Imaging in pelvic exenteration-a multidisciplinary practice guide from the ESGAR-SAR-ESUR-PelvEx collaborative group.

Pelvic exenteration (PE) is a radical surgical approach designed for the curative treatment of advanced pelvic malignancies, requiring en-bloc resection of multiple pelvic organs. While the procedure is radical, it has shown promise in enhancing long-term survival and is now comparable in surgical mortality to elective resections for primary pelvic cancers. Imaging plays a crucial role in preoperative planning, with MRI, CT, and PET/CT being pivotal in assessing the extent of cancer and formulating a surgical roadmap.

study of radiosensitivity in colorectal cancer cell lines associated with Lynch syndrome.

Introduction: Lynch syndrome patients have an inherited predisposition to cancer due to a deficiency in DNA mismatch repair (MMR) genes which could lead to a higher risk of developing cancer if exposed to ionizing radiation. This pilot study aims to reveal the association between MMR deficiency and radiosensitivity at both a CT relevant low dose (20 mGy) and a therapeutic higher dose (2 Gy).

Methods: Human colorectal cancer cell lines with (dMMR) or without MMR deficiency (pMMR) were analyzed before and after exposure to radiation using cellular and cytogenetic analyses i.

Influence of diffusion weighted imaging and contrast enhanced T1 sequences on the diagnostic accuracy of magnetic resonance enterography for Crohn's disease.

Objectives: To evaluate the additional diagnostic benefit of diffusion weighted imaging (DWI) and contrast enhanced (CE) images during MR enterography (MRE) of Crohn's disease.

Methods: Datasets from 73 patients (mean age 32; 40 male) (28 new-diagnosis, 45 relapsed) were read independently by two radiologists selected from a pool of 13. Radiologists interpreted datasets using three sequential sequence blocks: (1) T2 weighted and steady state free precession gradient echo (SSFP) images alone (T2^); (2) T2 weighted and SSFP images with DWI (T2 + DWI^) and; (3) T2 weighted images, SSFP, DWI and post-contrast enhanced (CE) T1 images (T2 + DWI + CE^), documenting presence, location, and activity of small bowel disease.

Potential risks associated with the use of ionizing radiation for imaging and treatment of colorectal cancer in Lynch syndrome patients.

The aim of this review is to investigate the literature pertaining to the potential risks of low-dose ionizing radiation to Lynch syndrome patients by use of computed tomography (CT), either diagnostic CT colonography (CTC), standard staging CT or CT surveillance. Furthermore, this review explores the potential risks of using radiotherapy for treatment of rectal cancer in these patients. No data or longitudinal observational studies of the impact of radiation exposure on humans with Lynch syndrome were identified.

Influence of oral contrast type and volume on patient experience and quality of luminal distension at MR Enterography in Crohn's disease: an observational study of patients recruited to the METRIC trial.

Objectives: To compare the distention quality and patient experience of oral mannitol and polyethylene glycol (PEG) for MRE.

Methods: This study is a retrospective, observational study of a subset of patients enrolled in a multicentre, prospective trial evaluating the diagnostic accuracy of MRE for small bowel Crohn's. Overall and segmental MRE small bowel distention, from 105 patients (64 F, mean age 37) was scored from 0 = poor to 4 = excellent by two experienced observers (68 [65%] mannitol and 37 [35%] PEG).

Interobserver variation in the interpretation of magnetic resonance enterography in Crohn's disease.

Objectives: To evaluate interobserver variability for diagnosis of disease presence and extent of small bowel and colonic Crohn's disease using MR enterography (MRE).

Methods: Data from the first 73 consecutive patients (mean age 32, 33F, 28 new diagnosis, 45 suspected relapse) recruited to a multicentre, prospective diagnostic accuracy trial evaluating MRE for small bowel Crohn's disease were each read independently by three (from a pool of 20) radiologists. Radiologists documented presence and segmental location of small bowel Crohn's disease and recorded morphological mural/extramural parameters for involved segments.

Meeting the new joint British Society of Gastrointestinal and Abdominal Radiology and Royal College of Radiologists CT colonography standards: a 6-year experience.

Aim: To audit the performance of computed tomography colonography (CTC) at St Mark's Hospital against the joint British Society of Gastrointestinal and Abdominal Radiology (BSGAR) and Royal College of Radiologists (RCR) standards.

Materials And Methods: A retrospective audit of all CTC studies between January 2012 to December 2017 was performed against the BSGAR/RCR standards along with additional data outwith the guidelines. Evidence was obtained from a central database, radiology information systems (RISs), picture archiving and communication systems (PACSs), and electronic patient records (EPRs).

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study.

Background: Magnetic resonance enterography and enteric ultrasonography are used to image Crohn's disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn's disease was compared.

Objective: To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn's disease.

Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial.

Background: Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer.

Methods: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England.

Magnetic resonance enterography, small bowel ultrasound and colonoscopy to diagnose and stage Crohn's disease: patient acceptability and perceived burden.

Objectives: To compare patient acceptability and burden of magnetic resonance enterography (MRE) and ultrasound (US) to each other, and to other enteric investigations, particularly colonoscopy.

Methods: 159 patients (mean age 38, 94 female) with newly diagnosed or relapsing Crohn's disease, prospectively recruited to a multicentre diagnostic accuracy study comparing MRE and US completed an experience questionnaire on the burden and acceptability of small bowel investigations between December 2013 and September 2016. Acceptability, recovery time, scan burden and willingness to repeat the test were analysed using the Wilcoxon signed rank and McNemar tests; and group differences in scan burden with Mann-Whitney U and Kruskal-Wallis tests.

Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial.

Background: Magnetic resonance enterography (MRE) and ultrasound are used to image Crohn's disease, but their comparative accuracy for assessing disease extent and activity is not known with certainty. Therefore, we did a multicentre trial to address this issue.

Methods: We recruited patients from eight UK hospitals.

Appearances of screen-detected versus symptomatic colorectal cancers at CT colonography.

Objectives: The aim of this study was to compare the morphology, radiological stage, conspicuity, and computer-assisted detection (CAD) characteristics of colorectal cancers (CRC) detected by computed tomographic colonography (CTC) in screening and symptomatic populations.

Methods: Two radiologists independently analyzed CTC images from 133 patients diagnosed with CRC in (a) two randomized trials of symptomatic patients (35 patients with 36 tumours) and (b) a screening program using fecal occult blood testing (FOBt; 98 patients with 100 tumours), measuring tumour length, volume, morphology, radiological stage, and subjective conspicuity. A commercial CAD package was applied to both datasets.

Mechanisms of hyoscine butylbromide to improve adenoma detection: A case-control study of surface visualization at simulated colonoscope withdrawal.

Background And Study Aims: Antispasmodics may improve mucosal visualization during colonoscope withdrawal, potentially improving polyp and adenoma detection. Meta-analysis and case-control studies suggest a 9 % to 13 % relative increase in adenoma and polyp detection. We aimed to assess the impact of hyoscine butylbromide on the expected visualization during colonoscope withdrawal using a CT colonography (CTC) simulation.

Implementation of a new CT colonography service: 5 year experience.

Aim: To describe our experience using a 5 year audit of computed tomography colonography (CTC) practice and identify factors that influence diagnostic performance to guide implementation in other centres.

Material And Methods: Consecutive patients referred for CTC at a single institution over a 5 year period were identified, and reporting rates and positive predictive value (PPV) calculated for small polyps, large polyps, and colorectal cancer. Diagnostic performance was compared using the Chi-squared test, and trends over time were examined with logistic regression.

CT enterography: review of technique and practical tips.

CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation.

Essential requirements of a CT colonography service.

There are many potential challenges to developing a high quality, efficient CT colonography service. Some are clear and predictable, for example creating CT capacity and securing financial resources, but some are less obvious, such as harnessing local support or changing referral practice amongst clinical colleagues. Notwithstanding, such barriers will need to be overcome to deliver a well-resourced, successful CT colonography programme.

CT colonography training for radiographers--a formal evaluation.

Aims: To evaluate the efficacy of a new intensive "hands-on" course designed to train small teams of radiographers in computed tomography colonography (CTC) technique and initial interpretation for patient triage.

Materials And Methods: The course comprised small-group lectures, active participation in the daily CTC service with practical technique and image interpretation training by experienced radiologists and radiographers. Evaluation was by assessment of knowledge using randomized sets of multiple choice questions (MCQ; pre/post-course), practical technique using checklists and expert global scores, and interpretation performance outcomes using randomized pre/post-course test datasets (five validated CTC examinations each).

Flat colon polyps: what should radiologists know?

With the recent publication of international computed tomography (CT) colonography standards, which aim to improve quality of examinations, this review informs radiologists about the significance of flat polyps (adenomas and hyperplastic polyps) in colorectal cancer pathways. We describe flat polyp classification systems and propose how flat polyps should be reported to ensure patient management strategies are based on polyp morphology as well as size. Indeed, consistency when describing flat polyps is of increasing importance given the strengthening links between CT colonography and endoscopy.

CT colonography standards.

Computed tomography (CT) colonography is the established successor to the barium enema for the detection of colonic neoplasia due to superior performance and patient experience. Consequently, CT colonography is widely disseminated across Western populations and increasingly provided by both subspecialist and general radiologists alike. As a result, CT colonography is now part of the core training curriculum for radiology in the UK.

CT colonography: accuracy of initial interpretation by radiographers in routine clinical practice.

Aim: To investigate performance of computed-assisted detection (CAD)-assisted radiographers interpreting computed tomography colonography (CTC) in routine practice.

Materials And Methods: Three hundred and three consecutive symptomatic patients underwent CTC. Examinations were double-read by trained radiographers using primary two-dimensional/three-dimensional (2D/3D) analysis supplemented by "second reader" CAD.

Effect of visualization display colour on polyp conspicuity at virtual colonoscopy.

Aim: To investigate the effect of different colour three-dimensional (3D) displays on polyp detection at virtual colonoscopy (VC).

Methods: Five VC trained observers were shown "brief flashes" (lasting 0.2s) of 125 3D endoluminal image snap-shots, repeated for each of six display colours (750 images total).

Investigating rectal bleeding.

Conventional colonoscopy is considered the optimal investigation for rectal bleeding; however, this article explores the use of virtual colonoscopy as a new investigative technique