ECR 2013 Rec: MRI-based selection of clinical complete and good responders after chemoradiation for rectal cancer allows for successful minimal invasive treatment #SS1801a #B0940

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B-0949 MRI-based selection of clinical complete and good responders after chemoradiation for rectal cancer allows for successful minimal invasive treatment

L. Heijnen, M. Maas, M.H. Martens, D.M.J. Lambregts, J.W.A. Leijtens, R.G.H. Beets-Tan, G.L. Beets | Monday, March 11, 14:00 – 15:30 / Room E2

Purpose: Patients with good or complete response after neoadjuvant chemoradiation have excellent long-term outcome. Minimal invasive treatment (i.e. transanal endoscopic microsurgery (TEM) and wait-and-see policy) are increasingly considered as an alternative to major surgery. With this prospective cohort study we aimed to evaluate long-term outcome of strictly MR-based selected patients who have been treated with minimal invasive treatment.
Methods and Materials: Eight weeks after chemoradiation, endoscopy and restaging MRI were performed (including diffusion-weighted MRI for yT-staging and gadofosveset-enhanced MRI for yN-staging). Complete responders were selected for wait-and-see policy and good responders with small tumour remnant for TEM. Both treatment groups underwent intensive 3-to-6 monthly follow-up, using MR imaging (DWI+gadofosveset), CEA, CT of thorax and abdomen and endoscopy was performed. Long-term outcome was estimated with Kaplan-Meier curves.
Results: Forty-one patients were included, thirty-three in the wait-and-see group and eight in the TEM-group. Mean follow-up was 26 months (range 6-91). For the TEM-group, 4 patients had ypT0 and 4 had ypT2. Two patients, both in the wait-and-see group, developed a local recurrence within two years and underwent surgery, leading to a 2-year local recurrence rate of 9 %. Both recurrences were detected on (DWI-)MRI in an early stage. The cumulative probabilities of 2-year disease-free survival and overall survival were 93 % and 100 %, respectively. No recurrences occurred in the TEM-group.
Conclusion: Both selection and follow-up of good and complete responders after chemoradiation for rectal cancer with MRI is feasible. Long-term outcome so far is excellent. (DWI-)MRI seems to be a reliable tool for early recurrence detection.

Spanish radiologists celebrate IDoR 2013 in Madrid

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ESR staff writer Mélisande Rouger was in Madrid on November 8 and took the chance to catch up with members of the Spanish Society of Medical Radiology (SERAM) celebrating the International Day of Radiology.

Fans of medical imaging celebrated the 2nd International Day of Radiology (IDoR) on November 8, with many events taking place all over the world. More than 100 radiology-related societies observed the day and organised their own events, including SERAM, who held a well attended public event at the headquarters of the Spanish Association Against Cancer, in Madrid.

IDoR, which was launched by the European Society of Radiology (ESR), the Radiological Society of North America (RSNA) and the American College of Radiology (ACR) last year, aims to bring radiology closer to the public. This year’s theme was lung imaging, and Spanish radiologists provided clues on how to highlight the role of the radiologist in lung disease management in their lectures last Friday.

From left to right:  Dr. Inmaculada Herráez Ortega, Dr. Angel Gayete Cara, Ms. Elena Serrano García, Dr. Joaquin Ferreiros Dominguez, Dr. Carmen Ayuso Colella, Dr. Eva Castañer Gonzalez and Dr. Jesus De La Torre Fernandez. Photo courtesy of SERAM.

From left to right: Dr. Inmaculada Herráez Ortega, Dr. Angel Gayete Cara, Ms. Elena Serrano García, Dr. Joaquin Ferreiros Dominguez, Dr. Carmen Ayuso Colella, Dr. Eva Castañer Gonzalez and Dr. Jesus De La Torre Fernandez.
Photo courtesy of SERAM.

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ECR 2013 Rec: Breast tomosynthesis versus digital mammography: evaluation of diagnostic potential in women with abnormal screening mammograms #SS1702 #B0816

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B-0816 Breast tomosynthesis versus digital mammography: evaluation of diagnostic potential in women with abnormal screening mammograms

M. Mohamed Aly | Monday, March 11, 10:30 – 12:00 / Room F2

Purpose: To compare the diagnostic potential of digital mammography with tomosynthesis.
Methods and Materials: 100 women with abnormal screening mammograms,187 findings, and definite imaging or histopathological diagnosis were included. The screening mammography interpretation consisted of direct comparison of the tomosynthesis (DBT) examination with full field digital mammography (FFDM) images. The study radiologists subjectively rated the equivalence of the image quality of both the DBT and the FFDM examinations with no use of additional mammography, magnification views or comparison mammography. The next step was categorising the findings in both FFDM and DBT separately according to BIRADS classification and the statistical analysis evaluated the p values of DBT and FFDM as well as their sensitivities.
Results :All findings categorised as BIRADS 3 according to mammography showed reduction in number,particularly for masses, when examined with tomosynthesis. The image quality of tomosynthesis was subjectively rated as equivalent (53.5%) or superior (43.3%) to digital mammography in 96.8% of the total of findings; the test was highly significant (p <0.001). For masses, tomosynthesis image quality was rated as equivalent in 40.5% or superior in 58.1% of findings. Masses were 53 % of findings in which tomosynthesis had superior image quality. The FFDM Sensitivity was of 91.9 % compared with 95.2% for DBT.
Conclusion: The diagnostic potential of digital breast tomosynthesis is superior to that of full-field digital mammography by evaluating their image quality and their sensitivity. Based on a subjective analysis, DBT showed a significantly higher image quality compared with digital mammography in all finding types, especially in the characterisation of masses.

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Nov 2013
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ECR 2013 Rec: Ultrasound study of the pancreas with CPS (CEUS) and ARFI (elastography): improving the diagnosis of pancreatic tumours #SY9

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Ultrasound study of the pancreas with CPS (CEUS) and ARFI (elastography): improving the diagnosis of pancreatic tumours

M. D’Onofrio | Friday, March 8, 12:30 – 13:30 / Room L/M

Image fusion enables us to perform a direct, on-screen correlation between a current ultrasound study and a previously performed CT or MRI exam. Using this ability, the spatial resolution of the ultrasound image can be added to the superior overview of a CT or MRI providing additional clinical confidence, lesions first noted on CT or MRI may be more easily detected and characterised on ultrasound and interventions such as biopsies and tumour ablations may be guided by a combination of modalities. Participants in this symposium will become familiar with how image fusion adds another dimension both to diagnostic and interventional ultrasound.

Caceres’ Corner Case 79 (Update: Solution)

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Dear Friends,

To compensate for the subtle findings in the previous case, I am presenting an obvious one in a 69-year-old man with chest pain. What would be your diagnosis before CT?

Check the images below and leave your thoughts in the comments section. The answer will be added on Friday.

1. Endothoracic goiter
2. Aortic aneurysm
3. Thymoma
4. None of the above

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11
Nov 2013
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ESR invites more friends to Vienna

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This year the European Society of Radiology (ESR) will again invite three national radiological societies and a partner discipline to take part in the popular ‘ESR meets’ programme during its annual meeting, the European Congress of Radiology (ECR). Delegations from Russia, home country of ECR 2014 President, Professor Valentin Sinitsyn, Mexico and Serbia will present their latest achievements in imaging. The European Society of Cardiology (ESC) will focus on the cooperation between cardiologists and radiologists in the field of cardiac imaging. The European Federation of Radiographers Societies (EFRS) will also take part in joint sessions with Russian radiographers, to stress the role of this important partner discipline.

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Nov 2013
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Thoracic radiologists welcome IDoR 2013 celebrations

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The International Day of Radiology (IDoR) takes place in just a couple of days’ time, on November 8, and this year the focus is on lung imaging. The ESR chose to approach this theme by creating a book on the subject, with the help of the European Society of Thoracic Imaging (ESTI), which will be published to coincide with this year’s IDoR.

ESTI board members, including several contributors to the forthcoming book, gathered in Vienna recently to discuss plans for their society, so we took the opportunity to ask them why it is necessary to inform the public of the importance of radiology in healthcare.

“Doctors form a team, and in this team radiologists are a very important group, but their role is not so well known. A lot of people think that we are only photographers, but we have a crucial role in making a diagnosis. It’s important for the public to know what role we play,” said Doctor Eva CastaÑer González, a radiologist working at the Corporació Parc Taulí in Sabadell, Spain.

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Dr. Pepe’s Diploma Casebook: Case 45 – SOLVED!

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Dear Friends,

Today I am presenting the case of a 73-year-old woman who had preoperative radiographs for haemorrhoid treatment.

Check the two images below and leave me your comments and diagnosis in the comments. Come back on Friday for the answer!

Diagnosis:
1. Cyanotic heart disease
2. Acyanotic heart disease
3. No heart disease
4. None of the above

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IDoR and patients’ organisations: new collaborations to benefit all

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In the course of preparing a book on lung imaging that will be published to mark the International Day of Radiology (IDoR), the ESR spoke to Nicola Bedlington, executive director of the European Patients’ Forum (EPF), who shared her views on healthcare in the EU and explained why she chose to participate in IDoR 2013.

ESR: What is the overall aim of your organisation?

Nicola Bedlington: Our vision is high quality, patient-centred and equitable healthcare for all patients throughout the European Union.
The European Patients’ Forum is an umbrella organisation that works with patients’ groups in public health and health advocacy across Europe. Our members represent specific chronic disease groups at EU level, or are national coalitions of patients. We currently represent almost 60 such organisations.
Our mission is to be the collective patients’ voice at EU level, manifesting the solidarity, power and unity of the EU patients’ movement, and to provide a strong and united patients’ voice in order to put patients at the centre of EU health policy and programmes. In this regard we are the key interlocutor with EU institutions on cross-cutting issues affecting all patients.

Nicola Bedlington, executive director of the European Patients’ Forum (EPF)

Nicola Bedlington, executive director of the European Patients’ Forum (EPF)

ESR: What exactly does your organisation do to meet this aim?

NB: The EPF helps to empower patients’ organisations through educational seminars, policy initiatives and projects. We coordinate best practice exchanges between patient organisations at European and national levels. Our programmes also help to strengthen organisational and advocacy capacity.

ESR: Your organisation has experience working with various chronic disease groups. Do many patients suffer from chronic diseases in the EU?

NB: Following consultation with our members we estimate there are at least 150 million patients with chronic conditions across the European Union. This figure is likely to increase given the ageing population.

ESR: Many EU countries face significant health budget cuts, leading to shorter hospital stays and less access to modern equipment (i.e. long waiting lists for MRI exams). How can patient care be promoted in this context?

NB: The EPF is working with its member organisations to ensure health is seen as an investment, and patients are not perceived as purely cost drivers. Major health inequalities exist across the EU which impact enormously on patients’ access to care.
Building on the three pillars of quality information, health literacy and empowerment, patients can be agents of change and sources of innovation, particularly in terms of equity and sustainability of care. There need to be meaningful opportunities for patient involvement throughout the healthcare sector. We promote meaningful patient involvement in all forms of innovation, whether it is in high or low technology, pharmaceuticals, information technology, social change or systems change. The patient community seeks partnerships with researchers, policy-makers and industry in order to achieve greater impact in this arena.

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Caceres’ Corner Case 78 (Update: Solution)

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Dear Friends,

Muppet saw this case while looking at daily chest radiographs and it caught his attention. We looked at the patient’s history and found that she was a 64-year-old female with back pain, who had a well-differentiated liposarcoma removed from her right thigh seven years earlier.

Do you see anything?
What do you think it is?

Check the images below and leave your thoughts in the comments section. The answer will be posted on Friday.

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28
Oct 2013
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