scholarly journals Rectal cancer staging using MRI: adherence in reporting to evidence-based practice

2020 ◽  
Vol 61 (11) ◽  
pp. 1463-1472
Author(s):  
Gustav Alvfeldt ◽  
Peter Aspelin ◽  
Lennart Blomqvist ◽  
Nina Sellberg
Keyword(s):  
Rectal Cancer ◽  
Evidence Based Practice ◽  
Imaging Modality ◽  
Anal Verge ◽  
Cancer Staging ◽  
Evidence Based ◽  
Mri Staging ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Local Lymph Node

Background Magnetic resonance imaging (MRI) is the first-line imaging modality for local staging of rectal cancer. The radiology report should deliver all relevant available imaging information to guide treatment. Purpose To explore and describe if there was a gap between the contents in MRI reports for primary staging of rectal cancer in Sweden in 2010 compared to evidence-based practice. Material and Methods A total of 243 primary MRI staging reports from 2010, collected from 10 hospitals in four healthcare regions in Sweden, were analyzed using content analysis with a deductive thematic coding scheme based on evidence-based practice. Focus was on: (i) most frequently reported findings; (ii) correlation to key prognostic findings; and (iii) identifying if any findings being reported were beyond the information defined in evidence-based practice. Results Most frequently reported findings were spread through the bowel wall or not, local lymph node description, tumor length, and distance of tumor from anal verge. These items accounted for 35% of the reporting content. Of all reported content, 86% correlated with the evidence-based practice. However, these included more information than was generally found in the reports. When adjusting for omitted information, 48% of the reported content were accounted for. Of the reported content, 20% correlated to key pathological prognostic findings. Six types of findings were reported beyond the evidence-based practice, representing 14% of the total reporting content. Conclusion There was a gap between everyday practice and evidence-based practice in 2010. This indicates a need for national harmonization and implementation of standardized structured reporting templates.

cT3N0 Rectal Cancer: Potential Overtreatment With Preoperative Chemoradiotherapy Is Warranted

2008 ◽  
Vol 26 (3) ◽  
pp. 368-373 ◽  
Author(s):  
José G. Guillem ◽  
Juan A. Díaz-González ◽  
Bruce D. Minsky ◽  
Vincenzo Valentini ◽  
Seung-Yong Jeong ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Combined Modality Therapy ◽  
Anal Verge ◽  
Pathologic Complete Response ◽  
Radical Resection ◽  
Complete Response ◽  
Preoperative Chemoradiotherapy ◽  
Mri Staging ◽  
Magnetic Resonance Imaging Mri

Purpose Although combined-modality therapy (CMT) is the preferred treatment for T3 and/or lymph node (LN)-positive rectal cancer, the German rectal cancer study published in 2004 demonstrated that 18% of patients deemed suitable for preoperative CMT by endorectal ultrasound (ERUS) may be overstaged. Because data also suggest that LN-negative rectal cancer after total mesorectal excision may not require radiotherapy, it is reasonable to consider omitting radiotherapy for the cT3N0 subset. We therefore determined the accuracy of pre-CMT ERUS or magnetic resonance imaging (MRI) staging, to explore the validity of a nonpreoperative CMT approach for cT3N0 disease. Patients and Methods One hundred eighty-eight ERUS-/MRI-staged T3N0 rectal cancer patients received preoperative CMT (fluorouracil based and 45-50.4 Gy) followed by radical resection. Rates of pathologic complete response (pCR) and mesorectal LN involvement were determined. Results Tumors were located a median of 5 cm from the anal verge. Sphincter-preserving surgery was performed in 143 patients (76%). Overall pCR was 20%, and 41 patients (22%) had pathologically positive mesorectal LNs. The incidence of positive LNs significantly increased with T stage: ypT0, 3%; ypT1, 7%; ypT2, 20%; ypT3-4, 36% (P = .001). Conclusion The accuracy of preoperative ERUS/MRI for staging mid to distal cT3N0 rectal cancer is limited because 22% of patients have undetected mesorectal LN involvement despite CMT. Therefore, ERUS-/MRI-staged T3N0 rectal cancer patients should continue to receive preoperative CMT. Although 18% may be overstaged and therefore overtreated, our data suggest that an even larger number would be understaged and require postoperative CMT, which is associated with significantly inferior local control, higher toxicity, and worse functional outcome.

Radiology reporting in rectal cancer using MRI: adherence to national template for structured reporting

2021 ◽  
pp. 028418512110572
Author(s):  
Gustav Alvfeldt ◽  
Peter Aspelin ◽  
Lennart Blomqvist ◽  
Nina Sellberg
Keyword(s):  
Rectal Cancer ◽  
Qualitative Content Analysis ◽  
Cancer Staging ◽  
Free Text ◽  
Reporting Practice ◽  
Key Factor ◽  
Content Coverage ◽  
Magnetic Resonance Imaging Mri ◽  
National Workshop ◽  
Completeness Of Reporting

Background In 2014, a national workshop program was initiated and a reporting template and manual for rectal cancer primary staging using magnetic resonance imaging (MRI) was introduced and made available by the national Swedish Colorectal Cancer Registry. Purpose To evaluate the effect of the national template program by identify if there was a gap between the content in Swedish MRI reports from 2016 and the national reporting template from 2014. The aim was to explore and compare differences in content in reporting practice in different hospitals in relation to the national reporting template, with focus on: (i) identifying any implementational differences in reporting styles; and (ii) evaluating if reporting completeness vary based on such implementational differences. Material and Methods A total of 250 MRI reports from 10 hospitals in four healthcare regions in Sweden were collected. Reports were analyzed using qualitative content analysis with a deductive thematic coding scheme based on the national reporting template. Results Three different implemented reporting styles were identified with variations of content coverage in relation to the template: (i) standardized and structured protocol (reporting style A); (ii) standardized semi-structured free-text (reporting style B); and (iii) regular free-text (reporting style C). The relative completeness of reporting practice of rectal cancer staging in relation to the national reporting template were 92.9% for reporting style A, 77.5% for reporting style B, and 63.9% for reporting style C. Conclusion The implementation of template-based reporting according to reporting style A is a key factor to conform to evidence-based practice for rectal cancer reporting using MRI.

Pulley, Flexor, and Extensor Tendon Injuries of the Hand

2021 ◽  
Vol 25 (02) ◽  
pp. 203-215
Author(s):  
Andrea B. Rosskopf ◽  
Mihra S. Taljanovic ◽  
Luca M. Sconfienza ◽  
Salvatore Gitto ◽  
Carlo Martinoli ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Extensor Tendon ◽  
Tendon Injuries ◽  
Resonance Imaging ◽  
First Line ◽  
A2 Pulley ◽  
Dynamic Examination ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Extensor Tendon Injuries

AbstractTendon injuries represent the second most common injury of the hand (after fractures) and are a common scanning indication in radiology. Pulley injuries are very frequent in rock climbers with the A2 pulley the most commonly affected. Tendon and pulley injuries can be reliably evaluated using ultrasound (US) and magnetic resonance imaging (MRI). US can be postulated as a first-line imaging modality, allowing dynamic examination. MRI is essential for cases with ongoing diagnostic doubt post-US and also for preoperative pulley reconstruction assessment.

cT3N0 rectal cancer: Potential overtreatment with preoperative chemoradiation (CRT) is warranted

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3568-3568
Author(s):  
J. G. Guillem ◽  
J. Diaz-Gonzalez ◽  
B. Minsky ◽  
M. Rodriguez-Bigas ◽  
S. Jeong ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
Pathologic Complete Response ◽  
Radical Resection ◽  
Complete Response ◽  
Median Number ◽  
Mri Staging ◽  
Significant Difference ◽  
The Us ◽  
To Receive

3568 Background: Although CRT has emerged as the preferred treatment for T3 and/or lymph node (LN) positive rectal cancer, Sauer et al (NEJM 2004) demonstrated that 18% of patients deemed suitable for preop CRT via endorectal ultrasound (ERUS) were overstaged and therefore received unnecessary preoperative CRT. Since data also suggest that LN negative rectal cancer s/p TME may not need adjuvant therapy, it is reasonable to consider the omission of radiotherapy for the cT3N0 subset. We therefore determined the accuracy of pre-CRT ERUS/MRI staging in order to explore the validity of a non-radiation approach for cT3N0 disease. Methods: 188 ERUS/MRI staged T3N0 rectal cancer patients from 6 insitutions in the US, Europe and Asia received preoperative CRT (5-FU based and 45–52.5 Gy) followed by radical resection. Rates of pathologic complete response (pCR) and mesorectal LN involvement were determined. Results: Tumors were located a median of 5 centimeters from the anal verge. Sphincter-preserving surgery was performed in 135 (81%) patients. Overall pCR was 19%. Median number of LN sampled was 9 (range 0–38). Rate of positive LN was significantly associated with T-stage: pT0: 3%, pT1: 7%, pT2: 20%, pT3–4: 36%(p=0.001). 41 patients (22%) had pathologically positive mesorectal LN. There was no significant difference in rate of positive LN between those staged by ERUS and MRI(25% vs 16%, p=0.19). Conclusions: Accuracy of preoperative ERUS/MRI for identifying mid to distal T3N0 rectal cancer is limited, as 22% will have undetected mesorectal LN involvement despite CRT. Therefore, ERUS/MRI staged T3N0 patients should continue to receive preoperative CRT. Although 19% are overstaged and therefore overtreated, our data suggest that an even larger number would be understaged and require postoperative CRT, which is associated with inferior local control, higher toxicity, and poor functional outcome. No significant financial relationships to disclose.

Staging Rectal Cancer: The Utility of Chest Radiograph and Chest Computed Tomography

2016 ◽  
Vol 82 (10) ◽  
pp. 1005-1008
Author(s):  
Michael P. O'Leary ◽  
Aaron B. Parrish ◽  
Cynthia M. Tom ◽  
Brian W. Maclaughlin ◽  
Beverley A. Petrie
Keyword(s):  
Rectal Cancer ◽  
Metastatic Cancer ◽  
Anal Verge ◽  
Cancer Staging ◽  
Chest Ct ◽  
X Ray ◽  
Primary Rectal Cancer ◽  
Abnormal Chest ◽  
Normal Chest ◽  
Chest X Ray

The National Comprehensive Cancer Network recommends that patients who are newly diagnosed with rectal cancer undergo staging CT scan of the chest. It is unclear whether posteroanterior and lateral chest radiography (X-ray) alone would provide adequate staging for most of these patients. A retrospective review was performed on all patients who had a two-view chest X-ray along with a chest CT for rectal cancer staging from 2007 to 2015. A total of 74 patients had both modalities. Sixty-three (85%) had a normal chest X-ray and 11 (15%) had an abnormal chest X-ray. Of the 63 patients with a normal chest X-ray, 40 (63%) had a corresponding normal chest CT and 23 (37%) had a lesion only noted on chest CT. Four patients (17%) in the latter group had metastatic cancer to the lung at the time of workup and four out of five of the tumors found to metastasize were within 5 cm from the anal verge. Our data suggest that a staging chest X-ray is unlikely to diagnose metastatic lungs lesions from a primary rectal cancer. Conversely, staging chest CT will accurately stage metastatic disease but will also reveal benign lung lesions in this patient population.

scholarly journals Orbital Subperiosteal Hematoma in the Newborn Causing Unilateral Proptosis: Ultrasound as First-Line Imaging Modality

2017 ◽  
Vol 07 (02) ◽  
pp. e138-e143 ◽  
Author(s):  
Florencia Angkasa ◽  
Leila Mohammadi ◽  
Deepa Taranath ◽  
Ajay Taranath ◽  
Marcus Brecht
Keyword(s):  
Imaging Modality ◽  
Ultrasound Images ◽  
First Line ◽  
Common Causes ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Management Approaches ◽  
Unilateral Proptosis ◽  
Orbital Hematoma

Proptosis in the neonatal period is relatively infrequent and has diverse underlying etiologies. One of the more common causes appears to be orbital subperiosteal hematoma. Early detection, differentiation from other causes, and regular follow-up are essential as loss of vision can occur. We describe two cases of neonatal proptosis caused by orbital subperiosteal hematoma highlighting different diagnostic and management approaches, and provide a summary of previously reported cases. Spontaneous resolution occurs in most cases; however, emergent surgical evacuation is warranted in cases of optic nerve compression. This is the first report to provide orbital ultrasound images of uncomplicated neonatal orbital subperiosteal hematoma. Orbital ultrasound followed by magnetic resonance imaging (MRI) is a valid nonradiation approach for assessing neonatal proptosis due to subperiosteal orbital hematoma.

Imaging in Nontraumatic Pediatric Head and Neck Emergencies

2017 ◽  
Vol 15 (05) ◽  
pp. 263-293
Author(s):  
Meghna Chadha ◽  
Zhiyun Yang ◽  
Shehanaz Ellika
Keyword(s):  
Head And Neck ◽  
Pediatric Patients ◽  
Imaging Modality ◽  
Emergency Setting ◽  
Resonance Imaging ◽  
First Line ◽  
Neoplastic Lesions ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Fascial Spaces

AbstractPediatric patients often present to the emergency department with a wide variety of infectious, inflammatory, and neoplastic lesions of the head and neck. Evaluation of pediatric patients in the emergency setting is complicated by limited history and physical examination. Imaging plays an important role in arriving at an accurate diagnosis. The fascial spaces and compartments of the neck provide an approach to differential diagnosis, and knowledge of the typical clinical and imaging manifestations of common pediatric head and neck emergencies allows the radiologist to identify the condition and associated complications that may require emergent surgical management. Computed tomography (CT) is the first-line imaging modality in the emergency setting; however, magnetic resonance imaging (MRI) plays an important secondary role.

scholarly journals A Rapidly Enlarging Solitary Infantile Myofibroma

2020 ◽  
Vol 4 (6) ◽  
pp. 608-612
Author(s):  
Stephany Vittitow ◽  
Merrick Kozak ◽  
Reza Daughtery ◽  
Barrett Zlotoff
Keyword(s):  
Imaging Modality ◽  
Mesenchymal Cell ◽  
Whole Body ◽  
Infantile Myofibromatosis ◽  
Life Threatening ◽  
Body Magnetic Resonance Imaging ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Effects Of Radiation ◽  
Infantile Myofibroma

Infantile myofibromatosis is a rare disorder of mesenchymal cell proliferation that can affect the skin, bone, muscle, and viscera. We present a case of a 6-week-old male with a rapidly enlarging congenital solitary infantile myofibroma. The differential for congenital tumors of the head and neck is broad, and thorough evaluation is required to rule out life-threatening malignancy. Currently, there is no first-line imaging modality of choice to assess for skeletal and/or visceral involvement in patients with infantile myofibromatosis. We recommend the use of whole-body magnetic resonance imaging (MRI), as it quickly provides detailed information regarding extent of disease and does not expose the patient to the harmful effects of radiation.  

scholarly journals MSBC-Net: Automatic Rectal Cancer Segmentation from MR Scans

2021 ◽  
Author(s):  
Ping Meng ◽  
Chao Sun ◽  
Yi Li ◽  
Long Zhou ◽  
Xinyu Zhao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Wall ◽  
Region Of Interest ◽  
Cancer Staging ◽  
Medical Image Segmentation ◽  
Research Progress ◽  
Dice Similarity Coefficient ◽  
Boundary Constraints ◽  
Segmentation Strategy ◽  
Magnetic Resonance Imaging Mri

<div>Accurate segmentation of rectal cancer and rectal wall based on high-resolution T2-weighted magnetic resonance imaging (MRI-HRT2) is the basis of rectal cancer staging. However, complex imaging background, highly characteristics variation and poor contrast hindered the research progress of the automatic rectal cancer segmentation. In this study, a multi-task learning network, namely mask segmentation with boundary constraints (MSBC-Net), is proposed to overcome these limitations and to obtain accurate segmentation results by locating and segmenting rectal cancer and rectal wall automatically. Specifically, at first, a region of interest (RoI)-based segmentation strategy is designed to enable end-to-end multi-task training, where a sparse object detection module is used to automatically localize and classify rectal cancer and rectal wall to mitigate the problem of background interference, and a mask and boundary segmentation block is used to finely segment the RoIs; second, a modulated deformable backbone is introduced to handle the variable features of rectal cancer, which effectively improves the detection performance of small objects and adaptability of the proposed model. Moreover, the boundary head is fused into the mask head to segment the ambiguous boundary of the target and constrain the mask head to obtain more refined segmentation results. In total, 592 annotated rectal cancer patients in MRI-HRT2 are enrolled, and the comprehensive results show that the proposed MSBC-Net outperforms state-of-the-art methods with a dice similarity coefficient (DSC) of 0.801 (95\% CI, 0.791-0.811), which can be well extended to other medical image segmentation tasks with high potential clinical applicability.</div>

scholarly journals MSBC-Net: Automatic Rectal Cancer Segmentation from MR Scans

2021 ◽  
Author(s):  
Ping Meng ◽  
Chao Sun ◽  
Yi Li ◽  
Long Zhou ◽  
Xinyu Zhao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Wall ◽  
Region Of Interest ◽  
Cancer Staging ◽  
Medical Image Segmentation ◽  
Research Progress ◽  
Dice Similarity Coefficient ◽  
Boundary Constraints ◽  
Segmentation Strategy ◽  
Magnetic Resonance Imaging Mri

<div>Accurate segmentation of rectal cancer and rectal wall based on high-resolution T2-weighted magnetic resonance imaging (MRI-HRT2) is the basis of rectal cancer staging. However, complex imaging background, highly characteristics variation and poor contrast hindered the research progress of the automatic rectal cancer segmentation. In this study, a multi-task learning network, namely mask segmentation with boundary constraints (MSBC-Net), is proposed to overcome these limitations and to obtain accurate segmentation results by locating and segmenting rectal cancer and rectal wall automatically. Specifically, at first, a region of interest (RoI)-based segmentation strategy is designed to enable end-to-end multi-task training, where a sparse object detection module is used to automatically localize and classify rectal cancer and rectal wall to mitigate the problem of background interference, and a mask and boundary segmentation block is used to finely segment the RoIs; second, a modulated deformable backbone is introduced to handle the variable features of rectal cancer, which effectively improves the detection performance of small objects and adaptability of the proposed model. Moreover, the boundary head is fused into the mask head to segment the ambiguous boundary of the target and constrain the mask head to obtain more refined segmentation results. In total, 592 annotated rectal cancer patients in MRI-HRT2 are enrolled, and the comprehensive results show that the proposed MSBC-Net outperforms state-of-the-art methods with a dice similarity coefficient (DSC) of 0.801 (95\% CI, 0.791-0.811), which can be well extended to other medical image segmentation tasks with high potential clinical applicability.</div>

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