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GI Tract - Colon, GI Tract - Rectum, Quantitative Imaging
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Panvini, Latina, IT","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/951_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/951_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/18529A00.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/951_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/951_1p-thumbnails.vtt"}]},{"name":"SS 2.6 - The impact of mismatch repair status on the preoperative staging of local colon cancer","mode":"playlist","public":true,"info":{"id":506,"presentation":"SS 2.6 - The impact of mismatch repair status on the preoperative staging of local colon cancer","session":"SS 2 - CT colonography and colorectal cancer imaging","presenter":"S. Rafaelsen, Vejle, DK","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/506_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/506_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/423C36D8.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/506_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/506_1p-thumbnails.vtt"}]},{"name":"SS 2.7 - Positron emission tomography may be useful to stage patients with rectal cancer and lateral pelvic lymph nodes with a short axis of at least 5 mm","mode":"playlist","public":true,"info":{"id":366,"presentation":"SS 2.7 - Positron emission tomography may be useful to stage patients with rectal cancer and lateral pelvic lymph nodes with a short axis of at least 5 mm","session":"SS 2 - CT colonography and colorectal cancer imaging","presenter":"C. Ortega, S\u00e3o Paulo, BR","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/366_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/366_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/3C383F15.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/366_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/366_1p-thumbnails.vtt"}]},{"name":"SS 2.8 - Prediction value of CT texture analysis to differentiate V-Ki-ras-2 Kirsten rat sarcoma viral oncogene homolog mutation status in colorectal cancer","mode":"playlist","public":true,"info":{"id":992,"presentation":"SS 2.8 - Prediction value of CT texture analysis to differentiate V-Ki-ras-2 Kirsten rat sarcoma viral oncogene homolog mutation status in colorectal cancer","session":"SS 2 - CT colonography and colorectal cancer imaging","presenter":"F. Landolfi, Rome, IT","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/992_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/992_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/70E96EF7.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/992_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/992_1p-thumbnails.vtt"}]},{"name":"SS 2.9 - Diagnostic performance of dedicated rectal CT for staging rectal cancer: comparison with high-resolution rectal MRI and histopathology","mode":"playlist","public":true,"info":{"id":690,"presentation":"SS 2.9 - Diagnostic performance of dedicated rectal CT for staging rectal cancer: comparison with high-resolution rectal MRI and histopathology","session":"SS 2 - CT colonography and colorectal cancer imaging","presenter":"S. Kim, Seoul, KR","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/690_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/690_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/C3C73207.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/690_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/22\/v\/690_1p-thumbnails.vtt"}]}]
{"type":2,"code":"9E32WM0o"}
[session]
[presentation]
[presenter]
SS 2.2 - Performance and evaluation in CTC screening: a cluster randomised trial
Presentation Number
SS 2.2
Channel
On-demand channel 6
Purpose
To determine if a structured CTC training programme for experienced CTC readers increases interpretation accuracy.
Material and methods
We recruited representative, experienced CTC radiologists (median: 500-999 CTCs interpreted) who interpret CTC in their routine practice (median: 151 to 200 cases/year) from 72 NHS hospitals. We cluster randomised them into intervention (one-day training plus regular feedback) or control (no training or feedback) groups. Participants’ sensitivity for colorectal cancer (CRC) and 6mm+ polyps was tested at 0, 1, 6 and 12 months post-training (intervention group) or post-enrollment date (control group), via interpretation of 10 CTC examinations with endoscopic validation. The primary outcome was the difference in sensitivity for 6mm+ polyps at the 1-month test between arms, analysed using analysis of covariance (ANCOVA). Secondary outcomes include diagnostic sensitivity at 6 and 12 months.
Results
139 radiologists were randomised (intervention: 79; control: 60); currently, data regarding the primary outcome are available for 89 (due to ongoing follow-up). Mean baseline sensitivity was similar between the two groups (intervention: 49.7% ±17.4%; control: 45.1% ±13.4%, p=NS). At 1 month post-intervention, sensitivity was significantly greater in the intervention arm than the control group (intervention: 66.3% ±16.8%; control: 46.8% ±19.7%; difference = 16.9% [95%CI 9.9 to 23.8%], p<0.001). This effect persisted at 6 months (intervention: 65.9% ±14.6%; control: 55.3% ±16.5%; difference = 10.0% [95%CI 2.4 to 17.6%], p=0.01).
Conclusion
An easily administered intervention of one-day training with regular ongoing feedback significantly increases experienced CTC radiologist sensitivity for 6mm+ polyps, an effect sustained to at least 6 months.
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[session]
[presentation]
[presenter]
SS 2.4 - Low-volume reduced bowel preparation for CTC: a randomised controlled trial
Presentation Number
SS 2.4
Channel
On-demand channel 6
Purpose
To investigate the feasibility and patient tolerance of a reduced bowel preparation for CTC.
Material and methods
Asymptomatic and symptomatic patients were enrolled in this multicentric randomised trial. All patients were randomly assigned (1:1 ratio, blocks of ten) to receive a reduced (52.5 g of Macrogol dissolved in 500 mL of water, RBP) or full (105 g of Macrogol in 1000 mL, FBP) bowel preparation and faecal tagging. Five readers performed a blinded subjective image analysis, by means of four-point Likert scales from 0 (highest score) to 3 (worst score). Endpoints were the quality of large bowel cleansing and tolerance to the assigned bowel preparation regimen.
Results
Seventy-eight patients were randomly allocated to treatments (44 in FBP group, 34 in RBP group). Both groups resulted in optimal colon cleansing. Homogeneity of fluid tagging (median score 0 vs 0, p=0.075), volume of residual stools (median score 0 vs 0, p=0.082), and colonic distension (median score 0 vs 0, p=0.073) were similar for both groups. RBP resulted in better patient tolerance.
Conclusion
Reduced bowel preparation may provide better tolerance for patients undergoing CTC without affecting colon cleansing and image quality.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM0hp\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM0hp\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"7E22WM0hp"}
[session]
[presentation]
[presenter]
SS 2.6 - The impact of mismatch repair status on the preoperative staging of local colon cancer
Presentation Number
SS 2.6
Channel
On-demand channel 6
Purpose
CT scan is standard in preoperative local staging of colon cancer. Tumours with a deficient mismatch repair (dMMR) system are characterised by unique clinical and pathophysiologic aspects that may impact the accuracy of the preoperative CT staging.
Material and methods
Data from the Danish Colorectal Cancer Group national clinical database addressing a cohort of patients operated for stage I-III colon cancer during 2010-15 were analysed. The analyses of MMR status had been conducted consecutively through means of immunohistochemistry. All CT scans were blindly assessed by a certified radiologist.
Results
Data from 590 patients, operated at a specialised cancer centre, were available for analyses. 135 (22.9%) of the patients had tumours demonstrating dMMR. The overall correlation of the clinical and pathological T-category was significant for both groups. There was an inferior correlation between clinical (cN) and pathological (pN) N-category (p>0.05) in pMMR cancers with a higher degree of over-staging assessed by CT scan compared to a significant correlation between cN and pN stages in pMMR cancers (p<0.01). Of the 91 dMMR tumours assessed node-positive by the preoperative CT scan, 59 (64.8%) showed no sign of metastatic involvement at the postoperative assessment.
Conclusion
Preoperative CT staging of dMMR colon cancer seems to overestimate nodal involvement and two-thirds of the patients preoperatively judged node-positive are false positive. The overall clinical value of a routine assessment of MMR status in the diagnostic setup is evident and the current study argues for implications to treatment decisions as well.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM09J\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM09J\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"7E22WM09J"}
[session]
[presentation]
[presenter]
SS 2.7 - Positron emission tomography may be useful to stage patients with rectal cancer and lateral pelvic lymph nodes with a short axis of at least 5 mm
Presentation Number
SS 2.7
Channel
On-demand channel 6
Purpose
To verify the minimum size of lateral pelvic lymph nodes (LPLNs) that can be considered metastatic by positron emission tomography (PET) when integrated 18F-fluorodeoxyglucose (FDG)-PET/MRI is used to evaluate patients with rectal cancer at baseline staging.
Material and methods
IRB-approved retrospective analysis of prospectively collected data between Nov 2016 and Apr 2018 of 99 consecutive patients with rectal cancer at baseline staging (NCT02537340) was done. Inclusion criteria: >18 years with biopsy-proven rectal adenocarcinoma. Exclusion criteria: previous treatment, known neoplasia, PET/MRI contraindications, failure to consent and unavailable images. Images were reviewed in consensus by radiologist with 10years of experience in reading MRI and nuclear medicine physician with 3years of experience in reading PET. Assessment included a) MRI-identified LPLNs with malignant features (mixed signal intensity/border irregularity); b) the short axis (SA) of the largest LPLNs showing no malignant features in internal, external iliac or obturator compartments. Volume of interest (VOI) was drawn over the selected LPLNs to measure SUV; c) PET-identified LPLNs, considered metastatic when SUVmax was higher than 2.5. The SA of PET-positive nodes was recorded. The median node size was calculated.
Results
Fourteen patients (30 nodes) were positive on both PET and MRI components, five (5 nodes) were MRI-positive and PET-negative and two (2 nodes) were PET-positive and MRI negative. Median SUVmax uptake of PET-positive nodes was 4.9(2.6-17.6). Median size of PET-positive nodes was 10mm (5-18mm). Median size of MRI-positive nodes was 10mm (5-18mm). Twenty patients had no visible LPLN. Fifty-eight remaining patients had metabolic and morphological negative nodes with median size of 5.1mm (2-8mm).
Conclusion
The smallest PET-positive node had a short axis of 5mm.
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[session]
[presentation]
[presenter]
SS 2.8 - Prediction value of CT texture analysis to differentiate V-Ki-ras-2 Kirsten rat sarcoma viral oncogene homolog mutation status in colorectal cancer
Presentation Number
SS 2.8
Channel
On-demand channel 6
Purpose
To investigate the value of CT texture analysis in the prediction of V-Ki-ras-2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status in patients with lung metastases from colorectal cancer.
Material and methods
Eighteen patients with pathologically proven lung metastases from colorectal cancer were retrospectively enrolled. All patients underwent contrast-enhanced CT before the resection of metastases and KRAS mutation testing was performed on surgical specimen. Each metastasis was manually segmented from portal venous-phase CT images by an expert radiologist and analyzed with a dedicated software (TexRAD Ltd, Somerset, UK), which extrapolated the following texture parameters: mean, standard deviation of the pixel histogram (SD), skewness, kurtosis, mean value of positive pixel (MPP) and entropy. Mean value of texture parameters was calculated for each spatial spacing factor (SSF 0-6) and compared with KRAS mutation status. P values <0.05 were considered statistically significant.
Results
Nine patients (50%) had mutant KRAS and nine patients (50%) had wild-type KRAS. SD, entropy, MPP and kurtosis resulted significantly different (SD: p = 0.0016; entropy: p = 0.042; MPP, p = 0.0025; kurtosis, p = 0.05) between mutant and wild-type patients at medium and high filter levels (SSF 4-6). Mean and skewness showed no significant differences between the two groups of patients.
Conclusion
Texture parameters are significantly different between mutant and wild-type patients; texture analysis, providing a quantitative assessment of tumor microenvironment, may represent a non-invasive tool in the early prediction of KRAS mutation status in patients with metastatic colorectal cancer, allowing to customize treatment according to the predicted outcome.
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[session]
[presentation]
[presenter]
SS 2.9 - Diagnostic performance of dedicated rectal CT for staging rectal cancer: comparison with high-resolution rectal MRI and histopathology
Presentation Number
SS 2.9
Channel
On-demand channel 6
Purpose
To evaluate the diagnostic performance of dedicated rectal CT compared with high-resolution rectal MRI and histopathology in assessing rectal cancer.
Material and methods
Sixty-seven rectal cancer patients, who underwent dedicated rectal CT with rectal distension using 80-100ml of sonographic gel and high-resolution MRI within a month, were enrolled. For rectal CT, axial, coronal, and sagittal images were acquired with 3-mm reconstruction interval. For CT and MRI, the following items were analyzed by an experienced gastrointestinal radiologist: distance from anal verge and anorectal junction, shortest distance to mesorectal fascia, extramural depth (EMD), extramesorectal lymph node (LN) involvement, extramural venous invasion (EMVI), and T and N stages. CT and MRI findings were compared. Of 67 patients, 20 underwent radical surgery without concurrent chemoradiation therapy for whom CT findings were also compared with histopathology. Interclass correlation (ICC) and kappa statistics were used for statistical analysis.
Results
For all patients, distance from anal verge and anorectal junction showed strong correlation between CT and MRI (correlation coefficient, 0.972 and 0.955) (P<0.001). For EMD (cut-off: 5mm), threatened circumferential resection margin (cut-off: <2mm), LN metastasis, extramesorectal LN, and EMVI, kappa values between CT and MRI were 0.944, 0.931, 1.000, 0.892, and 0.884, respectively (P<0.001). For T stage, a weighted-kappa value was 0.954 (P<0.001). For 20 patients who received surgery, CT showed good agreement for T staging with histopathologic staging (kappa value, 0.865) (P<0.001). For involvement of CRM, EMVI, and LN metastasis, rectal CT showed acceptable concordance rates with histopathology in 75% (15/20), 95% (19/20), and 60% (12/20), respectively.
Conclusion
Dedicated rectal CT shows acceptable diagnostic performance comparable with MRI and histopathology for evaluating rectal cancers.
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[session]
[presentation]
[presenter]
