ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in IBD

Background and Aims: Diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI], and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. // Methods: An expert consensus panel consisting of gastroenterologists, radiologists, and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography, and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. // Results: Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications, and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. // Conclusions: This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD

Management of colorectal cancer presenting with synchronous liver metastases

Up to a fifth of patients with colorectal cancer (CRC) present with synchronous hepatic metastases. In patients with CRC who present without intestinal obstruction or perforation and in whom comprehensive whole-body imaging confirms the absence of extrahepatic disease, evidence indicates a state of equipoise between several different management pathways, none of which has demonstrated superiority. Neoadjuvant systemic chemotherapy is advocated by current guidelines, but must be integrated with surgical management in order to remove the primary tumour and liver metastatic burden. Surgery for CRC with synchronous liver metastases can take a number of forms: the 'classic' approach, involving initial colorectal resection, interval chemotherapy and liver resection as the final step; simultaneous removal of the liver and bowel tumours with neoadjuvant or adjuvant chemotherapy; or a 'liver-first' approach (before or after systemic chemotherapy) with removal of the colorectal tumour as the final procedure. In patients with rectal primary tumours, the liver-first approach can potentially avoid rectal surgery in patients with a complete response to chemoradiotherapy. We overview the importance of precise nomenclature, the influence of clinical presentation on treatment options, and the need for accurate, up-to-date surgical terminology, staging tests and contemporary management options in CRC and synchronous hepatic metastatic disease, with an emphasis on multidisciplinary care

Zufallsbefunde von Leber, Gallensystem, Pankreas und Milz bei asymptomatischen Patienten : Bewertung und Managementempfehlung

Klinisches Problem Die vermehrte Verwendung hoch entwickelter bildgebender Verfahren wie Multidetektorcomputertomographie und Magnetresonanztomographie hat zu einer beträchtlichen Zunahme asymptomatischer und unerwarteter Befunde geführt. Radiologische Standardverfahren Besonders betroffen sind abdominelle CT-Untersuchungen mit einer Vielzahl inzidenteller Befunde. Dieses wertvolle Diagnoseverfahren birgt auch die Gefahr aufwendiger und auch kostenintensiver Folgeuntersuchungen mit z. T. invasiven Verfahren. Bewertung Vor diesem Hintergrund stellt sich für den Radiologen immer häufiger die schwierige Aufgabe, diese Läsionen korrekt einzuschätzen, über die Notwendigkeit einer weiteren Abklärung zu entscheiden und den Patienten umfassend über die klinische Relevanz zu informieren. Empfehlung für die Praxis Das Ziel dieses Artikels ist es, die am häufigsten vorkommenden abdominellen Zufallsbefunde zu beschreiben sowie Hilfestellung bei ihrer Interpretation und Differenzialdiagnose mit Empfehlungen für das weitere Management zu geben.Clinical issue The increased use of highly developed imaging procedures, such as multidetector-row computed tomography and magnetic resonance imaging has led to a substantial increase of asymptomatic and unexpected findings. Standard radiological methods Abdominal CT investigations are particularly affected with a large number of incidental findings. This valuable diagnostic procedure also entails the risk of complex and cost-intensive subsequent investigations with partly invasive procedures. Achievements For this reason radiologists are more often confronted with the difficult task of correctly assessing these lesions, to decide on the need for additional investigations and to inform the patient in detail about the clinical relevance. Practical recommendations The aims of this article are to describe the most common abdominal incidentalomas, to assist with the interpretation and differential diagnosis and to give recommendations for further management.(VLID)353372

Der Radiologe / Zufallsbefunde von Niere, Nebenniere, Adnexen, Gastrointestinaltrakt, Mesenterium und Lymphknoten : Bewertung und Managementempfehlung

Klinisches Problem Neben den parenchymatösen Oberbauchorganen hat der zunehmende Einsatz von Schnittbildverfahren zu einer vermehrten Anzahl von Zufallsbefunden der Nieren, Nebennieren, Adnexe, des Gastrointestinaltrakts, Mesenteriums und der intraabdominellen Lymphknoten geführt. Radiologische Standardverfahren Abdominelle CT-Untersuchungen zeigen häufig unerwartete Befunde ohne korrelierende Symptomatik. Die steigende klinische Relevanz ist einerseits auf die Zunahme inzidenteller Pathologien und andererseits auf ein wachsendes Bewusstsein ethischer und sozioökonomischer Faktoren zurückzuführen. Bewertung Bei der radiologischen Interpretation sind neben morphologischen Kriterien sowohl die Einbeziehung der individuellen Risikofaktoren des Patienten als auch der klinische Gesamtkontext von großer Bedeutung. Empfehlung für die Praxis Das Ziel dieses Artikels ist eine Beschreibung und Bewertung der in der Computertomographie detektierten genannten Zufallsbefunde sowie weiterer Managementempfehlungen.Clinical issue Besides the upper abdominal parenchymal organs, the increasing application of cross-sectional imaging has also led to a rising number of incidental findings in the kidneys, adrenal glands, adnexa uteri, the gastrointestinal tract, mesentery and abdominal lymph nodes. Standard radiological methods Abdominal computed tomography investigations often show unexpected findings without any correlating symptoms. The growing clinical relevance is due to the large number of incidental findings as well as an increasing awareness of ethical and socioeconomic factors. Achievements When interpreting radiological findings not only morphological criteria but also individual risk factors of the patient and the clinical context are of great importance. Practical recommendations The aims of this article are the description and evaluation of frequent incidental findings detected by computed tomography and to provide information about management recommendations.(VLID)353373

A visuoperceptual measure for videofluoroscopic swallow studies (VMV): a pilot study of validity and reliability in adults with dysphagia

The visuoperceptual measure for videofluoroscopic swallow studies (VMV) is a new measure for analysing the recordings from videofluoroscopic swallow studies (VFSS). This study evaluated the reliability and validity of the pilot version of the VMV using classical test theory (CTT) analysis, informed by the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. Forty participants, diagnosed with oropharyngeal dysphagia by fibreoptic endoscopic evaluation of swallowing, were recruited. The VFSS and administration of bolus textures and volumes were conducted according to a standardised protocol. Recordings of the VFSS were rated by three blinded raters: a speech-language pathologist, a radiologist and a phoniatrician. Inter- and intra-rater reliability was assessed with a weighted kappa and resulted in 0.889 and 0.944 overall, respectively. Structural validity was determined using exploratory factor analyses, which found four and five factor solutions. Internal consistency was evaluated with Cronbach's alpha coefficients, which found all but one factor scoring within an acceptable range (>0.70 and <0.95). Hypothesis testing for construct validity found the expected correlations between the severity of dysphagia and the VMV's performance, and found no impact of gender on measure performance. These results suggest that the VMV has potential as a reliable and valid measure for VFSS. Further validation with a larger sample is required, and validation using an item response theory paradigm approach is recommended

Upper esophageal sphincter dysfunction: diverticula-globus pharyngeus

The following discussion of upper esophageal sphincter dysfunction includes commentaries on the role of the cricopharyngeus muscle in reflux disease; the etiology and treatment of Zenker diverticulum; the use of videofluoroscopy in patients with dysphagia, suspicion of aspiration, or globus; the role of pH-impedance monitoring in globus evaluation; and treatment for reflux-associated globus

ECCO-ESGAR topical review on optimizing reporting for cross-sectional imaging in IBD

Background and Aims The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. Methods An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when >= 80% of the participants agreed on a recommendation. Results Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. Conclusions This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD