The need for using fluoroscopic guidance to obtain gastric biopsies when in search of Helicobacter pylori with a nonendoscopic method

PURPOSE: Nonendoscopic, fluoroscopic biopsy of the gastric mucosa, following barium examination of the stomach, has gained attention with its ease of performance and cost savings potential over endoscopy. Endoscopic research concerning the efficacy of biopsy sites has revealed an increased sensitivity of antral biopsies over greater curvature biopsies for the detection of Helicobacter pylori. Fluoroscopically guided biopsies of the gastric mucosal are studied to determine whether such a difference between site sensitivity held true. If not, blind biopsy through a nasogastric tube, which traditionally samples only the greater curvature, might prove an even less expensive alternative. MATERIALS AND METHODS: Seventy-two patients underwent nonendoscopic, fluoroscopically guided, mucosal biopsy of both the gastric antrum and the greater curvature of the stomach. Pathologic reports from both sites, using each patient as their own control, are compared to assess site sensitivity in the diagnosis of H. pylori gastritis. RESULTS: The sensitivity for the detection of H. pylori gastritis by antral biopsy is 89%, whereas the sensitivity of greater curvature biopsy is 62%, The difference is considered clinically significant at P < or = 0.05. CONCLUSIONS: This study confirms the need for antral biopsies when desiring a nonendoscopic approach to gastric mucosal sampling, in order to obtain a reasonable yield of data in dyspeptic patients with H. pylori gastritis. Blind techniques cannot reliably reach the antrum. Fluoroscopy can, and remains a less expensive alternative to endoscopy.     

Intraluminal duodenal diverticulum associated with trisomy 21.

An intraluminal duodenal diverticulum is an uncommon congenital abnormality that may produce intermittent ostruction. The true pathogenesis of this lesion is still disputed, but it probably results from ballooning of a congenital web or diaphragm with prolonged peristalsis. An intraluminal "wind sock"-like structure filed with barium and surrounded by a radiolucent halo is the classic and diagnostic radiologic appearance. An association with trisomy 21 is made.     

Primary colorectal lymphoma: spectrum of imaging findings with pathologic correlation

Primary colorectal lymphoma is a very uncommon disease; therefore, it has received little attention in the radiology literature. Moreover, imaging features of newly described pathologic subtypes have not been reported such as low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue and peripheral T-cell lymphoma that involves colorectal area. We retrospectively reviewed double-contrast barium enema and CT scans in the patients with primary colorectal lymphoma. In this article the radiologic appearances of primary colorectal lymphoma are categorized into focal lesion and diffuse lesion. Focal lesion includes polypoid mass, circumferential infiltration with smooth mucosal surface, circumferential infiltration with extensive ulceration, cavitary mass, mucosal nodularity, and mucosal fold thickening. Diffuse lesion includes diffuse ulcerative lesion and diffuse nodular lesion. Peripheral T-cell lymphomas that involve the colon manifested as either a diffuse or focal segmental lesion and showed extensive mucosal ulceration. These findings are similar to those of Crohn's disease or tuberculous colitis and are different from those of previously reported colorectal lymphoma. Low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue manifest as multiple mucosal nodularity. The imaging features of primary colorectal lymphoma are quite variable and overlap with other colonic pathology; however, it is important for radiologists to know the imaging features of primary colorectal lymphoma with their pathologic correlation.     

小肠间质肿瘤钡餐造影与CT扫描对照分析

目的 评价钡餐造影和CT扫描诊断小肠间质肿瘤的价值。资料与方法 分析11例经手术病理证实的小肠间质肿瘤的影像学资料。结果 良性间质肿瘤4例，恶性间质肿瘤7例。以空肠最多见（6/11）。钡餐造影主要表现为黏膜变平。环状皱襞消失或破坏。肠腔偏侧性狭窄，出现钡斑或窦道样改变，腔内充盈缺损，CT检查均确诊为小肠肿瘤，主要征象为腔外不规则肿块，肿块内多灶性低密度坏死区。结论 小肠间质肿瘤并非罕见，对临床疑为此症者应首选胃肠钡剂造影。CT是明确诊断的主要影像检查技术。并可为手术治疗进一步明确病变范围。     

胃肠道间质瘤的X线和CT表现

目的:分析胃肠道间质瘤的钡餐造影和CT表现,探讨其诊断价值。方法:回顾分析31例经手术病理证实的胃肠道间质瘤钡餐造影和CT表现,其中经数字化胃肠钡餐造影15例,多层螺旋CT检查16例。结果:本组胃肠道间质瘤中,胃部16例,小肠14例,直肠1例。恶性20例,良性10例,交界性1例。良性肿块直径均小于5cm10例(10/10),恶性肿块直径大于5cm17例(17/20),小于5cm3例(3/20)。钡餐造影表现为胃肠黏膜皱襞推压变平或破坏13例(13/15),偏侧性充盈缺损或肠壁不清、缺失、肠腔狭窄14例(14/15),病变区可见溃疡形成,位于腔外或部分腔外6例(6/15)。CT均可见软组织块影(16例),位于腔内或腔外,呈圆形或分叶、不规则形。良性密度均匀,呈均匀性强化,恶性密度大部分欠均匀,肿块内可见低密度坏死灶11例,明显不均匀强化,胃间质瘤肿块内可见钙化影5例。结论:钡餐造影和CT是诊断胃肠道间质瘤的主要手段。偏侧性腔壁不清或缺失以及肠腔狭窄,黏膜皱襞推压变平或消失,肿块内的钙化及腔外钡斑或溃疡是其诊断重要的征象,CT在诊断和鉴别良、恶性上有更大优势。     

Gastroduodenal involvement in chronic granulomatous disease of childhood.

Obstruction of the gastric outlet as a complication of chronic granulomatous disease (CGD) is uncommon. The usual findings in a barium examination of the upper gastrointestinal tract are irregular antral mucosal folds and antral narrowing. There is typically a sharp demarcation of the affected area from the normal proximal stomach. The authors report a case of CGD of childhood in which there was diffuse gastric involvement with extension into the duodenal cap. The patient recovered with conservative therapy after a diagnostic exploratory laparotomy.     

Segmental dilatation of the small bowel: report of three cases and literature review

Segmental dilatation of the small bowel is a rare congenital abnormality that occurs mainly in children and produces significant nonspecific symptoms. The authors reviewed 33 cases reported in the literature and present three new cases in which the lesion was demonstrated on radiographs obtained before laparotomy. These cases showed the spectrum of symptoms and characteristic radiologic features of this condition in both plain abdominal radiographs and barium studies. Plain radiographs of the abdomen may show an isolated loop of bowel containing an air-fluid level. The characteristic finding in barium studies of the small bowel is a localized dilatation of the small bowel lumen with afferent and efferent loops. In the absence of a complication or coexistent cause of obstruction, the transit time of contrast medium through the small bowel is not delayed. The radiologic examination is useful in diagnosis, and the condition is cured with surgery.     

A case of minute gastric cancer preoperatively diagnosed

A case of minute gastric cancer which was preoperatively diagnosed, measuring 3 X 3 mm in diameter is reported. The X-ray examination revealed a faint barium collection surrounded by the mucosal folds. The endoscopic findings showed a small ulcerated lesion with a reddish and irregular margin and convergent folds. Radiological characteristics of the minute gastric cancer and its diagnostic approach are discussed.     

Esophageal fistulas associated with mycobacterial infection in patients at risk for AIDS

Although opportunistic infections of the esophagus occur commonly in acquired immunodeficiency syndrome (AIDS), inflammation is generally limited to the mucosal surface. During a 7-month interval, six men at risk for AIDS underwent barium esophagography because of persistent symptoms of esophageal disease. In each case, transmural inflammation of the esophagus was found (esophagomediastinal communication in three cases and esophagobronchial fistulas in three cases). Two patients had an esophagoesophageal fistula, an inflammatory lesion that has not, to the authors' knowledge, been previously described with mycobacterial infection. Mycobacterial infection was documented by means of culture findings in all six patients (Mycobacterium tuberculosis in five, M avium in one). In three cases mycobacteria were either seen in or cultured from esophageal biopsy specimens. The finding of deep esophageal ulceration, intramural dissection, or fistula formation in a patient with AIDS should suggest the diagnosis of esophageal tuberculosis.     

Comparison of radiologists' confidence in excluding significant colorectal neoplasia with multidetector-row CT colonography compared with double contrast barium enema

The aim of this study was to compare the confidence of experienced radiologists in excluding colonic neoplasia with CT colonography (CTC) compared with barium enema. 78 patients (median age 70 years, range 61-87 years, 44 women) underwent same day CTC and barium enema. Two radiologists experienced in reporting barium enema assessed whether the examination had excluded a polyp 6 mm or greater as "yes", "probably" or "no" for each of 6 colonic segments. Two different radiologists experienced in CTC independently performed the same assessment on the CT datasets. Responses were compared using a paired exact test. Formal barium enema and CT reports were compared with any endoscopic examination performed within 1 year. Studies reporting polyps 6 mm+ in patients not subsequently undergoing endoscopy were reviewed by two independent observers. Radiologists stated they had confidently excluded a significant lesion in 314 (71%) and 382 (86%) of 444 segments with barium enema and CTC, respectively (p<0.001). Confidence was significantly higher with CTC in the in the descending and ascending colon (p = 0.02 and p<0.001, respectively), and caecum (p<0.001). 22 patients underwent some form of endoscopy. Of five patients with proven colorectal neoplasia (including two with cancer), CTC and barium enema correctly identified five and three, respectively. In 56 patients not undergoing endoscopy, CTC reported 17 polyps 6 mm+, of which 16 were retrospectively classified as definite or probable. 11 could not be identified on the barium enema, even in retrospect. Confidence in excluding polyps 6 mm or larger is significantly greater with CT colonography particularly in the proximal colon.     

Computed tomography gastrography with volume-rendering technique: correlation with double-contrast barium study and conventional gastroscopy

The volume-rendering technique uses computed tomography data to produce simulated images of conventional barium and endoscopic studies of the stomach. Various gastric lesions are detected on volume-rendered images, and submucosal tumors are easily differentiated from mucosal lesions by means of the overlying bridging fold. Lesions that are only manifested by a change of mucosal color (early gastric cancer type 2b) or a loss of mucosal detail (gastritis) are difficult to detect from volume-rendered images, however. In cases of gastric neoplasm and varix, both the extraluminal pathologies of the lesion and the relation between the intraluminal and extraluminal components can be evaluated simultaneously.     

Comparison of a new colon lavage solution (Golytely-RSS) with a standard preparation for air-contrast barium enema

Golytely is a balanced electrolyte solution for per oral whole-gut lavage. It has been an accepted alternative to standard preparations for barium enema. Golytely-RSS is a new formulation designed to taste better through reduction in sodium and sulfate content. In addition, a slight increase in osmolality is intended to decrease further the net absorption/secretion ratio. One hundred outpatients who were to undergo air-contrast barium enema examinations were randomly assigned one of two colon-cleansing preparations. A standard 1-day diet/cathartic method was compared with Golytely-RSS plus oral bisacodyl. Radiographs were evaluated for the amount of fecal material present and the degree of mucosal coating by two radiologists independently of each other and without knowledge of the preparation used. Good to excellent feces removal was provided by Golytely-RSS in 98% of patients and by the standard method in 95% (p greater than .1, not significant). Mucosal coating also was similar between groups. Unpleasant side effects were reported significantly more often in the lavage group. Unwillingness to use the preparation a second time was reported in 36% of the Golytely-RSS group and in 8% of the standard preparation group (p = .03). Golytely-RSS is an acceptable alternative method to standard colon-cleansing methods for air-contrast barium enema and may be preferable in patients with certain renal or cardiovascular diseases. Side effects may preclude the use of this colon-cleansing regimen routinely.     

Evaluation of tiny abnormal mucosal findings on double contrast barium enema study

Tiny abnormal mucosal findings on double contrast barium enema studies in 104 cases were classified into 5 patterns, as follows 1) small elevation, 2) elevation with barium fleck, 3) spotty barium fleck, 4) ill defined barium fleck and 5) barium fleck with halo. Each mucosal pattern was correlated with age, sex and symptoms, as well as the coexistence of the fine network pattern. They were compared with those of 86 control cases. 44 histologically proven cases were reviewed in order to clarify the clinical significance of the above 5 patterns. Incidence of the tiny mucosal findings was 4.8% (104/2186). 1) small elevation, 2) spotty barium fleck, 3) ill defined barium fleck and 4) barium fleck with halo were suggested the possibility of inflammatory bowel diseases.     

The retrorectal space

Ninety-nine adults with an enlarged retrorectal space on barium enema examination have been evaluated. Measurements were based on previously described methods using the lateral view of the barium filled rectum. In 38.4% of the cases there was no lesion (normal variations). The rest were classified as inflammatory conditions, tumours, and miscellaneous lesions. It is concluded that an increased width of the presacral space per se does not necessarily connote a lesion. Pathological widening of the space is usually associated with changes of the contour of the rectum, abnormalities of the sacrum, or other alterations of the presacral soft tissues.     

Magnesium ions and barium coating of colonic mucosa: is it a simple question of viscosity?

The aim of the present study was to verify whether magnesium-induced increase of barium coating of the colonic mucosa is specifically due to the increase of barium suspension viscosity. One hundred sixty-one patients scheduled for double-contrast barium enema (DCBE) were randomised in one group of 23 patients (control group, CG), and three groups of 23 pairs (G1, G2 and G3), i.e. 138 patients. The DCBE was performed with standard technique using a barium suspension with dynamic viscosity of 280 cPs (CG), or with viscosity increased to 320 cPs (G1), 2500 cPs (G2) or 3200 cPs (G3), by extemporaneous addition of MgSO4 1, 2 or 3 g in one member of the pair, Na2SO4 1, 4.2 or 8 g in the other one. Three radiologists evaluated on an ordinal scale mucosal coating and free fluid. In all magnesium subgroups barium coating was better than in CG (p < 0.008), the highest value being obtained in G2. No difference was observed as regards free fluid. Inside paired groups, mucosal coating was more effective in magnesium than in sodium members (p < 0.0002). Viscosity of barium suspension being equal inside each group, this effect must be attributed to magnesium-specific interactions with additives of the barium suspension inducing events other than viscosity changes.     

Hypertrophied antral-pyloric fold: reassessment of radiographic findings in 40 patients.

PURPOSE: To reassess the findings of a hypertrophied antral-pyloric fold on double-contrast barium studies. MATERIALS AND METHODS: A search of radiologic files resulted in recovery of records of 1,796 patients with findings of antral gastritis on double-contrast upper gastrointestinal studies. According to radiologic reports, 40 patients had a hypertrophied antral-pyloric fold. The radiographs were reviewed retrospectively to determine the size, location, and morphologic features of the folds. Clinical, radiologic, and/or endoscopic follow-up data were obtained in 22 patients. RESULTS: All but two patients were symptomatic, and all but one responded to medical treatment. The hypertrophied antral-pyloric fold was located on the lesser curvature of the distal antrum in all patients and extended to the pylorus in 25 (62%) and into the base of the duodenal bulb in 15 (38%). The fold appeared as a smooth or slightly lobulated submucosal mass in 37 (92%) patients and as a plaquelike lesion in three (8%). Other radiographic findings of antral gastritis were present in 26 (65%) patients. In nine patients who underwent endoscopy, endoscopic and/or histologic findings of antral gastritis were present in five, but none had evidence of tumor. CONCLUSION: A hypertrophied antral-pyloric fold may be a sign of antral gastritis that is associated with characteristic radiographic findings. Endoscopy and biopsy may not be warranted when lesions with features typical of a hypertrophied antral-pyloric fold are seen on double-contrast barium studies.     

伴有脊柱后突的不可复性食管裂孔疝--胸部平片与CT、MRI对照观察

目的 加深对伴有脊柱后突的不可复性食管裂孔疝影像表现的认识,并探讨此类食管裂孔疝形成的机制。材料与方法 对照分析８例经钡餐造影确诊的伴有脊柱后突的不可复性食管裂孔疝的胸片与ＣＴ、ＭＲ影像表现。结果 ８例均为老年人,以女性居多,胸片与ＣＴ、ＭＲ影像表现均见疝囊在心脏之后呈肿块状,内含气体或气－液面,并有食管裂孔增宽、膈肌后份变平、后肋膈角变浅、贲门位于膈上而食管不短;均见脊柱胸腰段后突,该水平胸廓前     

The adhesiometer: a simple device to measure adherence of barium sulfate to intestinal mucosa

A simple, inexpensive device assessing barium sulfate adherence to alimentary tract mucosa was tested in an animal study using pigs and dogs. Interaction of gastric, intestinal, and colonic mucosal lining with three different barium preparations was studied. In both pigs and dogs, barium adherence to gastric mucosa was significantly stronger when compared with colonic mucosa.     

Superficial esophageal carcinoma. Radiological findings in double- contrast studies

Most cases of superficial esophageal cancer have been reported in Japan and China. Radiological findings in 11 patients (13 lesions) are described. Superficial spreading cancer is difficult to detect despite widespread mucosal involvement. Double-contrast technique is essential, both to detect lesions and to demonstrate their extent. An irregular, rigid wall, mucosal abnormalities such as barium pooling and coating, and protrusions of various sizes and shapes are diagnostic features.     

Urothelial microvascular response to chronic renal inflammatory disease

Renal pelvocaliceal mucosal opacification has been observed clinically in patients with inflammatory disease. We studied the microvascular changes that might be responsible for this finding using barium injection and microradiographic studies of 20 human kidneys excised due to infection. There were six patients with staghorn calculi and chronic pyelonephritis, four with pyohydronephrosis, eight with acute and chronic pyelonephritis, and two with xanthogranulomatous pyelonephritis. The microangiograms correlated with severity of inflammation. In mild cases, slight vessel hypertrophy involved the terminal arterioles and arteries supplying the urothelium. In severe cases, there was marked neovascularity with feeding vessel hypertrophy and mucosal thickening. Our studies demonstrate that abnormal pelvocaliceal vascularity is responsible for the findings seen on urography and angiography of inflammatory disease.