Poster Author of 3 e-Posters
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EE-064 - Imaging of gastrointestinal neuroendocrine tumours (NETs)
EE-069 - Ballistic trauma and high grade intra-abdominal visceral injury; the experiences of a London regional trauma centre
EE-070 - The abdominal manifestations of Immunoglobulin G4- related disease (IgG4- RD)
Author of 3 Presentations
EE-064 - Imaging of gastrointestinal neuroendocrine tumours (NETs)
Abstract
Objectives
List subtypes of gastroenteropancreatic NETs
Describe the imaging techniques used in diagnosis, staging and follow-up of NETs
Understand the utility and selection of functional imaging in NETs
Background
Gastrointestinal and pancreatic NETs arise from the neuroendocrine system. Metabolically active tumours produce hormones leading to symptoms and non-metabolically active lesions are more likely to produce locally aggressive disease. The spectrum includes carcinoid, gastrointestinal stromal tumours (GIST) and pancreatic neuroendocrine tumours including insulinoma, VIPoma, gastrinoma and glucagonoma.
Imaging combines both morphological and functional imaging. Cross-sectional imaging includes computed tomography (CT) and magnetic resonance imaging (MRI). Functional imaging includes 18-fluoro-deoxy-glucose PET (FDG-PET) and somatostatin-receptor based imaging including octreotide analogue studies and 68-Gallium DOTATATE.
Using cases from our tertiary referral centre we demonstrate the utility and selection of multimodality imaging in NETs including carcinoid, GIST, pancreatic NETs and multiple endocrine neoplasia (MEN).
Imaging findings OR Procedure findings
CT performed with arterial phase contrast provides excellent assessment of tumour size, relation to structures and staging.
MRI is useful in assessment of pancreatic and liver lesions.
Most NETs are not avid on FDG-PET, which therefore has a limited role other than in high-grade tumours.
The ubiquity of somatostatin receptor (SSTRs) on neuroendocrine cells makes them ideal targets for function imaging. Octreotide analogue studies and 68-Gallium DOTATATE are the two primary types of somatostatin receptor imaging.
Conclusion
The diagnosis, treatment and follow-up of NETs requires cross-sectional and functional imaging. Selection of imaging depends on tumour subtype and metabolic activity.
EE-069 - Ballistic trauma and high grade intra-abdominal visceral injury; the experiences of a London regional trauma centre
Abstract
Objectives
• Understand the mechanism of injury caused by ballistic trauma • Recall the key steps in radiological assessment of ballistic injuries; identification of wound tract, localisation of projectiles and identification of visceral, vascular and bone injury • Identify high grade traumatic visceral injury • Describe complications of high-grade penetrating visceral injuryBackground
Ballistic injuries result from direct trauma from a projectile and the associated shockwave along its trajectory. Imaging is used to identify the wound tract, localise projectiles and demonstrate visceral, vascular and bone injury, all of which is vital to guide correct management. Patients have a high frequency of post-operative imaging, with identification of complications including retained foreign bodies, infection, occult injuries, leaks and delayed vascular complications. Based on our experience at a regional trauma centre we present multiple cases of ballistic trauma with high grade intra-abdominal visceral injury and subsequent complications.Imaging findings OR Procedure findings
We review multiple cases including high grade liver, pancreatic, splenic and renal injury. We also demonstrate cases of both overt and occult bowel injury and intraperitoneal bladder rupture. Complications including retained non-radiopaque foreign body, biloma and intra-abdominal collections are demonstrated.Conclusion
Radiologists play a key role in the initial assessment and follow up of ballistic trauma. Key components of the radiological assessment includes identification of wound tract, localisation of projectiles and identification of visceral, vascular and bone injury.EE-070 - The abdominal manifestations of Immunoglobulin G4- related disease (IgG4- RD)
Abstract
Objectives
Review the clinical presentation and aetiology of IgG4-RD
Discuss the abdominal manifestations of IgG4-RD including biliary, pancreatic, liver and retroperitoneal manifestations
Describe the imaging features of abdominal manifestations of IgG4-RD on cross-sectional imaging including computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine studies
Background
IgG4-RD is a multisystem clinical entity characterised by visceral infiltration of IgG4. Diagnostic criteria requires a combination of clinical presentation, histopathological and serological evaluation of IgG4. Imaging plays a key role in diagnosis and may be the primary modality in identifying various abnormalities associated with this disease.
Autoimmune pancreatitis is the commonest abdominal manifestation of IgG4-RD. Additional manifestations include sclerosing cholangitis, sclerosing mesenteritis, lymphadenopathy, retroperitoneal fibrosis and renal disease.
Imaging findings OR Procedure findings
We present multimodality images of abdominal IgG4-RD including computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine studies including imaging of autoimmune pancreatitis, demonstrating the characteristic features, as well as other cases of IgG4-RD including liver and retroperitoneal manifestations. We discuss the differential diagnoses.
Conclusion
Abdominal manifestations of IgG4-RD include biliary, pancreatic, liver, retroperitoneal and renal manifestations. Imaging may be the first investigation to identify such manifestations and is therefore vital in the diagnostic pathway.
Presenter of 2 Presentations
EE-064 - Imaging of gastrointestinal neuroendocrine tumours (NETs)
Abstract
Objectives
List subtypes of gastroenteropancreatic NETs
Describe the imaging techniques used in diagnosis, staging and follow-up of NETs
Understand the utility and selection of functional imaging in NETs
Background
Gastrointestinal and pancreatic NETs arise from the neuroendocrine system. Metabolically active tumours produce hormones leading to symptoms and non-metabolically active lesions are more likely to produce locally aggressive disease. The spectrum includes carcinoid, gastrointestinal stromal tumours (GIST) and pancreatic neuroendocrine tumours including insulinoma, VIPoma, gastrinoma and glucagonoma.
Imaging combines both morphological and functional imaging. Cross-sectional imaging includes computed tomography (CT) and magnetic resonance imaging (MRI). Functional imaging includes 18-fluoro-deoxy-glucose PET (FDG-PET) and somatostatin-receptor based imaging including octreotide analogue studies and 68-Gallium DOTATATE.
Using cases from our tertiary referral centre we demonstrate the utility and selection of multimodality imaging in NETs including carcinoid, GIST, pancreatic NETs and multiple endocrine neoplasia (MEN).
Imaging findings OR Procedure findings
CT performed with arterial phase contrast provides excellent assessment of tumour size, relation to structures and staging.
MRI is useful in assessment of pancreatic and liver lesions.
Most NETs are not avid on FDG-PET, which therefore has a limited role other than in high-grade tumours.
The ubiquity of somatostatin receptor (SSTRs) on neuroendocrine cells makes them ideal targets for function imaging. Octreotide analogue studies and 68-Gallium DOTATATE are the two primary types of somatostatin receptor imaging.
Conclusion
The diagnosis, treatment and follow-up of NETs requires cross-sectional and functional imaging. Selection of imaging depends on tumour subtype and metabolic activity.
EE-070 - The abdominal manifestations of Immunoglobulin G4- related disease (IgG4- RD)
Abstract
Objectives
Review the clinical presentation and aetiology of IgG4-RD
Discuss the abdominal manifestations of IgG4-RD including biliary, pancreatic, liver and retroperitoneal manifestations
Describe the imaging features of abdominal manifestations of IgG4-RD on cross-sectional imaging including computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine studies
Background
IgG4-RD is a multisystem clinical entity characterised by visceral infiltration of IgG4. Diagnostic criteria requires a combination of clinical presentation, histopathological and serological evaluation of IgG4. Imaging plays a key role in diagnosis and may be the primary modality in identifying various abnormalities associated with this disease.
Autoimmune pancreatitis is the commonest abdominal manifestation of IgG4-RD. Additional manifestations include sclerosing cholangitis, sclerosing mesenteritis, lymphadenopathy, retroperitoneal fibrosis and renal disease.
Imaging findings OR Procedure findings
We present multimodality images of abdominal IgG4-RD including computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine studies including imaging of autoimmune pancreatitis, demonstrating the characteristic features, as well as other cases of IgG4-RD including liver and retroperitoneal manifestations. We discuss the differential diagnoses.
Conclusion
Abdominal manifestations of IgG4-RD include biliary, pancreatic, liver, retroperitoneal and renal manifestations. Imaging may be the first investigation to identify such manifestations and is therefore vital in the diagnostic pathway.