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Article ; Online: Erratum

Abhijit Sunnapwar / Arpit Nagar / Rashmi Katre / Lokesh Khanna / Hari Prasad Sayana

Journal of Gastrointestinal and Abdominal Radiology (2021)

Imaging of Ampullary and Periampullary Conditions

2021

Keywords	Internal medicine ; RC31-1245 ; Diseases of the digestive system. Gastroenterology ; RC799-869
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Erratum: Imaging of Ampullary and Periampullary Conditions

Sunnapwar, Abhijit / Nagar, Arpit / Katre, Rashmi / Khanna, Lokesh / Sayana, Hari Prasad

Journal of Gastrointestinal and Abdominal Radiology

2021

Language	English
Publishing date	2021-06-11
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2581-9178
ISSN (online)	2581-9178
DOI	10.1055/s-0041-1731096
Database	Thieme publisher's database

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Article ; Online: Imaging of Ampullary and Periampullary Conditions

Abhijit Sunnapwar / Arpit Nagar / Rashmi Katre / Lokesh Khanna / Hari Prasad Sayana

Journal of Gastrointestinal and Abdominal Radiology, Vol 4, Iss 03, Pp 214-

2021 Volume 228

Abstract: The ampulla of Vater is formed by the union of the pancreatic duct and the common bile duct and is also known as hepatopancreatic ampulla or hepatopancreatic duct. The ampulla is surrounded by a muscular valve known as the sphincter of Oddi, which ... ...

Abstract	The ampulla of Vater is formed by the union of the pancreatic duct and the common bile duct and is also known as hepatopancreatic ampulla or hepatopancreatic duct. The ampulla is surrounded by a muscular valve known as the sphincter of Oddi, which controls the flow of bile and pancreatic juices into the duodenum in response to food. The ampulla is also an important embryological landmark as it marks the anatomical transition from foregut to the midgut. Because of this, it is a watershed zone where the blood supply changes from the celiac axis to the superior mesenteric artery. Radiologic evaluation of the ampulla and the periampullary region is challenging because it requires an understanding of the embryology, the normal appearance, and different anatomic variants. Also, a wide variety of pathologies can occur in this region. The purpose of this review is to present the normal anatomy of the ampulla and the periampullary region on different imaging modalities and to summarize the imaging features of the common variants, and benign and malignant ampullary and periampullary conditions. Understanding of the normal anatomical appearance and variants along with the knowledge of common pathologic conditions affecting the ampulla and periampullary conditions can help radiologists in making accurate diagnosis resulting in optimum patient care.
Keywords	ampullary ; biliopancreatic junction ; neoplasms ; periampullary ; Internal medicine ; RC31-1245 ; Diseases of the digestive system. Gastroenterology ; RC799-869
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Multimodality imaging of adult gastric emergencies: A pictorial review.

Sunnapwar, Abhijit / Ojili, Vijayanadh / Katre, Rashmi / Shah, Hardik / Nagar, Arpit

The Indian journal of radiology & imaging

2017 Volume 27, Issue 1, Page(s) 13–22

Abstract: Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist ... ...

Abstract	Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist may be the first one to suggest a diagnosis as the imaging findings are often characteristic. The purpose of this article is to provide a comprehensive review of multimodality imaging (plain radiograph, fluoroscopy, and computed tomography) of various life threatening gastric emergencies.
Language	English
Publishing date	2017-03-03
Publishing country	India
Document type	Journal Article
ZDB-ID	605869-3
ISSN	0971-3026 ; 0970-2016
ISSN	0971-3026 ; 0970-2016
DOI	10.4103/0971-3026.202957
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Article: Imaging of Ampullary and Periampullary Conditions

Sunnapwar, Abhijit / Nagar, Arpit / Katre, Rashmi / Khanna, Lokesh / Sayana, Hari Prasad

Journal of Gastrointestinal and Abdominal Radiology

2021 Volume 4, Issue 03, Page(s) 214–228

Abstract	The ampulla of Vater is formed by the union of the pancreatic duct and the common bile duct and is also known as hepatopancreatic ampulla or hepatopancreatic duct. The ampulla is surrounded by a muscular valve known as the sphincter of Oddi, which controls the flow of bile and pancreatic juices into the duodenum in response to food. The ampulla is also an important embryological landmark as it marks the anatomical transition from foregut to the midgut. Because of this, it is a watershed zone where the blood supply changes from the celiac axis to the superior mesenteric artery. Radiologic evaluation of the ampulla and the periampullary region is challenging because it requires an understanding of the embryology, the normal appearance, and different anatomic variants. Also, a wide variety of pathologies can occur in this region. The purpose of this review is to present the normal anatomy of the ampulla and the periampullary region on different imaging modalities and to summarize the imaging features of the common variants, and benign and malignant ampullary and periampullary conditions. Understanding of the normal anatomical appearance and variants along with the knowledge of common pathologic conditions affecting the ampulla and periampullary conditions can help radiologists in making accurate diagnosis resulting in optimum patient care.
Keywords	ampullary ; biliopancreatic junction ; neoplasms ; periampullary
Language	English
Publishing date	2021-05-05
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2581-9178
ISSN (online)	2581-9178
DOI	10.1055/s-0041-1726663
Database	Thieme publisher's database

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Article ; Online: Pancreatic Neuroendocrine Neoplasms: 2020 Update on Pathologic and Imaging Findings and Classification.

Khanna, Lokesh / Prasad, Srinivasa R / Sunnapwar, Abhijit / Kondapaneni, Sainath / Dasyam, Anil / Tammisetti, Varaha S / Salman, Umber / Nazarullah, Alia / Katabathina, Venkata S

Radiographics : a review publication of the Radiological Society of North America, Inc

2020 Volume 40, Issue 5, Page(s) 1240–1262

Abstract: Pancreatic neuroendocrine neoplasms (panNENs) are heterogeneous neoplasms with neuroendocrine differentiation that show characteristic clinical, histomorphologic, and prognostic features; genetic alterations; and biologic behavior. Up to 10% of panNENs ... ...

Abstract	Pancreatic neuroendocrine neoplasms (panNENs) are heterogeneous neoplasms with neuroendocrine differentiation that show characteristic clinical, histomorphologic, and prognostic features; genetic alterations; and biologic behavior. Up to 10% of panNENs develop in patients with syndromes that predispose them to cancer, such as multiple endocrine neoplasia type 1, von Hippel-Lindau disease, tuberous sclerosis complex, neurofibromatosis type 1, and glucagon cell adenomatosis. PanNENs are classified as either functioning tumors, which manifest early because of clinical symptoms related to increased hormone production, or nonfunctioning tumors, which often manifest late because of mass effect. PanNENs are histopathologically classified as well-differentiated pancreatic neuroendocrine tumors (panNETs) or poorly differentiated pancreatic neuroendocrine carcinomas (panNECs) according to the 2010 World Health Organization (WHO) classification system. Recent advances in cytogenetics and molecular biology have shown substantial heterogeneity in panNECs, and a new tumor subtype, well-differentiated, high-grade panNET, has been introduced. High-grade panNETs and panNECs are two distinct entities with different pathogenesis, clinical features, imaging findings, treatment options, and prognoses. The 2017 WHO classification system and the eighth edition of the American Joint Committee on Cancer staging system include substantial changes. Multidetector CT, MRI, and endoscopic US help in anatomic localization of the primary tumor, local-regional spread, and metastases. Somatostatin receptor scintigraphy and fluorine 18-fluorodeoxyglucose PET/CT are helpful for functional and metabolic assessment. Knowledge of recent updates in the pathogenesis, classification, and staging of panNENs and familiarity with their imaging findings allow optimal patient treatment.
MeSH term(s)	Diagnosis, Differential ; Humans ; Mutation ; Neoplasm Grading ; Neoplasm Staging ; Neuroendocrine Tumors/diagnostic imaging ; Neuroendocrine Tumors/genetics ; Neuroendocrine Tumors/pathology ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/genetics ; Pancreatic Neoplasms/pathology ; Prognosis
Language	English
Publishing date	2020-08-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603172-9
ISSN	1527-1323 ; 0271-5333
ISSN (online)	1527-1323
ISSN	0271-5333
DOI	10.1148/rg.2020200025
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Article ; Online: Multimodality imaging of adult gastric emergencies

Abhijit Sunnapwar / Vijayanadh Ojili / Rashmi Katre / Hardik Shah / Arpit Nagar

Indian Journal of Radiology and Imaging, Vol 27, Iss 01, Pp 13-

A pictorial review

2017 Volume 22

Abstract	Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist may be the first one to suggest a diagnosis as the imaging findings are often characteristic. The purpose of this article is to provide a comprehensive review of multimodality imaging (plain radiograph, fluoroscopy, and computed tomography) of various life threatening gastric emergencies.
Keywords	ct ; emergencies ; fluoroscopy ; gastric ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Language	English
Publishing date	2017-01-01T00:00:00Z
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inflammation appears as high Prostate Imaging-Reporting and Data System scores on prostate magnetic resonance imaging (MRI) leading to false positive MRI fusion biopsy.

Rourke, Elizabeth / Sunnapwar, Abhijit / Mais, Daniel / Kukkar, Vishal / DiGiovanni, John / Kaushik, Dharam / Liss, Michael A

Investigative and clinical urology

2019 Volume 60, Issue 5, Page(s) 388–395

Abstract: Purpose: To investigate if inflammation as a potential cause of false-positive lesions from recent UroNav magnetic resonance imaging (MRI) fusion prostate biopsy patients.: Materials and methods: We retrospectively identified 43 men with 61 MRI ... ...

Abstract	Purpose: To investigate if inflammation as a potential cause of false-positive lesions from recent UroNav magnetic resonance imaging (MRI) fusion prostate biopsy patients. Materials and methods: We retrospectively identified 43 men with 61 MRI lesions noted on prostate MRI before MRI ultrasound-guided fusion prostate biopsy. Men underwent MRI with 3T Siemens TIM Trio MRI system (Siemens AG, Germany), and lesions were identified and marked in DynaCAD system (Invivo Corporation, USA) with subsequent biopsy with MRI fusion with UroNav. We obtained targeted and standard 12-core needle biopsies. We retrospectively reviewed pathology reports for inflammation. Results: We noted a total of 43 (70.5%) false-positive lesions with 28 having no cancer on any cores, and 15 lesions with cancer noted on systematic biopsy but not in the target region. Of the men with cancer, 6 of the false positive lesions had inflammation in the location of the targeted region of interest (40.0%, 6/15). However, when we examine the 21/28 lesions with an identified lesion on MRI with no cancer in all cores, 54.5% had inflammation on prostate biopsy pathology (12/22, p=0.024). We noted the highest proportion of inflammation. Conclusions: Inflammation can confound the interpretation of MRI by mimicking prostate cancer. We suggested focused efforts to differentiate inflammation and cancer on prostate MRI.
MeSH term(s)	Aged ; Data Systems ; False Positive Reactions ; Humans ; Image-Guided Biopsy ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Interventional ; Male ; Middle Aged ; Prostate/diagnostic imaging ; Prostate/pathology ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Prostatitis/diagnostic imaging ; Prostatitis/pathology ; Retrospective Studies ; Ultrasonography, Interventional
Language	English
Publishing date	2019-07-30
Publishing country	Korea (South)
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2923014-7
ISSN	2466-054X ; 2466-0493
ISSN (online)	2466-054X
ISSN	2466-0493
DOI	10.4111/icu.2019.60.5.388
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Restriction Spectrum Imaging-Magnetic Resonance Imaging to Improve Prostate Cancer Imaging in Men on Active Surveillance.

Besasie, Benjamin D / Sunnapwar, Abhijit G / Gao, Feng / Troyer, Dean / Clarke, Geoffrey D / White, Hugh / Fox, Peter T / Dale, Anders / Wheeler, Allison / Liss, Michael A

The Journal of urology

2021 Volume 206, Issue 1, Page(s) 44–51

Abstract: Purpose: Restriction spectrum imaging-magnetic resonance imaging is a short duration enhanced diffusion-weighted technique that seeks to standardize sequences and predict upgrading. We test this technology for active surveillance biopsies. Our objective ...

Abstract	Purpose: Restriction spectrum imaging-magnetic resonance imaging is a short duration enhanced diffusion-weighted technique that seeks to standardize sequences and predict upgrading. We test this technology for active surveillance biopsies. Our objective is to investigate the utility of restriction spectrum imaging-magnetic resonance imaging to improve upgrading detection in a prostate cancer active surveillance cohort. Materials and methods: We prospectively enrolled men on active surveillance undergoing repeat biopsy from January 2016 to June 2019. Subjects underwent prostate multiparametric magnetic resonance imaging and restriction spectrum imaging-magnetic resonance imaging reviewed by a urological radiologist for PI-RADS® scored lesions, followed by magnetic resonance imaging-guided prostate biopsy by a urologist. Restriction spectrum imaging-magnetic resonance imaging analysis with proprietary research software (CorTechs Labs, San Diego, California) generated a restricted signal map. We compared the restricted signal map and apparent diffusion coefficient values using T-test, ANOVA, and logistic regression analyses for prediction of upgrading. Results: Of 123 enrolled men we identified 74 restriction spectrum imaging-magnetic resonance imaging regions of interest (targeted lesions) in 110 subjects, with 105 subjects completing biopsy. The restricted signal map was significant per PI-RADS score for true-positive lesion detection (mean difference 28, SD 0.7, p=0.001), and better than apparent diffusion coefficient (mean difference -15, SD 55, p=0.6). Restriction spectrum imaging generated restricted signal map values >50 improved sensitivity, specificity, positive predictive value and negative predictive value (81.0%, 81.8%, 54.2% and 94.2%) over PI-RADS ≥3 (71.4%, 38.9%, 23.7% and 83.7%, respectively) for Gleason upgrading. Overall restriction spectrum imaging is able to improve the AUC of 0.70 (95% CI 0.49-0.92, p=0.03) to 0.90 (95% CI 0.82-0.98, p <0.001). Conclusions: Restriction spectrum imaging-magnetic resonance imaging enhances the standard PI-RADS system by providing a noninvasive radiological biomarker to predict upgrading in active surveillance.
MeSH term(s)	Aged ; Biopsy ; Diffusion Magnetic Resonance Imaging/methods ; Humans ; Male ; Middle Aged ; Multiparametric Magnetic Resonance Imaging ; Predictive Value of Tests ; Prospective Studies ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Sensitivity and Specificity ; Watchful Waiting
Language	English
Publishing date	2021-02-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1097/JU.0000000000001692
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Article ; Online: Multimodality Imaging Findings in Carcinoid Tumors: A Head-to-Toe Spectrum.

Baxi, Ameya Jagdish / Chintapalli, Kedar / Katkar, Amol / Restrepo, Carlos S / Betancourt, Sonia L / Sunnapwar, Abhijit

Radiographics : a review publication of the Radiological Society of North America, Inc

2017 Volume 37, Issue 2, Page(s) 516–536

Abstract: Carcinoid tumors are a rare biologically heterogeneous group of neuroendocrine tumors with a spectrum ranging from benign indolent to aggressive metastatic tumors. They belong to the category of amine precursor uptake and decarboxylase tumors, or ... ...

Abstract	Carcinoid tumors are a rare biologically heterogeneous group of neuroendocrine tumors with a spectrum ranging from benign indolent to aggressive metastatic tumors. They belong to the category of amine precursor uptake and decarboxylase tumors, or apudomas. The most common sites for primary locations are the gastrointestinal and respiratory tracts; however, any organ can be involved. The clinical presentation depends on location, aggressiveness, production of biologically active amines and peptides, paraneoplastic syndromes, and tendency for metastasis. Their reported age-adjusted incidence has increased in recent years, partly due to improved detection at radiologic imaging and endoscopy. Not a ll neuroendocrine cell tumors are carcinoids. Numerous systems have been proposed regarding their nomenclature and classification. Cross-sectional and functional imaging plays an important role in diagnosis, lesion characterization, and staging. Awareness of nomenclature, classification, common sites of involvement, and imaging presentation are pivotal for making the diagnosis. Knowledge of the diverse clinical, pathologic, and radiologic spectrum of carcinoid tumors involving various organs of the body is important for diagnosis and patient management.
MeSH term(s)	Carcinoid Tumor/diagnostic imaging ; Carcinoid Tumor/pathology ; Diagnosis, Differential ; Humans ; Multimodal Imaging ; Neoplasm Staging
Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603172-9
ISSN	1527-1323 ; 0271-5333
ISSN (online)	1527-1323
ISSN	0271-5333
DOI	10.1148/rg.2017160113
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