Crohn disease (CD) and ulcerative colitis (UC) are the two main forms of idiopathic inflammatory bowel disease (IBD). CD is a transmural chronic inflammatory disorder that can affect any part of the gastrointestinal tract in a discontinuous distribution. UC is a mucosal and submucosal chronic inflammatory disease that typically originates in the rectum and may extend proximally in a continuous manner. In treating patients with CD and UC, clinicians rely heavily on accurate diagnoses and disease staging. Magnetic resonance (MR) enterography used in conjunction with endoscopy and histopathologic analysis can help accurately diagnose and manage disease in the majority of patients. Endoscopy is more sensitive for detection of the early-manifesting mucosal abnormalities seen with IBD and enables histopathologic sampling. MR enterography yields more insightful information about the pathologic changes seen deep to the mucosal layer of the gastrointestinal tract wall and to those portions of the small bowel that are not accessible endoscopically. CD can be classified into active inflammatory, fistulizing and perforating, fibrostenotic, and reparative and regenerative phases of disease. Although CD has a progressive course, there is no stepwise progression between these disease phases, and various phases may exist at the same time. The endoscopic and MR enterographic features of UC can be broadly divided into two categories: acute phase and subacute-chronic phase. Understanding the endoscopic features of IBD and the pathologic processes that cause the MR enterographic findings of IBD can help improve the accuracy of disease characterization and thus optimize the medication and surgical therapies for these patients. RSNA, 2016.
The PCA only group included 11 males and 7 females with a mean age of 66.8 years and mean tumor diameter of 46.2 mm. No differences in these characteristics were identified. All RCCs were a solitary tumor. No significant differences were seen between the groups in their tumor geometry (p ¼ 0.83), R.E.N.A.L. nephrometry scores (p ¼ 0.14), or comorbidity indices (p ¼ 0.39). TAE was technically successful and without complication in all cases. Mean time between TAE and PCA was 10.9 days. PCA was technically successful in 8/9 patients in the TAE+PCA group and in 14/18 patients in the PCA only group (p ¼ 0.48). There were 3 minor complications (perinephric hematomas) in the TAE+PCA group and 8 minor complications (perinephric hematoma ¼ 5, pneumothorax ¼ 1, hematuria ¼ 1, hypertension ¼ 1) in the PCA only group (p ¼ 0.48). The TAE+PCA and PCA only groups had a 2.8% decrease and 1.0% increase in eGFR, respectively (p ¼ 0.69). The TAE+PCA and PCA only groups had a 2.1% and 9.3% drop in hematocrit, respectively (p ¼ 0.15). Four patients in the TAE+PCA group and seven patients in the PCA only group required repeat cryoablation (p ¼ 0.78). Conclusions: TAE of RCC prior to PCA is safe, technically feasible, and does not adversely affect patient outcomes. Data shows a trend toward less blood loss with this approach; although, this number did not reach statistical significance. Larger, prospective studies are needed to assess for potential clinical benefits of this approach.
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