Gas-containing gallstones as a cause of the "effervescent gallbladder" sign and pneumobilia.

The "effervescent gallbladder" sign, the sonographic finding of tiny echogenic foci rising from the dependent portion of the gallbladder, reminiscent of bubbles rising in a glass of champagne, has been reported previously as a finding of emphysematous cholecystitis. We report two additional cases of this unusual finding in an asymptomatic patient and in a patient with acute, gangrenous cholecystitis, confirmed in both cases by CT, to be secondary to the release of gas from gallstones. These two cases cast doubt on the sonographic sign as a pathognomonic finding of emphysematous cholecystitis.

Pictorial review of colonic polyp and mass distortion and recognition with the CT virtual dissection technique.

Virtual dissection is a three-dimensional (3D) display technique for CT colonography that could potentially reduce interpretation times. With virtual dissection, the 3D model of the colon is "sliced" open along a centerline trace, rendering a 360° view of the endoluminal mucosa as a rectangular image. However, one must be familiar with several pitfalls and limitations to avoid errors in interpretation.

Feasibility of using a walking workstation during CT image interpretation.

Objective: Two-thirds of the US population is overweight or obese. Sedentary lifestyles and occupations are one factor in the development of obesity. Methods to help reduce sedentary work environments may help reduce obesity.

Noncathartic CT colonography with stool tagging: performance with and without electronic stool subtraction.

Objective: The purpose of our study was to evaluate the performance of noncathartic, dietary unrestricted CT colonography, without and with the aid of electronic stool subtraction, for detecting colorectal neoplasia in a high-prevalence referral population.

Materials And Methods: Patients with known or suspected colorectal neoplasms were potentially eligible for participation, regardless of the presence or absence of gastrointestinal symptoms. Subjects ingested 21.

Effect of slice thickness and primary 2D versus 3D virtual dissection on colorectal lesion detection at CT colonography in 452 asymptomatic adults.

Objective: The objective of our study was to compare the performance of primary 3D search using 360 degree virtual dissection with primary 2D search using a 2.5- versus a 1.25-mm slice thickness.

Occult colorectal polyps on CT colonography: implications for surveillance.

Objective: Our purpose was to determine the prevalence of polyps that are invisible on CT colonography (CTC) in a population previously screened for colorectal neoplasms. Differences in the prevalence of occult polyps in various populations might help explain the discordant reported sensitivities for polyp detection in published reports of CTC.

Subjects And Methods: Seventy-five consecutive patients who had been previously screened for polyps underwent same-day colonoscopy and CTC.

CT colonography using 360-degree virtual dissection: a feasibility study.

Objective: Using a 3D rendering technique called "virtual dissection," we sought to evaluate polyp and fold distortion using a colon phantom, estimate the polyp detection performance in humans, and estimate the added benefit of double interpretation and computer-aided diagnosis.

Materials And Methods: A colon phantom containing 144 polyps of varying sizes (5-12 mm) and shapes (flat, sessile, pedunculated) was scanned. Polyp shape and distortion at virtual dissection were categorized as flame, club, pea, or bizarre.

Comparison of the relative sensitivity of CT colonography and double-contrast barium enema for screen detection of colorectal polyps.

Background & Aims: In a population reflective of a screening setting, our aim was to compare the relative sensitivity and specificity of computed tomography (CT) colonography with double-contrast barium enema (DCBE) for detection of colorectal polyps and to assess the added value of double reading at CT colonography, using endoscopy as the arbiter.

Methods: This prospective, blinded study comprised 837 asymptomatic persons at higher than average risk for colorectal cancer who underwent CT colonography followed by same-day DCBE. Examinations with polyps > or =5 mm in diameter were referred to colonoscopy.

Characterization of lesions missed on interpretation of CT colonography using a 2D search method.

Objective: We examined potential factors that may cause false-negative results on CT colonography examinations.

Materials And Methods: In this prospective and retrospective study, 500 asymptomatic patients at high risk for colorectal cancer underwent CT colonography and colonoscopy. Each CT data set was interpreted by two independent observers, who were unaware of endoscopic findings, using a method of searching through enlarged axial images to detect intraluminal lesions.

Computerized tomographic colonography: performance evaluation in a retrospective multicenter setting.

Background & Aims: No multicenter study has been reported evaluating the performance and interobserver variability of computerized tomographic colonography. The aim of this study was to assess the accuracy of computerized tomographic colonography for detecting clinically important colorectal neoplasia (polyps >or=10 mm in diameter) in a multi-institutional study.

Methods: A retrospective study was developed from 341 patients who had computerized tomographic colonography and colonoscopy among 8 medical centers.

Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps.

Background & Aims: This study used a low lesion prevalence population reflective of the screening setting to estimate the sensitivity and specificity of computerized tomographic (CT) colonography for detection of colorectal polyps.

Methods: This prospective, blinded study comprised 703 asymptomatic persons at higher-than-average risk for colorectal cancer who underwent CT colonography followed by same-day colonoscopy. Two of 3 experienced readers interpreted each CT colonography examination.

Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population.

Background & Aims: To assess the prevalence and spectrum of extracolonic findings in a screening population undergoing computed tomography colonography (CTC), and to evaluate the short-term direct medical costs incurred from subsequent radiologic follow-up evaluation.

Methods: Six hundred and eighty-one asymptomatic patients undergoing colonoscopy screening consented to a CTC examination. Extracolonic CT findings were classified into high, medium, and low importance.

Detection of flat lesions in the colon with CT colonography.

Background: We investigated whether flat lesions of the colon could be detected on computed tomographic colonography (CTC).

Methods: CTC and conventional colonoscopy were performed on 547 consecutive patients. A subset of 22 polyps was described as flat on colonoscopy (n = 16) or CTC (n = 6) and are the basis of this report.

A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer.

Background & Aims: The influence of preoperative staging of rectal carcinoma on therapeutic decisions is uncertain. The use of fine-needle aspiration (FNA) of perirectal nodes in this setting has not been evaluated. The aim of this prospective, blinded study of patients with rectal cancer was to assess the impact of preoperative staging on treatment decisions and compare the tumor (T), nodal (N) staging performance characteristics of pelvic computed tomography (CT), rectal endoscopic ultrasonography (EUS), and EUS FNA.

Pirfenidone in the treatment of primary sclerosing cholangitis.

Our aim was to evaluate the safety and assess the efficacy of pirfenidone, an antifibrotic drug, in patients with primary sclerosing cholangitis (PSC). Twenty-four patients with PSC were enrolled in this pilot study. Oral pirfenidone, 2400 mg daily, was given for one year.

CT colonography: single- versus multi-detector row imaging.

Purpose: To compare respiratory artifacts, colonic distention, and polyp detection at computed tomographic (CT) colonography by using single- and multi-detector row helical CT systems.

Materials And Methods: A total of 237 consecutive patients received subcutaneously administered glucagon and underwent prone and supine CT colonography with single-detector row CT (n = 77) and multi-detector row CT (n = 160), followed by colonoscopy. Examination results were graded for colonic distention, respiratory artifacts, and polyp depiction by two radiologists working independently.

Optimization of CT colonography technique: prospective trial in 180 patients.

Purpose: To assess the added benefits of prone positioning in addition to supine positioning and oral iodinated contrast medium for help in the detection of colonic polyps at computed tomographic (CT) colonography.

Materials And Methods: CT colonography was performed in prone and supine positions in 180 patients with polyps or risk factors for colonic neoplasia. Patients were randomly assigned to receive a standard bowel preparation or a standard preparation plus oral iodinated contrast medium.

Eosinophilic ileocolitis secondary to Enterobius vermicularis: case report.

We describe an unusual presentation of Enterobius vermicularis infestation. Computed tomography showed wall thickening in the distal ileum and cecum, with fat stranding, ascites and mesenteric adenopathy. Fluoroscopic examination confirmed distal ileal transverse fold thickening.

Incidental extracolonic findings at CT colonography.

Purpose: To determine the frequency of extracolonic findings at computed tomographic (CT) colonography and the effect of these findings on subsequent patient treatment and cost.

Materials And Methods: Conventional transverse CT colonographic scans in 264 consecutive patients were evaluated independently by two radiologists. Extracolonic findings were classified as having high, moderate, or low clinical importance.

Amyloidosis of the alimentary canal: radiologic-pathologic correlation of CT findings.

Background: The purpose of the study was to describe the computed tomographic (CT) findings of the alimentary canal and mesentery in amyloid infiltration of the gastrointestinal (GI) tract and to correlate the CT findings with histologic extent and distribution and with amyloid subtype.

Methods: Abdominal CT scans performed between 1988 and 1997 on patients with pathologically proven amyloidosis of the alimentary canal and mesentery. Histology was graded for extent of mucosal, submucosal, and muscularis propria involvement and for degree of interstitial and vascular distribution.

Risk and significance of endoscopic/radiological evidence of recurrent Crohn's disease.

Background & Aims: The aim of this study was to determine the risk of endoscopic/radiological recurrence of Crohn's disease postoperatively and the long-term outcome.

Methods: A randomized placebo-controlled trial was performed to determine the effectiveness of mesalamine in preventing recurrent Crohn's disease postoperatively. Patients in the control group were examined endoscopically/radiologically before entry into and annually during the trial.

Detection of colorectal polyps with CT colography: initial assessment of sensitivity and specificity.

Purpose: To estimate the sensitivity and specificity of computed tomographic (CT) colography in detection of colorectal polyps and to compare these findings with those at axial CT.

Materials And Methods: In 70 consecutive patients, CT colography and colonoscopy were performed. Helical axial CT images and CT colographic images (multiplanar two- and three-dimensional endoluminal images) were evaluated separately by two radiologists blinded to results from colonoscopy and other imaging studies.

Barium enema: detection of colonic lesions in a community population.

Objective: The purposes of this study were to assess the prevalence of colonic lesions detected at barium enema in a community practice, to compare the findings at barium enema between patients who are asymptomatic and have no known risk factors for colorectal cancer (screening group) and patients who have symptoms of colonic disease or have known risk factors, and to determine if a questionnaire about symptoms and risk factors is an appropriate screening tool.

Subjects And Methods: A self-administered questionnaire about colorectal symptoms and risk factors was given to 1779 patients scheduled for barium enema examination. On the basis of their responses, patients were divided into three groups: screening group (asymptomatic, without risk factors), symptomatic, and asymptomatic with risk factors.