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

Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection

PURPOSE: To compare the accuracy of PET/MR imaging with that of FDG PET/CT and to determine the MR sequences necessary for the detection of liver metastasis using a trimodality PET/CT/MR set-up. METHODS: Included in this single-centre IRB-approved study were 55 patients (22 women, age 61 ± 11 years) with suspected liver metastases from gastrointestinal cancer. Imaging using a trimodality PET/CT/MR set-up (time-of-flight PET/CT and 3-T whole-body MR imager) comprised PET, low-dose CT, contrast-enhanced (CE) CT of the abdomen, and MR with T1-W/T2-W, diffusion-weighted (DWI), and dynamic CE imaging. Two readers evaluated the following image sets for liver metastasis: PET/CT (set A), PET/CECT (B), PET/MR including T1-W/T2-W (C), T1-W/T2-W with either DWI (D) or CE imaging (E), and a combination (F). The accuracy of each image set was determined by receiver-operating characteristic analysis using image set B as the standard of reference. RESULTS: Of 120 liver lesions in 21/55 patients (38 %), 79 (66 %) were considered malignant, and 63/79 (80 %) showed abnormal FDG uptake. Accuracies were 0.937 (95 % CI 89.5 - 97.9 %) for image set A, 1.00 (95 % CI 99.9 - 100.0 %) for set C, 0.998 (95 % CI 99.4 - 100.0 %) for set D, 0.997 (95 % CI 99.3 - 100.0 %) for set E, and 0.995 (95 % CI 99.0 - 100.0 %) for set F. Differences were significant for image sets D - F (P < 0.05) when including lesions without abnormal FDG uptake. As shown by follow-up imaging after 50 - 177 days, the use of image sets D and both sets E and F led to the detection of metastases in one and three patients, respectively, and further metastases in the contralateral lobe in two patients negative on PET/CECT (P = 0.06). CONCLUSION: PET/MR imaging with T1-W/T2-W sequences results in similar diagnostic accuracy for the detection of liver metastases to PET/CECT. To significantly improve the characterization of liver lesions, we recommend the use of dynamic CE imaging sequences. PET/MR imaging has a diagnostic impact on clinical decision making

Der Radiologe / Differenzialdiagnosen von Gallenwegerkrankungen : Computertomographie und Magnetresonanztomographie

Klinisches/methodisches Problem Gallenwegerkrankungen können in allen Altersgruppen auftreten und weisen in Nordeuropa erhöhte Prävalenzen auf. Die Pathologien reichen von benignen Erkrankungen bis zu malignen Tumoren mit sehr schlechten Überlebensraten. Radiologische Standardverfahren Die Magnetresonanztomographie (MRT) und die Computertomographie (CT) haben sich neben der Sonographie als radiologische Standardmethoden für eine detaillierte Evaluation des Gallengangsystems etabliert. Durch Beurteilung des Lumens und der Wand der Gallengänge sowie der umgebenden Strukturen können sowohl obstruktive als auch nichtobstruktive Pathologien mit hoher Sensitivität und Spezifität diagnostiziert werden. Methodische Innovationen Technische Weiterentwicklungen mit verschiedenen Nachbearbeitungsmöglichkeiten sowie die Verwendung von biliär ausgeschiedenem leberspezifischem MR-Kontrastmittel verbessern die Diagnostik und Beurteilung struktureller wie auch funktioneller Pathologien. Leistungsfähigkeit Aufgrund der hohen Patiententoleranz und des minimalen Risikos sowie der dreidimensionalen Darstellung der Gallengänge ist die MRT mit Magnetresonanz-Cholangiographie (MRC) neben der CT die Methode der Wahl und hat die Indikationen der diagnostischen endoskopischen retrograden Cholangiopankreatikographie (ERCP) deutlich eingeschränkt. Ein komplementärer multimodaler und multiparametrischer Zugang ist besonders hilfreich für die präoperative Abklärung. Empfehlung für die Praxis Die sich rasant entwickelnden Technologien stellen sowohl Chancen als auch Herausforderungen dar. Durch die Kenntnis moderner MR- und CT-Techniken sowie des Spektrums von Gallenwegerkrankungen können die richtigen Diagnosen präziser gestellt und mögliche Differenzialdiagnosen stärker eingegrenzt werden.Clinical/methodical issue Bile duct diseases can be found in all age groups and show an increased prevalence in northern Europe. Pathologies range from benign diseases to malignant tumors with very poor survival. Standard radiological methods Magnetic resonance imaging (MRI) and computed tomography (CT) are the radiological methods of choice for a detailed evaluation of the bile duct system in addition to sonography. By assessing the lumen and the wall of the bile ducts as well as the surrounding structures, both obstructive and nonobstructive pathologies can be diagnosed and differentiated with high sensitivity and specificity. Methodical innovations Technical developments with postprocessing modalities as well as the use of biliary-excreted liver-specific MR contrast agents improve the diagnosis of bile duct diseases and enable morphological and functional assessment. Performance Due to high patient tolerance, minimal procedural risk in contrast to invasive endoscopic methods and the possibility of three-dimensional post-processing, beside CT, MRI with magnetic resonance cholangiography (MRC) represents the method of choice in patients with sonographically or clinically suspected bile duct disease and has significantly reduced the indications of diagnostic endoscopic retrograde cholangiopancreatography (ERCP). A complementary multimodality and multiparametric imaging approach is particularly helpful for preoperative assessment. Practical recommendations Rapidly evolving technology for both MRI and CT represent opportunities and challenges. By understanding the advantages and limitations of modern MR and CT techniques and by knowing the spectrum of bile duct pathologies, improved diagnosis and narrowing of possible differential diagnosis can be achieved.(VLID)507217

Der Radiologe / Bildgebung gastrointestinaler Entzündungen : Charakteristische Muster und Zeichen

Klinisches Problem Pathologische Veränderungen der Wand des Gastrointestinaltrakts können durch eine Vielzahl entzündlicher, infektiöser, neoplastischer oder ischämischer Ursachen bedingt sein. Radiologische Standardverfahren Moderne Schnittbildverfahren haben konventionelle Durchleuchtungsuntersuchungen wie die Doppelkontrast-Enterographie oder den Kolonkontrasteinlauf weitgehend abgelöst und durch die Möglichkeit einer raschen, genauen und minimal-invasiven Diagnostik wachsende Bedeutung in der Diagnostik entzündlicher Darmerkrankungen erlangt. Die Distension des Lumens mit neutralem, oral verabreichtem Kontrastmittel (KM) verbessert die Beurteilbarkeit der gesamten Darmwand. Darüber hinaus ist auch die Beurteilung extraintestinaler Strukturen und Organe möglich. Methodische Innovationen und Bewertung Durch zunehmende technische Fortschritte können die Darmwandveränderungen in der Computertomographie (CT) und der Magnetresonanztomographie (MRT) genauer charakterisiert werden. Ein strukturierter Zugang mit Analyse der radiologischen Zeichen und Muster sowie der Assoziation mit extraintestinalen Auffälligkeiten hilft bei der genaueren Zuordnung zu spezifischen Krankheitsgruppen. Empfehlung für die Praxis In diesem Artikel werden die häufigsten Zeichen und Muster angeführt, die bei entzündlichen Veränderungen des Gastrointestinaltrakts gefunden werden. Praktische Tipps für die systematische Befundanalyse sowie häufige Fehlermöglichkeiten sollen bei der korrekten Interpretation und Eingrenzung der Differenzialdiagnosen helfen.Clinical problem Pathological conditions of the gastrointestinal tract can result from various disorders, including inflammatory, infectious, neoplastic, and ischemic diseases. Radiological standard procedures Cross-sectional imaging techniques have largely replaced many of the conventional fluoroscopic examinations, such as small bowel follow-through and double-contrast barium enema. The former allow for time-efficient, accurate, and minimally invasive diagnostics. Therefore, they have become important diagnostic tools for the evaluation of inflammatory diseases of the gastrointestinal tract. The distension of the intestinal lumen with orally administered neutral contrast media improves not only the evaluation of the intraluminal aspect, but also of the cross-sectional appearance. Furthermore, with cross-sectional imaging techniques, the additional assessment of the extraintestinal structures and organs is also possible. Methodical innovations and assessment With the ongoing development of scanner and software technology, pathologic conditions of the gastrointestinal wall can be characterized in more detail by both computed tomography and magnetic resonance imaging. A structured approach, based on the analysis of typical radiological signs and patterns, combined with the evaluation of extraintestinal findings may help to assign the observed imaging findings to specific disease groups. Recommendations This article summarizes common signs and typical patterns frequently seen in inflammatory conditions of the gastrointestinal tract. A systematic approach for structured analysis of specific and nonspecific imaging features and common pitfalls may aid in the interpretation and help to narrow the spectrum of potential differential diagnoses.(VLID)357833

Gestaltung fallbasierter Selbstlernquizze für klinische Diagnosewissenschaften für Studierende der Humanmedizin am Beispiel der Radiologie

Background: Diagnostic tests and examinations inform clinical decision making. Thus, an essential part of medical students' workplace-based training is dedicated to core skills in clinical diagnostic sciences. Due to a reduction of clinical internships for fifth-year students in the wake of COVID-19 learning activities replacing this aspect of training were needed.Project description: Virtual Patient online learning materials addressing clinical diagnostic sciences, specifically, radiology, were developed to prepare students for the transition to workplace-based learning. Three types of activities related to interprofessional patient treatment, showing how radiology knowledge improves the diagnosing and treatment of patients, were used to design the narrative of each virtual patient. The materials also showed students "how to learn" in the clinical workplace while showing "what to learn". Students complete relevant tasks and compare their approach with experts' approach in a self-directed way.Results: Twenty self-study quizzes, accompanied by nine interactive Webinars were developed, providing 13% of the overall available replacement learning materials for the summer term 2020. In June 2020, 486 students completed the program and collected a mean share of 16% (SD=10) of their required credits by choosing to learn with these materials. Conclusion: Developing virtual patients based on three types of clinical activities to prepare students for the transition to workplace based learning proved successful and allowed rapid development of learning materials. The presented online quiz format and webinar format showed high acceptance and interest among students.Hintergrund: Ergebnisse aus diagnostischen Tests und Untersuchungen stellen relevante Informationen für die klinische Entscheidungsfindung dar. Daher ist ein wesentlicher Teil der arbeitsplatzbasierten Ausbildung von Medizinstudierenden dem Erwerb von Kernkompetenzen in klinischen Diagnosewissenschaften gewidmet. Da COVID-19 bedingt die klinischen Praktikumsplätze für Studierende im fünften Studienjahr reduziert wurden, war es notwendig, diese Teile der Ausbildung zu ersetzen.Projektbeschreibung: Am Beispiel der Radiologie wurden online-Lernmaterialien zum Thema klinische Diagnosewissenschaften entwickelt, um Studierende durch die Arbeit mit virtuellen PatientInnen auf den Übergang zu arbeitsplatzbezogenem Lernen vorzubereiten. Zur Entwicklung der PatientInnenszenarien wurden drei für die interdisziplinäre PatientInnenbehandlung relevante Aktivitätstypen definiert. Die entwickelten Lernszenarien zeigen, was zu lernen ist und wie radiologisches Wissen die Diagnose und Behandlung von PatientInnen verbessert. Gleichzeitig zeigen die Szenarien den Studierenden, wie man am klinischen Arbeitsplatz lernt: Nach möglichst selbständiger Erledigung einer praxisrelevanten Aufgabe vergleichen Studierende die Übereinstimmung ihres Ansatzes mit einem von klinischen ExpertInnen vorgestellten Ansatz.Ergebnisse: Die entwickelten zwanzig Selbstlernquizze und neun interaktiven Webinare entsprechen 13% der für Jahr 5 insgesamt angebotenen akademischen Ersatz-Stunden für das Sommersemester 2020. Im Juni 2020 schlossen 486 Studierende das Ersatzprogramm ab und sammelten einen durchschnittlichen Anteil von 16% (SD=10) ihrer benötigten akademischen Stunden durch Teilnahme an Quizzen und/oder Webinaren. Schlussfolgerung: Der vorgestellte Ansatz, virtuelle PatientInnenszenarien zur Vorbereitung auf späteres arbeitsplatzbasiertes Lernen anhand prototypischer klinischer Aktivitätstypen zu entwickeln, kann als erfolgreich bezeichnet werden. Das aufgrund von Covid-19 sehr rasch entwickelte Online-Quiz-Format und das Webinar-Format zeigten hohe Akzeptanz und Interesse unter den Studierenden

Effects of gastric acid on euro coins: chemical reaction and radiographic appearance after ingestion by infants and children

Objectives: This study investigated whether coins of the new European currency (€) corrode when they are exposed to gastric acid, and whether this change can be detected radiographically. Methods: The eight different denominations of € coins were immersed for seven days in 0.15 N hydrochloride acid (HCl), which corresponds to the level of post-prandial gastric acid. A Swedish crown coin and three different Austrian schilling coins were used as controls. The coins were weighed and radiographed daily to evaluate visible corrosions and HCl was analysed daily for possible dissolved substances. Results: All coins lost weight within 24 hours after exposure to HCl. The 1, 2, and 5 € cent coins developed changes that were visible on radiographs. The weights of all coins decreased by 0.43% to 11.30% during one week. The dissolved substances measured in the HCl corresponded to the different metals and alloys of the coins, except for copper, which does not dissolve in HCl. The highest absolute weight loss was observed in the Swedish crown coin (0.67 g), and the highest relative weight loss in the 1 Austrian schilling coin (11.30%). The two € coins that showed the highest absolute and relative weight losses were the 2 € (0.54 g or 6.35%) and the 1 € (0.48 g or 6.39%) coin. Conclusions: A higher rate of toxicity for the new European coins compared with coins of other currencies is not expected, unless a massive coin ingestion occurs

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