Upper GI tract CT modelling to assist magnetic-assisted capsule endoscopy development

Clinical Radiology 69 (2014) S1eS9 S3 nodes in the excised specimen was 16.6 6.2 in males and 17.3 5.7 in females (p 1⁄4 0.413). For male patients only, VFA was weakly correlated with reducedLNexcision(Spearman’s r1⁄4 0.17,p1⁄40.045).VFAwasnotassociated with adequacy (>1⁄412) of LN retrieval (Mann-Whitney U test, p 1⁄4 0.066). Conclusion: In our cohort, increased VFA was not associated with adequacy of LN retrieval although increasing visceral fat was weakly correlated with decreased LN excision in males. MRI enterography: indications, technique and findings in 600 cases Authors: Emer McLoughlin*, Edward Goble, Jamal A. Abdulkarim Purpose: to outline the indications, advantages and limitations of MRI Enterography, to explain how MRI Enterography is performed, to highlight the range of intrinsic small bowel and extra-luminal findings seen using this technique. Methods and materials: MRI enterography confers advantages over other small bowel imaging techniques as it is noninvasive and non ionising. This is of particular benefit to a young patient population in whom the investigation and monitoring of Inflammatory Bowel Disease (IBD) is more commonly performed. It involves administering oral enteric contrast and performing specific MRI pulse sequences to image the bowel. Spasmolytic agents are given to reduce bowel peristalsis. Intravenous contrast is also administered to look for areas of hyperenhancement indicating active inflammation. Results: In our institution, approximately 600 MRI Enterography examinations have been performed. Results have shown: mean age of patients undergoing MRI Enterography is 48yrs. most common indications are suspected IBD (32%), follow up of IBD (30%) and investigation of non specific abdominal pain or altered bowel habit. positive findings have been reported in 31% of examinations. a range of non small bowel findings have also been shown. Conclusion: MRI Enterography allows evaluation of the small bowel without the use of ionising radiation. This is beneficial in young patients with known or suspected IBD, allowing safe diagnosis and follow up. The need for laxative in bowel preparation prior to CTC: does it really make a difference? Authors: Gohar Ayub*, Andy Lowe, Clive Kay, Anne Williams Purpose: To see if there is a significant difference in the quality of CTcolonography produced between patients prescribed bowel clearance preparation containing laxative to those not containing laxative. Also to get patient feedback on bowel preparation experience. Methods and materials: Retrospective study looking at 300 CTC investigations. This included 138 CTC in which full preparation (FP) was prescribed (3 day regime with laxative), and 162 CTC in which minimum preparation (MP) was prescribed (2 day regime without laxative). Both preparations involved a low residue diet and gastrografin for faecal tagging. CTCs were analysed for degree of bowel clearance and insufflation, graded as either poor, moderate or good. Questionnaires were given to patients attending for the investigation to get feedback on bowel preparation experience. Results: There was no significant difference in the quality of CTC produced with respect to bowel clearance (p 1⁄4 0.23) and insufflation (p 1⁄4 0.81) between the two regimes. 45 patient feedback questionnaires (21 FP, 24 MP) * Guarantor and correspondent: Emer McLoughlin * Guarantor and correspondent: Gohar Ayub * Guarantor and correspondent: Michael Kay * Guarantor and correspondent: Michael Kay showed a statistically insignificant (p> 0.05) increase in faecal incontinence, urgency, diarrhoea, nausea and disturbed sleep in patients taking a laxative. Conclusion: High quality diagnostic CTC can be obtained without the need for laxative in bowel preparations, also the MP regime is of benefit as it is a shorter regime with reasonably fewer symptoms, and therefore more manageable for the patient. Upper GI tract CT modelling to assist magnetic-assisted capsule endoscopy development Authors: Michael Kay*, Imdadur Rahman, Praful Patel, Tim Bryant Purpose: A prototype capsule endoscope has been developed, steerable with a handheld magnet. The best stomach position for the capsule to obtain optimal luminal mucosal visualisation or where to position the magnet to aid pyloric traversing is not known. Potential skin to capsule distances in the upper GI tract are needed for magnet strength design. Methods and materials: 100 small bowel protocol CT studies were reviewed. 5 stations in the stomach were chosen that were envisaged to give the best views of the stomach lumen. Using multiplanar reformatting, the ability to see 6 landmarks in the stomach were assessed (cardia, fundus, body, incisura, antrum & pylorus).Pyloric canal angles both axially & sagitally were calculated to create a pyloric vector to aid skin magnet placement. Measurements from the skin to the GOJ, fundal dependent point & antral dependent point were taken. Results: Maximal stomach visualisation was achieved by combining the fundal dependent station & the station opposite the antral dependent point, achieving complete stomach visualisation in 84%. The mean pyloric canal angles were 68.7 (+/-31.2 ) axially and 68.4 (+/-29.6 ) sagittally. The mean skin distances from the GOJ was 11.5 cm(+/2.46), the fundal dependent point was 16.5 cm(+/-2.52) and the antral dependent point was 9.0 cm(+/2.28). Conclusion: CT modelling has gathered invaluable information to further develop the magnetic capsule hardware and the methodology of its use. Do we need to modify renal cell carcinoma (RCC) follow-up protocols? Authors: Michael Kay*, James Bennett, Tom Geldart, Arnie Drury Purpose: Ongoing drug development in RCC treatment, especially with the newer vascular endothelial growth factor receptor targeted drugs, has increased both the progression free survival and overall survival of patients. The pelvis & femora are a site of symptomatically occult bony metastatic disease, with potential significant morbidity, that is becoming increasingly common as patients survive longer with active disease. Methods andmaterials: Current follow up protocols for metastatic RCC at our hospital are an arterial chest and upper abdomen with portal venous phase imaging of the abdomen & pelvis. This only extends to the ischia and femoral necks. We present a pictorial review of cases from our practice to illustrate the consequences of untreated disease outside of this imaging field. Results: Femoral and low pelvic disease could be readily identified on CT. The prophylactic treatment of spinal disease is well established as it is easily detected in current follow-up protocols. The addition of the complete pelvis and femora to follow-up CT in patients with knownmetastatic disease would identify treatable disease at relatively low cost without significant burden on reporting resources. Conclusion: Scanning the complete pelvis and femora in patients is a low cost intervention that can bring cost benefits to the health service but most importantly reducemorbidity in a patient groupwith limited life expectancy.