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Caterina Giannitto,1 Giuseppe Mercante,2,3 Giuseppe Spriano,2,3 Rossella Natoli,4 Francesca Gaino,2 Ludovica Lofino,1 Andrea Alessandro Esposito,5 Nino Giannitto,6 Giulia Vatteroni,1 Barbara Fiamengo,7 Antonello Vidiri,8 Letterio Salvatore Politi,1,3,* Luca Balzarini1,* 1Department of Diagnostic Radiology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy; 2Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Milan, Italy; 3Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; 4University of Milano-Bicocca, Milan, Italy; 5Department of Diagnostic Radiology, Foundation I.R.C.C.S Ca’ Granda Ospedale Maggiore Policlinico Hospital, Milan, Italy; 6Department of Pediatric Sciences, University of Messina, Messina, Italy; 7Pathology Unit, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Milan, Italy; 8Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy*These authors contributed equally to this workCorrespondence: Caterina GiannittoDepartment of Diagnostic Radiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, Rozzano, Milan, 20089, ItalyTel +39282247529Email caterina.giannitto@humanitas.itAndrea Alessandro EspositoDepartment of Diagnostic Radiology Foundation I.R.C.C.S Ca’ Granda Ospedale Maggiore Policlinico Milano, Via F. Sforza 35, Milan, 20121, ItalyTel +393475476654Email andrea.esposito@policlinico.mi.itBackground: Masson’s tumor (MT) is a rare benign vascular disease. In literature, detailed description of its radiological findings is not available and functional imaging such as diffusion weighted (DW)-MRI has never been described. We aim to summarize the CT and MRI findings in our representative case and to conduct a systematic review of the literature.Case Presentation: We reported a 54-year-old ex-smoker male patient who presented with a nodular mass to the left cheek. He denied any previous trauma. CT examination performed on initial presentation revealed a well circumscribed solid oval mass with soft tissue density, a calcified focus and no significative contrast enhancement after contrast administration. MRI showed a well circumscribed solid oval mass, with intermediate T2 signal intensity with areas of high T2 signal intensity and the presence of peripheral high-flow serpentine vessels, low T1 signal intensity. The mass showed a non-enhancing area with enhancing vessels after intravenous contrast administration. We surveyed CT and MRI findings of head and neck MT of English and French language papers, published from 1981 to 2019, together with our representative case. We included articles with a description of CT and/or MRI findings of head and neck MT.Conclusion: We have experienced one case and have evaluated imaging findings through systematic review. Only 36 articles were eligible. CT and MRI findings were reported in 27 and 23 articles, respectively. To date, no diffusion weighted imaging (DWI)-MRI findings have been described. The most frequent findings in CT were a well-defined mass with high or soft tissue density. The most frequent MRI findings were a non-homogeneous signal intensity in T1 and T2 weighted sequences, with foci of hyperintensity, multiple septations or flow voids. After contrast administration, the enhancement could be homogeneous, non-homogeneous, nodular or peripheral. In our case, we found a non-homogeneous hyperintensity in DWI-MRI with an area of restricted diffusion and low apparent diffusion coefficient (ADC) was observed (0.963 × 10− 3 mm2/s +\-0.12 SD). The imaging characteristics cannot provide a pre-operative identikit of MT and surgical removal is necessary to accurately differentiate it from malignant angiosarcoma but radiological evaluation is useful in surgical planning.Keywords: Masson’s tumor, case report, computed tomography, magnetic resonance imaging, diffusion weighted imaging

BackgroundStenosis is the most common complication of Crohn’s disease (CD), often requiring surgical resection. Long-term outcome of patients receiving anti-TNF therapy for such disease complication is poorly known.MethodsEnrolled were 51 CD patients followed-up in a tertiary IBD Centre between July 2006 and November 2015. All of them had stricturing CD (ileal = 49 and colonic = 2), diagnosed by colonoscopy and/or MRI enterography. Thirty-one subjects (61%) were given adalimumab and 20 (39%) infliximab. The primary outcome was the rate of surgery for stricturing CD. Statistical analysis included descriptive analysis, Wilcoxon test for differences in median values, logistic regression with univariate analysis for risk factors, and Kaplan–Meyer curves and Cox analysis for estimation of efficacy of anti-TNFs in avoiding surgical resection. All differences were considered statistically significant for p < 0.05.ResultsIn the study, 51 CD patients (27 males; median age at diagnosis 31.9 yr [range 12–61]) were analysed. Median duration of disease at the beginning of anti-TNF therapy was 4.4 yr (range 0.3–37). The location of CD was ileal in 22 subjects, colonic in one, and ileocolonic in 28 patients. After a median follow-up period of 35.8 months (range 3–105), 20/51 patients (39%) underwent abdominal surgery. Amongst patients not undergoing surgery, half of them (25/51) continued anti-TNF therapy at last follow-up and 6/51 (11.7%) stopped anti-TNF treatment (1 for secondary loss of response, 1 for infusion reaction, 2 for psoriasis, 1 for pregnancy, and 1 for recurrent tonsillitis). Median values of the Harvey–Bradshaw Index (HBI) and the Simple Endoscopic Score for Crohn’s Disease (SES-CD) were reduced significantly from baseline (p = 0.01 for both), whereas the median value of the Lémann score did not change significantly (4.9 vs 4.2, p = 0.28). Based on univariate analysis, only penetrating behaviour at baseline was more likely to be associated with the risk of surgery (OR 5.09; CI 95% 1.45 to 17.82; p = 0.01). Survival curve analysis and Cox regression model showed that patients treated with infliximab were more likely to avoid surgery compared with those treated with adalimumab (HR 3.13, CI 95% 1.63–12.67, p = 0.0038 and OR 6.54; CI 95% 0.66–3.09; p = 0.0026, respectively). The use of infliximab and longer duration of anti-TNF therapy were protective from surgery (OR 1.05; CI 95% 0.01–0.08; p = 0.0017).ConclusionHalf of CD patients starting anti-TNF therapy for stricturing disease avoided surgery after a median follow-up of 3 years. Penetrating behaviour was associated with an increased risk of surgery. Patients treated with infliximab remained free of surgery longer than patients treated with adalimumab did.

International audience; BACKGROUND:Many Crohn's disease patients require surgery. Intraoperative detection of new lesions may lead to change in planned surgery. This study aimed to determine whether magnetic resonance enterography can optimize surgical planning and guide decision making in Crohn's disease.METHODS:Seventy-five patients with complicated Crohn's disease were enrolled and underwent preoperative magnetic resonance enterography. Analysis included imaging accuracy and change in surgical strategy due to discordance with imaging findings.RESULTS:Surgery was performed laparoscopically in 39/75 patients (52 %), with conversion to open surgery required in six (15 %). Concordance between observers was excellent (kappa value >0.8). Magnetic resonance enterography accuracy for stenosis, abscess, and fistula were all above 85 % in per-patient analysis. In 68/75 cases (90.7 %) surgery was correctly predicted. Conversely, in 7/75 cases (three false-positives and four false-negatives) surgical strategy (type of resection or strictureplasty, n = 5) and/or surgical approach (conversion from laparoscopy to open surgery, n = 2) changed due to discordance with magnetic resonance enterography findings.CONCLUSION:Surgical strategy and approach are correctly predicted by magnetic resonance enterography in the majority of patients with complicated Crohn's disease.

Background: Studies comparing magnetic resonance enterography (MRE) and computerized tomography enterography (CTE) for Crohn's disease (CD) are scarce. Methods: The aim of this study was to prospectively compare the sensitivity, specificity, and accuracy of abdominal MRE and CTE to assess disease activity and complications (fistulas, strictures) in ileocolonic CD. A total of 44 patients (23 male; 21 female; mean age 44) with ileocolonic CD underwent both MR and CT in a short time interval (mean 5 days). A 16-slice CT with intravenous contrast and an MRI with oral and paramagnetic intravenous contrast were performed. Ileocolonoscopy was used as the reference standard. Sensitivity values of CT and MR for detection of extraenteric signs of disease were compared with the McNemar test, with results of imaging studies, surgery, and physical examination as reference standards. Results: No significant differences in sensitivity, specificity, and accuracy were observed between MRE and CTE regarding the following parameters at the patient level: localization of CD (P = 1.0), bowel wall thickening (P = 1.0), bowel wall enhancement (P = 1.0), enteroenteric fistulas (P = 0.08), detection of abdominal nodes (P = 1.0), and perivisceral fat enhancement (P = 0.31). MR was significantly superior compared to CT in detecting strictures (P = 0.04). Per segment analysis showed that MRE was significantly superior to CTE in detecting ileal wall enhancement (P = 0.02). Conclusions: MR and CT are equally accurate to assess disease activity and bowel damage in CD. MR may be superior to CT in detecting intestinal strictures and ileal wall enhancement. MR may represent an alternative technique to CT in assessing ileocolonic CD. (Inflamm Bowel Dis 2011;17:1073-1080) BACKGROUND: Studies comparing magnetic resonance enterography (MRE) and computerized tomography enterography (CTE) for Crohn's disease (CD) are scarce.METHODS: The aim of this study was to prospectively compare the sensitivity, specificity, and accuracy of abdominal MRE and CTE to assess disease activity and complications (fistulas, strictures) in ileocolonic CD. A total of 44 patients (23 male; 21 female; mean age 44) with ileocolonic CD underwent both MR and CT in a short time interval (mean 5 days). A 16-slice CT with intravenous contrast and an MRI with oral and paramagnetic intravenous contrast were performed. Ileocolonoscopy was used as the reference standard. Sensitivity values of CT and MR for detection of extraenteric signs of disease were compared with the McNemar test, with results of imaging studies, surgery, and physical examination as reference standards.RESULTS: No significant differences in sensitivity, specificity, and accuracy were observed between MRE and CTE regarding the following parameters at the patient level: localization of CD (P = 1.0), bowel wall thickening (P = 1.0), bowel wall enhancement (P = 1.0), enteroenteric fistulas (P = 0.08), detection of abdominal nodes (P = 1.0), and perivisceral fat enhancement (P = 0.31). MR was significantly superior compared to CT in detecting strictures (P = 0.04). Per segment analysis showed that MRE was significantly superior to CTE in detecting ileal wall enhancement (P = 0.02).CONCLUSIONS: MR and CT are equally accurate to assess disease activity and bowel damage in CD. MR may be superior to CT in detecting intestinal strictures and ileal wall enhancement. MR may represent an alternative technique to CT in assessing ileocolonic CD.

International audience; Background and aims:Bowel damage [BD] will develop in the majority of Crohn’s disease [CD] patients. Recently, the Lémann Index [LI] was developed to measure BD.Methods:This was a prospective single-center cohort study. All included patients underwent full evaluation for bowel damage before starting anti-TNF therapy and every year thereafter. BD at baseline and during follow-up was measured using the LI. We assessed the impact of anti-TNF therapy on BD. We also assessed the sensitivity to change of the LI and the relationship between BD progression and disease outcomes, including the need for surgery.Results:Thirty CD patients were enrolled [13 on infliximab, 17 on adalimumab]. Median baseline LI was 9.1 [range, 1.6–34.1]. Median follow up was 32.5 months [range, 10–64].By a ROC curve analysis, a LI >4.8 defined CD subjects with BD. Any change >0.3 in the LI was related to BD change [AUC 0.98]. During follow-up, 83% of subjects had BD regression and 17% had BD progression. Anti-TNF therapy significantly reduced LI at 12 months [p=0.007]. Subjects with BD progression were more likely to undergo major abdominal surgery through the follow-up period [HR 0.19, p=0.005].Conclusion:The LI has good sensitivity to change. Anti-TNFs agents are able to reverse BD in some CD patients. BD progression as measured by the LI may be predictive of major abdominal surgery in these patients.

Purpose: To prospectively assess the diagnostic performance of noncathartic computed tomographic (CT) colonography in the detection of clinically relevant colorectal lesions (≥6 mm polyps or masses) in a well-defined cohort of first-degree relatives of patients with colorectal cancer (CRC), using colonoscopy and histologic review as the standard of reference. Materials and Methods: Institutional review board approval was obtained, and all subjects provided written informed consent. Consecutive patients admitted with CRC (index cases) were prospectively evaluated, and those who agreed to contact their first-degree relatives who were at least 40 years old were included. Available first-degree relatives were invited to undergo noncathartic CT colonography (200 mL of diatrizoate meglumine and diatrizoate sodium). Colonoscopy was performed the following day, and findings from CT colonography were disclosed for each segment. Sensitivity, specificity, and positive and negative predictive values of CT colonography were assessed for detecting subjects with any lesion at least 6 mm, any lesion at least 10 mm, and advanced neoplasia at least 6 mm. Colonoscopy with segmental unblinding and histologic diagnosis were used as the standard of reference. Matching between findings from CT colonography and colonoscopy was allowed when lesions were located in the same or adjacent colon segments and when the size difference was 50% or less. Results: Three hundred four first-degree relatives (median age, 47 years; age range, 40-79 years; 46.7% women) identified from 221 index cases were included. Overall, CT colonography helped identify 17 of 22 subjects with polyps measuring at least 6 mm (sensitivity, 0.77; 95% confidence interval [CI]: 0.59, 0.95) and helped correctly classify as negative 278 of 282 subjects without lesions measuring at least 6 mm (specificity, 0.99; 95% CI: 0.97, 1.00). CT colonography helped detect eight of nine subjects with polyps measuring at least 10 mm as well as eight of nine subjects with advanced neoplasia measuring at least 6 mm (sensitivity, 0.89 for both). Per-subject positive and negative predictive values for lesions measuring at least 6 mm were 0.81 (17 of 21 subjects; 95% CI: 0.65, 0.97) and 0.98 (282 of 287 subjects; 95% CI: 0.96, 0.99), respectively. Conclusion: Noncathartic CT colonography is an effective screening method in first-degree relatives of patients with CRC. © 2014 RSNA.