The development of a minimum dataset for MRI reporting of anorectal fistula: a multi-disciplinary, expert consensus process – European Radiology

Magnetic resonance imaging (MRI) is the gold standard for characterization of anal fistula (AF). Treatment of AF relies on accurate assessment of fistula anatomy, making imaging key to preoperative management. This study aims to improve the clinical utility of MR reports for AF through use of a minimum dataset to ensure that all the key features are described, while still giving some reporting flexibility to the radiologist. The authors reviewed articles describing recommended features to report on MRI and sent a nationwide clinician survey to determine relevant information needed for clinical decision making with regards to AF. The minimum dataset was developed in multiple stages using this data. An expert panel of radiologists and surgeons then convened to discuss and vote on the minimum dataset. Features that should always be reported include Parks classification subtype, number and morphology of tracts, anal clock location and anatomical location, relationship to sphincters/pelvic musculature, tract extensions and presence of any associated collections. Specific and more detailed discussion of each of these necessary points are included in the paper.

Iqbal, N., Sackitey, C., Gupta, A. et al. The development of a minimum dataset for MRI reporting of anorectal fistula: a multi-disciplinary, expert consensus process. Eur Radiol 32, 8306–8316 (2022). https://doi.org/10.1007/s00330-022-08931-z

Associations of radiological features of adipose tissues with postoperative complications and overall survival of gastric cancer patients – European Radiology

Gastric cancer, the third leading cause of cancer death, is treated most effectively by radical gastrectomy, which has a high incidence of complications, which may be severe and lead to death. This study evaluates characteristics of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and their relationship to complication rates and overall survival in patients who underwent radical gastrectomy for gastric cancer. Intraoperative data, postoperative data and long term outcomes for 142 patients who underwent laparoscopic radical gastrectomy was evaluated and included in the study.  VAT and SAT features were taken from 3 continuous slices of the abdomen at the level L4, including Hounsfield unit measurements and cross-sectional area. The perioperative complication rate was found to be 18.3% in this study and was significantly higher in patients with higher VAT area. However, a protective effect of high VAT area was found in terms of overall survival. Patients with lower density fat tissue also had better overall survival. The authors assert that a presurgical risk assessment may possibly be developed using features of adipose tissue which can guide clinical treatment of patients with gastric cancer.

Bian, L., Wu, D., Chen, Y. et al. Associations of radiological features of adipose tissues with postoperative complications and overall survival of gastric cancer patients. Eur Radiol 32, 8569–8578 (2022). https://doi.org/10.1007/s00330-022-08918-w

Diagnostic Value of Quantitative Contrast-Enhanced Ultrasound in Comparison to Endoscopy in Children with Crohn’s Disease – Journal of Ultrasound in Medicine

The current reference standard for assessment of mucosal healing in Crohn’s disease (CD) is endoscopy. Due to invasiveness, complication risk and need for general anesthesia in children, alternatives to endoscopy for evaluation of CD activity are appealing. This study aims to evaluate the use of contrast enhanced quantitative ultrasound (CEUS) in comparison to endoscopy. The study additionally compared CEUS to fecal calprotectin (FC) and the pediatric Crohn’s Disease Activity Index (PCDAI) in evaluation of CD activity. After exclusion criteria, 36 children underwent endoscopy, PCDAI evaluation and quantitative CEUS. 32 of these children also had FC values obtained during the designated time interval. The authors found a moderate correlation between quantitative CEUS with endoscopic disease activity, with a sensitivity of 78.6% and specificity of 100%. CEUS is great for evaluating activity of CD but cannot rule out active disease. The data from this study ultimately suggests that a combination of PCDAI, FC and quantitative CEUS are more reliable for assessment of CD activity than any of those measures alone.

Ponorac, S., Dahmane Gošnak, R., Urlep, D. and Ključevšek, D. (2023), Diagnostic Value of Quantitative Contrast-Enhanced Ultrasound in Comparison to Endoscopy in Children with Crohn’s Disease. J Ultrasound Med, 42: 193-200. https://doi.org/10.1002/jum.16044

Contrast-enhanced MRI for T Restaging of Locally Advanced Rectal Cancer Following Neoadjuvant Chemotherapy and Radiation Therapy – Radiology (RSNA)

Accurate restaging of rectal cancer is crucial for the selection of candidates for local excision after neoadjuvant chemotherapy and radiation therapy (NCRT). However, accuracy for T-staging with the current standard of diffusion weighted images (DWI) and T2 weighted images (T2WI), can be as low as 52%, with over-staging often leading to low accuracy. The value of contrast enhanced MRI (CE-MRI) for rectal cancer staging has been demonstrated in recent literature. This study aims to evaluate the use of CE-MRI in distinguishing ypT0–1 and ypT2–4 rectal cancer following NCRT, to determine suitability for resection, compared to T2WI/DWI. After exclusion criteria, 328 patients with locally advanced rectal cancer who underwent total mesorectal excision after NCRT from January 2014 to October 2018 were chosen for the study. Two radiologists interpreted the pre and post NCRT MRI images for each patient, including DWI/T2WI and CE-MRI sequences. If there was discrepancy between the readers, a third reader would act as arbiter. After interpretation and statistical analysis, the area under the curve for the CE-MRI protocol in predicting pathologic stage ypT0–1 tumors was 0.81, while the T2W/DWI protocol was 0.66. The authors determine that CE-MRI protocol is superior to T2W/DWI protocol and that the CE-MRI protocol provides accurate differentiation of ypT0–1 from ypT2–4 tumors after NCRT.

Lu QY, Guan Z, Zhang XY, et al. Contrast-enhanced MRI for T Restaging of Locally Advanced Rectal Cancer Following Neoadjuvant Chemotherapy and Radiation Therapy. Radiology. 2022;305(2):364-372. doi:10.1148/radiol.212905

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the presentation of paediatric acute appendicitis: an observational study – Clinical Radiology

Pediatric ER visits decreased during the COVID-19 pandemic, during which time a decreased incidence of pediatric acute appendicitis (AA), delayed presentation, and increased rate of complications have been demonstrated. However, in prior studies, despite the decreased number of patients worked up for AA, the overall number of patients diagnosed with it stayed the same. This study aims to examine the differences between clinical presentation of patients imaged for suspected AA both during and before the pandemic to help inform imaging decisions in the future. Twice as many patients were imaged for suspected AA during 2019 vs. 2020 (294 vs 171), despite similar number of patients being treated for AA during those years. Patients positive for AA in 2019 were most likely to have nausea and vomiting vs. diarrhea and constipation in 2020. During the pandemic, patients who were negative for AA tended to be older and have more generalized, nonspecific abdominal pain vs. right lower quadrant pain in the AA positive group. This same distinction was true for the pandemic vs. pre-pandemic group. Patients with symptoms of upper respiratory infection (URI) and abdominal pain were also less likely to have AA. The study suggests that URI symptoms may decrease the likelihood of AA and factor into precluding a patient from imaging in the proper clinical context. Ultimately, the pandemic did not significantly change the presenting features of AA and imaging is generally justified in these patients as other etiologies for the presenting symptoms (i.e., enterocolitis) are common.

Horst KK, Carr BM, Parvinian A, McDonald JS. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the presentation of paediatric acute appendicitis: an observational study. Clinical Radiology. Published online September 2022. doi:10.1016/j.crad.2022.08.126