Quantitative MRCP and metrics of bile duct disease over time in patients with primary sclerosing cholangitis:A prospective study

Background: Imaging markers of biliary disease in primary sclerosing cholangitis (PSC) have potential for use in clinical and trial disease monitoring. Herein, we evaluate how quantitative magnetic resonance cholangiopancreatography (MRCP) metrics change over time, as per the natural history of disease. Methods: Individuals with PSC were prospectively scanned using non‐contrast MRCP. Quantitative metrics were calculated using MRCP+ post‐processing software to assess duct diameters and dilated and strictured regions. Additionally, a hepatopancreatobiliary radiologist (blinded to clinical details, biochemistry and quantitative biliary metrics) reported each scan, including ductal disease assessment according to the modified Amsterdam Cholangiographic Score (MAS). Results: At baseline, 14 quantitative MRCP+ metrics were found to be significantly different in patients with PSC (N = 55) compared to those with primary biliary cholangitis (N = 55), autoimmune hepatitis (N = 57) and healthy controls (N = 18). In PSC specifically, baseline metrics quantifying the number of strictures and the number and length of bile ducts correlated with the MAS, transient elastography and serum ALP values (p < 0.01 for all correlations). Over a median 371‐day follow‐up (range: 364–462), 29 patients with PSC underwent repeat MRCP, of whom 15 exhibited quantitative changes in MRCP+ metrics. Compared to baseline, quantitative MRCP+ identified an increasing number of strictures over time (p < 0.05). Comparatively, no significant differences in biochemistry, elastography or the MAS were observed between timepoints. Quantitative MRCP+ metrics remained stable in non‐PSC liver disease. Conclusion: Quantitative MRCP+ identifies changes in ductal disease over time in PSC, despite stability in biochemistry, liver stiffness and radiologist‐derived cholangiographic assessment (trial registration: ISRCTN39463479)

Rectal cancer MR staging: pearls and pitfalls at baseline examination

International audienceIn recent years, rectal MRI has become a central diagnostic tool in rectal cancer staging. Indeed, rectal MR has the ability to accurately evaluate a number of important findings that may impact patient management, including distance of the tumor to the mesorectal fascia, presence of extramural vascular invasion (EMVI), presence of lymph nodes, and involvement of the peritoneum/anterior peritoneal reflection. Many of these findings are difficult to assess in nonexpert hands. In this review, we present a practical approach for radiologists to provide high-quality interpretations at initial baseline exams, based on recent guidelines from the Society of Abdominal Radiology, Rectal and Anal Cancer Disease Focused Panel. Practical pearls and pitfalls are discussed, focusing on optimization of technique including, patient preparation and protocol recommendations, interpretation, and essentials of reporting

Interactive training workshop to improve prostate mpMRI knowledge: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship

Purpose Prostate MRI is established for the investigation of patients presenting with suspected early prostate cancer. Outcomes are dependent on both image quality and interpretation. This study assessed the impact of an educational intervention on participants’ theoretical knowledge of the technique. Methods Eighty-one clinicians from two centres with varying experience in prostate MRI participated. Baseline knowledge was assessed with 10 written and image-based multiple-choice questions (MCQs) prior to a course including didactic lectures and hands-on interactive workshops on prostate MRI interpretation. Post-course, participants completed a second 10-question MCQ test, matched by format, themes, and difficulty, to assess for any improvement in knowledge and performance. Results were assessed using the Wilcoxon rank sum test, and the Wilcoxon signed-rank test for paired data. Results Thirty-nine participants, including 25/49 (51.0%) and 14/32 (43.8%) at each centre completed both assessments, with their results used for subsequent evaluation. Overall, there was a significant improvement from pre- (4.92 ±2.41) to post-course scores (6.77 ±1.46), p500 MRIs reported) experience (6.83 ±2.48 to 7.67 ±0.82, p=0.339). Conclusions A dedicated prostate MRI teaching course combining didactic lectures and hands-on workshops significantly improved short-term theoretical knowledge of the technique for clinicians with differing levels of experience.Author TB receives research was supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. TB also acknowledges support from Cancer Research UK (Cambridge Imaging Centre grant number C197/A16465), the Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester, and the Cambridge Experimental Cancer Medicine Centre