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Presenter: Daniel, Swerdlow, Washington D.C., United States
Authors: Daniel Swerdlow1, Raffaele Girlanda1, Cal Matsumoto1, Eddi Island1, Thomas Fishbein1
Daniel Swerdlow, Raffaele Girlanda, Cal Matsumoto, Eddi Island, Thomas Fishbein
Departments of Radiology (DS) and Transplant Surgery (RG,CM,EI,TF), Georgetown University Hospital, Washington, DC, United States
The radiological evaluation for prospective candidates for intestinal transplant must address a variety of clinical issues typical for these patients. These issues include central venous patency of the neck and chest region as well as the lower extremities and pelvic veins, abdominal arterial and venous anatomy, large and small bowel anatomy and length, the presence of enterocutaneous fistulas, and liver and spleen volumes. Additional issues regarding comorbid diseases must be addressed on a case by case basis. The numbers of imaging studies which can answer the above listed issues include computed tomography (CT) including CT angiography and venography, MRI with arteriography and venography (MRA/MRV), upper GI and small bowel follow through (UGI/SBFT), barium enema (BE), and duplex Doppler of the upper and lower extremities as well as of abdominal vasculature. Many of these studies are overlapping in their ability to address these issues. We believe that we have developed a simple two or three test protocol that will address the above issues in most patients. We have compared our protocol to that of seven other intestinal transplant centers for adults in the United States and found our protocol to be shorter and adequately addressed the above clinical issues in all patients studied thus far. Our protocol consists of a biphasic IV contrast enhanced CT scan of the chest, abdomen and pelvis with rectal carbon dioxide. This technique allows for CT venography of the lower neck and chest, abdomen, pelvis and common femoral veins, CT arteriography of the abdomen, CT colonography (CTC) for colon length and anatomy, liver volume, spleen volume and small bowel anatomy and assessment for the presence of fistulas. Patients also undergo an upper gastrointestinal study with small bowel follow through for small bowel length and transit time. Patients with enterocutaneous fistulas also undergo fistulograms. 12 patients from March to December 2010 underwent a mean of 2.25 distinct imaging studies without a technically unsuccessful examination. A survey of 7 U.S. transplant centers revealed a mean of 4.57 of the above examinations performed on typical patient. We conclude our protocol is highly efficient in delineating the necessary information and can often be accomplished in a single morning.
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