Outcome After Conservative and Endovascular Treatment of Stanford Type B Aortic Intramural Hematomas - A Single-Center Retrospective Study.

OBJECTIVES: Aortic intramural hematoma (IMH) is a rare disease. Thus far, only limited data is available and the indications for conservative and endovascular treatment are not well defined. The aim of this study was to investigate clinical presentation, course, CT imaging features and outcome of patients with type B aortic IMHs. METHODS: We included all patients with type B IMHs between 2012 and 2021 in this retrospective monocentric study. Clinical data, localization, thickness of IMHs and the presence of ulcer-like projections (ULPs) was evaluated before and after treatment. RESULTS: Thirty five patients (20 females; 70.3 y ± 11 y) were identified. Almost all IMHs (n = 34) were spontaneous and symptomatic with back pain (n = 34). At the time of diagnosis, TEVAR was deemed indicated in 9 patients, 26 patients were treated primarily conservatively. During the follow-up, in another 16 patients TEVAR was deemed indicated. Endovascularly and conservatively treated patients both showed decrease in thickness after treatment. Patients without ULPs showed more often complete resolution of the IMH than patients with ULPs (endovascularly treated 90.9% (10/11) vs 71.4% (5/7); conservatively treated 71.4% (10/14) vs 33.3% (1/3); P = .207). Complications after TEVAR occurred in 32% and more frequently in patients treated primarily conservatively (37.5% vs 22.2%). No in-hospital mortality was observed during follow-up. CONCLUSIONS: Prognosis of IMH seems favourable in both surgically as well as conservatively treated patients. However, it is essential to identify patients at high risk for complications under conservative treatment, who therefore should be treated by TEVAR. In our study, ULPs seem to be an adverse factor for remodeling.

Impact of the COVID-19 pandemic on therapeutic interventional oncology procedures and diagnostic CT/MRI examinations at a German university hospital.

PURPOSE: The COVID-19 pandemic led to the implementation of severe restrictions on public life in Germany and a reduction in the number of non-COVID patients presenting for care. The aim of this study was to measure the impact on the number of therapeutic interventional oncology procedures in relation to diagnostic imaging studies at a high-volume radiology department. MATERIALS AND METHODS: The numbers of therapeutic interventional oncology procedures and diagnostic CT/MRI examinations for the years 2010 to 2021 were extracted using the hospital information system. Monthly data from January 2010 to December 2019 were used to build forecasting models for the timeframe from January 2020 to December 2021. Real procedure numbers were compared with predicted numbers to calculate residual differences, which were considered statistically significant if the real number was outside the 95 % confidence interval (p < 0.05). RESULTS: During the first German lockdown (March/April 2020), the number of outpatient CT/MRI examinations decreased significantly, with a less pronounced decrease of overall CT/MRI numbers. The second German lockdown (January-May 2021) led to lower than predicted outpatient CT numbers, whereas outpatient MRI numbers in part even exceeded predicted numbers and overall CT/MRI numbers stayed within confidence limits. The lockdowns had a more pronounced negative effect on the number of oncological MRI examinations compared to CT examinations. The number of therapeutic interventional oncology procedures showed no significant decrease during both lockdowns. CONCLUSION: Lockdown measures had minor impact on the number of therapeutic interventional oncology procedures, possibly due to a shift from more resource-intensive therapies like surgery towards interventional oncology. The overall numbers of diagnostic imaging decreased during the first lockdown, while the second lockdown had less negative impact. The number of oncological MRI examinations was affected most severely. To avoid adverse outcomes, specific protocols for patient management during future pandemic outbreaks should be implemented and continuously adapted. KEY POINTS: · COVID-19 lockdowns had minor effect on therapeutic interventional oncology procedures.. · Numbers of diagnostic outpatient imaging procedures dropped markedly, especially during the first lockdown.. · The number of oncological MRI examinations showed a significant decrease during both lockdowns.. CITATION FORMAT: · Nebelung H, Radosa CG, Schön F et al. Impact of the COVID-19 pandemic on therapeutic interventional oncology procedures and diagnostic CT/MRI examinations at a German university hospital. Fortschr Röntgenstr 2023; 195: 707 - 712.

Plasma extracellular vesicle messenger RNA profiling identifies prognostic EV signature for non-invasive risk stratification for survival prediction of patients with pancreatic ductal adenocarcinoma.

BACKGROUND: The prognosis of pancreatic ductal adenocarcinoma (PDAC) is one of the most dismal of all cancers and the median survival of PDAC patients is only 6-8 months after diagnosis. While decades of research effort have been focused on early diagnosis and understanding of molecular mechanisms, few clinically useful markers have been universally applied. To improve the treatment and management of PDAC, it is equally relevant to identify prognostic factors for optimal therapeutic decision-making and patient survival. Compelling evidence have suggested the potential use of extracellular vesicles (EVs) as non-invasive biomarkers for PDAC. The aim of this study was thus to identify non-invasive plasma-based EV biomarkers for the prediction of PDAC patient survival after surgery. METHODS: Plasma EVs were isolated from a total of 258 PDAC patients divided into three independent cohorts (discovery, training and validation). RNA sequencing was first employed to identify differentially-expressed EV mRNA candidates from the discovery cohort (n = 65) by DESeq2 tool. The candidates were tested in a training cohort (n = 91) by digital droplet polymerase chain reaction (ddPCR). Cox regression models and Kaplan-Meier analyses were used to build an EV signature which was subsequently validated on a multicenter cohort (n = 83) by ddPCR. RESULTS: Transcriptomic profiling of plasma EVs revealed differentially-expressed mRNAs between long-term and short-term PDAC survivors, which led to 10 of the top-ranked candidate EV mRNAs being tested on an independent training cohort with ddPCR. The results of ddPCR enabled an establishment of a novel prognostic EV mRNA signature consisting of PPP1R12A, SCN7A and SGCD for risk stratification of PDAC patients. Based on the EV mRNA signature, PDAC patients with high risk displayed reduced overall survival (OS) rates compared to those with low risk in the training cohort (p = 0.014), which was successfully validated on another independent cohort (p = 0.024). Interestingly, the combination of our signature and tumour stage yielded a superior prognostic performance (p = 0.008) over the signature (p = 0.022) or tumour stage (p = 0.016) alone. It is noteworthy that the EV mRNA signature was demonstrated to be an independent unfavourable predictor for PDAC prognosis. CONCLUSION: This study provides a novel and non-invasive prognostic EV mRNA signature for risk stratification and survival prediction of PDAC patients.

ICU patients with infectious complications after abdominopelvic surgery: Is thoracic CT in addition to abdominal CT helpful?

BACKGROUND: The aim of this study was to assess the usefulness of adding thoracic CT to abdominal CT in intensive care unit (ICU) patients with signs of infection after abdominopelvic surgery. METHODS: 143 thoracoabdominal CTs of ICU patients with signs of infection after abdominopelvic surgery were retrospectively reviewed for thoracic pathologies. It was determined if pathologic findings were visible only on thoracic CT above the diaphragmatic dome or also on abdominal CT up to the diaphragmatic dome. All thoracic pathologies visible only above the diaphragmatic dome were retrospectively analyzed by an ICU physician in terms of clinical relevance. Diagnostic and therapeutic efficacy of thoracic CT were assessed with regard to an infectious focus and to other pathologic findings. RESULTS: 297 pathologic thoracic findings were recorded. 26 of the 297 findings could only be detected on images obtained above the diaphragmatic dome (in 23 of 143 CTs). A change in patient management was initiated due to only one of the 26 supradiaphragmatic findings. Diagnostic efficacy of thoracic CT in addition to abdominal CT to identify an infectious focus was 3.5% (95%-CI: 0.5-6.5%) and therapeutic efficacy was 0.7% (95%-CI: 0-2.1%). With regard to all pathologic thoracic findings, diagnostic efficacy was 16.1% (95%-CI: 10.1-22.1%) and therapeutic efficacy remained at 0.7%. CONCLUSIONS: Additional thoracic CT to detect an infectious focus in ICU patients after abdominopelvic surgery leads to identification of the focus in only 3.5% and to changes in patient management in only 0.7%. Other relevant findings are more common (16.1%), but very rarely affect patient management.

Robotic Esophagectomy Compared With Open Esophagectomy Reduces Sarcopenia within the First Postoperative Year: A Propensity Score-Matched Analysis.

INTRODUCTION: Sarcopenia is a known risk factor for adverse outcomes after esophageal cancer (EC) surgery. Robot-assisted minimally invasive esophagectomy (RAMIE) offers numerous advantages, including reduced morbidity and mortality. However, no evidence exists to date comparing the development of sarcopenia after RAMIE and open esophagectomy (OE). The objective was to evaluate whether the development of sarcopenia within the first postoperative year after esophagectomy is associated with the surgical approach: RAMIE versus OE. METHODS: A total of 168 patients with EC were analyzed who either underwent total robotic or fully open Ivor Lewis esophagectomy in a propensity score-matched analysis. Sarcopenia was assessed using the skeletal muscle index (cm2/m2) and psoas muscle thickness per height (mm/m) on axial computed tomography scans during the first postoperative year; in total 540 computed tomography scans were evaluated. RESULTS: After 1-to-1 propensity score matching for confounders, 67 patients were allocated to RAMIE and OE groups, respectively. Skeletal muscle index in the OE group was significantly lower compared with the RAMIE group at the third (43.2 ± 7.6 cm2/m2 versus 49.1 ± 6.9 cm2/m2, p = 0.001), sixth (42.7 ± 7.8 cm2/m2 versus 51.5 ± 8.2 cm2/m2, p < 0.001) and ninth (43.0 ± 7.0 cm2/m2 versus 49.9 ± 6.6 cm2/m2, p = 0.015) postoperative month. Similar results were recorded for psoas muscle thickness per height. CONCLUSIONS: To our knowledge, this study is the first to suggest a substantial benefit of RAMIE compared with open esophagectomy in terms of postoperative sarcopenia. These results add further evidence to support the implementation of the robotic approach in multimodal therapy of EC.

Predicting postoperative pancreatic fistula in pancreatic head resections: which score fits all?

PURPOSE: Postoperative pancreatic fistula (POPF) is a major complication of pancreatic surgery and can be fatal. Better stratification of patients into risk groups may help to select those who might benefit from strategies to prevent complications. The aim of this study was to validate ten prognostic scores in patients who underwent pancreatic head surgery. METHODS: A total of 364 patients were included in this study between September 2012 and August 2017. Ten risk scores were applied to this cohort. Univariate and multivariate analyses were performed considering all risk factors in the scores. Furthermore, the stratification of patients into risk categories was statistically tested. RESULTS: Nine of the scores (Ansorge et al., Braga et al., Callery et al., Graham et al., Kantor et al., Mungroop et al., Roberts et al., Yamamoto et al. and Wellner et al.) showed strong prognostic stratification for developing POPF (p < 0.001). There was no significant prognostic value for the Fujiwara et al. risk score. Histology, pancreatic duct diameter, intraabdominal fat thickness in computed tomography findings, body mass index, and C-reactive protein were independent prognostic factors on multivariate analysis. CONCLUSION: Most risk scores tend to stratify patients correctly according to risk for POPF. Nevertheless, except for the fistula risk score (Callery et al.) and its alternative version (Mungroop et al.), many of the published risk scores are obscure even for the dedicated pancreatic surgeon in terms of their clinical practicability. There is a need for future studies to provide strategies for preventing POPF and managing patients with high-risk stigmata.

Influence of the First Wave of the COVID-19 Pandemic on Cancer Care in a German Comprehensive Cancer Center.

Introduction: During the first wave of the COVID-19 pandemic in 2020, the German government implemented legal restrictions to avoid the overloading of intensive care units by patients with COVID-19. The influence of these effects on diagnosis and treatment of cancer in Germany is largely unknown. Methods: To evaluate the effect of the first wave of the COVID-19 pandemic on tumor board presentations in a high-volume tertiary referral center (the German Comprehensive Cancer Center NCT/UCC Dresden), we compared the number of presentations of gastrointestinal tumors stratified by tumor entity, tumor stage, and treatment intention during the pandemic to the respective data from previous years. Results: The number of presentations decreased by 3.2% (95% CI -8.8, 2.7) during the COVID year 2020 compared with the pre-COVID year 2019. During the first shutdown, March-May 2020, the total number of presentations was 9.4% (-18.7, 1) less than during March-May 2019. This decrease was significant for curable cases of esophageal cancer [N = 37, 25.5% (-41.8, -4.4)] and colon cancer [N = 36, 17.5% (-32.6, 1.1)] as well as for all cases of biliary tract cancer [N = 26, 50% (-69.9, -15)] during the first shutdown from March 2020 to May 2020. Conclusion: The impact of the COVID-19 pandemic on the presentation of oncological patients in a CCC in Germany was considerable and should be taken into account when making decisions regarding future pandemics.

Diagnostic performance of 18F-fluorodeoxyglucose-PET/MRI versus MRI alone in the diagnosis of pelvic recurrence of rectal cancer.

PURPOSE: To compare the diagnostic performance of 18F-fluorodeoxyglucose-PET/MRI and MRI in the diagnosis of pelvic recurrence of rectal cancer. METHODS: All PET/MRIs of patients in the follow-up of rectal cancer performed between 2011 and 2018 at our institution were retrospectively reviewed. Recurrence was confirmed/excluded either by histopathology or imaging follow-up (> 4 months). Four groups of readers (groups 1/2: one radiologist each, groups 3/4: one radiologist/one nuclear medicine physician) independently interpreted MRI and PET/MRI. The likelihood of recurrence was scored on a 5-point-scale. Inter-reader agreement, sensitivity, specificity, PPV/NPV and accuracy were assessed. ROC curve analyses were performed. RESULTS: Fourty-one PET/MRIs of 40 patients (mean 61 years ± 10.9; 11 women, 29 men) were included. Sensitivity of PET/MRI in detecting recurrence was 94%, specificity 88%, PPV/NPV 97% and 78%, accuracy 93%. Sensitivity of MRI was 88%, specificity 75%, PPV/NPV 94% and 60%, accuracy 85%. ROC curve analyses showed an AUC of 0.97 for PET/MRI and 0.92 for MRI, but the difference was not statistically significant (p = 0.116). On MRI more cases were scored as equivocal (12% versus 5%). Inter-reader agreement was substantial for PET/MRI and MRI (0.723 and 0.656, respectively). CONCLUSION: 18F-FDG-PET/MRI and MRI are accurate in the diagnosis of locally recurrent rectal cancer. Sensitivity, specificity, PPV, NPV and accuracy are comparable for both modalities, but PET/MRI increases readers' confidence levels and reduces the number of equivocal cases.

Radioembolization versus portal vein embolization for contralateral liver lobe hypertrophy: effect of cirrhosis.

PURPOSE: Preoperative hypertrophy induction of future liver remnant (FLR) reduces the risk of postoperative liver insufficiency after partial hepatectomy. One of the most commonly used methods to induce hypertrophy of FLR is portal vein embolization (PVE). Recent studies have shown that transarterial radioembolization (TARE) also induces hypertrophy of the contralateral liver lobe. The aim of our study was to evaluate contralateral hypertrophy after TARE versus after PVE taking into account the effect of cirrhosis. METHODS: Forty-nine patients undergoing PVE before hemihepatectomy and 24 patients with TARE as palliative treatment for liver malignancy were retrospectively included. Semi-automated volumetry of the FLR/contralateral liver lobe before and after intervention (20 to 65 days) was performed on CT or MRI, and the relative increase in volume was calculated. Cirrhosis was evaluated independently by two radiologists on CT/MRI, and interrater reliability was calculated. RESULTS: Hypertrophy after PVE was significantly more pronounced than after TARE (25.3% vs. 7.4%; p < 0.001). In the subgroup of patients without cirrhosis, the difference was also statistically significant (25.9% vs. 8.6%; p = 0.002), whereas in patients with cirrhosis, the difference was not statistically significant (18.2% vs. 7.4%; p = 0.212). After PVE, hypertrophy in patients without cirrhosis was more pronounced than in patients with cirrhosis (25.9% vs. 18.2%; p = 0.203), while after TARE, hypertrophy was comparable in patients with and without cirrhosis (7.4% vs. 8.6%; p = 0.928). CONCLUSION: TARE induces less pronounced hypertrophy of the FLR compared to PVE. Cirrhosis seems to be less of a limiting factor for hypertrophy after TARE, compared to PVE.

Importance and Qualitative Requirements of Magnetic Resonance Imaging for Therapy Planning in Rectal Cancer - Interdisciplinary Recommendations of AIO, ARO, ACO and the German Radiological Society. / Stellenwert und qualitative Voraussetzungen der Magnetresonanztomografie (MRT) für die Therapieplanung beim Rektumkarzinom ­ Interdisziplinäre Empfehlungen der AIO, ARO, ACO und der Deutschen Röntgengesellschaft.

Due to its excellent intrinsic soft tissue contrast, magnetic resonance imaging allows excellent visualization and anatomical separation of therapy-relevant risk structures such as the mesorectal fascia, local lymph nodes, and vascular structures in patients with rectal carcinoma. This makes magnetic resonance imaging (MRI) a valuable evaluation method for further therapeutic stratification. In particular, MRI is indispensable for the decision to refrain from neoadjuvant therapy and to choose a primary surgical approach. In addition to the oncologically generally relevant T-, N-, and M-criteria, two further parameters are included: the extramural vascular infiltration and the circumferential resection margin. Due to the significant impact of MRI on further therapeutic decision-making, standardized MR image quality is considered essential. KEY POINTS:: · Magnetic resonance imaging is a valuable evaluation method for further therapeutic stratification.. · Critical anatomic landmarks for evaluation are circumferential resection margins.. CITATION FORMAT: · Attenberger UI, Clasen S, Ghadimi M et al. Importance and Qualitative Requirements of Magnetic Resonance Imaging for Therapy Planning in Rectal Cancer - Interdisciplinary Recommendations of AIO, ARO, ACO and the German Radiological Society. Fortschr Röntgenstr 2021; 193: 513 - 520.

Rectal gas-induced susceptibility artefacts on prostate diffusion-weighted MRI with epi read-out at 3.0 T: does a preparatory micro-enema improve image quality?

PURPOSE: To assess whether the application of a preparatory micro-enema reduces gas-induced susceptibility artefacts on diffusion-weighted MRI of the prostate. METHODS: 114 consecutive patients who received multiparametric 3 T MRI of the prostate at our institution were retrospectively enrolled. 63 patients self-administered a preparatory micro-enema prior to imaging, and 51 patients underwent MRI without bowel preparation. Two blinded readers independently reviewed the diffusion-weighted sequences regarding gas-induced artefacts. The presence/severity of artefacts was scored ranging from 0 (no artefact) to 3 (severe artefact). A score ≥ 2 was considered a clinically relevant artefact. Maximum rectal width at the level of the prostate was correlated with the administration of a micro-enema. Scores were compared between the scans performed with and without bowel preparation using univariable and multivariable logistic regression, taking into account potential confounding factors (age and prostate volume). RESULTS: Significantly less artefacts were found on diffusion-weighted sequences after the administration of a micro-enema shortly prior to MR imaging. Clinically relevant artefacts were found in 10% in the patient group after enema, in 41% without enema. If present, artefacts were also significantly less severe. Mean severity score was 0.3 (enema administered) and 1.2 (no enema), and odds ratio was 0.137 (p < 0.0001) in univariable ordinal logistic regression. Inter-observer agreement was excellent (κ 0.801). CONCLUSION: The use of a preparatory micro-enema prior to 3 T multiparametric prostate MRI significantly reduces both the incidence and severity of gas-induced artefacts on diffusion-weighted sequences and thus improves image quality.

First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases.

PURPOSE: Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. METHODS: We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as "Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)". RESULTS: ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. CONCLUSION: To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.

MRI-based static and functional assessment of complex hip deformities in comparison with CT: a validation study.

OBJECTIVE: This study aimed at investigating the agreement between predefined quantitative parameters of hip morphology derived from magnetic resonance imaging (MRI) and virtual range of motion (ROM) analysis using computed tomography (CT) as standard of reference. METHODS: Twenty patients (13 females, 7 males, 16-59 years) with hip deformities underwent MRI prior to surgery. Clockwise alpha angle, femoral head and neck diameter, collum caput diaphysis angle, femoral torsion, center-edge angles, acetabular coverage of the femoral head, sourcil angle, and acetabular anteversion were measured. Additionally, tern single and combined movements were simulated using a motion analysis program. The MRI findings were compared with the corresponding results obtained by CT. Correlation of MRI with CT was assessed using different statistical methods (intraclass correlation coefficient, Bland-Altmann plot, two one-sided t test), and linear regression analysis was performed. RESULTS: The results showed near-perfect intraclass correlation coefficients (ICCs) for anteversion (0.95), acetabular sector angles (0.98-0.99), sourcil angle (0.95), and acetabular coverage (anterior 0.96, posterior 0.99). Intermethod correlation for femoral parameters showed almost perfect agreement except for the alpha angle (0.73-0.97). No significant proportional bias was detected for traditional acetabular and femoral parameters. ROM analysis was performed for 370 movements in 37 hips. For 78.4% (290/370) of the movements analysed, neither CT nor MRI detected impingement across the physiological ROM. For 18.6% (69/370) of the movements, impingement was detected by both CT and MRI, while 2.2% (8/370) of the movements with impingement in CT showed no impingement in MRI, and 0.8% (3/370) of the movements with impingement in MRI had no corresponding result in CT. CONCLUSION: Finally, it was concluded that MRI-based assessment of hip morphology and virtual ROM analysis is feasible and can be performed with good intermethod agreement in comparison to the gold standard (CT). Therefore, MRI appears to be substantially equivalent to CT for use in virtual ROM analysis and so may reasonably be used in place of CT for this purpose.

Holmium-166 Radioembolization in Hepatocellular Carcinoma: Feasibility and Safety of a New Treatment Option in Clinical Practice.

PURPOSE: To investigate clinical feasibility, technical success and toxicity of 166Ho-radioembolization (166Ho-RE) as new approach for treatment of hepatocellular carcinomas (HCC) and to assess postinterventional calculation of exact dosimetry through quantitative analysis of MR images. MATERIALS AND METHODS: From March 2017 to April 2018, nine patients suffering from HCC were treated with 166Ho-RE. To calculate mean doses on healthy liver/tumor tissue, MR was performed within the first day after treatment. For evaluation of hepatotoxicity and to rule out radioembolization-induced liver disease (REILD), the Model for End-Stage Liver Disease (MELD) Score, the Common Terminology Criteria for Adverse Events and specific laboratory parameters were used 1-day pre- and posttreatment and after 60 days. After 6 months, MR/CT follow-up was performed. RESULTS: In five patients the right liver lobe, in one patient the left liver lobe and in three patients both liver lobes were treated. Median administered activity was 3.7 GBq (range 1.7-5.9 GBq). Median dose on healthy liver tissue was 41 Gy (21-55 Gy) and on tumor tissue 112 Gy (61-172 Gy). Four patients suffered from mild postradioembolization syndrome. No significant differences in median MELD-Score were observed pre-, posttherapeutic and 60 days after 166Ho-RE. No deterioration of liver function and no indicators of REILD were observed. One patient showed a complete response, four a partial response, three a stable disease and one a progressive disease at the 6 months follow-up. CONCLUSION: 166Ho-RE seems to be a feasible and safe treatment option with no significant hepatotoxicity for treatment of HCC.

Is MRI an adequate replacement for CT scans in the three-dimensional assessment of acetabular morphology?

BACKGROUND: Appropriate three-dimensional imaging of the hip joint is a substantial prerequisite for planning and performing surgical correction of deformities. Although surgeons still use computed tomography (CT), modern and fast acquisition techniques of volumetric imaging using magnetic resonance imaging (MRI) for pelvic measurements enable similar resolution. PURPOSE: This study was designed to determine if already described measures of acetabular morphology are comparable in both techniques and if assessment can be performed with equal intra-observer and inter-observer reliability. MATERIAL AND METHODS: Thirty-two hips (16 patients) were examined with a pelvic CT and a MRI with 3-T. Pelvic orientation was standardized by each observer in coronal, axial, and sagittal planes. Acetabular version as well as seven acetabular sector angles were measured by two observers twice with a minimum of four weeks between sessions. RESULTS: Inter-rater reliability showed excellent results for intra- and inter-rater reliability for CT (0.977-0.999) and MRI (0.969-0.998) measuring acetabular version and sector angles. Evaluating the reliability of CT and MRI for each observer revealed excellent results (0.972-0.998). Evaluating the Bland-Altman plots for intra-observer reliability showed an equal distribution of angles, within acceptable 95% limits of agreement. The same results were observed for inter-observer reliability evaluating CT and MRI as well as inter-method reliability. CONCLUSION: Modern MRI scans are equally applicable to assess the bony pelvis as CT scans. In addition, MRI would enable the examination of soft tissues such as chondrolabral structures and muscle in the same examination. Since hip-preserving surgery is mostly conducted in younger patients, the reduction of radiation exposure is a benefit.

Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis.

OBJECTIVES: To perform a systematic review and meta-analysis of published data to evaluate the utility of chemical shift imaging (CSI) for differentiating between adrenal adenomas and non-adenomas. METHODS: A systematic search of the MEDLINE, Web of Science Core Collection, EMBASE and Cochrane Central Register of Controlled Trials electronic databases was performed. The methodological quality of the included studies was assessed by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. A bivariate random effect model was used to determine summary and subgroup sensitivity and specificity and calculate summary receiver operating characteristic curves (SROC). RESULTS: Eighteen studies with 1138 patients and 1280 lesions (859 adenomas, 421 non-adenomas) in total were included. In addition to summary analysis, quantitative analyses of the adrenal signal intensity index (SII, 978 lesions, 14 studies), adrenal-to-spleen ratio (ASR; 394 lesions, 7 studies) and visual analysis (560 lesions, 5 studies) were performed. The resultant data showed considerable heterogeneity (inconsistency index I2 of 94%, based on the diagnostic odds ratio, DOR). The pooled sensitivity of CSI for adenoma was 0.94 [95% confidence interval (CI) 0.88-0.97] and pooled specificity was 0.95 (95% CI 0.89-0.97). The area (AUC) under the SROC curve was 0.98 (95% CI 0.96-0.99). The corresponding AUCs were 0.98, 0.99 and 0.95 for SII, ASR and visual evaluation, respectively. CONCLUSION: CSI has high sensitivity, specificity and accuracy for adrenal adenoma. Diagnostic performance does not improve when quantitative indices are used. KEY POINTS: • Inclusion of CSI in abdominal MRI protocols provides an effective solution for classifying adrenal masses discovered on MR exams • Visual evaluation of adrenal CSI is sufficient; use of quantitative indices does not improve diagnostic accuracy.

Correction to: FDG-PET/MRI in patients with pelvic recurrence of rectal cancer: first clinical experiences.

The original version of this article, published on 6 July 2018, unfortunately contained a mistake.

FDG-PET/MRI in patients with pelvic recurrence of rectal cancer: first clinical experiences.

OBJECTIVES: To determine the value of 18F-FDG-PET/MRI in the diagnosis and management of patients with pelvic recurrence of rectal cancer. METHODS: Forty-four patients (16 women, 28 men) with a history of rectal cancer who received FDG-PET/MRI between June 2011 and February 2017 at our institution were retrospectively enrolled. Three patients received two FDG-PET/MRIs; thus a total of 47 examinations were included. Pelvic recurrence was confirmed either with histology (n = 27) or imaging follow-up (n = 17) (> 4 months). Two readers (one radiologist, one nuclear medicine physician) interpreted the images in consensus. Pelvic lesions were assessed regarding FDG uptake and morphology. Sensitivity, specificity, positive and negative predictive values as well as accuracy of PET/MRI in detecting recurrence were determined. RESULTS: In 47 FDG-PET/MRIs 30 suspicious pelvic lesions were identified, 29 of which were malignant. Two patients underwent resection and had histologically proven pelvic recurrence without showing suspicious findings on FDG-PET/MRI. Changes in management due to FDG-PET/MRI findings had been implemented in eight patients. Eighty per cent (16/20) of resected patients had histologically negative resection margins (R0), one patient had uncertain resection margins. Sensitivity of FDG-PET/MRI in detecting recurrence was 94%, specificity 94%, positive/negative predictive value and accuracy were 97%, 90% and 94%, respectively. CONCLUSIONS: FDG-PET/MRI is a valuable tool in the diagnosis and staging of pelvic recurrence in patients with rectal cancer. KEY POINTS: • Metabolic information obtained from PET coupled with excellent soft tissue contrast from MRI could facilitate detection of rectal cancer recurrence and assist in treatment planning. • PET/MRI demonstrates high sensitivity and specificity for the diagnosis of local recurrence of rectal cancer • PET/MRI led to alterations in management in 18.2% of patients.