Gastrointestinal Radiology Research Articles

The Role of MRI in Rectal Cancer: An Updated Review

To bring the radiologists up to date on the state of the art of the magnetic resonance imaging protocol of the rectal cancer and on the findings to consider for reports. Recently, the European Society of Gastrointestinal and Abdominal Radiology updated the 2012 guidelines with new recommendations on the acquisition and reporting of MRI for staging and restaging of rectal cancer; furthermore latest advanced MRI techniques (diffusion-weighted imaging, dynamic contrast-enhanced imaging, kurtosis) are object of ongoing studies with promising results. Magnetic resonance imaging plays a fundamental role in rectal cancer staging and restaging; moreover, it allows the detection of some findings with prognostic value. This review includes the last 2016 European Society of Gastrointestinal and Abdominal Radiology Updated Recommendations on magnetic resonance imaging protocol, interpretation, and reporting.

Computed Tomography Findings Predicting the Need for Surgery in Cases of Small Bowel Obstruction: Emphasis on Duodenal Distension.

The aim of the study is to retrospectively evaluate the utility of computed tomography (CT) findings, especially newly defined duodenal distension, for predicting the need to operate on small bowel obstruction (SBO) cases. During a 51-month period, 228 patients (100 women and 128 men; mean age, 55 years) were included in this study, among 438 patients who were hospitalized with a prediagnosis of SBO. The final study population was then divided into 2 groups: a surgery group (n = 76) and a conservative group (n = 152). The CT findings of the SBO patients whose treatment decisions and outcomes were unknown were examined by 2 gastrointestinal radiologists with consensus. Statistical analyses were conducted using univariate and binary logistic regression analyses. According to the univariate analysis, the degree of obstruction (P = 0.001), small bowel diameter (P = 0.014), and presence of mesenteric fluid (P < 0.001), intraperitoneal free fluid (P = 0.04), intra-abdominal free gas (P < 0.001), and duodenal distension (P < 0.001) showed statistically significant differences between the surgery and conservative groups. However, there were no statistically significant group differences regarding the presence of a transition point, small bowel feces or mesenteric congestion. According to the binary logistic regression analysis, the degree of obstruction (P = 0.012), presence of mesenteric fluid (P = 0.008), intra-abdominal free gas (P = 0.019), and duodenal distension (P < 0.001) were significant predictors of the need for surgery in SBO cases. Duodenal distension as a CT finding predicted the need for surgery in SBO cases.

European guidelines on chronic mesenteric ischaemia - joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia.

Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic mesenteric ischaemia remains an underappreciated and undertreated disease entity. Probable explanations are the lack of knowledge and awareness among physicians and the lack of a gold standard diagnostic test. The underappreciation of this disease results in diagnostic delays, underdiagnosis and undertreating of patients with chronic mesenteric ischaemia, potentially resulting in fatal acute mesenteric ischaemia. This guideline provides a comprehensive overview and repository of the current evidence and multidisciplinary expert agreement on pertinent issues regarding diagnosis and treatment, and provides guidance in the multidisciplinary field of chronic mesenteric ischaemia.

Interpretation of consensus on the watch and wait strategy in rectal cancer patients after neoadjuvant treatment (2020)

Watch and wait (W&W) after neoadjuvant treatment of rectal cancer has been a focus in the field of rectal cancer in recent years. Many Chinese or international centers have accumulated valuable experience through conducting clinical research, but there are many disputes about the details of developing W&W, and there is also a problem of insufficient evidence level. Dozens of experts of gastrointestinal surgery, oncology, radiotherapy, pathology and radiology shared the experience of developing W&W and compiled the consensus on the W&W policy in rectal cancer patients after neoadjuvant treatment (2020). This article further analyzes and interprets 5 issues that are likely to cause confusion in consensus, including near-cCR and prolonged waiting time, the relationship between cCR and pCR, the role of biopsy in W&W, local resection, and contact X-ray brachytherapy, and at the same time explains the adjustments in the consensus based on national conditions.

Diagnostic Performance and Interobserver Variability of Radiologists in CT-Scan Interpretation of Cases Suspected of Acute Appendicitis

Background: Acute appendicitis is one the most common and sometimes life threatening conditions in the Emergency Department referrals. Since suspected cases of acute appendicitis require immediate diagnosis and proper intervention, the computed tomography (CT) scan becomes the most frequently used modality for such conditions. However, due to the nature of emergency wards, gastrointestinal (GI) expert radiologists may not be always available. Objectives: The current study aimed at comparing the interobserver variability of GI expert radiologists, general radiologists, and radiology residents in in CT-scan interpretation of cases suspected of acute appendicitis. Methods: Seventy patients suspected of acute appendicitis admitted to the Emergency Department of our university hospital were included in the study. CT-scan with intravenous contrast was performed on patients that their Alvarado score ranged 5 to 8. Decision for surgical or non-surgical management of patients was made by the routine treatment team of hospital and retrospectively, CT-scan images of all 70 patients were reported blindly by three groups of radiologists. Results: Out of the 70 cases, 48 had positive confirmatory pathology for appendicitis (69%) and 22 had negative pathology report (31%). The sensitivity of the reports for radiology residents, general radiologists, and GI expert radiologists was 81.3%, 93.8% and 95.8%, respectively. The specificity of the diagnosis in the three groups was 72.7%, 86.4% and 81.8%, respectively. Conclusions: The study results showed that although the interpretation was not perfect, radiology residents and general radiologists can provide reports with acceptable sensitivity and specificity in the emergency ward.

Association of Faecal Calprotectin Level and Combined Endoscopic and Radiological Healing in Patients With Crohn's Disease Receiving Anti-tumour Necrosis Factor Therapy.

Combined endoscopic and radiological healing, or deep healing, is associated with favourable outcomes in patients with Crohn's disease; thus, a non-invasive biomarker for predicting deep healing would be invaluable. We evaluated the usefulness of faecal calprotectin for predicting deep healing in patients with Crohn's disease receiving anti-tumour necrosis factor [TNF] therapy. We analysed the records of patients with Crohn's disease who received anti-tumour necrosis factor therapy and underwent endoscopic evaluation, radiological evaluation, and faecal calprotectin measurement within a period of 3 months between August 2017 and November 2018. Results of endoscopic and radiological studies were independently reviewed by two gastrointestinal endoscopists and a gastrointestinal radiologist, respectively. Serum C-reactive protein and albumin were also measured. Out of 268 patients analysed, 77 [28.7%] had deep healing, 36 [13.4%] had endoscopic healing only, 36 [13.4%] had radiological healing only, and 119 [44.4%] had neither. The median duration of anti-TNF treatment was 40.0 months. The deep healing group had the lowest median faecal calprotectin level [56.5 mg/kg] among the four groups [p <0.001]. The faecal calprotectin cutoff level of 81.1 mg/kg showed a sensitivity of 0.623 and a specificity of 0.817 in predicting deep healing (area under the receiver operating characteristic curve [AUROC], 0.767; 95% confidence interval, 0.702-0.832). Adding serum C-reactive protein and serum albumin to faecal calprotectin further increased the AUROC to 0.805 [95% confidence interval, 0.752-0.858]. Faecal calprotectin, when combined with serum C-reactive protein and albumin, showed acceptable performance in predicting deep healing in patients with Crohn's disease.

European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations.

IntroductionAchalasia is a primary motor disorder of the oesophagus characterised by absence of peristalsis and insufficient lower oesophageal sphincter relaxation. With new advances and developments in achalasia management, there is an increasing demand for comprehensive evidence-based guidelines to assist clinicians in achalasia patient care.MethodsGuidelines were established by a working group of representatives from United European Gastroenterology, European Society of Neurogastroenterology and Motility, European Society of Gastrointestinal and Abdominal Radiology, and the European Association of Endoscopic Surgery in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A systematic review of the literature was performed and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Recommendations were voted upon using a nominal group technique.ResultsThese guidelines focus on the definition of achalasia, treatment aims, diagnostic tests, medical, endoscopic and surgical therapy, management of treatment failure, follow-up and oesophageal cancer risk.ConclusionThese multidisciplinary guidelines provide a comprehensive evidence-based framework with recommendations on the diagnosis, treatment and follow-up of adult achalasia patients.

Multidetector Computed Tomography Findings of Adhesive Internal Hernias.

To identify multidetector computed tomography (MDCT) findings of surgically confirmed adhesive internal hernias (IHs). Two gastrointestinal radiologists performed blinded, independent, and retrospective reviews of MDCT findings from a consecutive cohort of 35 adhesive IH and 41 adhesive small-bowel obstruction cases that had undergone surgery within 48 hours after MDCT. Univariate statistical analyses were performed to assess CT signs of adhesive IHs and CT findings of intestinal necrosis in patients presenting with adhesive IHs. Dislocated cluster of the intestine (P = 0.005), 2 transitional zones (P = 0.002), and presence of fat in the center sign (P = 0.001) were key CT outcomes that were significantly associated with adhesive IHs. Additionally, intramural hemorrhage was found the MDCT feature indicative of intestinal necrosis (P = 0.028). This study illustrates specific MDCT findings of IHs, and these observations may help guide early clinical management of the condition.

The Portsmouth protocol for intra-operative ultrasound of the small bowel in Crohn's disease.

Bowel preservation is paramount in Crohn's disease surgery as affected patients are typically young adults at risk of having several abdominal surgical procedures during their lifetime. Intra-operative assessment of the extent and location of Crohn's disease is not standardized and is left to a mixture of the surgeon's experience, tactile feedback, macroscopic appearance and preoperative imaging. The aim of this study was to describe the technical steps of a standardized protocol for intra-operative ultrasound assessment of the small bowel in patients undergoing surgery for ileocolic Crohn's disease. After laparoscopic mobilization of the bowel, a periumbilical incision is performed for extracorporeal division of the mesentery and the resection and anastomosis. A gastrointestinal consultant radiologist, with expertise in Crohn's disease imaging and abdominal ultrasound, performs full intra-operative assessment of the small bowel by applying a sterile ultrasound probe directly to the bowel, prior to resection being performed by the surgeon. The bowel is assessed through the wound protector with a sterile technique and the length, location and number of segments is documented together with further quantitative assessment using the METRIC (MR enterography or ultrasound in Crohn's disease) scoring guide. A step-by-step protocol for intra-operative ultrasound evaluation of the entire small bowel is described. A standardized approach to intra-operative evaluation of the extent and location of Crohn's disease is desirable. Intra-operative ultrasound may provide added value for assessment of proximal and multifocal Crohn's disease.

Is water-soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal?

Background and AimRoutine use of water‐soluble contrast enema (WSCE) to assess anastomotic integrity is debated. This study aimed to evaluate the role of WSCE to assess anastomotic integrity following anterior resections (AR) with defunctioning stoma prior to reversal and identify factors to limit its selective use.MethodsThis retrospective study evaluated all WSCE performed over a 7‐year period at a high‐volume colorectal unit. Risk factors for radiological abnormality/leak, including malignancy, chemoradiotherapy, and immediate postoperative complications, were recorded. A gastrointestinal specialist radiologist and surgeon validated all WSCEs reported as abnormal.ResultsOf the 486 WSCE studies identified, 92 were excluded (repeat studies (n = 51), pediatric cases [n = 2], no AR [n = 39]). A total of 394 WSCE studies were evaluated (260 cancer; 134 noncancer patients); 14% (37/260) of cancer patients and 8% (10/134) of noncancer patients had abnormal studies (P = 0.072). Of the 37 abnormal studies in cancer patients, 73% (27/37) radiological leaks were found, and 41% (n = 11/27) of these patients had postoperative complications. Of the 10 abnormal studies in noncancer patients, 20% (2/10) radiological leaks were found, but none of these patients had postoperative complications. Overall leak rates were 7% (29/394), and rates were significantly higher in cancer patients than noncancer patients (10 vs 2%, P = 0.005).ConclusionRoutine use of WSCE may not be necessary prior to reversal. WSCE should be selectively used in event of postoperative leak or complications. Noncancer resections are less likely demonstrate a leak.

Looking Ahead

HomeRadiology: Artificial IntelligenceVol. 1, No. 6 Next EditorialFree AccessLooking AheadCharles E. Kahn, Jr Charles E. Kahn, Jr Author Affiliations(e-mail: [email protected])Charles E. Kahn, Jr Published Online:Nov 27 2019https://doi.org/10.1148/ryai.2019194003MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail An investment in knowledge pays the best interest.Benjamin FranklinAs this journal completes its first year of publication, it’s truly a joy to reflect on our progress and to chart our course forward.I’m extremely grateful to our Deputy Editors—William Hsu, PhD, Jayashree Kalpathy-Cramer, PhD, Despina Kontos, PhD, and Ronnie A. Sebro, MD, PhD—for their outstanding guidance in setting the standards for this journal and overseeing the scientific review process. These individuals have given freely of their time to advance the journal. Together with our other Editorial Board members (https://pubs.rsna.org/page/ai/edboard), they have brought thoughtful and wide-ranging scholarship to the task of reviewing the journal’s submitted manuscripts.We have two noteworthy additions to our Editorial Board.Dania Daye, MD, PhD, has joined us as Associate Editor for Social Media. She brings a keen understanding of the power and nuances of various “SoMe” platforms and is working to develop ways to enhance the content and reach of the journal’s social-media offerings.Judy W. Gichoya, MBChB, MS, has joined the journal as Associate Editor and Program Director of our new Trainee Editorial Board. Dr Gichoya will lead the program and provide mentorship to these trainees.The Trainee Editorial Board (TEB) is a new venture for Radiology: Artificial Intelligence, and a new venture for the RSNA, as well. Although RSNA has offered distinguished journalism fellowship programs, our journal sought to do something a little different, and we’re grateful to the RSNA Board and to Dr Jeffrey Klein, our Board Liaison for Publications, for their support.In October, we invited applications from residents and fellows in diagnostic radiology, interventional radiology, and radiation oncology, and from graduate students and postdoctoral fellows in related scientific disciplines (such as medical physics, biomedical informatics, biomedical engineering, and computer science). We’re very proud to announce the inaugural members of the journal’s TEB (https://pubs.rsna.org/page/ai/teb), selected from among more than 80 highly qualified applicants.TEB members will learn about peer review, biostatistics, research design, and journalistic ethics. They’ll review up to six manuscripts per year and receive guidance from Dr Gichoya and from a faculty mentor at their own institution. They’ll also have an opportunity to learn from the other reviews on assigned manuscripts. TEB members will receive recognition on the journal’s masthead, participate in our annual Editorial Board meeting, and join in quarterly teleconferences with the Editor. They’ll also contribute to the journal’s activities such as the editor’s blog, social media, and journal club.We view the TEB as an opportunity to build capacity and to build community. We’ll work to increase the number of members of the radiology and AI communities who have the background and skills to think critically about scientific contributions at the intersection of machine learning and medical imaging. The TEB also provides a venue for our future colleagues to share ideas and get to know one another.On behalf of the entire Editorial Board, I extend our sincere gratitude to the authors, reviewers, and readers of Radiology: Artificial Intelligence and to the dedicated RSNA Publications staff. We extend a warm welcome to the TEB as the newest members of our journal family and will continue to invest in building our profession’s knowledge of AI in radiology.Article HistoryPublished online: Nov 27 2019 FiguresReferencesRelatedDetailsRecommended Articles Congratulations to the 2018 Editorial FellowsRadiology2018Volume: 289Issue: 1pp. 1-2Congratulations to the 2018 Editorial FellowsRadioGraphics2018Volume: 38Issue: 5pp. 1287-1288Diagnosis Please Certificates of Recognition Awarded to Three Individuals and to International and North American Radiology Resident GroupsRadiology2017Volume: 285Issue: 2pp. 336-339RadioGraphics 2021: Continuing the Path of ExcellenceRadioGraphics2021Volume: 41Issue: 1pp. 1-4Diagnosis Please Certificates of Recognition Awarded to Five Individuals and to International and North American Radiology Resident GroupsRadiology2016Volume: 281Issue: 2pp. 329-332See More RSNA Education Exhibits Interventional Radiology Educational Pathways: A 2017 Update, Including Review of 2017 Match Statistics and Key Ways for Students to Maximize Their Exposure to IRDigital Posters2017Incorporating Interventional Radiology into Medical School Curriculum: Report on Year 2 of Establishing a Longitudinal StudyDigital Posters2019Engaging Medical Students in Interventional Radiology: In the Era of the New Integrated IR ResidencyDigital Posters2018 RSNA Case Collection Pulmonary Arteriovenous MalformationRSNA Case Collection2021"Cold" Sentinel Lymph Node in Cutaneous Melanoma RSNA Case Collection2020Autosomal recessive polycystic kidney diseaseRSNA Case Collection2021 Recommended Articles Society of Abdominal Radiology Is Created by a Merger of the Society of Gastrointestinal Radiologists and the Society of Uroradiology: Form Follows FunctionRadiology2012Volume: 265Issue: 2pp. 336-338The RSNA Editorial Fellows: Then and NowRadiology2015Volume: 276Issue: 3pp. 624-631Congratulations to the 2018 Editorial FellowsRadiology2018Volume: 289Issue: 1pp. 1-2 Vol. 1, No. 6 Metrics Downloaded 241 times Altmetric Score

Guidelines for MR imaging in rectal cancer: Europe versus United States.

The aim of this study was to compare and contrast recently published guidelines for staging and reporting of MR imaging in rectal cancer from the European Society of Gastrointestinal and Abdominal Radiology and the North American Society of Abdominal Radiology. These guidelines were assessed on the presence of consensus and disagreement. Items were compared by two reviewers, and items with agreement and disagreement between the guidelines were identified and are presented in the current paper. Differences between guidelines are discussed to offer insights in practice variations between both continents and among expert centers, which to some extent may explain the differences between guidelines.

A Systematic Review of Technical Parameters for MR of the Small Bowel in non-IBD Conditions over the Last Ten Years

Technical guidelines for magnetic resonance imaging (MRI) of the small bowel (SB) in the setting of inflammatory bowel diseases (IBDs) were detailed in a 2017 consensus issued by European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Pediatric Radiology (ESPR); however, MRI for non-IBD conditions was not addressed. Hence, we performed a systematic review collecting researches on SB MRI for non-IBDs. The literatures were then divided into morphologic group and functional group. Information about the MRI techniques, gastrointestinal preparation, and details of cine-MRI protocols was extracted. We found that a 1.5 T MRI system, prone positioning, and MR enterography were frequently utilized in clinical practice. Gadolinium contrast sequences were routinely implemented, while diffusion-weighted imaging (DWI) was much less performed. The gastrointestinal preparation varied throughout the studies. No uniform protocols for cine imaging could be established. SB MRI examinations for non-IBDs are far from standardized, especially for functional studies. Recommendations for standard parameters in cine-MRI sequences are difficult to make due to lack of evidentiary support. MRI investigations in non-IBD conditions are needed and the standardization of non-IBD imaging in clinical practice is required.

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between...

Small bowel stricture is associated with abnormal motility on the cine MRI sequence in patients with Crohn’s disease

PurposeA multiphasic cine sequence performed during magnetic resonance enterography (MRE) has been shown to increase diagnostic accuracy of MRE demonstrating limited movement in inflamed intestine in patients with Crohn’s disease (CD). Our aim was to confirm in our study population that intestinal inflammation was associated with decreased motility and determine if factors suggestive of complicated disease such as the presence of a stricture or fistula were associated with decreased motility on the MRE cine sequence. MethodsThis was a retrospective study of 59 patients (mean age 40.8 ± 16.1) with Crohn’s disease who had a small bowel lesion on MRE. Two gastrointestinal radiologists independently scored MRE findings using a qualitative, subjective scoring system. Univariate and multivariable ordered logistic regression models were used to evaluate the associations between cine sequence score, radiologic image findings, and clinical data. ResultsOn univariate analysis, radiologic findings reflecting active inflammation, the presence of a stricture, and penetrating disease were associated with decreased motility. On multivariable analysis, hyper-enhancement, the presence of a comb sign, and global evidence of active inflammation remained associated with decreased motility. Of the factors suggesting complicated disease, the presence of stricture (Odds Ratio 0.40, 95% Confidence Interval 0.17-0.95, p-value 0.038) was associated with decreased motility. ConclusionsAs previously shown, well-established radiologic findings of bowel inflammation were associated with decreased small bowel motility. In this study, we have added that the radiologic finding of a fixed stricture is also associated with decreased motility.

Intensity-Modulated Radiotherapy With a Simultaneous Integrated Boost in Rectal Cancer

AimsDose–response curves suggest that higher doses of radiotherapy improve the complete response rate in rectal cancer. The UK adopted the EXPERT trial dose and fractionation, 45 Gy in 25 fractions to the pelvis with a sequential 9 Gy in five fractions to the gross tumour, in patients where the aim was to maximise the complete response. In the Oxford University Hospital NHS Foundation Trust (Oxford, UK) we deliver a biological equivalent dose (BED5) in selected patients using intensity-modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) in 25 fractions. We carried out a retrospective analysis of our series to: (i) document the toxicity of this protocol; (ii) ascertain whether dose constraints from RTOG 0822 were appropriate; (iii) assess the response. Materials and methodsThe demographics and treatment details for all consecutive patients treated with this protocol were collected using electronic systems. Patients received 45 Gy to the elective nodes and 52 Gy using a SIB to the gross tumour with capecitabine chemotherapy using IMRT or RapidArc plans. Acute toxicity was collected prospectively during weekly reviews. For the purpose of this study, a dedicated gastrointestinal radiologist reviewed all baseline and post-treatment magnetic resonance images and assigned a magnetic resonance tumour regression grade (mrTRG). ResultsSeventy-one patients were identified. Seventy completed radiotherapy with a median overall treatment time of 34 days (range 32–36 days); 67.6% received full-dose chemotherapy, with 21.2% receiving a reduced dose. There was a 4.2% incidence of grade 3+ non-haematological toxicity and 1.5% grade 3 + haematological toxicity. 4.2% were admitted during their radiotherapy, with one death due to a pelvic abscess. The RTOG 0822 constraints were achieved in ≥75% of cases, other than the high-dose bladder constraint. mrTRG 1–2 was seen in 47.8%, with mrTRG 1 seen in 23.9%. ConclusionsWe suggest that our protocol shows acceptable acute toxicity, with promising mrTRG results, and could be adopted by centres as an IMRT equivalent dose for EXPERT dose and fractionation.

Quantitative and qualitative assessment of a coding system for reporting CT colonography

To validate a coding system implemented to summarise computed tomography colonography (CTC) findings for the detection of suspected colorectal cancer (CRC) by assessing interobserver variability and also to evaluate any weaknesses through qualitative analysis. All CTC investigations over a 6-month period (01/07/2016 to 31/12/2016) were analysed retrospectively. Each study was read initially by an advanced practitioner radiographer with a final report issued by a consultant gastrointestinal radiologist. Rates of interobserver agreement, using the kappa statistic, provided a quantitative assessment of levels of agreement. Areas of poor interobserver agreement were identified for further qualitative assessment. The present study included 1,321 CTC procedures and the mean age of patients was 68.4 years (range 28-96 years). Percentage agreement for colonic coding was 90% and for extra-colonic coding 47%. This corresponds to kappa scores of 0.69 (substantial agreement) and 0.22 (fair agreement), respectively. Reasons and examples of disagreement in the colonic coding are highlighted. High interobserver agreement was observed for C coding, suggesting it is a reproducible method of classifying intra-colonic CTC findings. Some of the difference in classifying extra-colonic findings is the perceived importance of incidental findings between readers, as well as differences in skill set; however, some themes recurred in areas of disagreement and recommendations for refining and improving the coding system are provided.

Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice

PurposeRectal cancer staging with magnetic resonance imaging (MRI) allows accurate assessment and preoperative staging of rectal cancers. Therefore, complete MRI reports are vital to treatment planning. Significant variability may exist in their content and completeness. Template-style reporting can improve reporting standards, but its use is not widespread. Given the implications for treatment, we have evaluated current clinical practice amongst specialist gastrointestinal (GI) radiologists to measure the quality of rectal cancer staging MRI reports.Materials and methodsSixteen United Kingdom (UK) colorectal cancer multi-disciplinary teams (CRC-MDTs) serving a population over 5 million were invited to submit up to 10 consecutive rectal cancer primary staging MRI reports from January 2016 for each radiologist participating in the CRC-MDT. Reports were compared to a reference standard based on recognised staging and prognostic factors influencing case managementResultsFour hundred ten primary staging reports were submitted from 41 of 42 (97.6%) eligible radiologists. Three hundred sixty reports met the inclusion criteria, of these, 81 (22.5%) used a template. Template report usage significantly increased recording of key data points versus non-template reports for extra-mural venous invasion (EMVI) status (98.8% v 51.6%, p < 0.01) and circumferential resection margin (CRM) status (96.3% v 65.9%, p < 0.01). Local tumour stage (97.5% v 93.5%, NS) and nodal status (98.8% v 96.1%, NS) were reported and with similar frequency.ConclusionRectal cancer primary staging reports do not meet published standards. Template-style reports have significant increases in the inclusion of key tumour descriptors. This study provides further support for their use to improve reporting standards and outcomes in rectal cancer.Key Points• MRI primary staging of rectal cancer requires detailed tumour descriptions as these alter the neoadjuvant and surgical treatments.• Currently, rectal cancer MRI reports in clinical practice do not provide sufficient detail on these tumour descriptors.• The use of template-style reports for primary staging of rectal cancer significantly improves report quality compared to free-text reports.

Faecal Calprotectin and Magnetic Resonance Enterography in Ileal Crohn's Disease: Correlations Between Disease Activity and Long-Term Follow-Up.

Magnetic resonance enterography [MRE] is the gold standard for assessing ileal inflammation in Crohn's disease [CD]. The aim of the present study was to correlate faecal calprotectin [FC] to MRE via a simple score in an exclusive ileal cohort with long-term follow-up for association with time to surgery or biologic therapy. In total, 150 MRE studies with matched FC [±30 days] were identified from the Edinburgh FC Register [2008-12; n = 18138]. Scans were re-read blinded to clinical data, independently, by two expert gastrointestinal radiologists, to generate a simple MRE score [range 0-10] from assessment of the worst intestinal segment plus total disease extent. In total, 119 MRE scans were evaluated from 104 patients with ileal CD [L1 or L3 with panproctocolectomy]. Receiver operating characteristic analysis showed an area under the curve of 0.77 [0.67-0.87, p < 0.0001] for FC and MRE score >1, with an optimal cut-off of 145 μg/g for severe inflammation on MRE with 69.3% [57.6-79.5] sensitivity and 71.4% [53.7-85.4] specificity. Long-term follow-up over a median [interquartile range] of 2086 days [1786-2353] revealed FC ≥ 145 μg/g was associated with reduced biologic-free survival until 3 years following MRE, whereas MRE score [severe vs absent] was associated with reduced surgery- and biologic-free survival throughout follow-up. Backwards stepwise logistic regression revealed that length of ileal disease (odds ratio [OR] 3.8, 1.1-13.2, p = 0.034) and increased bowel wall thickness at MRE [OR 4.2, 1.6-10.7, p < 0.0001] or female sex [OR 5.2, 1.5-18.7, p = 0.011] increased the risk of biologic use or surgery, respectively. FC correlates well with MRE assessment of ileal CD with MRE parameters associated with long-term biologic- and surgery-free remission.

4. Achieving European Standards in Setting up Computed Tomographic Colonography (CTC) Service in A Rural Hospital

Background: CTC has been an established modality for investigation for colonic polyps or tumours for over a decade. This service is slowly being introduced in rural hospitals to compliment the increasing demands for colonoscopies. National and European standards have been set to ensure quality of acquisition, reporting validity, complications of procedure and patient experience. The aim of this audit is to assess compliance of this new service in a rural hospital against these recommendations set by the Royal College of Radiologists and European Society of Gastrointestinal Radiologists (ESGAR).