- Email: [email protected]
Sa1186 The Pathological Evaluation of Pancreatic Fibrosis Correlates With Apparent Diffusion Coefficient Values Based on Diffusion-Weighted MRI
Specimens were retrospectively reviewed to measure the length of interlobular and intralobular fibrosis and to determine the fibrosis grade according to the fibrotic structure change and the stage of pancreatic stellate cell (PSC) activity. Preoperative DWI with single-shot echo-planar technique at b values of 0 and 500 s/mm2 was performed to calculate ADC values in the same locations of pancreatic specimens. The ADC values were compared with pathological results using a Spearman's rank correlation and a Mann-Whitney test. Receiver operating characteristics (ROC) analysis was used to assess the performance of ADC in prediction of the presence of advanced pancreatic fibrosis. Results: There was a significant trend toward an increase in pathological measurement length of interlobular (r=0.553, p,0.0001) and intralobular (r=0.52, p ,0.0001) collagenous fibers with increasing the fibrosis grade. And there was a significant trend toward an increase in pathological measurement length of interlobular (r=0.576, p ,0.0001) and intralobular (r=0.552, p ,0.0001) collagenous fibers with increasing the PSC stage. And a significant strong correlation was identified between the fibrosis grade and the PSC stage (r=0.789, p ,0.0001). There was a significant trend toward a decrease in the ADC value with increasing the fibrosis grade (G0:1.842±0.284, G1:1.768±0.332, G2:1.600±0.423, G3:1.391±0.269) and with increasing the PSC stage (S0:1.913±0.284, S1:1.751±0.332, S2:1.577±0.292, S3:1.341±0.263), and the difference among the ADCs was statistically significant. The pancreas of the grade 3 fibrosis with aciner cell atrophy and the pancreas of the stage 3 PSC activity with strong positive immunoreaction of anti-alpha SMA were regarded as the hard pancreas. By the ROC analysis, we found the ADC value to be a significant predictor of the hard pancreas (the grade 3 fibrosis and the stage 3 PSC activity) with areas under the curve of 0.802 and 0.858, sensitivity of 100% and 100%, and specificity of 58% and 60% (ADC, 1.743×103mm2/s or less). Conclusion: ADC value based on DWI can be used for prediction of the presence of advanced pancreatic fibrosis.
Biodistribution of Orally Administered 99mtc-Heparin: A Radiolabeled Contrast Agent for Eosinophilic Esophagitis Associated Inflammation Hedieh Saffari, Russell M. Condie, Jeffrey Krstyen, Kathryn Peterson, Gerald J. Gleich, Leonard Pease Background: 99mTc-Heparin provides contrast for localized inflammation in eosinophilic esophagitis (EoE), because the markedly basic eosinophil granule proteins deposit in inflamed regions of the esophagus and eosinophil granule proteins, such as major basic protein 1 (MBP-1), bind strongly to heparin (Swaminathan GJ, et al., Biochemistry 44 (2005) 141528). In prior experiments, we tested the ability of 99mTc-heparin to bind to cationic eosinophil granule proteins, and we demonstrated that the 99mTc-heparin binds to Macaca monkey tissues coated with MBP-1. We also demonstrated that radiolabeled heparin binds in vitro to esophageal biopsies from patients with EoE. We are now poised to determine whether radiolabeled heparin localizes specifically to the esophagus of patients with eosinophilic esophagitis by having patients swallow the reagent and image its binding by single-photon emission computed tomography (SPECT). Aim: To evaluate the radiation risk from 99mTcheparin by studying the tissue distribution and calculating the radiation dose from orally administered 99mTc-heparin to mice. Method: 99mTc-Heparin (500 μCi/mouse, 15 mg) was administered to mice (C57-B16) by oral gavage. At each time point (0.75, 1.5, 3, 6, 18, and 30 hours), mice were euthanized with CO2 and positioned prone on the scanner bed. SPECT/CT images of mice were acquired by using an Inveon trimodality PET/SPECT/ CT scanner (Siemens Preclinical Solutions, Knoxville, TN). The activity of the harvested organs was measured in a well counter. Results: 99mTc-Heparin was not absorbed significantly through the GI tract into other bodily tissue. The highest radioactivities occurred mainly in stomach, small and large intestine. Discussion: These proof-of-principle experiments clearly show that 99mTc-heparin stays in GI tract and is not strongly absorbed. Furthermore, because heparin is a physiological substance that has long been used in clinical medicine, we believe that it will be well tolerated in our patients. This finding is important because it initiates a new avenue for clinical detection of EoE associated inflammation.
Sa1187 Long Term Rebleeding in Patients With Obscure Gastrointestinal Bleeding After First Deep Enteroscopy Wai K Leung, Sze Hang Kevin Liu, Yuk-Fai Lam, Teresa Tong, Ivan F. Hung Background: Deep enteroscopy is increasingly used for the diagnosis and treatment of patients with obscure gastrointestinal bleeding (OGIB). Few studies evaluated the long term rebleeding rates in OGIB patients after deep enteroscopy. Aim: To determine the long term rebleeding rates and the risk factors associated with rebleeding in OGIB patients after first deep enteroscopy. Methods: A retrospective cohort study in OGIB patients who have undergone their first deep enteroscopy (including single-balloon, double balloon and spiral) in our hospital between January 2005 and June 2012. All patients were managed according to their baseline enteroscopy findings to receive endoscopic therapy, surgery or supportive management. Endoscopic therapy including argon plasma coagulation, clipping, injections and heater probe were applied to small bowel bleeding pathology when appropriate. All patients were continuously monitored for clinical rebleeding which were defined as either overt bleeding with passage of melena/blood or the reappearance of iron deficiency anemia requiring blood transfusion. Factors associated with long term rebleeding were determined by univariate and multivariate analyses. Results: A total of 59 patients (mean age 65.7 years; 44.1% male) with OGIB (20 overt and 39 occult bleeding) had undergone their first deep enteroscopy (26 single-balloon, 28 double-balloon and 5 spiral) during the study period. The median follow up was 44 (Range 1 -82) months. The most common cause of bleeding was small bowel vascular lesion (37.2%), small bowel tumors (15.3%) and ulcers (13.6%). Thirty-two (54.2%) patients had clinical rebleeding on long term follow up. The median time to rebleeding was 5 (Range 1-60) months. The highest rebleeding rate was observed in patients with small bowel vascular lesions (86.4% vs 35.1% in other diagnoses; P = 0.001, Log Rank; Figure). The use of oral anti-coagulants (83.3% vs 46.8% in non-users; P= 0.024) and the presence of concurrent medical illnesses including cardiac disease, liver cirrhosis and renal failure (66.7% vs 38.5%; P = 0.028) were significantly associated with recurrent bleeding after first deep enteroscopy on univariate analysis. However, patient's age, the type of OGIB (overt vs occult), the use of anti-platelet agents and the choice of enteroscopy were not associated with rebleeding. Multivariate analysis showed that only a diagnosis of small bowel vascular lesions was significantly associated with long term rebleeding (hazard ratio 9.0; 95% CI, 2.1 - 39.6). Conclusion: Our long term follow up study shows a very high rebleeding rate in patients with small bowel vascular lesions after their first deep enteroscopy. The long term benefits of deep enteroscopy in this group of patients may have to be reevaluated.
SPECT image of oral administered Tc-99m Heparin to mice after 6 hours time point. Sa1186 The Pathological Evaluation of Pancreatic Fibrosis Correlates With Apparent Diffusion Coefficient Values Based on Diffusion-Weighted MRI Kaori Tanaka, Shinji Osada, Hiroyuki Tomita, Akira Hara, Kazuhiro Yoshida Time to rebleeding in patients with small bowel vascular lesions after the first deep enteroscopy
Objective: The purpose of this study was to evaluate the clinical usefulness of apparent diffusion coefficient (ADC) measurements based on diffusion-weighted MRI (DWI) to predict the quantification of pancreatic fibrosis. Subjects and methods: Subjects were comprised of 56 specimens which were obtained by patients who had performed pancreatic resection.
S-223
AGA Abstracts
AGA Abstracts
Sa1185
Biodistribution of Orally Administered 99mtc-Heparin: A Radiolabeled Contrast Agent for Eosinophilic Esophagitis Associated Inflammation Hedieh Saffari, Russell M. Condie, Jeffrey Krstyen, Kathryn Peterson, Gerald J. Gleich, Leonard Pease Background: 99mTc-Heparin provides contrast for localized inflammation in eosinophilic esophagitis (EoE), because the markedly basic eosinophil granule proteins deposit in inflamed regions of the esophagus and eosinophil granule proteins, such as major basic protein 1 (MBP-1), bind strongly to heparin (Swaminathan GJ, et al., Biochemistry 44 (2005) 141528). In prior experiments, we tested the ability of 99mTc-heparin to bind to cationic eosinophil granule proteins, and we demonstrated that the 99mTc-heparin binds to Macaca monkey tissues coated with MBP-1. We also demonstrated that radiolabeled heparin binds in vitro to esophageal biopsies from patients with EoE. We are now poised to determine whether radiolabeled heparin localizes specifically to the esophagus of patients with eosinophilic esophagitis by having patients swallow the reagent and image its binding by single-photon emission computed tomography (SPECT). Aim: To evaluate the radiation risk from 99mTcheparin by studying the tissue distribution and calculating the radiation dose from orally administered 99mTc-heparin to mice. Method: 99mTc-Heparin (500 μCi/mouse, 15 mg) was administered to mice (C57-B16) by oral gavage. At each time point (0.75, 1.5, 3, 6, 18, and 30 hours), mice were euthanized with CO2 and positioned prone on the scanner bed. SPECT/CT images of mice were acquired by using an Inveon trimodality PET/SPECT/ CT scanner (Siemens Preclinical Solutions, Knoxville, TN). The activity of the harvested organs was measured in a well counter. Results: 99mTc-Heparin was not absorbed significantly through the GI tract into other bodily tissue. The highest radioactivities occurred mainly in stomach, small and large intestine. Discussion: These proof-of-principle experiments clearly show that 99mTc-heparin stays in GI tract and is not strongly absorbed. Furthermore, because heparin is a physiological substance that has long been used in clinical medicine, we believe that it will be well tolerated in our patients. This finding is important because it initiates a new avenue for clinical detection of EoE associated inflammation.
Sa1187 Long Term Rebleeding in Patients With Obscure Gastrointestinal Bleeding After First Deep Enteroscopy Wai K Leung, Sze Hang Kevin Liu, Yuk-Fai Lam, Teresa Tong, Ivan F. Hung Background: Deep enteroscopy is increasingly used for the diagnosis and treatment of patients with obscure gastrointestinal bleeding (OGIB). Few studies evaluated the long term rebleeding rates in OGIB patients after deep enteroscopy. Aim: To determine the long term rebleeding rates and the risk factors associated with rebleeding in OGIB patients after first deep enteroscopy. Methods: A retrospective cohort study in OGIB patients who have undergone their first deep enteroscopy (including single-balloon, double balloon and spiral) in our hospital between January 2005 and June 2012. All patients were managed according to their baseline enteroscopy findings to receive endoscopic therapy, surgery or supportive management. Endoscopic therapy including argon plasma coagulation, clipping, injections and heater probe were applied to small bowel bleeding pathology when appropriate. All patients were continuously monitored for clinical rebleeding which were defined as either overt bleeding with passage of melena/blood or the reappearance of iron deficiency anemia requiring blood transfusion. Factors associated with long term rebleeding were determined by univariate and multivariate analyses. Results: A total of 59 patients (mean age 65.7 years; 44.1% male) with OGIB (20 overt and 39 occult bleeding) had undergone their first deep enteroscopy (26 single-balloon, 28 double-balloon and 5 spiral) during the study period. The median follow up was 44 (Range 1 -82) months. The most common cause of bleeding was small bowel vascular lesion (37.2%), small bowel tumors (15.3%) and ulcers (13.6%). Thirty-two (54.2%) patients had clinical rebleeding on long term follow up. The median time to rebleeding was 5 (Range 1-60) months. The highest rebleeding rate was observed in patients with small bowel vascular lesions (86.4% vs 35.1% in other diagnoses; P = 0.001, Log Rank; Figure). The use of oral anti-coagulants (83.3% vs 46.8% in non-users; P= 0.024) and the presence of concurrent medical illnesses including cardiac disease, liver cirrhosis and renal failure (66.7% vs 38.5%; P = 0.028) were significantly associated with recurrent bleeding after first deep enteroscopy on univariate analysis. However, patient's age, the type of OGIB (overt vs occult), the use of anti-platelet agents and the choice of enteroscopy were not associated with rebleeding. Multivariate analysis showed that only a diagnosis of small bowel vascular lesions was significantly associated with long term rebleeding (hazard ratio 9.0; 95% CI, 2.1 - 39.6). Conclusion: Our long term follow up study shows a very high rebleeding rate in patients with small bowel vascular lesions after their first deep enteroscopy. The long term benefits of deep enteroscopy in this group of patients may have to be reevaluated.
SPECT image of oral administered Tc-99m Heparin to mice after 6 hours time point. Sa1186 The Pathological Evaluation of Pancreatic Fibrosis Correlates With Apparent Diffusion Coefficient Values Based on Diffusion-Weighted MRI Kaori Tanaka, Shinji Osada, Hiroyuki Tomita, Akira Hara, Kazuhiro Yoshida Time to rebleeding in patients with small bowel vascular lesions after the first deep enteroscopy
Objective: The purpose of this study was to evaluate the clinical usefulness of apparent diffusion coefficient (ADC) measurements based on diffusion-weighted MRI (DWI) to predict the quantification of pancreatic fibrosis. Subjects and methods: Subjects were comprised of 56 specimens which were obtained by patients who had performed pancreatic resection.
S-223
AGA Abstracts
AGA Abstracts
Sa1185