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The radiology of drug-induced disorders of the GI tract
POSTERS
Vol. 2, No. 12, December 1995
P-9
The Radiology of Drug-Induced Disorders of the GI Tract Deborah A. Fein, M.D., Robert A. Gatenby, M.D,, Dina F. Caroline, M.D. Temple University.
This exhibit reviews the radiologic findings in drug-induced disorders involving the gastrointestinal tract. Adverse drug reactions are common, with a reported incidence in hospitalized patients of 10-20%, Some of these reactions are pharmacolog ca ly pred ctable while others are idiosyncratic, About 40% of clinically significant drug reactions affect the gastrointestinal tract. The resulting injury is usually nonspecific and involves the same physiologic processes found in other common diseases. Drug-induced GI disorders, therefore, may mimic infectious, inflammatory, or neoplastic processes. Examples of drug complications involving the gastrointestinal tract as seen by plain films, barium studies, CT, ultrasound, and MRI will be illustrated. These include inflammatory, ulcerative, infectious ischemic, and hemorrhagic processes as well as motility disorders. Drug-associated changes in liver attenuatioa, hepatic neoplasms, pancreatitis, and retroperitoneaI fibrosis will also be demonstrated and discussed.
P-1O Comparison of MRA Flow Measurements and Enalapril Renal Scintigraphy in a Rabbit Model of Renal Artery Stenosis David Fillmore, Kathryn Morton, Adil Mazhar, Daniel Kohlmorgan, Henry Buswell, University of Utah.
A model of renal artery stenosis was created by unilateral banding of renal artery in 11 rabbits. MR angiography and phase contrast (PC) measurements of renal artery flow were performed. Pre and Post enalapril renal scintigraphy were performed. Contrast Angiography was performed to quantitate the degree of renal artery stenosis. Our results demonstrate a significant correlation between the calculated MR PC renal artery flow measurements and the GFR calculated from the nuclear renal scintigraphy. Delay in Time to Peak of the nuclear renogram was also significantly correlated with MR PC renal artery flow measurements. Preliminary results of Gadolinium Echo Planar Imaging (EPI) of this model of rabbit renal artery stenosis will also be presented. Our i n i t i a l results suggest that an integrated MR functional and morphologic evaluation of renal artery stenosis using a combination of MRA and EPI is possible.
Since drug-induced disorders of the gastointestinal tract result in nonspecific findings, the radiologist must be cognizant of these disorders and include drug reactions in the differential diagnosis of many common radiographic abnormalities.
P-ll
The Role of Percutaneous Needle Biopsy for Establishing a Primary Diagnosis of Malignant Lymphoma Nicola Finn, M.D., Gerhard R. Wittich, M.D., Steven Quinn, M.D., Kent Knowles, M.D., Daniel Hyder, M.D., Vicki J. Schnadig, M.D., Eric M. Walser, M.D., RobertA. Morgan, M.D. Universityof Texas MedicalBranch.
Pu~ose: To present multi-institutional data illustrating the current role of percutaneoas radiologically guided needle biopsy for establishing a primary diagnosis of malignant lymphoma, Patients and Methods: This is a retrospective review or 56 patients with a final diagnosis of malignant lymphoma. Fine needle aspiration biopsies were combined with core biopsies using 16 gauge, 18 gauge, 20 and 21 gauge needles. The results of cytological, histological and immunoohemieal analysis were classified as: 1. Definitive tissue diagnosis of malignant lymphoma ineleding sub4yping. 2. Diagnosis suspicious for lymphoma 3. Negative biopsy 4. Biopsy results sufficient for patient managomenl Results: A definitivv tissue diagnosis including subtyping was achieved in 61 percent of patients. Biopsy was suspicious for lymphoma in 36 percent and negative in 3 percent. Overall, 84 percent of biopsy results were sufficient for patient management without the need for open surgical biopsy. Conclusion: The relatively low sensitivity of 61 percent in establishing a definitive diagnosis of primary lymphoma underscores persistent difficulties in retrieving sufficient tissue for histological subclassificatioa. However, advances in cytological classification and adjunctive immunophenotyping often provide sufficient information to allow patient management based on the results of peroutaneous needle biopsy. This was the case in 84 percent of our patients. Excisional biopsy can therefore be limited to a minority of patients.
P-12 Diagnosis of Femoral DV7 by CT Vani S. Garlapati, M.D., Susan A. Afonso, M.D., Jay M. Colby, M.D., Nina Napolitano, M.D., Ashley Davidoff, M.D. University of Massachusetts Medical Center.
Purpose| TO d e t e r m i n e t h e u t i l i t y d i a g n o s i n g ilio-femoral v e i n thrombosis, c o r r e l a t i v e study.
of c o m p u t e r i z e d t o m o g r a p h y in u s i n g d u p l e x scanning as the
Method: W e reviewed t h e abdominal CT scans o v e r a six m o n t h g e r i o d (Jan 1994 to J u n e 1994) and found 27 p a t i e n t s w h o w e r e d i a g n o s e d w i t h DVT. W e r e v i e w e d t h e d u p l e x scans of t h e s e p a t i e n t s and c o m p a r e d t h e m w i t h mT results. Results: A ~ i g n i f i c a n t p e r c e n t a g e of p a t i e n t s h a d c o r r e l a t i n g p o s i t i v e diagnoses. Findings included t a r g e t - l i k e a p p e a r a n c e to the vein, e n h a n c i n g r i m and distension of t h e vein. Conclusion: CT can b e specific in t h e d i a g n o s i s of D V T of t h e femoral vein. W e propose if u n s u s p e c t e d D V T is d i a g n o s e d by CT, no further c o n f i r m a t o r y studies are required, as l o n g as s t r i c t g u i d e l i n e s t o t h e d i a g n o s i s are followed.
1157
Vol. 2, No. 12, December 1995
P-9
The Radiology of Drug-Induced Disorders of the GI Tract Deborah A. Fein, M.D., Robert A. Gatenby, M.D,, Dina F. Caroline, M.D. Temple University.
This exhibit reviews the radiologic findings in drug-induced disorders involving the gastrointestinal tract. Adverse drug reactions are common, with a reported incidence in hospitalized patients of 10-20%, Some of these reactions are pharmacolog ca ly pred ctable while others are idiosyncratic, About 40% of clinically significant drug reactions affect the gastrointestinal tract. The resulting injury is usually nonspecific and involves the same physiologic processes found in other common diseases. Drug-induced GI disorders, therefore, may mimic infectious, inflammatory, or neoplastic processes. Examples of drug complications involving the gastrointestinal tract as seen by plain films, barium studies, CT, ultrasound, and MRI will be illustrated. These include inflammatory, ulcerative, infectious ischemic, and hemorrhagic processes as well as motility disorders. Drug-associated changes in liver attenuatioa, hepatic neoplasms, pancreatitis, and retroperitoneaI fibrosis will also be demonstrated and discussed.
P-1O Comparison of MRA Flow Measurements and Enalapril Renal Scintigraphy in a Rabbit Model of Renal Artery Stenosis David Fillmore, Kathryn Morton, Adil Mazhar, Daniel Kohlmorgan, Henry Buswell, University of Utah.
A model of renal artery stenosis was created by unilateral banding of renal artery in 11 rabbits. MR angiography and phase contrast (PC) measurements of renal artery flow were performed. Pre and Post enalapril renal scintigraphy were performed. Contrast Angiography was performed to quantitate the degree of renal artery stenosis. Our results demonstrate a significant correlation between the calculated MR PC renal artery flow measurements and the GFR calculated from the nuclear renal scintigraphy. Delay in Time to Peak of the nuclear renogram was also significantly correlated with MR PC renal artery flow measurements. Preliminary results of Gadolinium Echo Planar Imaging (EPI) of this model of rabbit renal artery stenosis will also be presented. Our i n i t i a l results suggest that an integrated MR functional and morphologic evaluation of renal artery stenosis using a combination of MRA and EPI is possible.
Since drug-induced disorders of the gastointestinal tract result in nonspecific findings, the radiologist must be cognizant of these disorders and include drug reactions in the differential diagnosis of many common radiographic abnormalities.
P-ll
The Role of Percutaneous Needle Biopsy for Establishing a Primary Diagnosis of Malignant Lymphoma Nicola Finn, M.D., Gerhard R. Wittich, M.D., Steven Quinn, M.D., Kent Knowles, M.D., Daniel Hyder, M.D., Vicki J. Schnadig, M.D., Eric M. Walser, M.D., RobertA. Morgan, M.D. Universityof Texas MedicalBranch.
Pu~ose: To present multi-institutional data illustrating the current role of percutaneoas radiologically guided needle biopsy for establishing a primary diagnosis of malignant lymphoma, Patients and Methods: This is a retrospective review or 56 patients with a final diagnosis of malignant lymphoma. Fine needle aspiration biopsies were combined with core biopsies using 16 gauge, 18 gauge, 20 and 21 gauge needles. The results of cytological, histological and immunoohemieal analysis were classified as: 1. Definitive tissue diagnosis of malignant lymphoma ineleding sub4yping. 2. Diagnosis suspicious for lymphoma 3. Negative biopsy 4. Biopsy results sufficient for patient managomenl Results: A definitivv tissue diagnosis including subtyping was achieved in 61 percent of patients. Biopsy was suspicious for lymphoma in 36 percent and negative in 3 percent. Overall, 84 percent of biopsy results were sufficient for patient management without the need for open surgical biopsy. Conclusion: The relatively low sensitivity of 61 percent in establishing a definitive diagnosis of primary lymphoma underscores persistent difficulties in retrieving sufficient tissue for histological subclassificatioa. However, advances in cytological classification and adjunctive immunophenotyping often provide sufficient information to allow patient management based on the results of peroutaneous needle biopsy. This was the case in 84 percent of our patients. Excisional biopsy can therefore be limited to a minority of patients.
P-12 Diagnosis of Femoral DV7 by CT Vani S. Garlapati, M.D., Susan A. Afonso, M.D., Jay M. Colby, M.D., Nina Napolitano, M.D., Ashley Davidoff, M.D. University of Massachusetts Medical Center.
Purpose| TO d e t e r m i n e t h e u t i l i t y d i a g n o s i n g ilio-femoral v e i n thrombosis, c o r r e l a t i v e study.
of c o m p u t e r i z e d t o m o g r a p h y in u s i n g d u p l e x scanning as the
Method: W e reviewed t h e abdominal CT scans o v e r a six m o n t h g e r i o d (Jan 1994 to J u n e 1994) and found 27 p a t i e n t s w h o w e r e d i a g n o s e d w i t h DVT. W e r e v i e w e d t h e d u p l e x scans of t h e s e p a t i e n t s and c o m p a r e d t h e m w i t h mT results. Results: A ~ i g n i f i c a n t p e r c e n t a g e of p a t i e n t s h a d c o r r e l a t i n g p o s i t i v e diagnoses. Findings included t a r g e t - l i k e a p p e a r a n c e to the vein, e n h a n c i n g r i m and distension of t h e vein. Conclusion: CT can b e specific in t h e d i a g n o s i s of D V T of t h e femoral vein. W e propose if u n s u s p e c t e d D V T is d i a g n o s e d by CT, no further c o n f i r m a t o r y studies are required, as l o n g as s t r i c t g u i d e l i n e s t o t h e d i a g n o s i s are followed.
1157