[Colorectal cancer screening with virtual colonography]. / Screening des Kolonkarzinoms mit virtueller Kolographie.

BACKGROUND: Since 2003, a decline in the age-standardized incidence rates of colorectal cancer (CRC) has been observed in Germany. Nonetheless, one in eight cancer cases still affects the colon or rectum. The prognosis has improved, with the relative 5­year survival rate for CRC being approximately 65%. METHODS: This positive trend is probably a result of preventive measures introduced over the last 20 years. This could be further improved, however, as CRC can not only be detected early but in almost all cases also prevented through the identification of benign precursors. Less than half of all eligible individuals participate in screening via colonoscopy. This implies that further, possibly even imaging, screening test methods should be explored and offered. Studies have reported that virtual colonography techniques have a comparable accuracy to endoscopy of about 90% for polyp sizes larger than 5 mm. The data for computed tomography (CT) is more extensive than for magnetic resonance imaging (MRI). CONCLUSION: Significant challenges are posed however by the fact that in Germany CT colonography (CTC) is not considered a viable screening option due to radiation protection concerns, and MRI screening is not an established screening method. Radiologists should be familiar with classification using the CT Colonography Reporting and Data System (C-RADS), which uses criteria such as CT density, morphology, size, and location for classification. C­RADS classification follows the categories: C0 (inadequate study), C1 (normal), C2a (indeterminate), C2b (benign), C3 (suspicious), and C4 (malignant), as well as extracolonic categories E1/2 (no clinically significant findings), E3 (likely insignificant findings), and E4 (likely significant findings).

Application of liver-specific contrast agents for evaluation of focal liver lesions - Expert recommendations from the Gastrointestinal and Abdominal Imaging Workgroup of the German Roentgen Society. / Einsatz leberspezifischer Kontrastmittel in der MRT zur Beurteilung von Leberläsionen ­ Expertenempfehlungen der AG Gastrointestinal- und Abdominaldiagnostik der Deutschen Röntgengesellschaft.

PURPOSE: Contrast-enhanced MRI is the imaging modality of choice for the detection and differential diagnosis of focal liver lesions. Liver-specific contrast agents (CAs) are now well established in addition to extracellular contrast agents. However, there is a lack of explicit recommendations reflecting the pros and cons of each specific contrast agent in the daily routine. MATERIALS AND METHODS: Development of recommendations for the clinical application of liver-specific CAs by members of the Gastrointestinal and Abdominal Imaging Workgroup within the Germany Radiological Society, using methodology comparable to that of an S1 guideline with informal consensus. The diagnostic criteria for the evaluation of liver lesions are intentionally outside the scope of this article, as there are already plenty of excellent publications available. RESULTS AND CONCLUSION: The application of liver-specific CAs in the daily routine is associated with advantages and disadvantages due to the specific pharmacokinetic and pharmacodynamic properties and necessitates adjustment of the imaging technique as well consideration during image interpretation. Recommendations for the application of liver-specific CAs are presented based on different clinical scenarios, taking into account current evidence and guidelines. KEY POINTS: · Both liver-specific and extracellular contrast agents are established. · Liver-specific contrast agents make it possible to draw conclusions about the hepatocellular function of a lesion. · Recommendations for the use of liver-specific contrast agents in the daily routine are presented. CITATION FORMAT: · Ringe KI, Fischbach F, Grenacher L et al. Einsatz leberspezifischer Kontrastmittel in der MRT zur Beurteilung von Leberläsionen - Expertenempfehlungen der AG Gastrointestinal- und Abdominaldiagnostik der Deutschen Röntgengesellschaft. Fortschr Röntgenstr 2023; DOI: 10.1055/a-2192-9921.

Intestinal MRI in Inflammatory Bowel Disease - Literature and Survey-Based Recommendations regarding Reporting by the German Radiological Society (DRG) and the German Competence Network for Inflammatory Bowel Diseases. / Intestinale MRT bei chronisch-entzündlichen Darmerkrankungen ­ Literatur- und umfragebasierte Empfehlungen zur Befundung durch die AG Gastrointestinal-/Abdominaldiagnostik der DRG und der AG Bildgebung des Kompetenznetz Darmerkrankungen.

BACKGROUND: MR-enterography/enteroclysis (MRE) is increasingly used for primary diagnosis, detection of complications, and monitoring of patients with inflammatory bowel disease (IBD). Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different faculties. The current manuscript describes the features that are required for optimized reporting of MRE in IBD. METHODS: An expert consensus panel of radiologists and gastroenterologists conducted a systematic search of the literature. In a Delphi process, members of the German Radiological Society (DRG) and members of the Competence Network for Inflammatory Bowel Diseases voted on relevant criteria for the reporting of findings in MRE. Based on the voting results, statements were developed by the expert consensus panel. RESULTS: Clinically relevant aspects of MRE findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on the description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images. CONCLUSION: The current manuscript provides standardized parameters and gives practical recommendations on how to report and how to characterize MRE findings in patients with IBD. KEY POINTS: · Systematic overview provides practice-oriented recommendations and names and evaluates the decisive criteria for reporting and interpretation of MRI in inflammatory bowel disease.. · Standardized terminology and reporting criteria for MRI in IBD improves interdisciplinary communication.. · Standardized collection and documentation of MRI findings in IBD helps to further establish the method and to improve care for IBD patients.. CITATION FORMAT: · Wessling J, Kucharzik T, Bettenworth D et al. Intestinal MRI in Inflammatory Bowel Disease - Literature and Survey-Based Recommendations regarding Reporting by the German Radiological Society (DRG) and the German Competence Network for Inflammatory Bowel Diseases. Fortschr Röntgenstr 2023; 195: 675 - 690.

[Position paper on reporting of intestinal ultrasound findings in patients with inflammatory bowel disease]. / Positionspapier zur Befunderhebung von Darmultraschallbefunden bei chronisch entzündlichen Darmerkrankungen.

BACKGROUND: Intestinal ultrasound is increasingly used for primary diagnosis, detection of complications and monitoring of patients with Crohn's disease and ulcerative colitis. Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different specialties. The current manuscript describes the features required for optimized reporting of intestinal ultrasound findings in inflammatory bowel disease (IBD). METHODS: An expert consensus panel of gastroenterologists, radiologists, pathologists, paediatric gastroenterologists and surgeons conducted a systematic literature search. In a Delphi- process members of the Kompetenznetz Darmerkrankungen in collaboration with members of the German Society for Radiology (DRG) voted on relevant criteria for reporting of findings in intestinal ultrasound. Based on the voting results statements were agreed by expert consensus. RESULTS: Clinically relevant aspects of intestinal ultrasound (IUS) findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images. CONCLUSION: The current manuscript provides practical recommendations on how to standardize documentation and reporting from intestinal ultrasound findings in patients with IBD.

Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. / Auswirkung der COVID-19-Pandemie auf die radiologische Bildgebung in Deutschland.

PURPOSE: To analyze the impact of the COVID-19 pandemic in 2020 on the radiological imaging volume in Germany. MATERIALS UND METHODS: In this retrospective multicenter study, we analyzed CT and MRI examinations of 7 radiology institutes across Germany from January to December 2020. The imaging volume was compared to 2019 (Wilcoxon-Mann-Whitney test). Modality, patient service locations, and examined body parts were assessed in consideration of time periods of the pandemic. In addition, correlation with the incidence of SARS-CoV-2 cases and associated death was performed (Spearman-test). RESULTS: In total, in 2020, imaging volume declined by 4 % (n = 8314) compared with 2019 (p < 0.05). The hard lockdown during the first pandemic wave (calendar week 12-16, March 22 - April 19) revealed the highest decrease with 29 % (n = 894, p < 0.01), with the greatest decrease in CT (36 % vs. MRI 26 %), outpatients (38 %, p < 0.01), and imaging of the spine and extremities (51-72 %, < 0.05 - p < 0.01). Examinations referred from the emergency department (-13 %, p < 0.05) and CT of the chest (-16 %, p < 0.05) were least affected. With the end of the first wave, gradual normalization of the imaging volume was observed and persisted until the end of the observation period. A reduction of imaging volume negatively correlated with the incidence of SARS-CoV-2-positive cases and associated deaths (r = 0.28 and 0.49, p < 0.05 and p < 0.001). CONCLUSION: The COVID-19 pandemic was associated with a significant temporary decline in imaging volume. After the first lockdown period, a quick recovery was observed with radiologic imaging examinations steadily approaching prior-year figures. KEY POINTS: · This study assesses the impact of dynamic pandemic activity on radiological imaging in a multicenter analysis in Germany.. · The COVID-19 pandemic was associated with a temporary decline in CT and MRI scans.. · Relaxation of restrictions was associated with fast normalization of imaging volumes to prior-year levels, which persisted until the end of the year.. · Significant catch-up effects were not observed.. CITATION FORMAT: · Schmidbauer M, Grenacher L, Juchems MS et al. Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. Fortschr Röntgenstr 2022; 194: 625 - 633.

Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology.

INTRODUCTION: Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. RECOMMENDATIONS: This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. CONCLUSIONS: The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online ( https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf ).

Functional endoscopy in neurogenic dysphagia: a feasibility study focusing on the esophageal phase of swallowing.

Background and study aims Due to demographic transition, neurogenic dysphagia has become an increasingly recognized problem. Patients suffering from dysphagia often get caught between different clinical disciplines. In this study, we implemented a defined examination protocol for evaluating the whole swallowing process by functional endoscopy. Special focus was put on the esophageal phase of swallowing. Patients and methods This prospective observational multidisciplinary study evaluated 31 consecutive patients with suspected neurogenic dysphagia by transnasal access applying an ultrathin video endoscope. Thirty-one patients with gastroesophageal reflux symptoms were used as a control group. We applied a modified approach including standardized endoscopic positions to compare our findings with fiberoptic endoscopic evaluation of swallowing and high-resolution manometry. The primary outcome measure was feasibility of functional endoscopy. Secondary outcome measures were adverse events (AEs), tolerability, and pathologic endoscopic findings. Results Functional endoscopy was successfully performed in all patients. No AEs were recorded. A variety of disorders were documented by functional endoscopy: incomplete or delayed closure of the upper esophageal sphincter in retroflex view, clearance disturbance of tubular esophagus, esophageal hyperperistalsis, and hypomotility. Analysis of results obtained with the diagnostic tools showed some discrepancies. Conclusions By interdisciplinary cooperation with additional assessment of the esophageal phase of deglutition using the innovative method of functional endoscopy, the diagnosis of neurogenic disorders including dysphagia may be significantly improved, leading to a better clinical understanding of complex dysfunctional patterns. To the best of our knowledge, this is the first study to show that a retroflex view of the ultrathin video endoscope within the esophagus can be safely performed. [NCT01995929].

[German Terminology of the Revised Atlanta Classification of Acute Pancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis]. / Deutschsprachige Terminologie der revidierten Atlanta-Klassifikation bei akuter Pankreatitis: Glossar basierend auf der aktuellen S3-Leitlinie zur akuten, chronischen und Autoimmunpankreatitis.

The Atlanta classification published in 1992 was supposed to classify the severity and complications in acute pancreatitis with the goal of providing uniform terminology for clinicians and researchers. After continuous evolution, the revised Atlanta classification was published in 2012. In this updated classification, imaging aspects were better integrated and unclear terms were better defined. To date, this terminology for disease grading, severity, and local complications has been solely available in English. This prevented wide acceptance of the classification by the German-speaking medical community. Therefore, an expert team of the German Radiological Society translated the terms based on German medical literature. This translation was approved by consensus in the new S3 guideline meeting in February 2020 with an approval rate of 97.3 %. This manuscript explains the translated and approved German terminology of the revised Atlanta classification and offers additional imaging examples. KEY POINTS:: · The revised Atlanta classification allows correct definition of the grading and complication assessment of acute pancreatitis.. · An expert group translated the terms into the German language. The translation was approved by the S3 guideline committee for pancreatitis.. · Based on the new German S3 guideline for pancreatitis, the translated terms should be employed consistently.. CITATION FORMAT: · Schreyer AG, Seidensticker M, Mayerle J et al. German Terminology of the Revised Atlanta Classification of Acute Pancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis. Fortschr Röntgenstr 2021; 193: 909 - 918.

LI-RADS in the year 2020 - Are you already using it or still considering? / LI-RADS im Jahr 2020 ­ Nutzt du es schon oder überlegst du noch?

PURPOSE: The working group for gastrointestinal and abdominal imaging within the German Radiological Society performed a nationwide online survey in order to assess the current status regarding the awareness and application of LI-RADS, a classification for evaluation of liver lesions in patients at risk. MATERIALS AND METHODS: Using the website www.deutsches-krankenhausverzeichnis.de a list of hospitals was generated meeting the criteria internal medicine, gastroenterology, general and visceral surgery and radiology (n = 391). Randomly, 102 department directors were contacted, and asked to name one consultant and one resident from their department in order to participate in the survey. 177 potential participants were invited to fill out an approximately 10-minute online survey in the form of 17 questions regarding the awareness and application of LI-RADS. The results of the survey were analyzed by means of descriptive statistics. RESULTS: 77 participants were registered, which corresponds to a response rate of 43.5 %. 47 % of all participants were radiologists, 30 % surgeons and 23 % internal doctors/gastroenterologists, respectively, many with more than 13 years of professional experience (37.2 %). The majority of participants worked in a hospital with a focus (37.2 %) or a university hospital (29.1 %). Even though the majority of participants knows about or has heard of LI-RADS (73.2 %), only a minority uses the classification themselves (26 %) or within the context of tumor boards (19.2 %). CONCLUSION: The results of our survey demonstrate that LI-RADS is relatively known in Germany, the application however quite sparse. This is in contrast to the general desire and endeavor for more standardized reporting in radiology. KEY POINTS: · LI-RADS is not yet broadly implemented in clinical routine in Germany. · The sparse application is in contrast to the general desire for more standardized reporting in radiology. · Interdisciplinary education may support the propagation and use of the LI-RDAS classification. CITATION FORMAT: · Ringe KI, Gut A, Grenacher L et al. LI-RADS in the year 2020 - Are you already using it or still considering? Fortschr Röntgenstr 2021; 193: 186 - 193.

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.

Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). / Strukturierte Befundung von soliden und zystischen Pankreasläsionen im CT und MRT: Konsensus-basierte Befundvorlagen der Deutschen Röntgengesellschaft (DRG).

BACKGROUND: Radiological reports of pancreatic lesions are currently widely formulated as free texts. However, for optimal characterization, staging and operation planning, a wide range of information is required but is sometimes not captured comprehensively. Structured reporting offers the potential for improvement in terms of completeness, reproducibility and clarity of interdisciplinary communication. METHOD: Interdisciplinary consensus finding of structured report templates for solid and cystic pancreatic tumors in computed tomography (CT) and magnetic resonance imaging (MRI) with representatives of the German Society of Radiology (DRG), German Society for General and Visceral Surgery (DGAV), working group Oncological Imaging (ABO) of the German Cancer Society (DKG) and other radiologists, oncologists and surgeons. RESULTS: Among experts in the field of pancreatic imaging, oncology and pancreatic surgery, as well as in a public online survey, structured report templates were developed by consensus. These templates are available on the DRG homepage under www.befundung.drg.de and will be regularly revised to the current state of scientific knowledge by the participating specialist societies and responsible working groups. CONCLUSION: This article presents structured report templates for solid and cystic pancreatic tumors to improve clinical staging (cTNM, ycTNM) in everyday radiology. KEY POINTS: · Structured report templates offer the potential of optimized radiological reporting with regard to completeness, reproducibility and differential diagnosis.. · This article presents consensus-based, structured reports for solid and cystic pancreatic lesions in CT and MRI.. · These structured reports are available open source on the homepage of the German Society of Radiology (DRG) under www.befundung.drg.de.. CITATION FORMAT: · Persigehl T, Baumhauer M, Baeßler B et al. Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). Fortschr Röntgenstr 2020; 192: 641 - 655.

Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. / Arbeits- und Weiterbildungsbedingungen in der Facharztweiterbildung Radiologie ­ Ergebnisse einer bundesweiten Weiterbildungsumfrage durch das Forum Junge Radiologie in der Deutschen Röntgengesellschaft.

PURPOSE: Good training is the basis for high job satisfaction and high-quality patient care in radiology. The aim of this survey was to record the current state of working conditions for residents in radiology training in Germany and to focus on the aspects of training and psychosocial workload. The description of the actual state should help to identify possible problem areas and to develop improvement approaches. MATERIALS AND METHODS: At the beginning of 2018, we sent an electronic questionnaire to the German Roentgen Society (DRG), the German Association of Chairmen in Academic Radiology (KLR), the Chief Physician Forum of the DRG (CAFRAD) and the Forum of Registered Radiologists (FUNRAD) with the request to forward it to radiology residents. With 63 questions, the questionnaire covered seven essential areas of medical working and training conditions. In order to ensure interdisciplinary comparability, most questions were identical to previous surveys among residents of other disciplines. RESULTS: 643 residents started the survey. 501 (78 %) questionnaires were fully processed and included in the final analysis. 65 % of respondents were satisfied with their current job situation. At the same time, shortcomings, especially with regard to the reconciliation of family and work as well as scientific and clinical work, became clear. Only 36 % of participants with children were satisfied with the compatibility of family and work at their workplace. Only 31 % of the researchers were satisfied with their research conditions. In addition, residents experienced a high psychosocial workload. CONCLUSION: Job satisfaction is high among radiology residents in direct comparison to other disciplines. However, based on this survey, adjustments to working conditions and training in radiology seem necessary to maintain the health of the physicians concerned, to encourage motivation for scientific work and to enhance development opportunities, especially for women, through a better compatibility of work and family life. The present survey identifies strategies and leadership tools that can help to achieve this. KEY POINTS: Residents in radiology training ... · have a relatively high job satisfaction.. · experience a high psychosocial workload.. · evaluate the compatibility of family and work as in need of improvement.. · are interested in research, but evaluate research conditions as insufficient. CITATION FORMAT: · Oechtering TH, Panagiotopoulos N, Völker M et al. Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Röntgenstr 2020; 192: 458 - 469.

Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures.

AIM: To compare endoscopic retrograde cholangio-pancreatography (ERCP), intraductal ultrasound (IDUS), endosonography (EUS), endoscopic transpapillary forceps biopsies (ETP) and computed tomography (CT) with respect to diagnosing malignant bile duct strictures. METHODS: A patient cohort with bile duct strictures of unknown etiology was examined by ERCP and IDUS, ETP, EUS, and CT. The sensitivity, specificity, and accuracy rates of the diagnostic procedures were calculated based on the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery. For each of the diagnostic measures, the sensitivity, specificity, and accuracy rates were calculated. In all cases, the gold standard was the histopathologic staging of specimens or long-term follow-up of at least 12 mo. A comparison of the accuracy rates between the localization of strictures was performed by using the Mann-Whitney U-test and the χ(2) test as appropriate. A comparison of the accuracy rates between the diagnostic procedures was performed by using the McNemar's test. Differences were considered statistically significant if P < 0.05. RESULTS: A total of 234 patients (127 males, 107 females, median age 64, range 20-90 years) with indeterminate bile duct strictures were included. A total of 161 patients underwent operative exploration; thus, a surgical histopathological correlation was available for those patients. A total of 113 patients had malignant disease proven by surgery; in 48 patients, benign disease was surgically found. In these patients, the decision for surgical exploration was made due to the suspicion of malignant disease in multimodal diagnostics (ERCP, CT, or EUS). Fifty patients had a benign diagnosis and were followed by a surveillance protocol with a follow-up of at least 12 mo; the median follow-up was 34 mo. Twenty-three patients had extended malignant disease, and thus were considered palliative. A comparison of the different diagnostic tools for detecting bile duct malignancy resulted in accuracy rates of 91% (ERCP/IDUS), 59% (ETP), 92% (IDUS + ETP), 74% (EUS), and 73% (CT), respectively. In the subgroup analysis, the accuracy rates (%, ERCP + IDUS/ETP/IDUS + ETP; EUS; CT) for each tumor entity were as follows: cholangiocellular carcinoma: 92%/74%/92%/70%/79%; pancreatic carcinoma: 90%/68%/90%/81%/76%; and ampullary carcinoma: 88%/90%/90%/76%/76%. The detection rate of malignancy by ERCP/IDUS was superior to ETP (91% vs 59%, P < 0.0001), EUS (91% vs 74%, P < 0.0001) and CT (91% vs 73%, P < 0.0001); EUS was comparable to CT (74% vs 73%, P = 0.649). When analyzing accuracy rates with regard to localization of the bile duct stenosis, the accuracy rate of EUS for proximal vs distal stenosis was significantly higher for distal stenosis (79% vs 57%, P < 0.0001). CONCLUSION: ERCP/IDUS is superior to EUS and CT in providing accurate diagnoses of bile duct strictures of uncertain etiology. Multimodal diagnostics is recommended.

Crohn's disease complicated by intestinal infection with methicillin-resistant Staphylococcus aureus.

We report on a 24-year-old male patient with history of bloody diarrhea, abdominal pain and vomiting. Endoscopy revealed massive ulcerative discontinuous proctosigmoiditis with deep, sharply demarcated epithelial denudations and enterotoxigenic methicillin-resistant Staphylococcus aureus (MRSA) was detected in mucosal biopsies. After treatment with linezolide and steroids, a significant amelioration of colitis was detected and testing for MRSA became negative. In face of the case presented here, we suggest that in patients with refractory inflammatory bowel disease (IBD), microbiological assessment should be performed to detect a possible Staphylococcus aureus infection in order to initiate an antimicrobial treatment in addition to IBD-specific treatment.

DexaBEAM versus ICE salvage regimen prior to autologous transplantation for relapsed or refractory aggressive peripheral T cell lymphoma: a retrospective evaluation of parallel patient cohorts of one center.

High-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) is considered standard in the treatment of patients with relapsed or refractory aggressive peripheral T cell lymphoma (PTCL). However, the optimal salvage regimen before ASCT has not yet been established. We retrospectively analyzed 31 patients with relapsed or refractory aggressive PTCL after anthracycline-based first-line chemotherapy who received either DexaBEAM (dexamethasone, carmustine, etoposide, cytarabine, and melphalan; n = 16) or ICE (ifosfamide, carboplatin, and etoposide; n = 15) regimen as first salvage chemotherapy followed by HDT/ASCT. The overall response rate (OR) was significantly higher for patients treated with DexaBEAM (69 %; 95 % confidence interval 46.0-91.5 %) as compared to the ICE group (20 %; 95 % confidence interval -0.2-40.2 %; P = 0.01), with higher complete response (CR; 38 %; 95 % confidence interval 13.8-61.2 %; vs. 7 %; 95 % confidence interval -6.0-19.6 %) as well as partial response (PR; 31 vs. 13 %) rate. Changing regimen due to failure of first salvage therapy, 12 patients initially receiving ICE still achieved an OR of 58 % (33 % CR, 25 % PR) with DexaBEAM as second salvage therapy, whereas in three patients receiving ICE after DexaBEAM failure, only one achieved an OR (1 PR). Median progression-free survival was significantly higher in the DexaBEAM group (6.4 vs. 2 months; P = 0.01). Major adverse event in both groups was myelosuppression with higher but tolerable treatment-related toxicity for patients in the DexaBEAM group. For all patients proceeding to HDT/ASCT, a 3-year overall survival was 50 %. Together, considering the limitations of the retrospective design of the evaluation and the small sample size, our data suggest that DexaBEAM salvage chemotherapy is superior to ICE for patients with relapsed or refractory aggressive PTCL for remission induction prior to autologous transplantation, with higher but manageable treatment-related toxicity.

An observational study to evaluate the efficiency and safety of ioversol pre-filled syringes compared with ioversol bottles in contrast-enhanced examinations.

BACKGROUND: The use of pre-filled syringes for contrast media (CM) administration allows efficient and optimized workflow during radiologic diagnostic procedures, and reduces the risk of contamination, providing benefits for both patients and healthcare workers. PURPOSE: To compare the efficiency and safety of ioversol (Optiray(TM)) bottles and pre-filled syringes in clinical practice. MATERIAL AND METHODS: This was an observational, non-interventional, prospective, multicenter study conducted at 72 centers in Germany. Patients undergoing contrast-enhanced computed tomography (CT) examinations with ioversol were enrolled. The use of ioversol bottles and pre-filled syringes in the diagnostic procedure was recorded in terms of efficiency (residual volume, re-use of CM) and safety (adverse events [AEs]). RESULTS: A total of 10,836 patients were enrolled and included in this study. Ioversol bottles and syringes were used in 72% and 28% of cases, respectively. Analysis of the volume of CM in bottles before and after examinations, together with the volume used during the examination, suggested that in 22.5% of cases a new bottle was connected during the procedure. Further analysis revealed that in 80.2% of cases, the remaining volume of CM in the bottles could potentially be used for subsequent investigations, compared with <1% of cases for pre-filled syringes. For the total study population, AEs and serious AEs were reported in 30 (0.28%) and four (0.037%) patients, respectively, with no significant difference observed between ioversol bottles and syringes. CONCLUSION: Administration of ioversol for contrast-enhanced CT examinations is associated with a low incidence of AEs and is generally safe and well tolerated. Ioversol pre-filled syringes were associated with lower residual volumes and less potential re-use compared with bottles.

Detection and differentiation of inflammatory versus fibromatous Crohn's disease strictures: prospective comparison of 18F-FDG-PET/CT, MR-enteroclysis, and transabdominal ultrasound versus endoscopic/histologic evaluation.

BACKGROUND: Differentiation between inflammatory and fibromatous strictures in Crohn's disease (CD) is difficult but crucial for therapeutic decisions. The aim of this study was to assess the best noninvasive imaging method for the detection and differentiation of inflammatory and fibromatous stenoses in CD in comparison to endoscopic and histologic evaluation. METHODS: Patients with suspected CD strictures were included. According to a formalized endoscopic and histologic protocol, strictures were classified as inflammatory, mixed, and fibrostenotic. Strictures were further analyzed using fluorine 18-labeled fluoro-2-deoxy-D-glucose ((18) FDG) / positron emission tomography (PET) low-dose computed tomography (CT), magnetic resonance (MR) enteroclysis and transabdominal ultrasound using standardized scoring systems. RESULTS: Thirty patients with 37 strictures were evaluated (inflamed n = 22; mixed n = 12, fibromatous n = 3). (18) FDG-PET/CT detected 81%, MR-enteroclysis 81%, and ultrasound 68% of the strictures. Correct differentiation rates of strictures were 57% for MRE, 53% for (18) FDG-PET/CT, and 40% for ultrasound. Differences of detection rates and differentiation rates were not statistically significant. When combining transabdominal ultrasound with (18) FDG-PET/CT or MR-enteroclysis all strictures that required invasive treatment were detected. CONCLUSIONS: Detection rates of the strictures were not significantly different between (18) FDG-PET/CT, MR-enteroclysis, and ultrasound. Despite good stricture detection rates relating to our gold standard, (18) FDG-PET/CT nor MR-enteroclysis nor ultrasound can accurately differentiate inflamed from fibrotic strictures. A combination of MR-enteroclysis and ultrasound as well as a combination of (18) FDG-PET/CT and ultrasound resulted in a 100% detection rate of strictures requiring surgery or endoscopic dilation therapy, suggesting the combination of these methods as an alternative to endoscopy at least in the group of patients not able to perform an adequate bowel preparation.