CT imaging of primary pancreatic lymphoma: experience from three referral centres for pancreatic diseases

To describe CT characteristics of primary pancreatic lymphoma (PPL), a rare disease with features in common with adenocarcinoma

Correction to. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting

Objectives: To update the 2012 ESGAR consensus guidelines on the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. Methods Fourteen abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) participated in a consensus meeting, organised according to an adaptation of the RAND-UCLA Appropriateness Method. Two independent (non-voting) Chairs facilitated the meeting. 246 items were scored (comprising 229 items from the previous 2012 consensus and 17 additional items) and classified as ‘appropriate’ or ‘inappropriate’ (defined by ≥ 80 % consensus) or uncertain (defined by < 80 % consensus). Results: Consensus was reached for 226 (92 %) of items. From these recommendations regarding hardware, patient preparation, imaging sequences and acquisition, criteria for MR imaging evaluation and reporting structure were constructed. The main additions to the 2012 consensus include recommendations regarding use of diffusion-weighted imaging, criteria for nodal staging and a recommended structured report template. Conclusions: These updated expert consensus recommendations should be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI

Imaging standardization in metastatic colorectal cancer : a joint EORTC-ESOI-ESGAR expert consensus recommendation

Background: Treatment monitoring in metastatic colorectal cancer (mCRC) relies on imaging to evaluate the tumor burden. Response Evaluation Criteria in Solid Tumors (RECIST) provide a framework on reporting and interpretation of imaging findings yet offer no guidance on a standardized imaging protocol tailored to mCRC patients. Imaging protocol heterogeneity remains a challenge for the reproducibility of conventional imaging endpoints and is an obstacle for research on novel imaging endpoints. Patients and methods: Acknowledging the recently highlighted potential of radiomics and artificial intelligence (AI) tools as decision support for patient care in mCRC, a multidisciplinary, international, and expert panel of imaging specialists was formed to find consensus on mCRC imaging protocols using the Delphi method. Results: Under the guidance of the European Organisation for Research and Treatment of Cancer (EORTC) Imaging and Gastrointestinal Tract Cancer Groups, the European Society of Oncologic Imaging (ESOI) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), the EORTC-ESOI-ESGAR core imaging protocol was identified. Conclusion: This consensus protocol attempts to promote standardization and to diminish variations in patient preparation, scan acquisition and scan reconstruction. We anticipate that this standardization will increase reproducibility of radiomics and AI studies and serve as a catalyst for future research on imaging endpoints. For ongoing and future mCRC trials, we encourage principal investigators to support the dissemination of these imaging standards across recruiting centers.peer-reviewe

Diffusion Weighted Magnetic Resonance Imaging in staging of rectal cancer

Aim: To investigate the value of diffusion weighted magnetic resonance imaging (DWMRI) in identifiying the detailed extent of rectal cancer with greater diagnostic precision with regards to local, lymph node and metastatic status. Methodology: Two diffusion weighted sequences were developed, Spin Echo Echo Planar Imaging-SEEPI and Inversion Recovery Echo Planar Imaging for the study of focal liver lesions and depiction of primary rectal cancer. For the quality control of these sequences a phantom from solutions of different sucrose concentrations was constructed and scanned repeatedly with a DWMRI sequence with multiple b values and different fitting algorithms. Coefficient of variation of ADC values of different solutions was measured. In 38 patients ADC values of focal liver lesions and normal parenchyma were measured and threshold value for differentiation of most common benign from malignant lesions was investigated. In 51 patients quantitative analysis was performed in parametric maps created selecting different b values on an in house image processing toolbox on a separate workstation. The value of normalization with ADC value of spleen was investigated. In 50 consecutive patients with primary rectal cancer, ADC value of primary cancer and normal appearing rectal wall was noted. In addition the number of mesorectal lymph nodes presenting with restriction of diffusion was noted and comparison was made with T2 weighted sequence and the pathology report. 16 patients underwent long scheme of chemoradiation after which they were reimaged with DWMRI and change in ADC value of primary tumor was noted. Results-Conclusions: DWMRI sequence can depict all focal liver lesions and primary rectal cancer. SE EPI DWI sequence has produced very good results in characterization of hepatic lesions and in differentiation of colonic wall invaded by tumor and not. It provided a complementary role to the morphological MRI sequences increasing the certainty level for accurate roadmapping of rectal cancer and depiction of mesorectal lymph nodes.Distinction between metastatic and non metastatic lymph nodes based on qualitative and quantitative informations from the sequence was not possible.Στόχος:Η διερεύνηση της δυνατότητας των τεχνικών μοριακής διάχυσης του ΜΣ να προσδιορίσουν την λεπτομερή έκταση του καρκίνου του ορθού με μεγαλύτερη διαγνωστική ακρίβεια σε τοπικό, λεμφαδενικό και μεταστατικό επίπεδο. Μεθοδολογία:Aναπτύχθηκαν δύο ακολουθίες έμφασης μοριακής διάχυσης η Spin Echo Echo Planar Imaging-SEEPI και η Inversion Recovery Echo Planar Imaging για την μελέτη των εστιακών ηπατικών βλαβών και την ανάδειξη του πρωτοπαθούς καρκίνου του ορθού. Για τον ποιοτικό έλεγχο των ακολουθιών κατασκευάστηκε ομοίωμα με διαλύματα διαφορετικών συγκεντρώσεων σακχαρόζης, στο οποίο εφαρμόστηκε επανειλημένα ακολουθία έμφασης μοριακής διάχυσης με πολλές τιμές b, διαφορετικούς αλγόριθμους προσαρμογής και καταγράφηκε ο συντελεστής διακύμανσης των τιμών ADC των διαφορετικών διαλυμάτων. Σε 38 ασθενείς μετρήθηκαν οι τιμές ADC των εστιακών βλαβών και του ηπατικού παρεγχύματος και αναδείχθηκαν τιμές κατώφλι για την διαφοροποίηση των πιο συχνών καλόηθων και κακόηθων ηπατικών βλαβών. Σε 51 ασθενείς ακολούθησε ποσοτική αξιολόγηση και σε παραμετρικούς χάρτες που κατασκευάστηκαν επιλέγοντας διαφορετικές τιμές b με ειδικά κατασκευασμένο λογισμικό σε ανεξάρτητο σταθμό εργασίας και διερευνήθηκε η αξία της κανονικοποίησης των τιμών ADC με την τιμή ADC του σπληνός ως ιστού αναφοράς. Παράλληλα σε 50 διαδοχικούς ασθενείς με πρωτοπαθή καρκίνο του ορθού καταγράφηκε η τιμή ADC του πρωτοπαθούς όγκου και του φυσιολογικού παρακείμενου τοιχώματος του ορθού. Επιπρόσθετα καταγράφηκε ο αριθμός των μεσοορθικών λεμφαδένων με περιορισμό διάχυσης και έγινε συσχέτιση με την ακολουθία έμφασης Τ2 και το παθολογοανατομικό πόρισμα. 16 ασθενείς υποβλήθηκαν σε σχήμα χημειοακτινοθεραπείας μετά την οποία επανεξετάστηκαν με ΜΣ και μελετήθηκε η μεταβολή της τιμής ADC του πρωτοπαθούς όγκου. Αποτελέσματα-Συμπεράσματα:H ακολουθία έμφασης μοριακής διάχυσης απεικονίζει με επιτυχία τις εστιακές βλάβες του ήπατος και τον πρωτοπαθή καρκίνο του ορθού. Η SE EPI έδωσε πολύ καλά αποτελέσματα στον χαρακτηρισμό των ηπατικών βλαβών και στον διαχωρισμό του εντερικού τοιχώματος προσβεβλημένου από καρκίνο και μή. Παρείχε συμπληρωματικό ρόλο στις συμβατικές ακολουθίες ΜΣ ενισχύοντας το ποσοστό βεβαιότητας για την ακριβή χαρτογράφηση του καρκίνου του ορθού και την ανάδειξη των μεσοορθικών λεμφαδένων. Δεν κατέστη δυνατός ο διαχωρισμός μεταξύ μεταστατικών και μη μεσοορθικών λεμφαδένων με βάση τα ποιοτικά και ποσοτικά χαρακτηριστικά της ακολουθίας

Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Challenging Diagnosis

Intraductal papillary mucinous neoplasm of the pancreas (IPMN) was classified as a distinct entity from mucinous cystic neoplasm by the WHO in 1995. It represents a mucin-producing tumor that originates from the ductal epithelium and can evolve from slight dysplasia to invasive carcinoma. In addition, different aspects of tumor progression may be seen in the same lesion. Three types are recognized, the branch duct variant, the main duct variant, which shows a much higher prevalence for malignancy, and the mixed-type variant, which combines branch and main duct characteristics. Advances in cross-sectional imaging have led to an increased rate of IPMN detection. The main imaging characteristic of IPMN is the dilatation of the pancreatic duct without the presence of an obstructing lesion. The diagnosis of a branch duct IPMN is based on the proof of its communication with the main pancreatic duct on MRI-MRCP examination. Early identification by imaging of the so-called worrisome features or predictors for malignancy is an important and challenging task. In this review, we will present recent imaging advances in the diagnosis and characterization of different types of IPMNs, as well as imaging tools available for early recognition of worrisome features for malignancy. A critical appraisal of current IPMN management guidelines from both a radiologist’s and surgeon’s perspective will be made. Special mention is made of complications that might arise during the course of IPMNs as well as concomitant pancreatic neoplasms including pancreatic adenocarcinoma and pancreatic endocrine neoplasms. Finally, recent research on prognostic and predictive biomarkers including radiomics will be discussed

Diffusion-weighted imaging and texture analysis: current role for diffuse liver disease

Multiparametric MRI represents the primary imaging modality to assess diffuse liver disease, both in a qualitative and in a quantitative manner. Diffusion-weighted imaging (DWI) is among the imaging techniques that can be used to assess fibrosis due to its unique capability to assess microstructural changes at the tissue level. DWI is based on water mobility patterns and has the potential to become a non-invasive and non-destructive virtual biopsy to assess diffuse liver disease, overcoming sampling bias errors due to its three-dimensional imaging capabilities. Parallel to DWI, another quantitative method called texture analysis may be used to assess early and advanced diffused liver disease through quantifying spatial relationships in a global and local level, applying to any type of digital imaging technique like MRI or CT. Initial results using texture analysis hold great promise. In the current paper, we will review the role of DWI and texture analysis using MR images in assessing diffuse liver disease

The Spectrum of Solitary Benign Splenic Lesions—Imaging Clues for a Noninvasive Diagnosis

Cross-sectional imaging of the upper abdomen, especially if intravenous contrast has been administered, will most likely reveal any acute or chronic disease harbored in the spleen. Unless imaging is performed with the specific purpose of evaluating the spleen or characterizing a known splenic lesion, incidentally discovered splenic lesions pose a small challenge. Solitary benign splenic lesions include cysts, hemangiomas, sclerosing angiomatous nodular transformation (SANT), hamartomas, and abscesses, among others. Sarcoidosis and tuberculosis, although predominantly diffuse micronodular disease processes, may also present as a solitary splenic mass lesion. In addition, infarction and rupture, both traumatic and spontaneous, may take place in the spleen. This review aims to describe the imaging features of the most common benign focal splenic lesions, with emphasis on the imaging findings as these are encountered on routine cross-sectional imaging from a multicenter pool of cases that, coupled with clinical information, can allow a definite diagnosis