Gastrointestinal Radiology

547 Pages·2016·2.46 MB·English

Gastrointestinal Radiology

ED023

CME Learning Checkpoint Exhibit ED023 (Neoplastic Diseases of Duodenum)

All Day Room: Case of Day, Learning Center

GI

AMA PRA Category 1 Credit ™: .50

Participants
Yong-Soo Kim, MD, PhD, Guri City, Korea, Republic Of (Presenter) Nothing to Disclose
Sangjoon Lee, MD, Guri, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sanghyeok Lim, MD, Gyeonggi-do, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose

ED029

CME Learning Checkpoint Exhibit ED029 (Dect Applications in the Liver: All You Need to Know)

All Day Room: Case of Day, Learning Center

GI

AMA PRA Category 1 Credit ™: .50

Participants
Avinash R. Kambadakone, MD, Boston, MA (Presenter) Nothing to Disclose
Manuel Patino, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Dushyant V. Sahani, MD, Boston, MA (Abstract Co-Author) Research support, General Electric Company; Medical Advisory Board,
Allena Pharmaceuticals, Inc
Andrea Prochowski Iamurri, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose

GI001-EB-X

Acute Mesenteric Ischaemia: Imaging Presentation of Common and Rare Findings and Differential Diagnoses

All Day Room: GI Community, Learning Center

Participants
Marie-Luise Kromrey, MD, Greifswald, Germany (Presenter) Nothing to Disclose
Norbert Hosten, MD, Greifswald, Germany (Abstract Co-Author) Institutional research agreement, Siemens AG; Institutional research
agreement, Bayer AG; Stockholder, Siemens AG

TEACHING POINTS

1. Review etiology, diagnosis and therapeutic options of acute mesenteric ischaemia.2. Outline its common direct and indirect
imaging presentation.3. Illustrate case-based rare findings and differential diagnoses.

TABLE OF CONTENTS/OUTLINE

Background on Acute Mesenteric Ischaemia- Etiology- Imaging Techniques- Therapeutic OptionsCommon Imaging Presentation of
Acute Mesenteric Ischaemia- Direct Signs of Acute Mesenteric Ischaemia- Indirect Signs of Acute Mesenteric IschaemiaRare
Findings – Differential Diagnoses Radiologists Should ConsiderConclusion

GI002-EB-X

Inside Out: Ductal Morphology in Characterization of Pancreatic Pathology

All Day Room: GI Community, Learning Center

Awards
Certificate of Merit

Participants
Ali Pirasteh, MD, Dallas, TX (Presenter) Nothing to Disclose
Gaurav Khatri, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Alberto Diaz de Leon, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Nisa Kubiliun, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Ivan Pedrosa, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

Different pancreatic duct appearances are predictive of pancreas disease processes. Multiple ancillary findings associated with
ductal anomalies help with pancreatic disease diagnosis.

TABLE OF CONTENTS/OUTLINE

Embryology, normal anatomy, and variants of the pancreatic ductal system. Pattern recognition Inflammatory Acute pancreatitis:
invisible/compressed duct secondary to an inflamed pancreas Chronic pancreatitis: areas of duct stricture and dilatation in an
atrophied pancreas +/- parenchymal and intraductal calcifications Autoimmune pancreatitis: multifocal duct narrowing and loss of
pancreatic lobulations +/- pseudocapsule Neoplastic Primary ductal – 1) Main-duct Intraductal Papillary Mucinous Neoplasm (IPMN):
dilated main duct without strictures +/- side branch dilatation and intraductal papillary projections; 2) Branch-type IPMN; 3) Mixed-
type IPMN Adenocarcinoma: duct dilatation upstream to the infiltrative lesion and normal duct downstream +/- common bile duct
dilatation for pancreatic head lesions Neuroendocrine and other rare variants: mild dilation from extrinsic mass effect without direct
invasion. Atypical presentation with intraductal masses Metastases – e.g. renal cell, lung, breast: mild irregularity of the duct
without dilation Post-surgical – e.g. Post Whipple and Fray

GI003-EB-X

Identification of Atypical Presentation of Pancreatic Neuroendocrine Tumor (NET)

All Day Room: GI Community, Learning Center

Participants
Wu S. Liu, DO, Tucson, AZ (Presenter) Nothing to Disclose
Bobby T. Kalb, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Hina Arif Tiwari, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Ferenc Czeyda-Pommersheim, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
Iva Petkovska, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Diego R. Martin, MD, PhD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
James R. Costello, MD, PhD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

NETs with atypical imaging features challenge the most experienced radiologists. By sharing atypical presentations of NETs, we
hope to increase imaging accuracy and early diagnosis. The spectrum of NET presentations include: typical solid NET, atypical
solid NET, cystic NET. Dynamic contrast-enhanced magnetic resonance imaging and diffusion weighted imaging provide powerful
imaging tools. Most NETs are hyper-vascular with typical MRI features: hypointense to background pancreas on pre-contrast
imaging, robust enhancement on arterial phase, marked restricted diffusion on DWI. Atypical presentations of NETs can include both
solid and cystic variants. Solid tumors can demonstrate hypointensity on pre-contrast imaging which becomes isointense to
background pancreas on arterial phase. Since expectations predict the mass to be hyperintense to background pancreas, this
enhancement pattern can confound even the most skilled radiologists. Equally challenging are cystic neuroendocrine tumors which
can closely resemble such mimics as pseudocysts, solid pseudopapillary tumors, ductal adenocarcinomas with cystic features,
pancreatic IPMNs, and mucinous cystadenomas.

TABLE OF CONTENTS/OUTLINE

- MRI techniques- Solid typical NET MRI features- Atypical NET MRI features- Cystic NET MRI features- MRI features of NET
mimickers

GI004-EB-X

Clinical Challenges and Images of Incidental Splenic Masses: How Much Do You Know Regarding Splenic
Tumors and Mimickers?

All Day Room: GI Community, Learning Center

FDA
Discussions may include off-label uses.

Awards
Identified for RadioGraphics

Participants
Jin Woong Kim, MD, Jeollanamdo, Korea, Republic Of (Presenter) Nothing to Disclose
Sang Soo Shin, MD, Gwangju, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyo Soon Lim, MD, Jeollanam-Do, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyun Ju Seon, MD, Hwasun-Eup, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Suk Hee Heo, MD, Hwasun-Gun, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Young Hoe Hur, Jeollanam-Do, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yong-Yeon Jeong, MD, Chonnam, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

1. To overview imaging findings of various splenic tumors and mimickers2. To illustrate radiologic-pathologic correlation in various
splenic tumors and mimickers3. To discuss differential points to help discriminate among various splenic tumors and mimickers

TABLE OF CONTENTS/OUTLINE

1. Classification of splenic neoplastic and non-neoplastic lesions2. Clinical challenges and images 1) Case 1: Metastasis 2) Case 2:
Pseudocyst 3) Case 3: Hamartoma 4) Case 4: Hemangioma 5) Case 5: Microabscess 6) Case 6: Angiosarcoma 7) Case 7: Epithelial
cyst 8) Case 8: Lymphangioma 9) Case 9: Splenic abscess 10) Case 10: Hemangiomatosis 11) Case 11: Splenic infarction 12) Case
12: Malignant lymphoma 13) Case 13: Invasive aspergillosis 14) Case 14: Intraparenchymal hematoma 15) Case 15: Malignant
fibrous histiocytoma 16) Case 16: Sclerosing angiomatoid nodular transformation3. Review of cases 1~16 with radiologic-pathologic
correlation4. Summary of useful radiologic findings to help discriminate among various splenic tumors and mimickers5. Suggested
algorithms for narrowing differential diagnosis of various splenic tumors and mimickers

GI005-EB-X

How To Differentiate Cystic Pancreatic Lesions: A Pictorial Review with Pathologic Correlation

All Day Room: GI Community, Learning Center

Participants
Suraj J. Kabadi, MD, Charlottesville, VA (Presenter) Nothing to Disclose
Arun Krishnaraj, MD, MPH, Charlottesville, VA (Abstract Co-Author) Nothing to Disclose
Eduard E. DeLange, MD, Charlottesville, VA (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

Illustrate the imaging features of various cystic pancreatic lesions, specifically pseudocyst, serous cystadenoma, mucinous cystic
neoplasm, solid and pseudopapillary neoplasm, and side-branch and main duct intraductal papillary mucinous neoplasm Highlight the
demographics, pathologic appearance, and cyst aspiration profiles characteristic of each lesion Review the malignant potential and
management of each lesion

TABLE OF CONTENTS/OUTLINE

1. A review of the imaging features on CT and MRI of the following cystic pancreatic lesions with a focus on how demographics and
other contributory patient data can help favor a diagnosis Pseudocyst Serous cystadenoma Mucinous cystic neoplasm Solid and
pseudopapillary neoplasm Side-branch intraductal papillary mucinous neoplasm Main duct intraductal papillary mucinous neoplasm
Other miscellaneous cystic lesions2. A brief review of the gross pathologic features and microscopic features of each lesion3.
Correlation of cyst aspiration profiles associated with each lesion, with an emphasis on CEA, CA 19-9, mucin, and amylase/lipase4.
A review of the natural history of each lesion, malignant potential, and management algorithms

GI006-EB-X

Imaging Presentations of Pancreatic Neuroendocrine Neoplasms

All Day Room: GI Community, Learning Center

Participants
Mirko D'onofrio, MD, Verona, Italy (Presenter) Nothing to Disclose
Valentina Ciaravino, MD, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Nicolo Cardobi, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Paolo Tinazzi Martini, MD, Peschiera del Garda, Italy (Abstract Co-Author) Nothing to Disclose
Riccardo De Robertis, MD, Verona, Italy (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

To show different typical and atypical, common and uncommon, rare and very rare imaging presentations of pancreatic
neuroendocrine neoplasms. The images cases will be presented with multimodalities approaches and pathologic correlations to
justify and explain the presented features.

TABLE OF CONTENTS/OUTLINE

Pancreatic neuroendocrine neoplasms usually present as hypervascular masses. More rarely can be hypovascular making the
differential diagnosis in respect to ductal adenocarcinoma very difficult or impossible. Many other presentations of pancreatic
neuroendocrine neoplasms are possible because the lesions can be cystic, necrotic or calcified. Moreover these tumors can be
single or multiple involving different site of the pancreatic gland. Regarding the growth patterns the pancreatic neuroendocrine
neoplasms can involve vessels by infiltration or colonization of the vascular lumen that is quite typical of this pancreatic tumor
hystoptype. Finally the pancreatic neuroendocrine tumors can spread to other sites with few organ or multi-organ metastatic
diffusion.All these aspects will be shown and explained to improve radiologist knowledge to diagnose and stage pancreatic
neuroendocrine neoplasms.The radiologist should be aware of all these possible presentations to better diagnosis, report and
manage each every single case.

GI007-EB-X

Evaluation of Subepithelial Lesions of Stomach with Three-dimensional Multi-detector CT Gastrography:
Emphasis on Differential Diagnosis

All Day Room: GI Community, Learning Center

FDA
Discussions may include off-label uses.

Participants
Jin Woong Kim, MD, Jeollanamdo, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sang Soo Shin, MD, Gwangju, Korea, Republic Of (Presenter) Nothing to Disclose
Hyo Soon Lim, MD, Jeollanam-Do, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyun Ju Seon, MD, Hwasun-Eup, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Suk Hee Heo, MD, Hwasun-Gun, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Young Hoe Hur, Jeollanam-Do, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yong-Yeon Jeong, MD, Chonnam, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

1. To list common and uncommon gastric subepithelial lesions (SELs)2. To correlate imaging features of various gastric SELs in CT
gastrography with endoscopy and EUS3. To discuss differential diagnosis of various gastric SELs

TABLE OF CONTENTS/OUTLINE

A. IntroductionB. Frequency and location of various SELs in stomachC. Diagnostic approach to gastric SELs 1. Comparison among
conventional endoscopy, EUS and CT gastrography 2. Role of CT gastrography for evaluation of gastric SELs 3. Comprehensive
guidelines for imaging diagnosis of SELsD. Imaging findings of various SELs in CT gastrography with endoscopic and EUS
correlation 1. True neoplasiaa. GIST, b. leiomyoma, c. schwannoma, d. glomus tumor, e. lipoma, f. hemangioma, g. inflammatory
fibroid polyp, h. carcinoid tumor 2. Non-neoplastic lesionsa. ectopic pancreas, b. gastritis cystica profunda, C. varices3. Diagnostic
pitfallsE. Summary of useful imaging findings in differential diagnosis of various SELs in stomachF. Suggested diagnostic algorithms
for various gastric SELs

GI008-EB-X

Accurate Magnetic Resonance Imaging Diagnosis of Splenic Pathology

All Day Room: GI Community, Learning Center

Participants
Viral Patel, DO, Tucson, AZ (Presenter) Nothing to Disclose
Bobby T. Kalb, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Hina Arif Tiwari, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Ferenc Czeyda-Pommersheim, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
Iva Petkovska, MD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
Diego R. Martin, MD, PhD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose
James R. Costello, MD, PhD, Tucson, AZ (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

Advanced magnetic resonance imaging (MRI) provides a powerful imaging tool for the accurate diagnosis of splenic pathology.
Splenic findings present frequently as an incidental observation, and advanced MRI techniques provide valuable insight to generate
an accurate imaging description. Advanced MRI techniques rely upon traditional T2w and T1w imaging in addition to such functional
imaging techniques as diffusion weighted imaging and spectroscopic evaluation of fat and iron content. MRI frequently provides an
additional component of soft tissue contrast which eludes traditional CT imaging. More importantly, MRI helps not only to distinguish
between benign and malignant etiologies but also to provide an accurate and specific description of often confused diagnostic
considerations.

TABLE OF CONTENTS/OUTLINE

Advanced MRI techniques
Congenital variants of the spleen on commonly acquired MR sequences
Overview of disease processes affecting the spleen: Heterotaxy Syndrome with Left Isomerism Abscess & Microabscesses
Sarcoidosis Hematologic (Sickle Cell Disease, Extramedullary Hematopoiesis, Gaucher Disease, Hemosiderosis) Chronic liver Disease
with Stigmata of Portal Hypertension Laceration Infarct Splenic Cyst Hydatid Cyst Hemangioma Hamartoma Lymphangioma
Lymphoma Angiosarcoma Metastatic disease including periserosal implants

GI009-EB-X

Cystic Lesions of Upper Gastrointestinal Tract

All Day Room: GI Community, Learning Center

Participants
Youngseo Cho, MD, Kuri, Korea, Republic Of (Presenter) Nothing to Disclose
Yong-Soo Kim, MD, PhD, Guri City, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sanghyeok Lim, MD, Gyeonggi-do, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

1. To review CT findings of various cystic lesion involving stomach and duodenum
2. To correlated with CT, endoscopic, endoscopic ultrasonography and pathologic findings of various cystic diseases of stomach
and duodenum

TABLE OF CONTENTS/OUTLINE

Cystic lesion in the stomach and duodenum are rare disease entity. Most of cystic lesions are benign lesions and their imaging
features look very similar. Patients have various chief complains such as nonspecific abdominal pain, bowel obstruction, bleeding,
and associated malignancy. We will show the CT and endoscopic ultrasonographic findings of cystic lesion in the upper GI and
correlate these features with pathologic findings. We demonstrate diverse cystic lesions in stomach and duodenum classified as
follows;1. Congenital lesions (bronchogenic cyst, duplication cyst and ectopic pancreas)
2. Inflammatory lesions (gastritis cystica profunda, Tuberculosis, pancreatic pseudocyst and anisakiasis)
3. Neoplasms (lymphangioma, cystic degeneration of GIST and mucinous adenocarcinoma)
4. Miscellaneous lesions (Brunner’s gland cyst, trauma related submucosal hematoma and gossypiboma)

GI011-EB-X

Yellow Alert Simply Noting at the Bedside: Early Detection of Complication Following Liver or Pancreas
Transplantation Using Contrast-enhanced US

All Day Room: GI Community, Learning Center

FDA
Discussions may include off-label uses.

Participants
Ran Kim, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Woo Kyoung Jeong, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Ji Hye Min, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Tae Wook Kang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Kyoung Doo Song, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Won Jae Lee, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Research Grant, Samsung Electronics Co, Ltd

TEACHING POINTS

Contrast-enhanced US (CEUS) is very useful to detect early vascular complications after transplantation at the bedside and enable
to take action immediately. The purposes of this exhibit are :1. To review early complications of liver and pancreas
transplantations.2. To understand the complexity of vascular anatomy after pancreas transplantation.3. To demonstrate various
early complications after liver or pancreas transplantation using CEUS.

TABLE OF CONTENTS/OUTLINE

A. Liver transplantation - Strength of CEUS - Indication/protocol of CEUS after LT - Early complications of liver transplantation *
Hepatic artery thrombosis * Hepatic artery stenosis * Liver ischemia and infarction * Portal vein thrombosis or stenosis * Inferior
vena cava and hepatic vein thrombosis or stenosis * Hyperemia or congestion due to hepatic vein occlusion * Hematoma with
active bleedingB. Pancreas transplantation - Complexity of vascular anatomy following the pancreas transplantation - Early
complications of pancreas transplantation * Vascular graft thrombosis or stenosis * Stricture of duodeno-cystostomy * Graft
rejection

GI012-EB-X

Variable Injection Parameters in Contrast-Enhanced CT: Theory and Clinical Application of the Variable-
Injection Method

All Day Room: GI Community, Learning Center

Participants
Kazuaki Terasawa, PhD, Saitama-Shi, Japan (Presenter) Nothing to Disclose
Tomoyuki Ogata, RT, Saitama, Japan (Abstract Co-Author) Nothing to Disclose
Tomohiro Tsukimata, RT, Nagano-Shi, Japan (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

A contrast method can change around weight and time only with two parameters, the amount of iodine (mgI/kg/s), and injection
duration time (s). From this, in order to change the contrast enhancement effect, the clinical application by the theory of a
variable-injection method and it which used the variation factor (an injection end rate / injection start rate) as the 3rd parameter
was considered.

TABLE OF CONTENTS/OUTLINE

The components of the contrast material flow phantom (TEC phantom).1) Plastic water tank; Contrast material is injected into
(1)2) Flow pump3) Flow meter4) Water-filled acrylic cylinder5) Closed metallic tank6) Connecting tubeContrast material was
circulated with the pulsatile flow pump at a rate of 60 pulses per minute.

GI013-EB-X

Staging and Response Assessment in Pancreatic Cancer: Images Advances and Updates

All Day Room: GI Community, Learning Center

Participants
Vinit Baliyan, MBBS, MD, Boston, MA (Presenter) Nothing to Disclose
Hamed Kordbacheh, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Dushyant V. Sahani, MD, Boston, MA (Abstract Co-Author) Research support, General Electric Company; Medical Advisory Board,
Allena Pharmaceuticals, Inc
Avinash R. Kambadakone, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose

TEACHING POINTS

The purpose of this educational exhibit is: To review the current role of imaging in staging of pancreatic cancer Imaging Role of
advanced Imaging techniques in pancreatic cancer To discuss recent advances and updates in imaging of pancreatic cancer To
highlight key imaging features of pancreatic cancer staging using an interactive quiz based format

TABLE OF CONTENTS/OUTLINE

Updates of technical advances (Dual energy CT, Diffusion weighted MRI) Discuss current criteria and updates in assessment of
pancreatic cancer resectability Prognostic markers and predictors of treatment response on Imaging Interactive case-based imaging
quiz to highlight role of imaging in pancreatic cancer Answers and explanations

Honored Educators

Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/

Dushyant V. Sahani, MD - 2012 Honored Educator
Dushyant V. Sahani, MD - 2015 Honored Educator
Dushyant V. Sahani, MD - 2016 Honored Educator