Search

Mutual diffusion coefficients for selected alkanes in carbon tetrachloride were calculated using molecular dynamics and Lennard-Jones (LJ) potentials. Use of effective spherical LJ parameters is desirable when possible for two reasons: (i) computer time is saved due to the simplicity of the model and (ii) the number of parameters in the model is kept to a minimum. Results of this study indicate that mutual diffusivity is particularly sensitive to the molecular size cross parameter, σ12, and that the commonly used Lorentz–Berthelot rules are inadequate for mixtures in which the component structures differ significantly. Good agreement between simulated and experimental mutual diffusivities is obtained with a combining rule for σ12 which better represents these asymmetric mixtures using pure component LJ parameters obtained from self-diffusion coefficient data. The effect of alkane chain length on the mutual diffusion coefficient is correctly predicted. While the effects of alkane branching upon the diffusion coefficient are comparable in size to the uncertainty of these calculations, the qualitative trend due to branching is also correctly predicted by the MD results. [ABSTRACT FROM AUTHOR]

Faecal incontinence is a common multifactorial disorder. Major causes of faecal incontinence are related to vaginal delivery and prior anorectal surgery. In addition to medical history and physical examination, several anorectal functional tests and imaging techniques can be used to assess the underlying pathophysiology and to guide treatment planning in faecal incontinent patients. Anorectal functional tests provide functional information, but the potential strength comes from combining test results. Imaging techniques, including defecography, endoanal sonography, and magnetic resonance (MR) imaging, provide structural information about the anorectal region with a direct clinical impact. The major role of imaging techniques in faecal incontinence is visualising the structural and functional integrity of the anal sphincter complex. Both two-dimensional endoanal sonography and endoanal MR imaging are accurate tools to depict anal sphincter defects. The major advantage of endoanal MR imaging is the accurate demonstration of external anal sphincter atrophy. Recent studies have suggested that external phased array MR imaging and three-dimensional endoanal sonography are also valuable tools in the diagnostic work up of faecal incontinence. Decisions about the preferred technique will mainly be determined by availability and local expertise. This article demonstrates the current role of tests, predominantly imaging tests, in the diagnostic work up of faecal incontinence. [ABSTRACT FROM AUTHOR]

Abstract Aim: It has long been established from controlled experiments in anaesthetized animals that it is more accurate to quantify the mean frequency of efferent sympathetic nerve activity from single unit than from multi-unit bursts recordings. More recently, sympathetic nerve hyperactivity has been reported in patients with essential hypertension (EHT) when using microneurographic recordings from peripheral efferent nerves. This review will focus on the mean frequency of single unit of muscle sympathetic nerve activity (s-MSNA) in relation to that of multi-unit bursts (MSNA) as obtained by microneurography in EHT. Results: We have shown that the resting levels of s-MSNA and MSNA were increased in uncomplicated EHT, white coat hypertension and in EHT complicated by left ventricular hypertrophy. There was a relatively greater increase in s-MSNA than in MSNA in mild hypertension and in complicated EHT. We also found that both s-MSNA and MSNA were increased to a similar extent in conditions known to affect reflexes emanating from the heart and influencing sympathetic output, such as acute myocardial infarction. In other preliminary studies, the increase of s-MSNA in response to the discomfort of cold pressor test was greater than that of MSNA and this difference was abolished by the centrally sympatholytic agent moxonidine. Conclusion: These results are consistent with the hypothesis that an increase in the mean frequency of central sympathetic discharge to the periphery (greater s-MSNA than MSNA) is involved in the pathogenesis and complications of EHT. Target organ damage may in turn lead to an increase in overall sympathetic output (excessive MSNA increase) through the operation of peripheral reflex mechanisms. [ABSTRACT FROM AUTHOR]

Summary Background: Over the past two decades developments in imaging have changed the assessment of patients with anorectal disease. Methods: The literature on imaging techniques for anorectal diseases was reviewed over the period 1980–1999. Results: For the staging of primary rectal tumours, phased array magnetic resonance imaging (MRI) may be regarded as the most appropriate single technique. The combination of endosonography or endoluminal MRI with ultrasonography or spiral computed tomography yields similar results. All techniques have limitations both for local staging and in the assessment of distant metastases. MRI or positron emission tomography is preferable for tumour recurrence. For perianal fistula, high-resolution MRI (phased array or endoluminal) is the technique of choice. For constipation, defaecography is the preferred technique, nowadays with emphasis on functional information. The role of magnetic resonance defaecography is currently being evaluated. For faecal incontinence, endosonography and endoluminal MRI give similar results in detecting sphincter defects; endoluminal MRI has the advantage of detecting external sphincter atrophy. Conclusion: High-resolution MRI, endosonography and defaecography are currently the optimal imaging techniques for anorectal disease. [ABSTRACT FROM AUTHOR]

SummaryBackground: There is still considerable debate about the value of preoperative anorectal physiological parameters in predicting the clinical outcome after sphincteroplasty. Recently it has been reported that atrophy of the external anal sphincter can be clearly shown with endoanal magnetic resonance imaging (MRI). The aims of this study were to investigate the prevalence of external anal sphincter atrophy in women with anterior sphincter defects due to obstetric injury and to determine the impact of external anal sphincter atrophy on the outcome of sphincteroplasty. Methods: In this prospective study, 20 consecutive women (median age 50 (range 28–75) years) with faecal incontinence due to obstetric trauma were assessed before operation with endoanal ultrasonography and endoanal MRI. The external anal sphincter was examined and evaluated for the presence of atrophy. The clinical outcome of sphincteroplasty was interpreted without knowledge of the magnetic resonance and ultrasonographic images. Results: In all patients anterior sphincter defects could be demonstrated with ultrasonography and MRI. External anal sphincter atrophy could only be demonstrated on MRI. Eight of 20 patients had external anal sphincter atrophy. Continence was restored in 13 patients. Outcome was significantly better in those without external anal sphincter atrophy (11 of 12 patients versus two of eight; P = 0·004). Conclusion: External anal sphincter atrophy can only be visualized on endoanal MRI and affects continence after sphincteroplasty. Endoanal MRI is valuable in the preoperative assessment of patients with faecal incontinence. Presented to the American Society of Colon and Rectal Surgeons in Philadelphia, Pennsylvania, USA, June 1997. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is often detected at a relatively late stage when tumour size prohibits curative surgery. Screening to detect HCC at an early stage is performed for patients at risk. Aim: The aim of this study was to compare prospectively the diagnostic accuracy and classification for management of the two state of the art secondline imaging techniques: triphasic spiral computer tomography (CT) and super paramagnetic iron oxide (SPIO) enhanced magnetic resonance imaging (MRI). Patients: Sixty one patients were evaluated between January 1996 and January 1998. Patients underwent CT and MRI within a mean interval of 6.75 days. Methods: CT and MRI were evaluated blindly for the presence and number of lesions, characterisation of these lesions, and classification for management. For comparison of the data on characterisation, the CT and MRI findings were compared with histopathological studies of the surgical specimens and/or follow up imaging. Data of patients not lost to follow up were available to January 2001. Results: SPIO enhanced MRI detected more lesions and overall smaller lesions than triphasic spiral CT (number of lesions 189 v 124; median diameter 1.0 v 1.8 cm; Spearman rank's correlation coefficient 0.63, p<0.001). There was no significant difference in accuracy between CT and MRI for lesion characterisation. The agreement in classification for management was very good (weighted kappa 0.91, 95% CI 0.83-0.99). Conclusion: SPIO enhanced MRI detects more and smaller lesions, but both techniques are comparable in terms of classification for management. SPIO enhanced MRI may be preferred as there is no exposure to ionising radiation. [ABSTRACT FROM AUTHOR]

Background: Disease recurrence remains one of the biggest concerns in patients after resection of pancreatic ductal adenocarcinoma (PDAC). Despite (neo)adjuvant systemic therapy, most patients experience local and/or distant PDAC recurrence within 2 years. High-level evidence regarding the benefits of recurrence-focused surveillance after PDAC resection is missing, and the impact of early detection and treatment of recurrence on survival and quality of life is unknown. In most European countries, recurrence-focused follow-up after surgery for PDAC is currently lacking. Consequently, guidelines regarding postoperative surveillance are based on expert opinion and other low-level evidence. The recent emergence of more potent local and systemic treatment options for PDAC recurrence has increased interest in early diagnosis. To determine whether early detection and treatment of recurrence can lead to improved survival and quality of life, we designed an international randomized trial. Methods: This randomized controlled trial is nested within an existing prospective cohort in pancreatic cancer centers in the Netherlands (Dutch Pancreatic Cancer Project; PACAP) and the United Kingdom (UK) (Pancreas Cancer: Observations of Practice and survival; PACOPS) according to the "Trials within Cohorts" (TwiCs) design. All PACAP/PACOPS participants with a macroscopically radical resection (R0-R1) of histologically confirmed PDAC, who provided informed consent for TwiCs and participation in quality of life questionnaires, are included. Participants randomized to the intervention arm are offered recurrence-focused surveillance, existing of clinical evaluation, serum cancer antigen (CA) 19–9 testing, and contrast-enhanced computed tomography (CT) of chest and abdomen every three months during the first 2 years after surgery. Participants in the control arm of the study will undergo non-standardized clinical follow-up, generally consisting of clinical follow-up with imaging and serum tumor marker testing only in case of onset of symptoms, according to local practice in the participating hospital. The primary endpoint is overall survival. Secondary endpoints include quality of life, patterns of recurrence, compliance to and costs of recurrence-focused follow-up, and the impact on recurrence-focused treatment. Discussion: The RADAR-PANC trial will be the first randomized controlled trial to generate high level evidence for the current clinical equipoise regarding the value of recurrence-focused postoperative surveillance with serial tumor marker testing and routine imaging in patients after PDAC resection. The Trials within Cohort design allows us to study the acceptability of recurrence-focused surveillance among cohort participants and increases the generalizability of findings to the general population. While it is strongly encouraged to offer all trial participants treatment at time of recurrence diagnosis, type and timing of treatment will be determined through shared decision-making. This might reduce the potential survival benefits of recurrence-focused surveillance, although insights into the impact on patients' quality of life will be obtained. Trial registration: Clinicaltrials.gov, NCT04875325. Registered on May 6, 2021. [ABSTRACT FROM AUTHOR]

Background: Disease recurrence remains one of the biggest concerns in patients after resection of pancreatic ductal adenocarcinoma (PDAC). Despite (neo)adjuvant systemic therapy, most patients experience local and/or distant PDAC recurrence within 2 years. High-level evidence regarding the benefits of recurrence-focused surveillance after PDAC resection is missing, and the impact of early detection and treatment of recurrence on survival and quality of life is unknown. In most European countries, recurrence-focused follow-up after surgery for PDAC is currently lacking. Consequently, guidelines regarding postoperative surveillance are based on expert opinion and other low-level evidence. The recent emergence of more potent local and systemic treatment options for PDAC recurrence has increased interest in early diagnosis. To determine whether early detection and treatment of recurrence can lead to improved survival and quality of life, we designed an international randomized trial. Methods: This randomized controlled trial is nested within an existing prospective cohort in pancreatic cancer centers in the Netherlands (Dutch Pancreatic Cancer Project; PACAP) and the United Kingdom (UK) (Pancreas Cancer: Observations of Practice and survival; PACOPS) according to the "Trials within Cohorts" (TwiCs) design. All PACAP/PACOPS participants with a macroscopically radical resection (R0-R1) of histologically confirmed PDAC, who provided informed consent for TwiCs and participation in quality of life questionnaires, are included. Participants randomized to the intervention arm are offered recurrence-focused surveillance, existing of clinical evaluation, serum cancer antigen (CA) 19–9 testing, and contrast-enhanced computed tomography (CT) of chest and abdomen every three months during the first 2 years after surgery. Participants in the control arm of the study will undergo non-standardized clinical follow-up, generally consisting of clinical follow-up with imaging and serum tumor marker testing only in case of onset of symptoms, according to local practice in the participating hospital. The primary endpoint is overall survival. Secondary endpoints include quality of life, patterns of recurrence, compliance to and costs of recurrence-focused follow-up, and the impact on recurrence-focused treatment. Discussion: The RADAR-PANC trial will be the first randomized controlled trial to generate high level evidence for the current clinical equipoise regarding the value of recurrence-focused postoperative surveillance with serial tumor marker testing and routine imaging in patients after PDAC resection. The Trials within Cohort design allows us to study the acceptability of recurrence-focused surveillance among cohort participants and increases the generalizability of findings to the general population. While it is strongly encouraged to offer all trial participants treatment at time of recurrence diagnosis, type and timing of treatment will be determined through shared decision-making. This might reduce the potential survival benefits of recurrence-focused surveillance, although insights into the impact on patients' quality of life will be obtained. Trial registration: Clinicaltrials.gov, NCT04875325. Registered on May 6, 2021. [ABSTRACT FROM AUTHOR]

Background: Mesenchymal stem cell treatment (MST) has emerged as a new therapeutic strategy for Crohn's perianal fistulas. It has been demonstrated that a fibrotic tract on MRI with a MAGNIFI-CD score ≤ 6 is the best predictor for long-term clinical closure. Therefore, the aim of the current study was to analyse the effectiveness of MST for complex Crohn's perianal fistulas based on MRI. Methods: Consecutive patients with complex Crohn's perianal fistulas, previously failing both anti-TNF treatment and surgical closure, who had surgical closure of the internal opening with MST were included. The primary endpoint was radiological remission of the fistula(s) defined as a MAGNIFI-CD ≤ 6 on MRI, read by an experienced radiologist. Results: Between December 2019 and March 2023, 30 patients (15 males) with 48 fistula tracts were included with a median follow-up of 16.5 months. Radiological remission was achieved in thirteen patients (43.3%) after a median follow-up of 5.0 months (IQR 3.0–6.0). The median MAGNIFI-CD at baseline was 15.0 (IQR 7.0–20.0) which significantly decreased to 8.0 (IQR 3.0–15.0) after treatment (p = 0.001). Clinical closure was achieved in 21 patients (70.0%). Three patients (14.3%) developed a recurrence during long-term FU, all with clinically closed fistula(s), but no radiological remission. The median PDAI decreased significantly from 10.5 (IQR 7.0–14.0) to 4.0 (IQR 0.0-7.3) (p = 0.001). Conclusion: MST is a promising treatment strategy for therapy refractory Crohn's perianal fistulas, resulting in > 40% radiological remission, clinical closure in 70% and a significant improvement in quality of life. No recurrences were seen in patients with radiological remission. [ABSTRACT FROM AUTHOR]

Background: [18F]FDG-PET/CT is used for staging and treatment planning in patients with locally advanced cervical cancer (LACC). We studied if a PET-based prediction model could provide additional risk stratification beyond International Federation of Gynaecology and Obstetrics (FIGO) staging in our population with LACC to aid treatment decision making. Methods: In total, 183 patients with LACC treated with chemoradiation between 2013 and 2018 were included. Patients were treated according to FIGO 2009 and retrospectively reclassified according to FIGO 2018 staging system. After validation of an existing PET-based prediction model, the predicted recurrent free survival (RFS), disease specific survival (DSS) and overall survival (OS) at 1, 3, and 5 years, based on metabolic tumor volume (MTV), maximum standardized uptake value (SUVmax) and highest level of [18F]FDG-positive node was calculated. Then the observed survival was compared to the predicted survival. An area under the curve (AUC) close to or higher than 0.7 was considered adequate for accurate prediction. The Youden (J) index defined survival chance cutoff values for low and high risk groups. Results: All AUC values for the comparison between predicted and observed outcomes were > 0.7 except for 5-year RFS and for 5-year OS which were close to 0.7 (0.684 and 0.650 respectively). Cutoff values for low and high risk survival chance were 0.44 for the 3-year RFS and 0.47 for the 5-year OS. The FIGO 2009 system could not differentiate between the risk profiles. After reclassification according to FIGO 2018, all patients with stage IIIC2 and IVB fell in the high risk and almost all patients with stages IB2-IIIB and IVA in the low risk group. In patients with stage IIIC1 disease the FIGO stage cannot discriminate between the risk profiles. Conclusions: Low and high risk patients with LACC can be identified with the PET-based prediction model. In particular patients with stage IIIC1 need additional risk stratification besides the FIGO 2018 staging. The Kidd model could be a useful tool to aid treatment decision making in these patients. Our results also support the choice of [18F]FDG-PET/CT imaging in patients with LACC. [ABSTRACT FROM AUTHOR]

Visceral obesity (VO) is a risk factor for developing postoperative complications in patients undergoing abdominal oncological surgery. However, in ovarian cancer patients this influence of body composition on postoperative morbidity is not well established. The aim of this study is to assess the association between body composition and complications in patients with advanced ovarian cancer undergoing cytoreductive surgery. Patients with FIGO stage 3 or 4 ovarian cancer between 2006 and 2017 were included. Visceral fat area, total skeletal mass and total fat area were measured on a single slice on the level of L3-L4 of the preoperative CT-scan. VO was defined as visceral fat ≥100cm2. The perioperative data were extracted retrospectively. A multivariate logistic regression analysis was performed to test the predictive value of multiple variables such as body composition, albumin levels and preoperative morbidity. 298 consecutive patients out of nine referring hospitals were included. VO patients were more likely to be hypertensive (38% vs 17% p < 0.001), and to have an ASA 3 score (21% vs 10% P = 0.012). Complications occurred more often in VO patients (43% vs 21% P < 0.001). Thrombotic events were found in 4.9% of VO patients versus 0.6% of the non-visceral obese patients (p = 0.019). VO(OR: 4.37, p < 0.001), hypertension (OR:1.9, p = 0.046) and duration of surgery (OR: 1.004, p = 0.017) were predictors of post-surgical complications. Muscle mass is not a predictor of complications. Visceral obesity is associated with a higher occurrence of complications in patients with advanced ovarian cancer undergoing cytoreductive surgery. • Visceral obesity predicts post-surgical complications in ovarian cancer patients undergoing cytoreductive treatment. • Visceral obese patients have more hypertension and higher ASA scores. • Patients with a normal BMI can be visceral obese and therefore have an higher risk of complications. [ABSTRACT FROM AUTHOR]

We employ a Paul-Straubel ring-type electrodynamic trap for studies of single microparticles. Such a trap provides ready access for laser beams to a stored species and is especially suited for scattering and spectroscopic studies of fine particles. We derive the pseudopotential for such a trap and determine the stability regions for confinement of charged particles considering also the viscous force of a buffer medium and the force of gravity. The dynamics of microparticles in such a trap is numerically simulated. The diffraction pattern of light scattered on a polystyrene particle of about 10 μm diameter was registered. For measuring Raman spectra from a single dipicolinic acid microparticle, we used excitation at 488 nm and detection with a fiber optics spectrometer. To improve the collection of light, the trap with the stored particle was placed inside an elliptical mirror. [ABSTRACT FROM AUTHOR]

Objective. The bowel is an important organ at risk for toxicity during pelvic and abdominal radiotherapy. Identifying regions of high and low bowel motion with MRI during radiotherapy may help to understand the development of bowel toxicity, but the acquisition time of MRI is rather long. The aim of this study is to retrospectively evaluate the precision of bowel motion quantification and to estimate the minimum MRI acquisition time. Approach. We included 22 gynaecologic cancer patients receiving definitive radiotherapy with curative intent. The 10 min pre-treatment 3D cine-MRI scan consisted of 160 dynamics with an acquisition time of 3.7 s per volume. Deformable registration of consecutive images generated 159 deformation vector fields (DVFs). We defined two motion metrics, the 50th percentile vector lengths (VL50) of the complete set of DVFs was used to measure median bowel motion. The 95th percentile vector lengths (VL95) was used to quantify high motion of the bowel. The precision of these metrics was assessed by calculating their variation (interquartile range) in three different time frames, defined as subsets of 40, 80, and 120 consecutive images, corresponding to acquisition times of 2.5, 5.0, and 7.5 min, respectively. Main results. For the full 10 min scan, the minimum motion per frame of 50% of the bowel volume (M50%) ranged from 0.6–3.5 mm for the VL50 motion metric and 2.3–9.0 mm for the VL95 motion metric, across all patients. At 7.5 min scan time, the variation in M50% was less than 0.5 mm in 100% (VL50) and 95% (VL95) of the subsets. A scan time of 5.0 and 2.5 min achieved a variation within 0.5 mm in 95.2%/81% and 85.7%/57.1% of the subsets, respectively. Significance. Our 3D cine-MRI technique quantifies bowel loop motion with 95%–100% confidence with a precision of 0.5 mm variation or less, using a 7.5 min scan time. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the currently used effective doses in CT colonography (CTC) and to search for trends in time. A Pubmed search for articles and a search for congress abstracts concerning CTC was performed. Research institutions were sent a CTC dose questionnaire concerning the type of CT system employed and the CT parameters used. With the ImPACT CT Dosimetry Spreadsheet effective doses were calculated. Of 83 institutions, 34 returned a complete questionnaire; 21 (62%) used 64-detector row CT and 17 (50%) used dose modulation. The median effective dose per institution was 5.7 mSv (2.8 mSv supine; 2.5 mSv prone) for screening protocols and 9.1 mSv (5.2 and 3.0 mSv, respectively) for daily practice protocols (p<0.05). Doses did not differ significantly between CT machines with different numbers of detector rows. In 17 institutions incorporated in a study in 2004 as well, the median dose for daily practice protocols changed from 11 mSv in 2004 to 9.7 mSv now (n.s.). Median effective dose for CTC is significantly lower for screening than for daily practice protocols. Although the number of CTC protocols with dose modulation increased substantially since 2004, no significant decrease in effective dose was found. [ABSTRACT FROM AUTHOR]

The article focuses on magnetic resonance imaging (MRI) in the diagnosis of acute abdomen. It mentions that computed tomography (CT) and ultrasonography (US) are important in determining acute abdomen since they improve diagnostic accuracy and bring meaningful change in clinical management. It states that MRI does not require ionizing radiation, free from cancer induction and is safe when performed during pregnancy. A forecast states that MRI methodologies may improve value of the diagnosis.

Context: Magnetic resonance angiography (MRA) is a rapidly evolving technique that has been reported to be accurate for assessment of lower extremity arterial disease.Objective: To obtain the best available estimates of the diagnostic performance of MRA in patients with lower extremity arterial disease.Data Sources: Studies published from January 1985 through May 2000 in English, German, or French, identified from the MEDLINE, EMBASE, and Current Contents databases.Study Selection: Studies were included that allowed construction of 2 x 2 contingency tables for detection of stenosis greater than 50% or occlusion with MRA or arteriography in patients with claudication or critical ischemia.Data Extraction: Two observers graded the following elements of study quality: consecutively enrolled patients, prospective study design, clear cut-off levels, blinded assessment, and clear description of MRA technique. Summary receiver operating characteristic analysis was performed to examine the influence of year of publication, all methodological criteria, arterial tract, number of subdivisions within arterial tracts, and MRA technique on diagnostic performance.Data Synthesis: Of 3583 studies initially identified, 34 were included that evaluated MRA in 1090 patients (72% men; median age, 65 years). Magnetic resonance angiography was highly accurate for assessment of all lower extremity arteries. Three-dimensional gadolinium-enhanced (3-D Gd) MRA improved diagnostic performance compared with 2-D MRA (relative diagnostic odds ratio, 2.8 [95% confidence interval, 1.2-6.4]), adjusted for number of subdivisions within arterial tracts. The estimated points of equal sensitivity and specificity were 94% and 90% for 3-D Gd MRA and 2-D MRA, respectively.Conclusions: Magnetic resonance angiography is highly accurate for assessment of the entire lower extremity for arterial disease. Three-dimensional Gd-enhanced MRA improves diagnostic performance compared with 2-D MRA. [ABSTRACT FROM AUTHOR]

A response by the author to the letter to the editor about his article related to magnetic resonance imaging and the acute abdomen in the previous issue is presented.

Purpose: This study aimed to determine the outcome of perineal hernia repair with a biological mesh after abdominoperineal resection (APR).Method: All consecutive patients who underwent perineal hernia repair with a porcine acellular dermal mesh between 2010 and 2014 were included. Follow-up was performed by clinical examination and MRI.Results: Fifteen patients underwent perineal hernia repair after a median of 25 months from APR. Four patients had a concomitant contaminated perineal defect, for which a gluteal fasciocutaneous flap was added in three patients. Wound infection occurred in three patients. After a median follow-up of 17 months (IQR 12-24), a clinically recurrent perineal hernia developed in 7 patients (47 %): 6 of 11 patients after a non-cross-linked mesh and 1 of 4 patients after a cross-linked mesh (p = 0.57). Routine MRI at a median of 17 months revealed a recurrent perineal hernia in 7 of 10 evaluable patients, with clinical confirmation of recurrence in 5 of these 7 patients. No recurrent hernia was observed in the three patients with combined flap reconstruction for contaminated perineal defects.Conclusion: A high recurrence rate was observed after biological mesh repair of a perineal hernia following APR. [ABSTRACT FROM AUTHOR]

Objectives: To compare translabial three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for the measurement of levator hiatal biometry at rest in women with pelvic organ prolapse, and to determine the interobserver reliability between two independent observers for ultrasound and MRI measurements.Methods: Data were derived from a multicenter prospective cohort study in which women scheduled for conventional anterior colporrhaphy underwent translabial 3D ultrasound and MRI prior to surgery. Intraclass correlation coefficients (ICCs) were calculated to estimate interobserver reliability between two independent observers and determine the agreement between ultrasound and MRI measurements. Bland-Altman plots were created to assess the agreement between ultrasound and MRI measurements.Results: Data from 139 women from nine hospitals were included in the study. The interobserver reliability of ultrasound assessment at rest, during Valsalva maneuver and during contraction and of MRI assessment at rest were moderate or good. The agreement between ultrasound and MRI for the measurement of levator hiatal biometry at rest was moderate, with ICCs of 0.52 (95%CI, 0.32-0.66) for levator hiatal area, 0.44 (95%CI, 0.21-0.60) for anteroposterior diameter and 0.44 (95%CI, 0.22-0.60) for transverse diameter. Levator hiatal biometry measurements were statistically significantly larger on MRI than on translabial 3D ultrasound.Conclusions: The agreement between translabial 3D ultrasound and MRI for measurement of the levator hiatus at rest in women with pelvic organ prolapse was only moderate. The results of translabial 3D ultrasound and MRI should therefore not be used interchangeably in daily practice or in clinical research. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

NRG 0617 established that the standard dose of photon RT for unresectable NSCLC is 60 Gy in 30 fractions. However, no dose-escalating trials have been reported for modern active-scanning PBT. A signal-seeking Phase II randomized study (MC1623) was designed and conducted to address this. A single-institutional study was performed. Inclusion criteria included patient (pt)'s age ≥ 18 years; tissue confirmation of NSCLC; PFT's FEV1 ≥ 1 L; unresectable or medically inoperable stage II-III; ECOG PS 0-1; acceptable labs for concurrent chemo; and curative intent. Exclusion criteria included weight loss ≥ 10%; M1 cancer; uncontrolled illnesses; active second malignancy; and prior RT that would overlap with planned PBT. A brain MRI was required. The original design was to randomize pts into 60 Gy/30 fractions (fx) vs. 66 Gy/33 fx vs. 72 Gy/36 fx arms in a 1:1:1 fashion. Contouring included generations of GTV, iGTV, and CTV's. SFO/MFO optimization methods were used for PBT. The primary endpoint was progression-free survival (PFS) improvement, with secondary endpoints being overall survival (OS), adverse events, locoregional and distant failure rates. Accrual was slower than expected, and the 66-Gy arm was first closed, followed by the entire study. Between Aug 2017 and June 2021, 20 pts met inclusion criteria (originally planned for 48 pts). 1 pt was denied by insurance for PBT; 2 (11%) withdrew their consent after randomization. The final analysis consisted of 17 pts. 2 (12%) pts were randomized to the 66-Gy arm, and they were included with the other 8 pts (60 Gy) as standard-dose arm. 7 (41%) pts received 72 Gy (high-dose). The Mayo Prognostic scores for comorbidities were balanced (P = 0.89). The mean age was 76.4 (standard) vs. 74.2 years (P = 0.50); 8 (47%) were male. 13 (77%) smoked in the past. 8 (47%) pts had squamous cell carcinoma; 8 (50%) pts had T3/4 tumors, and 14 (82%) with N2 nodes. At the end of follow-up (median 1.86 years), 6 pts were alive, and 11 deaths had occurred. There was no difference in progression-free (2.04 vs. 0.94 years, P = 0.71) nor overall (3.05 vs. 2.36 years, P = 0.74) survivals, for standard vs high dose arms, respectively. Female gender appeared to favor PFS (P = 0.03), and no nodal involvement for improved OS (P = 0.08). There was 1 pt with grade 3 pneumonitis in standard-dose arm, and 1 pt each with grade 3 myocardial infraction and pulmonary fibrosis in high-dose arm. A competing risk analysis is being planned. While the study was too small to statistically determine a benefit of one dose arm vs. the other, numerically, there appeared no clear advantage to 72-Gy dose escalation in terms of PFS and OS which could be verified in a larger randomized trial. NRG 1308 should clarify if PBT is superior to photon-based RT. With standard use of immunochemotherapy in addition to CRT for locally advanced NSCLC, the increased chance of cardiopulmonary toxicities may be lessened with better tissue-sparing PBT. This, too, will require further prospective studies. [ABSTRACT FROM AUTHOR]

Objectives: Enlarged lateral lymph nodes (LLNs) are associated with increased (lateral) local recurrence rates. Size and anatomical location should therefore always be reported by radiologists and discussed during multidisciplinary meetings. The objective was to investigate how often LLNs are mentioned in MRI reports in a tertiary referral centre. Methods: A single - centre, retrospective study of 202 patients treated for primary rectal cancer between 2012 and 2020, with at least a T2 tumour located within 12cm of the anorectal junction. The radiology reports were written by 30–40 consultant radiologists. MRI scans were independently re-assessed by an expert radiologist. The primary outcome was how often the presence or absence of LLNs was mentioned in the initial report. Results: Primary MRI reports explicitly mentioned the presence or absence of LLNs in 89 (44%) cases. Of the 43 reports with present LLNs, only one (1%) reported on all features such as size, location or malignant features. Expert review revealed 17 LLNs which were ≥ 7 mm (short-axis); two of these were not mentioned in the original reports. In 14/43 (33%) cases, LLNs were discussed during the primary multidisciplinary meeting, while 17/43 (40%) restaging MRI reports failed to report on the previously visible LLN. Reporting LLNs increased significantly with higher N-stage (p =.010) and over time (p =.042). Conclusions: Though improving with time, there is still limited consistency in reporting LLNs. Only 44% of primary MRI reports mentioned LLNs and relevant features of those LLNs were seldomly reported. Given the importance of this information for subsequent treatment; increased awareness, proper training and the use of templates are needed. Key Points: • Comprehensive reporting of lateral lymph nodes in primary MRI reports was limited to less than 50%. • Lateral lymph nodes are not always discussed during primary multidisciplinary meetings or mentioned in restaging reports. • Improvements in the awareness and knowledge of lateral lymph nodes are needed to ensure adequate multidisciplinary treatment decisions. [ABSTRACT FROM AUTHOR]

Background: In women with unexplained infertility, tubal flushing with oil-based contrast during hysterosalpingography (HSG) increases ongoing pregnancy and subsequent live birth rates when compared to tubal flushing with water-based contrast. It is currently unclear whether an HSG with oil-based contrast also results in more ongoing pregnancies and live births in women of advanced age, women with ovulation disorders, and women with potential tubal pathology when compared to an HSG with water-based contrast.Methods: We plan an international, multicentre, open-label, randomized controlled trial (RCT) studying three groups of infertile women who have an indication for tubal patency testing according to their treating physician and additionally; (1) are 39 years of age or older, (2) have an ovulation disorder or (3) have a high risk for tubal pathology based on their medical history. Women with an allergy for iodinated contrast medium are excluded, as are women with diabetes, hyperprolactinemia or untreated hyper- or hypothyroidism, and women with a partner with severe male infertility. After informed consent, women will be randomly allocated to the intervention, tubal flushing with the use of oil-based contrast during HSG or the control group, tubal flushing with the use of water-based contrast during HSG in a 1:1 ratio by the web-based system Castor. The primary endpoint will be ongoing pregnancy leading to live birth with conception within six months after randomization. Secondary outcomes are other pregnancy outcomes, used fertility treatments, adverse events and cost-effectiveness. Based on the expected ongoing pregnancy rate of 17% in the control group and 27% in the intervention group, the sample size will be 930 women (465 per group). Study inclusion is expected to be complete in four years.Discussion: This multicentre RCT will establish whether, for women of advanced age, women with ovulatory disease, and women who have a high risk for tubal pathology, there is a fertility enhancing effect of tubal flushing with oil-based contrast during HSG and whether the use of this contrast medium is cost-effective. Trial Registration The study was prospectively registered in the Netherlands Trial Register on August 1st 2019 as 'H2Oil2' (reference number NL7925, https://www.trialregister.nl/trial/7925 ). [ABSTRACT FROM AUTHOR]

Objectives: Computed tomography (CT) colonography cost assumptions so far ranged from €346 to €594 per procedure, based on clinical CT reimbursement rates. The aim of our study was to estimate the costs in a screening situation. Methods: Data were collected within an invitational population-based CRC screening trial ( n = 2,920, age 50-75 years) with a dedicated CT-screening setting. Unit costs were calculated per action, per invitee and per participant (depending on adherence) and per individual with detected advanced neoplasia. Sensitivity analyses were performed, and alternative scenarios were considered. Results: Of the invitees, 47.2 % were reminded, 38.8 % scheduled for an intake, 37.2 % scheduled for CT colonography, 33.6 % underwent CT colonography and 1.1 % needed a re-examination. Lesions ≥10 mm were detected in 2.9 % of the invitees. Invitation costs were €5.57. Costs per CT colonography (intake to results) were €144.00. Extra costs of communication of positive results were €9.00. Average costs of invitational-based CT colonography screening were €56.97 per invitee, €169.40 per participant and €2,772.51 per individual with detected advanced neoplasia. Conclusions: Dutch costs of CT-screening were substantially lower than the cost assumptions that were used in published cost-effectiveness analyses on CT colonography screening. This finding indicates that previous cost-effectiveness analyses should be updated, at least for the Dutch situation. Key Points: • CT colonography screening costs have historically been based on (local) clinical reimbursement rates • Estimates ranged from €346-€594, based on abdominal and/or pelvic computed tomography • Average costs per participant within an invitational population-based screening program: €169.40 • Average CT colonography costs per individual with detected advanced neoplasia: €2,772.51 • Previous cost-effectiveness analyses should probably be updated [ABSTRACT FROM AUTHOR]

Objectives: To prospectively determine the feasibility of diffusion tensor imaging (DTI) with fibre tractography as a tool for the three-dimensional (3D) visualisation of normal pelvic floor anatomy.Methods: Five young female nulliparous subjects (mean age 28 ± 3 years) underwent DTI at 3.0T. Two-dimensional diffusion-weighted axial spin-echo echo-planar (SP-EPI) pulse sequence of the pelvic floor was performed, with additional T2-TSE multiplanar sequences for anatomical reference. Fibre tractography for visualisation of predefined pelvic floor and pelvic wall muscles was performed offline by two observers, applying a consensus method. Three eigenvalues (λ1, λ2, λ3), fractional anisotropy (FA) and mean diffusivity (MD) were calculated from the fibre trajectories.Results: In all subjects fibre tractography resulted in a satisfactory anatomical representation of the pubovisceral muscle, perineal body, anal - and urethral sphincter complex and internal obturator muscle. Mean FA values ranged from 0.23 ± 0.02 to 0.30 ± 0.04, MD values from 1.30 ± 0.08 to 1.73 ± 0.12 × 10(-)³ mm²/s. Muscular structures in the superficial layer of the pelvic floor could not be satisfactorily identified.Conclusions: This study demonstrates the feasibility of visualising the complex three-dimensional pelvic floor architecture using 3T-DTI with fibre tractography. DTI of the deep female pelvic floor may provide new insights into pelvic floor disorders. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of MR-colonography for the detection of colorectal lesions.Methods: A comprehensive literature search was performed for comparative MR-colonography studies, published between May 1997 and February 2009, using the MEDLINE, EMBASE and Cochrane databases. We included studies if MR-colonography findings were prospectively compared with conventional colonoscopy in (a)symptomatic patients. Two reviewers independently extracted study design characteristics and data for summarising sensitivity and specificity. Heterogeneity in findings between studies was tested using I (2) test statistics. Sensitivity and specificity estimates with 95% confidence intervals (CI) were calculated on per patient basis and summary sensitivity on per polyp basis, using bivariate and univariate statistical models.Results: Thirty-seven studies were found to be potentially relevant and 13 fulfilled the inclusion criteria. The study population comprised 1,285 patients with a mean disease prevalence of 44% (range 22-63%). Sensitivity for the detection of CRC was 100%. Significant heterogeneity was found for overall per patient sensitivity and specificity. For polyps with a size of 10 mm or larger, per patient sensitivity and specificity estimates were 88% (95% CI 63-97%; I (2) = 37%) and 99% (95% CI 95-100%; I (2) = 60%). On a per polyp basis, polyps of 10 mm or larger were detected with a sensitivity of 84% (95% CI 66-94%; I (2) = 51%). The data were too heterogeneous for polyps smaller than 6 mm and 6-9 mm.Conclusion: MR-colonography can accurately detect colorectal polyps more than 10 mm in size. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare a 1-day with a 2-day iodine bowel preparation for CT colonography in a positive faecal occult blood test (FOBT) screening population.Materials and Methods: One hundred consecutive patients underwent CT colonography and colonoscopy with segmental unblinding. The first 50 patients (group 1) ingested 7 50 ml iodinated contrast starting 2 days before CT colonography. The latter 50 patients (group 2) ingested 4 50 ml iodinated contrast starting 1 day before CT colonography. Per colonic segment measurements of residual stool attenuation and homogeneity were performed, and a subjective evaluation of tagging quality (grade 1-5) was done. Independently, two reviewers performed polyp and carcinoma detection.Results: The tagging density was 638 and 618 HU (p = 0.458) and homogeneity 91 and 86 HU for groups 1 and 2, respectively (p = 0.145). The tagging quality was graded 5 (excellent) in 90% of all segments in group 1 and 91% in group 2 (p = 0.749). Mean per-polyp sensitivity for lesions >or=10 mm was 86% in group 1 and 97% in group 2 (p = 0.355). Patient burden from diarrhoea significantly decreased for patients in group 2.Conclusions: One-day preparation with meglumine ioxithalamate results in an improved patient acceptability compared with 2-day preparation and has a comparable, excellent image quality and good diagnostic performance. [ABSTRACT FROM AUTHOR]

Published results to date have indicated a good per patient sensitivity of computed tomographic colonography (CTC) for colorectal cancer and for polyps measuring 10 mm or more together with a very good specificity. Sensitivity and specificity for polyps in the range of 6-10 mm are moderate. These results, however, can be achieved only with meticulous attention to technique including adequate colonic distention, and acquisition of supine and prone thin-section computed tomographic (CT) images. Moreover, there is a significant learning curve involved in the interpretation of CTC studies, with performance statistics improving with operator experience. Radiologists must be comfortable in reporting directly from workstation monitors and have access to and be familiar with software for multiplanar and endoluminal reconstructions. In addition to maximize polyp detection and minimize false positive results, reporting radiologists must have a working knowledge of normal colorectal anatomy and pathology on CTC and be familiar with potential pitfalls in interpretation. Besides the description of several possible causes for perceptive errors, also a literature search of perceptive errors in CTC is included in this paper. [ABSTRACT FROM AUTHOR]

Computed tomographic (CT) colonography has been advocated as an alternative colorectal screening method because studies in populations with a high prevalence of polyps have demonstrated that sensitivity for patients with large (> or =10 mm) polyps is generally high (approximately 90%). In three recent studies in low-prevalence populations, however, these values vary from 55% to 94%. Many questions have been raised as to the cause of this remarkable variability, which hampers the implementation of CT colonography in colorectal cancer screening and surveillance. We provide an overview of some potential causes and discuss the available, often indirect, evidence. In addition, several other obstacles that may influence implementation are discussed. Many differences between the study with high sensitivity (94%) and the two studies with low sensitivity (55% and 64%) exist: the primary method to review the data (two or three dimensional), bowel preparation (with or without oral contrast agents), study design (verification method and analysis of adenomas only), reader's experience, and scanning technique (single vs. multislice, thin vs. thick sections). Additional obstacles for implementation in prevention of colorectal cancer may be controversial results concerning patient acceptance, the large-scale use of ionizing radiation, difficulties in detecting flat adenomas, and extracolonic findings. Use of primary three-dimensional review methods, addition of oral contrast agents to bowel preparation, and endoscopic verification of false-positive results on CT colonography are speculated to have a positive influence on sensitivity. Future investigations should demonstrate the influence of these potential factors on sensitivity of CT colonography. Despite a growing body of evidence, it remains uncertain to what extent patient acceptance, radiation issues, flat lesions, and extracolonic findings will be a stumbling block to using CT colonography for colorectal cancer screening. [ABSTRACT FROM AUTHOR]

Background: The 2019 ESC-guidelines on chronic coronary syndromes (ESC-CCS) recommend computed tomographic coronary angiography (CTCA) or non-invasive functional imaging instead of exercise ECG as initial test to diagnose obstructive coronary artery disease. Since impact and challenges of these guidelines are unknown, we studied the current utilisation of CTCA-services, status of CTCA-protocols and modeled the expected impact of these guidelines in the Netherlands. Methods and results: A survey on current practice and CTCA utilisation was disseminated to every Dutch hospital organisation providing outpatient cardiology care and modeled the required CTCA capacity for implementation of the ESC guideline, based on these national figures and expert consensus. Survey response rate was 100% (68/68 hospital organisations). In 2019, 63 hospital organisations provided CTCA-services (93%), CTCA was performed on 99 CTCA-capable CT-scanners, and 37,283 CTCA-examinations were performed. Between the hospital organisations, we found substantial variation considering CTCA indications, CTCA equipment and acquisition and reporting standards. To fully implement the new ESC guideline, our model suggests that 70,000 additional CTCA-examinations would have to be performed in the Netherlands. Conclusions: Despite high national CTCA-services coverage in the Netherlands, a substantial increase in CTCA capacity is expected to be able to implement the 2019 ESC-CCS recommendations on the use of CTCA. Furthermore, the results of this survey highlight the importance to address variations in image acquisition and to standardise the interpretation and reporting of CTCA, as well as to establish interdisciplinary collaboration and organisational alignment. [ABSTRACT FROM AUTHOR]

Presents information on a study which addressed practical aspects of computed tomography (CT) colonography. Commonly used bowel preparations for CT colonography; Procedure of the CT colonography examination; Data evaluation.

The aim of this study was to assess day-to-day variability of left ventricular (LV) volume and ejection fraction (EF) calculated from 3-dimensional echocardiography (3-DE) and to compare the reproducibility of the measurement with magnetic resonance imaging. Forty-six subjects were examined including 15 normal volunteers (group A) and 31 patients with LV dysfunction (group B). Precordial 3-DE acquisition was performed at 2 degrees rotational intervals and repeated 1 week later. Magnetic resonance imaging was performed at 0.5 T. End-diastolic and end-systolic LV volumes were derived using Simpson's rule by manual endocardial tracing of 8 equidistant parallel LV short-axis slices with 3-DE, whereas 9-mm slices were used with magnetic resonance imaging. The mean +/- SD of end-diastolic and end-systolic LV volumes (ml) and EF (%) from magnetic resonance imaging were 182 +/- 75, 121 +/- 76, and 39 +/- 18, whereas those from 3-DE were 182 +/- 76, 121 +/- 77, and 39 +/- 18 respectively. Day-to-day measurements of end-diastolic and end-systolic LV volumes, and EF on 3-DE were not significantly different as assessed with SEE (2.7, 1.1, and 2.4, respectively). Intra- and interobserver SEE for calculating end-diastolic and end-systolic LV volumes and EF for magnetic resonance imaging were 6.3, 4.7, and 2.1 and 13.6, 11.5, and 4.7, respectively, whereas those for 3-DE were 3.1, 4.4, and 2.2 and 6.2, 3.8, and 3.6, respectively. Day-to-day variability of LV volume and EF calculation on 3-DE were small and not significantly different for normal and dysfunctional left ventricles. Observer variabilities of 3-DE were fewer than those of magnetic resonance imaging. Therefore, 3-DE is recommended for serial assessment of LV volume and EF in normal and abnormally shaped ventricles. [ABSTRACT FROM AUTHOR]

Aim: Ligation of the intersphincteric fistula tract (LIFT) is increasingly being used for surgical closure of high perianal fistulas in Crohn's disease. Currently, data on postoperative MRI findings are scarce, although they are considered important for assessing healing and recurrence. Our aim, therefore, was to evaluate fistula characteristics on MRI and their relationship with clinical outcomes after LIFT. Method: Consecutive Crohn's patients treated with LIFT between 2007 and 2018 who underwent baseline and follow‐up MRI were retrospectively included. MRIs were scored by two radiologists according to characteristics based on the original and modified Van Assche indices. MRI findings, with emphasis on fibrosis, and the relationship with clinical healing, re‐interventions and recurrences are described. Results: Twelve patients were included [four men, median age 34 (interquartile range 28–39) years]. Follow‐up MRI was performed at a median of 5.5 months (interquartile range 2.5–6.0) after LIFT. At baseline, all patients showed a tract with predominantly granulation tissue, which changed to predominantly fibrotic in seven (in three of whom it was completely fibrotic). All patients with a (predominantly) fibrotic tract had clinical closure and no re‐interventions or recurrences during long‐term follow‐up. In contrast, of the five patients with persisting granulation tissue, two reached clinical healing, two needed re‐intervention and one had a recurrence. Conclusion: Markedly decreased fistula activity can be observed on MRI after LIFT. The majority of patients develop a predominantly fibrotic tract relatively soon after LIFT without clinical recurrence, suggesting a highly effective therapy. Unfavourable clinical outcomes were only present in patients with persisting granulation tissue, indicating the potential prognostic value of MRI. [ABSTRACT FROM AUTHOR]

Objectives: To develop imaging guidelines for patients with fistula-in-ano and other causes of anal sepsis.Methods: An expert group of 13 members of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) used a modified Delphi process to vote on a series of consensus statements relating to the imaging of patients with potential anal sepsis. Participants first completed a questionnaire to gather practice information and to help frame the statements posed.Results: In the first round of voting, the expert group scored 51 statements of which 45 (88%) achieved immediate consensus. The remaining 6 statements were redrafted following input from the expert group and consensus achieved for all during a second round of voting, including an additional statement drafted. No statement was rejected due to a lack of consensus. After redrafting to improve clarity, 53 individual statements were presented.Conclusion: These expert consensus statements can be used to guide appropriate indication, acquisition, interpretation and reporting of medical imaging for patients with potential fistula-in-ano and other causes of anal sepsis.Key Points: • Medical imaging, notably magnetic resonance imaging, is used widely for the diagnosis and monitoring of fistula-in-ano and other causes of anal and perianal sepsis. • While the indexed medical literature is clear that diagnostic accuracy is potentially excellent, this depends on competent image acquisition and interpretation. • In order to facilitate this, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) has produced expert consensus guidelines regarding the imaging of fistula-in-ano and related conditions. [ABSTRACT FROM AUTHOR]

Objectives: To compare Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) with 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) as quantitative liver function tests for the preoperative assessment of patients undergoing liver resection.Methods: Patients undergoing liver surgery and preoperative assessment of future remnant liver (FRL) function using 99mTc-mebrofenin HBS were included. Patients underwent DHCE-MRI. Total liver uptake function was calculated for both modalities: mebrofenin uptake rate (MUR) and Ki respectively. The FRL was delineated with both SPECT-CT and MRI to calculate the functional share. Blood samples were taken to assess biochemical liver parameters.Results: A total of 20 patients were included. The HBS-derived MUR and the DHCE-MRI-derived mean Ki correlated strongly for both total and FRL function (Pearson r = 0.70, p = 0.001 and r = 0.89, p < 0.001 respectively). There was a strong agreement between the functional share determined with both modalities (ICC = 0.944, 95% CI 0.863-0.978, n = 20). There was a significant negative correlation between liver aminotransferases and bilirubin for both MUR and Ki.Conclusions: Assessment of liver function with DHCE-MRI is comparable with that of 99mTc-mebrofenin HBS and has the potential to be combined with diagnostic MRI imaging. This can therefore provide a one-stop-shop modality for the preoperative assessment of patients undergoing liver surgery.Key Points: • Quantitative assessment of liver function using hepatobiliary scintigraphy is performed in the preoperative assessment of patients undergoing liver surgery in order to prevent posthepatectomy liver failure. • Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) is an emerging method to quantify liver function and can serve as a potential alternative to hepatobiliary scintigraphy. • Assessment of liver function with dynamic gadoxetate-enhanced MRI is comparable with that of hepatobiliary scintigraphy and has the potential to be combined with diagnostic MRI imaging. [ABSTRACT FROM AUTHOR]

The article offers information on the importance of the clinical guidelines in patient care and improving the patient outcomes. Topics discussed include information on the role of the clinical guidelines in clinical decision making and service commissioning; discussions on the construction and ratification of guideline statements; and the information on the role of the European Society of Gastrointestinal and Abdominal Radiology in the guideline development process.

Summary: Background: Fibrotic stricture is a common complication of Crohn's disease (CD) affecting approximately half of all patients. No specific anti‐fibrotic therapies are available; however, several therapies are currently under evaluation. Drug development for the indication of stricturing CD is hampered by a lack of standardised definitions, diagnostic modalities, clinical trial eligibility criteria, endpoints and treatment targets in stricturing CD. Aim: To standardise definitions, diagnosis and treatment targets for anti‐fibrotic stricture therapies in Chron's disease. Methods: An interdisciplinary expert panel consisting of 15 gastroenterologists and radiologists was assembled. Using modified RAND/University of California Los Angeles appropriateness methodology, 109 candidate items derived from systematic review and expert opinion focusing on small intestinal strictures were anonymously rated as inappropriate, uncertain or appropriate. Survey results were discussed as a group before a second and third round of voting. Results: Fibrotic strictures are defined by the combination of luminal narrowing, wall thickening and pre‐stenotic dilation. Definitions of anastomotic (at site of prior intestinal resection with anastomosis) and naïve small bowel strictures were similar; however, there was uncertainty regarding wall thickness in anastomotic strictures. Magnetic resonance imaging is considered the optimal technique to define fibrotic strictures and assess response to therapy. Symptomatic strictures are defined by abdominal distension, cramping, dietary restrictions, nausea, vomiting, abdominal pain and post‐prandial abdominal pain. Need for intervention (endoscopic balloon dilation or surgery) within 24‐48 weeks is considered the appropriate endpoint in pharmacological trials. Conclusions: Consensus criteria for diagnosis and response to therapy in stricturing Crohn's disease should inform both clinical practice and trial design. [ABSTRACT FROM AUTHOR]

Background: Many solid neoplasms have a propensity for osteomedullary metastases of which detection is important for staging and subsequent treatment. Whole-body magnetic resonance imaging (WB-MRI) has been shown to accurately detect osteomedullary metastases in adults, but these findings cannot be unconditionally extrapolated to staging of children with malignant solid tumors.Objective: To conduct a literature review on the sensitivity of WB-MRI for detecting skeletal metastases in children with solid tumors.Materials and Methods: Searches in MEDLINE and EMBASE databases up to 15 May 2017 were performed to identify studies on the diagnostic value of WB-MRI. Inclusion criteria were children and adolescents (age <21 years) with a primary solid tumor who were evaluated for skeletal metastases by WB-MRI and compared to any type of reference standard. The number of included patients had to be at least five and data on true positives, true negatives, false-positives and false-negatives had to be extractable.Results: Five studies including 132 patients (96 patients with solid tumors) were eligible. Patient groups and used reference tests were heterogeneous, producing unclear or high risk of bias. Sensitivity of WB-MRI ranged between 82% and 100%. The positive predictive value of WB-MRI was variable among the studies and influenced by the used reference standard.Conclusion: Although WB-MRI may seem a promising radiation-free technique for the detection of skeletal metastases in children with solid tumors, published studies are small and too heterogeneous to provide conclusive evidence that WB-MRI can be an alternative to currently used imaging techniques. [ABSTRACT FROM AUTHOR]

Dynamic magnetic resonance imaging ( MRI) of gastrointestinal motility has developed rapidly over the past few years. The non-invasive and non-ionizing character of MRI is an important advantage together with the fact that it is fast and can visualize the entire gastrointestinal tract. Advances in imaging and quantification techniques have facilitated assessment of gastric, small intestinal, and colonic motility in a clinical setting. Automated quantitative motility assessment using dynamic MRI meets the need for non-invasive techniques. Recently, studies have begun to examine this technique in patients, including those with IBD, pseudo-obstruction and functional bowel disorders. Remaining challenges for clinical implementation are processing the large amount of data, standardization and validation of the numerous MRI metrics and subsequently assessment of the potential role of dynamic MRI. This review examines the methods, advances, and remaining challenges of evaluation of gastrointestinal motility with MRI. It accompanies an article by Khalaf et al. in this journal that describes a new protocol for assessment of pan-intestinal motility in fasted and fed state in a single MRI session. [ABSTRACT FROM AUTHOR]

Background Magnetic resonance imaging ( MRI) is the gold standard for assessment of perianal fistulising Crohn's disease ( CD). The Van Assche index is the most commonly used MRI fistula index. Aims To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a novel index for fistulising CD. Methods A consensus process developed scoring conventions for existing Van Assche index component items and new items. Four experienced radiologists evaluated 50 MRI images in random order on three occasions. Reliability was assessed by estimates of intraclass correlation coefficients ( ICCs). Common sources of disagreement were identified and recommendations made to minimise disagreement. A mixed effects model used a 100 mm visual anologue scale ( VAS) for global severity as outcome and component items as predictors to create a modified Van Assche index. Results Intraclass correlation coefficients (95% confidence intervals) for intra-rater reliability of the original and modified Van Assche indices and the VAS were 0.86 (0.81-0.90), 0.90 (0.86-0.93) and 0.86 (0.82-0.89). Corresponding ICCs for inter-rater reliability were 0.66 (0.52-0.76), 0.67 (0.55-0.75) and 0.58 (0.47-0.66). Sources of disagreement included number, location, and extension of fistula tracts, and rectal wall involvement. A modified Van Assche index (range 0-24) was created that included seven component items. Conclusions Although 'almost perfect' intra-rater reliability was observed for the assessment of MRI images for fistulising CD using the Van Assche index, inter-rater reliability was considerably lower. Our modification of this index should result in a more optimal instrument. [ABSTRACT FROM AUTHOR]