiologists and a gastroemerologist in consensus. The colon was subdivided in 7 parts (sigma, descending colon, right flexure, transverse colon, left flexure, ascending colon, coecum), imaging quaIity and diagnosis of each part was assessed. Additionally a volume rendered virtual colonoscopy of the bowel was performed. Results were compared with the findings of the video taped
A-556