Current Noninvasive MR-Based Imaging Methods in Assessing NAFLD Patients

The chapter will focus on the different aspects of nonalcoholic fatty liver disease (NAFLD). An update in noninvasive MR-based imaging will be offered in detail, pointing mainly to fat, iron, and fibrosis deposition and the accuracy of quantitative methods in disease grading and severity assessment. NAFLD is the most common cause of chronic liver disease (CLD) in Western countries. MRI is used to evaluate the disease, to assess the severity, and to quantify the amount of fat deposition, being also the method of choice to evaluate and quantify iron overload. Diagnosis and staging of liver fibrosis is one of the most challenging aspects of noninvasive imaging. “Virtual biopsy” refers to the possibility of imaging techniques to depict, map, and measure fibrosis minimizing the need for invasive liver biopsies in CLD. MRI allows an accurate determination of steatosis, iron overload, and fibrosis, even if they coexist

Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

Introduction: Multiacinar regenerative nodules are benign hepatocellular nodules related to vascular disturbances of the liver. They strongly resemble conventional focal nodular hyperplasia but are connected to different clinical settings, typically chronic liver disease. The purpose of the present study was to describe the key imaging features of these lesions and compare them with a control arm of focal nodular hyperplasia. Material and Methods: A blinded consensus review of liver magnetic resonance consisting of 26 cases of multiacinar regenerative nodules and 25 cases of focal nodular hyperplasia was performed. Lesion size, shape, margins, structure, T1 and T2 signal intensity, diffusion and contrast-enhanced features (including hepatobiliary phase), presence of a central scar and of a peripheral hypointense rim were compared between the two groups. Results: Significant differences between multiacinar regenerative nodules and focal nodular hyperplasia included size (median 2.35 cm, IQR: 2.13, vs 6.00 cm, IQR: 5.20, respectively, p < 0.001), presence of a peripheral hypointense rim after contrast (n = 9 vs n = 2 cases, p = 0.038) and of a central scar (n = 9 vs n = 20, p = 0.002). There were no other significant differences. Discussion: Overall multiacinar regenerative nodules and focal nodular hyperplasia have very similar imaging features but lack of a central scar and presence of a hypointense rim should suggest a diagnosis of multiacinar regenerative nodules. Conclusions: Recognition of the imaging findings of multiacinar regenerative nodules can explain some atypical cases of focal nodular hyperplasia, avoiding unnecessary biopsies. They may also be the trigger to investigate an unsuspected underlying liver vascular abnormality

Consensus report from the 9th International Forum for Liver Magnetic Resonance Imaging: applications of gadoxetic acid-enhanced imaging

Objectives The 9th International Forum for Liver Magnetic Resonance Imaging (MRI) was held in Singapore in September 2019, bringing together radiologists and allied specialists to discuss the latest developments in and formulate consensus statements for liver MRI, including the applications of gadoxetic acid-enhanced imaging. Methods As at previous Liver Forums, the meeting was held over 2 days. Presentations by the faculty on days 1 and 2 and breakout group discussions on day 1 were followed by delegate voting on consensus statements presented on day 2. Presentations and discussions centered on two main meeting themes relating to the use of gadoxetic acid-enhanced MRI in primary liver cancer and metastatic liver disease. Results and conclusions Gadoxetic acid-enhanced MRI offers the ability to monitor response to systemic therapy and to assist in pre-surgical/pre-interventional planning in liver metastases. In hepatocellular carcinoma, gadoxetic acid-enhanced MRI provides precise staging information for accurate treatment decision-making and follow-up post therapy. Gadoxetic acid-enhanced MRI also has potential, currently investigational, indications for the functional assessment of the liver and the biliary system. Additional voting sessions at the Liver Forum debated the role of multidisciplinary care in the management of patients with liver disease, evidence to support the use of abbreviated imaging protocols, and the importance of standardizing nomenclature in international guidelines in order to increase the sharing of scientific data and improve the communication between centers

ECCO essential requirements for quality cancer care : Oesophageal and gastric cancer

Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Oesophageal and gastric: essential requirements for quality care: Oesophageal and gastric (OG) cancers are a challenging tumour group with a poor prognosis and wide variation in outcomes among European countries. Increasing numbers of older people are contracting the diseases, and treatments and care pathways are becoming more complex in both curative and palliative settings. High-quality care can only be a carried out in specialised OG cancer units or centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Such units or centres are far from universal in all European countries. It is essential that, to meet European aspirations for comprehensive cancer control, healthcare organisations implement the essential requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality OG cancer service. The ERQCC expert group is aware that it is not possible to propose a one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with OG cancer.Peer reviewe

Just Friends? : Richard Rolle and the Possibility of Christian Friendship Between Men and Women

Tutkimus käsittelee Richard Rollen (k. 1349), englantilaisen erakon ja uskonnollisen kirjailijan, käsityksiä ystävyydestä yleensä ja erityisesti hengellisestä ystävyydestä miesten ja naisten välillä. Rolle kirjoitti useita latinan- ja keskienglanninkielisiä tutkielmia ja hengellisiä oppaita, joissa hän sivusi ystävyyden tematiikkaa sekä omaelämäkerrallisesta että teoreettisesta näkökulmasta. Tutkimuksen pääasiallisina lähteinä käytetään seitsemää Rollen omaa teosta sekä kanonisoinnin toivossa hänestä laadittua pyhimyselämäkertaa. Tutkimus esittelee Rollen ystävyysteoriaa ja suhteuttaa sen 1300-luvun Yorkshiren historialliseen kontekstiin, Rollen kirjallisiin esikuviin sekä hänen ajatteluunsa yleensä. Rolle näyttää tunteneen sekä Ciceron (k. 43 eaa.) että Aelred Rievaulxlaisen (k. 1167) teokset ystävyydestä, mutta sovelsi näiden näkemyksiä omintakeisesti. Rollen maailmankuvalle oli ominaista jyrkkä kaksijakoisuus maailman ja Jumalan rakkauden välillä, minkä vuoksi ero pyhän ja maallisen ystävyyden välillä oli ehdoton. Vääränlainen ystävyys oli vaarallista etenkin kontemplatiivista elämää harjoittaville erakoille ja anakoreeteille, joita Rolle opasti välttämään ihmiskontakteja. Jyrkkyydestään huolimatta Rolle erosi edeltäjistään ja 1300-luvun valtavirrasta puolustamalla sukupuolten välisen pyhän ystävyyden mahdollisuutta. Tutkimuksen keskeinen löytö on, että Rolle määritteli sukupuolten välisen ystävyyden hengelliseksi ohjaukseksi ja perusteli siten sen tarpeellisuutta; naiset tarvitsivat pyhien miesten neuvoja pelastuakseen. Tällainen opetusystävyys ei ollut tasa-arvoinen suhde, vaan miehen tuli opastaa ja oikaista naista tämän omaksi parhaaksi. Toisaalta Rolle uskoi naisten mahdollisuuksiin saavuttaa hengellisen elämän korkeimmat asteet. Lähteet paljastavat, että Rolle tosiasiassa opasti naisia esittämänsä mallin mukaan. Tutkimus osoittaa, että yksittäisille naisille laaditut kansankieliset opaskirjeet sisältävät opetusystävyyden keskeisiä piirteitä ja noudattavat sen hierarkista logiikkaa: Rolle esiintyy välittäjänä Jumalan ja lukijan välillä houkutellen, moittien ja neuvoen lukijaa, jotta tämä saavuttaisi yhä korkeamman pyhyyden asteen. Rollen ja anakoreetti Margaret Kirkebyn välinen suhde, jota on keskiajalla ja myöhemmin pidetty esimerkkinä pyhästä ystävyydestä, näyttää myös muiden lähteiden valossa olleen hierarkkinen opetussuhde. Tutkimuksessa argumentoidaan, että Rollen kirjoittamista motivoi tarve itsepuolustukseen ja toiminnan oikeuttamiseen; hänen kontaktinsa naisiin herättivät epäilyksiä. Rolle halusi olla hengellinen auktoriteetti, mutta hänellä ei ollut luostarisääntökunnan, kerjäläisveljestön tai pappisviran tuomaa virallista tukea, joten hänen paras mahdollisuutensa itsepuolustukseen oli kirjallinen toiminta. Oikeuttaakseen toimintansa naisten parissa Rolle esitti mallin Jumalan rakkauden elävöittämästä pyhästä elämästä, johon kuului velvollisuus opettaa naisia ystävinä. Lisäksi Rollen tuli osoittaa, että hänen oma elämänsä edusti hänen puolustamaansa mallia, jonka edellytyksenä oli välinpitämättömyys maallisia houkutuksia kohtaan. Kaiken tämän takana näyttää olleen toive tasavertaisen ystävän löytämisestä: Rolle ei ollut löytänyt vertaistaan ystävää, joka olisi jakanut hänen hengelliset kokemuksensa, joten hän pyrki hengellisen ohjauksen avulla nostamaan edes yhden oppilaistaan tasolleen. On huomionarvoista, että Rolle näyttää pitäneen naisia kelvollisina kandidaatteina tällaiseen suhteeseen

Imaging of colorectal cancer – the clue to individualized treatment

Colorectal cancer (CRC) is the most common gastrointestinal neoplasm and the second most common cause for cancer-related death in Europe. Imaging plays an important role both in the primary diagnosis, treatment evaluation, follow-up, and, to some extent, also in prevention. Like in the clinical setting, colon and rectal cancer have to be distinguished as two quite separate entities with different goals of imaging and, consequently, also different technical requirements. Over the past decade, there have been improvements in both more robust imaging techniques and new data and guidelines that help to use the optimal imaging modality for each scenario. For colon cancer, the continued research on computed tomography (CT) colonography (CTC) has led to high-level evidence that puts this technique on eye height to optical colonoscopy in terms of detection of cancer and polyps ≥10 mm. However, also for smaller polyps and thus for screening purposes, CTC seems to be an optimal tool. In rectal cancer, the technical requirements to perform state-of-the art imaging have recently been defined. Evaluation of T-stage, mesorectal fascia infiltration and extramural vascular invasion are the most important prognostic factors that can be identified on MRI. With this information, risk stratification both for local and distal failure is possible, enabling the clinician to tailor the optimal therapeutic approach in non-metastatic rectal cancer. Imaging of metastatic CRC is also covered, although the complex ramifications of treatment options in the metastatic setting are beyond the scope of this article. In this review, the most important recent developments in the imaging of colon and rectal cancer will be highlighted. If used in an interdisciplinary setting, this can lead to an individualized treatment concept for each patient

Post-treatment imaging of liver tumours

In the past few years, great improvements have been made to achieve local tumour control of primary liver malignancies and liver metastases. For hepatocellular carcinoma (HCC), transarterial chemoembolisation (TACE) and tumour ablation techniques, including percutaneous ethanol injection (PEI), radiofrequency ablation (RF), and laser-induced interstitial thermotherapy (LITT) have been developed. For colorectal liver metastases, surgery is still the standard technique in localised disease, although percutaneous RF ablation has gained considerable acceptance. In patients with widespread disease, chemotherapy with new drugs offers improved survival. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are the modalities of choice to evaluate treatment response. The present review demonstrates imaging findings of complete and incomplete tumour control after intervention as well as the imaging spectrum of complications. Imaging guidelines according to the World Health Organization and Response Evaluation Criteria In Solid Tumors (RECIST) for assessment of chemotherapy response are presented