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1.	Latifi, Ali, et al. (författare) The accuracy of focused abdominal CT in patients presenting to the emergency department 2009 Ingår i: Emergency Radiology. - : Springer Science and Business Media LLC. - 1070-3004 .- 1438-1435. ; 16:3, s. 209-215 Tidskriftsartikel (refereegranskat)abstract Focused computed tomography(CT) examination (FCT) is CT limited to a specific abdominal area in an attempt to reduce radiation exposure. We wanted to evaluate FCT on the basis of information from the request form and thus reduce radiation dose to the patient without missing relevant findings. We retrospectively analyzed 189 consecutive acute abdominal CT, dividing the findings as localized in the upper or lower abdomen. Another researcher blindly determined where the CT should be focused to, based only on information provided in the request form. The sensitivity and specificity of FCT in patients with symptoms from only upper abdomen was 100%. Sensitivity, specificity, and accuracy of FCT in patients with symptom from only lower abdomen were 79%, 100%, and 92%, respectively. Our study suggests that among patients with symptoms from the lower abdomen, not examining the upper abdomen would lead to missing relevant findings.
2.	Torkzad, Michael R., 1968-, et al. (författare) Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia : results of a survey 2015 Ingår i: Insights into Imaging. - : SPRINGER HEIDELBERG. - 1869-4101. ; 6:3, s. 339-346 Tidskriftsartikel (refereegranskat)abstract Aims To survey the perceived indications for magnetic resonance imaging of the small bowel (MRE) by experts, when MR enteroclysis (MREc) or MR enterography (MREg) may be chosen, and to determine how the approach to MRE is modified when general anaesthesia (GA) is required. Materials and methods Selected opinion leaders in MRE completed a questionnaire that included clinical indications (MREg or MREc), specifics regarding administration of enteral contrast, and how the technique is altered to accommodate GA. Results Fourteen responded. Only the diagnosis and follow-up of Crohn's disease were considered by over 80 % as a valid MRE indication. The remaining indications ranged between 35.7 % for diagnosis of caeliac disease and unknown sources of gastrointestinal bleeding to 78.6 % for motility disorders. Themajority chose MREg over MREc for all indications (from 100 % for follow-up of caeliac disease to 57.7 % for tumour diagnosis). Fifty per cent of responders had needed to consider MRE under GA. The most commonly recommended procedural change was MRI without enteral distention. Three had experience with intubation under GA (MREc modification). Conclusion Views were variable. Requests for MRE under GA are not uncommon. Presently most opinion leaders suggest standard abdominal MRI when GA is required. Main messages Experts are using MRE for various indications. Requests for MRE under general anaesthesia are not uncommon. Some radiologists employ MREc under general anaesthesia; others do not distend the small bowel.
3.	Arakelian, Erebouni, et al. (författare) Pulmonary influences on early post-operative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment : a retrospective study 2012 Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 10, s. 258- Tidskriftsartikel (refereegranskat)abstract Background: The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment option for peritoneal carcinomatosis (PC). There have been few studies on the pulmonary adverse events (AEs) affecting patient recovery after this treatment, thus this study investigated these factors. Methods: Between January 2005 and December 2006, clinical data on all pulmonary AEs and the recovery progress were reviewed for 76 patients with after CRS and HIPEC. Patients with pulmonary interventions (thoracocenthesis and chest tubes) were compared with the non-intervention patients. Two senior radiologists, blinded to the post-operative clinical course, separately graded the occurrence of pulmonary AEs. Results: Of the 76 patients, 6 had needed thoracocentesis and another 6 needed chest tubes. There were no differences in post-operative recovery between the intervention and non-intervention groups. The total number of days on mechanical ventilation, the length of stay in the intensive care unit, total length of hospital stay, tumor burden, and an American Society of Anesthesiologists (ASA) grade of greater than 2 were correlated with the occurrence of atelectasis and pleural effusion. Extensive atelectasis (grade 3 or higher) was seen in six patients, major pleural effusion (grade 3) in seven patients, and signs of heart failure (grade 1-2) in nine patients. Conclusions: Clinical and radiological post-operative pulmonary AEs are common after CRS and HIPEC. However, most of the pulmonary AEs did not affect post-operative recovery.
4.	Beets-Tan, Regina G. H., et al. (författare) Magnetic resonance imaging for the clinical management of rectal cancer patients : recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting 2013 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 23:9, s. 2522-2531 Tidskriftsartikel (refereegranskat)abstract To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by a parts per thousand yen 80 % consensus) or uncertain (defined by < 80 % consensus). Items not reaching 80 % consensus were noted. Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. These guidelines recommend standardised imaging for staging and restaging of rectal cancer. The guidelines were constructed through consensus amongst 14 abdominal imaging experts. Consensus was reached by in 88 % of 236 items discussed.
5.	Cashin, Peter H., et al. (författare) Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases : A randomised trial 2016 Ingår i: European Journal of Cancer. - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 53, s. 155-162 Tidskriftsartikel (refereegranskat)abstract Background: First-line treatment of isolated resectable colorectal peritoneal metastases remains unclear. This study (the Swedish peritoneal study) compares cytoreductive surgery and intraperitoneal chemotherapy (surgery arm) with systemic chemotherapy (chemotherapy arm). Methods: Patients deemed resectable preoperatively were randomised to surgery and intraperitoneal 5-fluorouracil 550 mg/m(2) /d for 6 d with repeated courses every month or to systemic oxaliplatin and 5-fluorouracil regimen every second week. Both treatments continued for 6 months. Primary end-point was overall survival (OS) and secondary end-points were progression-free survival (PFS), and morbidity. Results: The study terminated prematurely when 48 eligible patients (24/arm) were included due to recruitment difficulties. Two-year OS was 54% in the surgery arm and 38% in the chemotherapy arm (p = 0.04). After 5 years, 8 versus 1 patient were alive, respectively (p = 0.02). Median OS was 25 months versus 18 months, respectively, hazard ratio 0.51 (95% confidence interval: 0.27-0.96, p = 0.04). PFS in the surgery arm was 12 months versus 11 months in the chemotherapy arm (p = 0.16) with 17% versus 0% 5-year PFS. Grade III-IV morbidity was seen in 42% and 50% of the patients, respectively. No mortalities. Conclusions: Cytoreductive surgery with intraperitoneal chemotherapy may be superior to systemic oxaliplatin-based treatment of colorectal cancer with resectable isolated peritoneal metastases.(ClinicalTrials. gov nr: NCT01524094).
6.	Darkeh, M. H. S. E., et al. (författare) The minimum number of target lesions that need to be measured to be representative of the total number of target lesions (according to RECIST) 2009 Ingår i: British Journal of Radiology. - : British Institute of Radiology. - 0007-1285 .- 1748-880X. ; 82:980, s. 681-6 Tidskriftsartikel (refereegranskat)abstract Response evaluation criteria in solid tumours (RECIST) were introduced as a means to classify tumour response with no definition of the minimum number of lesions. This study was conducted in order to evaluate discrepancies between full assessments based on either all target lesions or fewer lesions. RECIST evaluation was performed on separate occasions based on between one and seven of the target lesions, with simultaneous assessment of non-target lesions. 99 patients were included. 38 patients demonstrated progressive disease, in 61% of whom it was a result of the appearance of new lesions or unequivocal progress in non-target lesions. 32 patients showed stable disease, with 8 having results that differed when 1-3 target lesions were measured. 22 cases were considered as having partial regression, with only 1 case differing when performing 1-3 target lesion assessments. Seven cases demonstrated complete response. The number of discordant cases increased gradually from measuring three lesions to one target lesion. The average number of available target lesions among those with discrepancies was 7.1, which was significantly higher than those demonstrating concordance (4.1 lesions; p<0.05). In conclusion, measuring fewer than four target lesions might cause discrepancies when more than five target lesions are present.
7.	Grevfors, Niklas, et al. (författare) Can acute abdominal CT prioritise patients with suspected diverticulitis for a subsequent clean colonic examination? 2012 Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 14:7, s. 893-896 Tidskriftsartikel (refereegranskat)abstract Aim: The aim of this study was to investigate whether patients with diverticulitis can be prioritised with higher urgency for a subsequent full colonic examination based upon the emergency abdominal computerised tomography (CT) at the time of presentation.Method: All patients with a diagnosis of diverticulitis hospitalized during 2006 having CT on admission and a subsequent 'clean colon' examination were reviewed. The CT was reviewed by two independent and blinded senior radiologists (A and B) for signs inconsistent with diverticulitis and suggestive of malignancy. The patients were classified on CT into group 1 (normal findings, non-tumour pathology or benign polyps < 1 cm) and group 2 (benign polyps ≥ 1 cm and cancer).Results: 93 patients were reviewed with 83 in group 1and 10 in group 2. Radiologist A suggested high priority colonic examination in 18% and 50% of groups 1 and 2, and Radiologist B in 63% and 90%. There was a statically significant inter-observer difference and also lower accuracy of Radiologist B than Radiologist A in predicting a subsequent 'clean colon' examination.Conclusion: Using an emergency acute CT scan at the time of diagnosis of diverticulitis to predict a clean colon examination for neoplasia is not reliable since there is considerable degree of inter-observer difference between rediologista.
8.	Latifi, Ali, et al. (författare) Does enteral contrast increase the accuracy of appendicitis diagnosis? 2011 Ingår i: Radiologic Technology. - 0033-8397 .- 1943-5657. ; 82:4, s. 294-299 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Several approaches traditionally have helped opacify the bowel when computed tomography (CT) is used to diagnose appendicitis. With the development of multidetector row CT (MDCT), the need for enteral contrast agents is less obvious. Purpose The objective of this study was to evaluate retrospectively the accuracy of MDCT demonstration of appendicitis using enteral contrast agents. METHODS: We reviewed radiologic reports of all 246 adult patients with suspected appendicitis who underwent 16-slice MDCT during 2005-2006 at our department. The use of enteral contrast agents and the route of administration were documented by one investigator. A radiologist evaluated whether the responses in the reports were consistent with diagnosis of appendicitis. The accuracy of the radiologic reports was assessed using the results of surgery, histopathology and 3 to 21 months of follow-up. RESULTS: Of patients studied, 14.6% received no enteral contrast agent, 8.5% received both oral contrast and rectal contrast (enema), 46.7% received oral contrast and 30.1% received rectal contrast enemas. The accuracies for the CT diagnosis of appendicitis with different combinations of agents ranged from 95% to 100%, with no significant difference among groups. CONCLUSION: Our study shows that the accuracy for diagnosis of appendicitis by abdominal 16-slice MDCT is high regardless of enteral contrast use. Therefore, further use of enteral contrast agents for CT diagnosis of appendicitis in adults cannot be recommended.
9.	Påhlman, Lars, et al. (författare) Rectal cancer staging : is there an optimal method? 2011 Ingår i: Future Oncology. - 1479-6694. ; 7:1, s. 93-100 Forskningsöversikt (refereegranskat)abstract The staging process in a newly diagnosed rectal cancer is divided into three parts. One essential part is the local staging, in which both endorectal ultrasound and MRI are used to disclose the size of the tumor and its correlation to the perirectal fascia, and to identify lymph node deposits and vascular invasion. This local staging process will guide clinicians to decide upon not only the type of surgery (local excision or radical surgery) but also whether or not some type of neoadjuvant treatment, such as radiotherapy and/or chemotherapy, is indicated. The second part is to evaluate whether or not the tumor has already metastasized at diagnosis. The most important organs to evaluate are the liver and lungs, and imaging techniques such as ultrasound. CT-scan, or sometimes PET-CT, and MRI can be used. The third important part is to investigate the rest of the large bowel for synchronous adenomas or cancers. This will preferably be done with colonoscopy or CT-colonography and sometimes barium enema. This article discusses the imaging techniques used for local staging and distant metastases.
10.	Suzuki, Chikako, et al. (författare) Interobserver and intraobserver variability in the response evaluation of cancer therapy according to RECIST and WHO-criteria 2010 Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 49:4, s. 509-514 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Response Evaluation Criteria In Solid Tumors (RECIST) and WHO-criteria are used to evaluate treatment effects in clinical trials. The purpose of this study was to examine interobserver and intraobserver variations in radiological response assessment using these criteria.MATERIAL AND METHODS: Thirty-nine patients were eligible. Each patient's series of CT images were reviewed. Each patient was classified into one of four categories according RECIST and WHO-criteria. To examine interobserver variation, response classifications were independently obtained by two radiologists. One radiologist repeated the procedure on two additional different occasions to examine intraobserver variation. Kappa statistics was applied to examine agreement.RESULTS: Interobserver variation using RECIST and WHO-criteria were 0.53 (95% CI 0.33-0.72) and 0.60 (0.39-0.80), respectively. Response rates (RR) according to RECIST obtained by reader A and reader B were 33% and 21%, respectively. RR according to WHO-criteria obtained by reader A and reader B were 33% and 23% respectively. Intraobserver variation using RECIST and WHO-criteria ranged between 0.76-0.96 and 0.86-0.91, respectively.CONCLUSION: Radiological tumor response evaluation according to RECIST and WHO-criteria are subject to considerable inter- and intraobserver variability. Efforts are necessary to reduce inconsistencies from current response evaluation criteria.
11.	Suzuki, Chikako, et al. (författare) Radiologic measurements of tumor response to treatment : practical approaches and limitations 2008 Ingår i: Radiographics. - : Radiological Society of North America (RSNA). - 0271-5333 .- 1527-1323. ; 28:2, s. 329-44 Tidskriftsartikel (refereegranskat)abstract Objective response assessment is important to describe the treatment effect of anticancer drugs. Standardization by using a "common language" is also important for comparison of results from different trials. In contrast to clinical results, which can be subjective, diagnostic imaging provides a greater opportunity for objectivity and standardization. It was generally accepted that a decrease in tumor size correlated with treatment effect; as a result, imaging was adopted for lesion measurement in the World Health Organization (WHO) criteria in 1979. However, because of some limitations of the WHO criteria, the Response Evaluation Criteria in Solid Tumors (RECIST) were introduced in 2000. In RECIST, imaging was recognized as indispensable for response evaluation of solid tumors. Nevertheless, the widespread use of multidetector computed tomography and other imaging innovations have made RECIST outdated, with a concomitant need for modifications. Meanwhile, newer anticancer agents with targeted mechanisms of action have demonstrated an inherent limitation and unsuitability of anatomic tumor evaluation that assesses only lesion size. In addition, the effect of these new drugs changes the paradigm according to which tumor response or response rate is measured. Complete and partial responses cannot be the end points in all clinical trials; in some cases, disease control or progression-free survival may be the more relevant end point.
12.	Suzuki, Chikako, et al. (författare) The importance of rectal cancer MRI protocols on interpretation accuracy 2008 Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 6, s. 89- Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Magnetic resonance imaging (MRI) is used for preoperative local staging in patients with rectal cancer. Our aim was to retrospectively study the effects of the imaging protocol on the staging accuracy. PATIENTS AND METHODS: MR-examinations of 37 patients with locally advanced disease were divided into two groups; compliant and noncompliant, based on the imaging protocol, without knowledge of the histopathological results. A compliant rectal cancer imaging protocol was defined as including T2-weighted imaging in the sagittal and axial planes with supplementary coronal in low rectal tumors, alongside a high-resolution plane perpendicular to the rectum at the level of the primary tumor. Protocols not complying with these criteria were defined as noncompliant. Histopathological results were used as gold standard. RESULTS: Compliant rectal imaging protocols showed significantly better correlation with histopathological results regarding assessment of anterior organ involvement (sensitivity and specificity rates in compliant group were 86% and 94%, respectively vs. 50% and 33% in the noncompliant group). Compliant imaging protocols also used statistically significantly smaller voxel sizes and fewer number of MR sequences than the noncompliant protocols CONCLUSION: Appropriate MR imaging protocols enable more accurate local staging of locally advanced rectal tumors with less number of sequences and without intravenous gadolinium contrast agents.
13.	Syk, Erik, et al. (författare) Local recurrence in rectal cancer : anatomic localization and effect on radiation target 2008 Ingår i: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier BV. - 0360-3016 .- 1879-355X. ; 72:3, s. 658-64 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To determine the sites of local recurrence after total mesorectal excision for rectal cancer in an effort to optimize the radiation target. METHODS AND MATERIALS: A total of 155 patients with recurrence after abdominal resection for rectal cancer were identified from a population-based consecutive cohort of 2,315 patients who had undergone surgery by surgeons trained in the total mesorectal excision procedure. A total of 99 cross-sectional imaging studies were retrieved and re-examined by one radiologist. The clinical records were examined for the remaining patients. RESULTS: Evidence of residual mesorectal fat was identified in 50 of the 99 patients. In 83 patients, local recurrence was identified on the imaging studies. All recurrences were within the irradiated volume if the patients had undergone preoperative radiotherapy or within the same volume if they had not. The site of recurrence was in the lower 75% of the pelvis, anatomically below the S1-S2 interspace for all patients. Only 5 of the 44 recurrences in patients with primary tumors >5 cm from the anal verge were in the lowest 20% of the pelvis. Six recurrences involved the lateral lymph nodes. CONCLUSION: These data suggest that a lowering of the upper limit of the clinical target volume could be introduced. The anal sphincter complex with surrounding tissue could also be excluded in patients with primary tumors >5 cm from the anal verge.
14.	Syk, Erik, et al. (författare) Radiological findings do not support lateral residual tumour as a major cause of local recurrence of rectal cancer 2006 Ingår i: British Journal of Surgery. - West Sussex, United Kingdom : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 93:1, s. 113-119 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract BACKGROUND: The aim of this study was to determine the sites of local recurrence following radical (R0) total mesorectal excision (TME) for rectal cancer in an effort to elucidate the reasons for recurrence. METHODS: Thirty-seven patients with recurrence following curative resection for rectal cancer were identified from a population of 880 patients operated on by surgeons trained in the TME procedure. Two radiologists independently examined 33 available computed tomograms and magnetic resonance images taken when the recurrence was detected. RESULTS: Twenty-nine of the 33 recurrences were found in the lower two-thirds of the pelvis. Two recurrent tumours appeared to originate from lateral pelvic lymph nodes. Evidence of residual mesorectal fat was identified in 15 patients. Fourteen of the recurrent tumours originated from primary tumours in the upper rectum; all of these tumours recurred at the anastomosis and 12 of the 14 patients had evidence of residual mesorectal fat. CONCLUSION: Lateral pelvic lymph node metastases are not a major cause of local recurrence after TME. Partial mesorectal excision may be associated with an increased risk of local recurrence from tumours in the upper rectum.
15.	Taylor, Fiona G M, et al. (författare) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone : a prospective, multicenter, European study 2011 Ingår i: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 253:4, s. 711-719 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)-predicted good prognosis tumors treated by surgery alone. BACKGROUND: The MERCURY study reported that high-resolution MRI can accurately stage rectal cancer. The routine policy in most centers involved in the MERCURY study was primary surgery alone in MRI-predicted stage II or less and in MRI "good prognosis" stage III with selective avoidance of neoadjuvant therapy. PATIENTS AND METHODS: Data were collected prospectively on all patients included in the MERCURY study who were staged as MRI-defined "good" prognosis tumors. "Good" prognosis included MRI-predicted safe circumferential resection margins, with MRI-predicted T2/T3a/T3b (less than 5 mm spread from muscularis propria), regardless of MRI N stage. None received preoperative or postoperative radiotherapy. Overall survival, disease-free survival, and local recurrence were calculated. RESULTS: Of 374 patients followed up in the MERCURY study, 122 (33%) were defined as "good prognosis" stage III or less on MRI. Overall and disease-free survival for all patients with MRI "good prognosis" stage I, II and III disease at 5 years was 68% and 85%, respectively. The local recurrence rate for this series of patients predicted to have a good prognosis tumor on MRI was 3%. CONCLUSIONS: The preoperative identification of good prognosis tumors using MRI will allow stratification of patients and better targeting of preoperative therapy. This study confirms the ability of MRI to select patients who are likely to have a good outcome with primary surgery alone.
16.	Thorisson, Arnar, et al. (författare) Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT 2020 Ingår i: BJS Open. - : John Wiley & Sons. - 2474-9842. ; 4:4, s. 659-665 Tidskriftsartikel (refereegranskat)abstract Purpose: To evaluate the diagnostic accuracy of non-enhanced low-dose computed tomography (LDCT) in acute colonic diverticulitis with contrast-enhanced standard-dose CT (SDCT) as the reference method.Materials and Methods: Consecutive patients with clinically suspected diverticulitis were included from two hospitals between January and October 2017. All patients underwent LDCT followed by SDCT. All CT examinations were assessed for signs of diverticulitis, complications, and other diagnoses by three independent radiologists (two radiology consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity, specificity, and agreement were calculated.Results: In total, 149 patients (median age 68, 107 women) were included; 107 had diverticulitis on standard CT. Sensitivity for diverticulitis using LDCT was 100%; the values were 99% for consulting radiologists and 92% for the radiology resident. Specificity was 100% for both consultants and 84% for the resident. Sensitivity for identification of complications was 74%, 60%, and 54%, respectively. Twenty-six patients had other causes of abdominal symptoms on standard CT, 23 (88%) of whom were diagnosed correctly on LDCT. One case of splenic infarction and two cases of segment colitis were missed on LDCT.Conclusion: The diagnostic accuracy of LDCT was high for acute diverticulitis. Therefore, it is recommended as a standard method that should help to reduce radiation dose and cost. LDCT had lower sensitivity for complications, although discrimination between an inflamed diverticulum and small pericolic abscess accounted for a proportion of the discrepancies.
17.	Torkzad, Michael, et al. (författare) Comparison between MRI and CT in prediction of peritoneal carcinomatosis index (PCI) in patients undergoing cytoreductive surgery in relation to the experience of the radiologist 2015 Ingår i: Journal of Surgical Oncology. - : Wiley. - 0022-4790 .- 1096-9098. ; 111:6, s. 746-751 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:To compare CT and MRI for peritoneal carcinomatosis index (PCI) assessment and to compare assessments made by the radiologist based on their experiences.METHOD AND MATERIALS:MRI and CT of abdomen and pelvis were performed on 39 prospectively followed by surgery directly. Two blinded radiologists with different experience levels evaluated PCI separately on different occasions on 19 cases initially and later on the remaining 20. The agreement between the radiologists' assessment and surgical findings in total and per site were recorded.RESULTS:Total PCI: The experienced radiologist was able to assess total tumor burden correctly on both CT and MRI (kappa = 1.0). For the inexperienced radiologist the assessment was better on CT (kappa = 0.73) compared to MRI (kappa = 0.58). Different sites: The experienced radiologist showed high agreement with kappa = 0.77 for MRI and 0.80 for CT. Corresponding figures were 0.39 and 0.60 for the inexperienced radiologist. For the second phase the agreement levels increased for the inexperienced radiologist increased to 0.80 and 0.70, respectively.CONCLUSION:CT and MRI are equal when read by experienced radiologist. CT shows better results when read by an inexperienced radiologist compared to MRI, however the results of the latter can easily be improved.
18.	Torkzad, Michael R. (författare) Abdominal and Pelvic Magnetic Resonance Imaging (MRI), the New Frontiers 2012 Ingår i: Current Medical Imaging Reviews. - : Bentham Science Publishers Ltd.. - 1573-4056. ; 8:2, s. 75-75 Tidskriftsartikel (refereegranskat)
19.	Torkzad, Michael R, et al. (författare) Comparison of different magnetic resonance imaging sequences for assessment of fistula-in-ano 2014 Ingår i: World Journal of Radiology. - : Baishideng Publishing Group Inc.. - 1949-8470. ; 6:5, s. 203-209 Tidskriftsartikel (refereegranskat)abstract AIM:To assess agreement between different forms of T2 weighted imaging (T2WI), and post-contrast T1WI in the depiction of fistula tracts, inflammation, and internal openings with that of a reference test.METHODS:Thirty-nine consecutive prospective cases were enrolled. The following sequences were used for T2WI: 2D turbo-spin-echo (2D T2 TSE); 3D T2 TSE; short tau inversion recovery (STIR); 2D T2 TSE with fat saturation performed in all patients. T1WI were either a 3D T1-weighted prepared gradient echo sequence with fat saturation or a 2D T1 fat saturation [Spectral presaturation with inversion (SPIR)]. Agreement for each sequence for determination of fistula extension, internal openings, and the presence of active inflammation was assessed separately and blindly against a reference test comprised of follow-up, surgery, endoscopic ultrasound, and assessment by an independent experienced radiologist with access to all images.RESULTS:Fifty-six fistula tracts were found: 2 inter-sphincteric, 13 trans-sphincteric, and 24 with additional tracts. The best T2 weighted sequence for depiction of fistula tracts was 2D T2 TSE (Cohen's kappa = 1.0), followed by 3D T2 TSE (0.88), T2 with fat saturation (0.54), and STIR (0.19). Internal openings were best seen on 2D T2 TSE (Cohen's kappa = 0.88), followed by 3D T2 TSE (0.70), T2 with fat saturation (0.54), and STIR (0.31). Detection of inflammation showed Cohen's kappa of 0.88 with 2D T2 TSE, 0.62 with 3D T2 TSE, 0.63 with STIR, and 0.54 with T2 with fat saturation. STIR, 3D T2 TSE, and T2 with fat saturation did not make any contributions compared to 2D T2 TSE. Post-contrast 3D T1 weighted prepared gradient echo sequence with fat saturation showed better agreement in the depiction of fistulae (Cohen's kappa = 0.94), finding internal openings (Cohen's kappa = 0.97), and evaluating inflammation (Cohen's kappa = 0.94) compared to post-contrast 2D T1 fat saturation or SPIR where the corresponding figures were 0.71, 0.66, and 0.87, respectively. Comparing the best T1 and T2 sequences showed that, for best results, both sequences were necessary.CONCLUSION:3D T1 weighted sequences were best for the depiction of internal openings and active inflammatory components, while 2D T2 TSE provided the best assessment of fistula extension.
20.	Torkzad, Michael R., et al. (författare) Enterclysis versus enterography : the unsettled issue 2009 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 19:1, s. 90-91; discussion 92 Tidskriftsartikel (refereegranskat)
21.	Torkzad, Michael R., et al. (författare) Impact of COVID-19 on the incidence of CT-diagnosed appendicitis and its complications in the UK and Sweden 2022 Ingår i: International Journal of Colorectal Disease. - : Springer Nature. - 0179-1958 .- 1432-1262. ; 37:6, s. 1375-1383 Tidskriftsartikel (refereegranskat)abstract Aim To compare the number of appendicitis cases and its complications, during the first months of the COVID-19 pandemic in Sweden and the UK and the corresponding time period in 2019. Method Reports of emergency abdominopelvic CT performed at 56 Swedish hospitals and 38 British hospitals between April and July 2020 and a corresponding control cohort from 2019 were reviewed. Two radiologists and two surgeons blinded to the date of cohorts analyzed all reports for diagnosis of appendicitis, perforation, and abscess. A random selection of cases was chosen for the measurement of inter-rater agreement. Result Both in Sweden (6111) and the UK (5591) fewer, abdominopelvic CT scans were done in 2020 compared to 2019 (6433 and 7223, respectively); p < 0.001. In the UK, the number of appendicitis was 36% lower in April-June 2020 compared to 2019 but not in Sweden. Among the appendicitis cases, there was a higher number of perforations and abscesses in 2020, in Sweden. In the UK, the number of perforations and abscesses were initially lower (April-June 2020) but increased in July 2020. There was a substantial inter-rater agreement for the diagnosis of perforations and abscess formations (K = 0.64 and 0.77). Conclusion In Sweden, the number of appendicitis was not different between 2019 and 2020; however, there was an increase of complications. In the UK, there was a significant decrease of cases in 2020. The prevalence of complications was lower initially but increased in July. These findings suggest variability in delay in diagnosis of appendicitis depending on the country and time frame studied.
22.	Torkzad, Michael R., et al. (författare) Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy 2010 Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 126:2, s. 107-112 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Pelvic deep vein thrombosis (DVT) is difficult to diagnose during pregnancy. In a two-center trial, we evaluated the agreement between ultrasonography and magnetic resonance imaging (MRI) in diagnosing the extent of DVT into the pelvic veins during pregnancy. MATERIALS AND METHODS: Pregnant women with proximal DVT were examined both with ultrasound and MRI as part of a study designed for treatment of DVT during pregnancy. Ultrasound was performed using color flow by specialist in vascular ultrasound with Doppler and compression techniques. The MRI sequences consisted of a 2D Time of Flight angiography with arterial flow suppression and maximum intensity projection reconstructions; a 3D, T1-w-prepared gradient echo sequence with fat saturation for thrombus imaging; a steady-state free precession sequence; and a Turbo-Spin-Echo. No contrast agent was used. Proportion of agreement (kappa) for detection of DVT in individual veins was measured for different ipsilateral veins and inferior vena cava. RESULTS: All 27 patients were imaged with both techniques at an average gestational age of 29 weeks (range 23-39). Three cases (11.5%) of DVT in the pelvic veins were missed on ultrasound but detected by MRI. The upper limit of the DVT was always depicted at a higher (20 cases, 65.4%) or the same level (seven cases, 34.6%) on MRI than on ultrasound. Agreement expressed as kappa was 0.33 (95% CI 0.27-0.40) demonstrating only fair agreement. In one woman the thrombus had propagated into the inferior vena cava, shown only on MRI. CONCLUSION: Our study suggests that in pregnant women there is only fair agreement between ultrasound and MRI for determination of extent of DVT into pelvic veins, with MRI showing consistently more detailed depiction of extension. Our results indicate that MRI has an important role as a complementary technique in the diagnosis of DVT during pregnancy.
23.	Torkzad, Michael R., et al. (författare) Magnetic resonance imaging (MRI) in rectal cancer : a comprehensive review 2010 Ingår i: Insights into Imaging. - : Springer Science and Business Media LLC. - 1869-4101. ; 1:4, s. 245-267 Tidskriftsartikel (refereegranskat)abstract Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience.
24.	Torkzad, Michael R., et al. (författare) Magnetic Resonance Imaging of Rectal and Anal Cancer 2014 Ingår i: Magnetic Resonance Imaging Clinics of North America. - : Elsevier BV. - 1064-9689. ; 22:1, s. 85- Tidskriftsartikel (refereegranskat)abstract Magnetic resonance imaging plays a pivotal role in the imaging and staging of rectal and anal carcinomas. Rectal adenocarcinomas and anal squamous cell carcinomas behave differently, and are staged and treated differently. This article attempts to explain these 2 entities, which share the same regions of interest, in a comprehensive manner.
25.	Torkzad, Michael R (författare) Magnetic resonance imaging of rectum : diagnostic and therapy related aspects 2006 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Papers I-II: The purpose of paper 1 was to assess the size and configuration of the perirectal fatty tissues (PF) using magnetic resonance imaging (MRI). In 25 subjects the volume and cross-sectional parameters based on the amount of PF to different sides of die rectum, and the total area occupied were retrospectively measured on MRI. There was a good correlation between anteroposterior diameter of the PF at four centimeter below S 1-2 (and the left-to-right diameter seven centimeter below S 1-2), and mesorectal volume (NW). Furthermore, the form of PF differed significantly between male and female subjects. In paper II, we analyzed the influence of MV on the accuracy of the first preoperative MRI. 267 patients with rectal cancer had their MV measured without knowledge of the prospective evaluations by the radiologist or the pathologist, and the discrepancies in the results were correlated to the MV and clinical data. T- or N-staging accuracy by MRI did not significantly correlate to MV. The difference between assessment by radiologist and pathologist did not differ based on MV. Finally patients with larger MV did not have fewer cases with involvement of mesorectal fascia (MF) or involvement of neighboring organs. Thus, MV does not appear to affect the locoregional prognostic factors, nor is it able to explain the difference in evaluation between the radiologist and pathologist. Papers III-IV: In paper III we tried to find out if the tumor size on MRI in patients without preoperative radiotherapy correlates to the corresponding pathologic findings. 18 patients were included. The tumor size was measured on MR and histopathologic specimen. Regression curves showed best correlations for area (r2=0.75) and volume (r2=0.65-0.82). With the formula proposed from this material, we assume that rectal tumors can be measured on MR images using a metric model, and then extrapolated to what we would expect from pathology, hence providing us with a tool where we could measure tumor response after neoadjuvant therapy. In paper IV, we used these tools to evaluate changes after radiotherapy and correlation between MRI and histopathology. RVs was defined as the residual pathologic tumor volume while RVm was similarly defined as the residual MRI tumor volume at 2 nd MRI. 25 patients with MRI before and after radiotherapy were included. The second MRI was not more accurate than the initial MRI for assessment of the T-stage or distance to circumferential resection margin (CRM). RVm showed significant correlation to RVs and pathologic T-stage. A 2 nd MRI alone after radiotherapy with delay before surgery has limited value in understanding the individual response to therapy, but followup volumetry can be helpful to understand which tumors have responded. Paper V: The aim of this study was to determine the sites of local recurrence (LR) following radical total mesorectal excision (TME) for rectal cancer in an effort to elucidate the reasons for recurrence. 33 CT and MRI of 37 patients with LR were examined. 29 LR were found in the lower two-thirds of the pelvis, with two appearing to originate from lateral pelvic lymph nodes (LN). Evidence of residual PF was identified in 15 patients. 14 of the LR originated from primary tumors in the upper rectum and 12 of them with evidence of residual PF. Lateral pelvic LN metastases are not a major cause of LR after TME. Partial mesorectal excision may be associated with an increased risk of LR from tumors in the upper rectum.
26.	Torkzad, Michael R, et al. (författare) Manifestations of small bowel disease in pediatric Crohn's disease on magnetic resonance enterography 2012 Ingår i: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1078-0998 .- 1536-4844. ; 18:3, s. 520-528 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: We report the manifestations of Crohn's disease (CD) observed on magnetic resonance enterography (MRE) in a pediatric population at the time of CD diagnosis. METHODS: MRE of 95 consecutive pediatric patients with inflammatory bowel disease (IBD) examined in 2006-2009 were retrospectively analyzed, with documentation of findings based on type and location of the small bowel (SB) disease. RESULTS: In all, 51 were boys and 44 girls. 54 had CD, 31 non-CD IBD, and 10 no IBD. The most common site of SB involvement in CD was the terminal ileum seen in 29 (53.7%) patients, followed by ileum in 10 (18.5%) and jejunum in 9 (16.7%) patients. Solitary jejunal inflammation (3.7%), SB stenoses (1.9%), fistula formation (0.95%), and abscess (0.95%) were much less common. Perienteric lymphadenopathy was seen in 30 (55.6%) patients and fatty proliferation in 9 (16.7%). The most common manifestation of SB inflammation was increased contrast enhancement of bowel wall (93.5%), thickening of the bowel wall (90.3%), and derangement of bowel shape with saccular formations (25.8%). CONCLUSIONS: MRE in the pediatric population often demonstrates increased contrast uptake, bowel wall thickening, and perienteral lymphadenopathy in CD. More chronic small bowel changes seen commonly in adults and solitary jejunal involvements are less commonly seen.
27.	Torkzad, Michael R., 1968-, et al. (författare) Morphological assessment of the interface between tumor and neighboring tissues, by magnetic resonance imaging, before and after radiotherapy in patients with locally advanced rectal cancer 2008 Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 49:10, s. 1099-103 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Magnetic resonance imaging (MRI) in rectal cancer is sometimes performed after radiotherapy (MRI 2) to evaluate tumor response and to choose alternative forms of surgery. The accuracy of MRI 2 in distinguishing tumor delineation might be difficult due to fibrosis. PURPOSE: To evaluate the morphological changes in the interface between the tumor and neighboring organs on MRI 2 performed after radiotherapy, and to assess the accuracies of MRI before and after radiotherapy compared to histopathology after surgery. MATERIAL AND METHODS: Sixteen patients with locally advanced primary rectal cancer, with MRI before and after radiotherapy, were retrospectively studied, concerning the interface between the tumor and neighboring structures. The accuracies of MRI before and after radiotherapy were compared based on histopathology as a reference. RESULTS: The accuracies of both MRI before and after radiotherapy were moderate, with no additional value of MRI after radiotherapy compared to MRI before radiotherapy. The most predictive form of interface for involvement of a neighboring organ after radiotherapy was nodular growth of the tumor into a neighboring structure. CONCLUSION: The morphological assessment of pelvic MRI after preoperative radiotherapy does not provide any significant new information about tumor extent in patients with locally advanced rectal cancer.
28.	Torkzad, Michael R., et al. (författare) MRI after preoperative radiotherapy for rectal cancer; correlation with histopathology and the role of volumetry. 2007 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 17:6, s. 1566-1573 Tidskriftsartikel (refereegranskat)abstract The objective is to assess if tumor size after radiotherapy in patients with rectal cancer can be assessed by a second magnetic resonance imaging (MRI), after radiotherapy prior to surgery and to correlate changes observed on MRI with findings at histopathology at surgery. Twenty-five patients with MRI before and after radiotherapy were included. Variables studied were changes in tumor size, T-staging and distance to the circumferential resection margin (CRM). RVs was measured as tumor volume at surgery (Vs) divided by tumor volume at the initial MRI (Vi) in percent. RVm was defined as the tumor volume at the second MRI (Vm) divided by Vi in percent. The ypT-stage was the same or more favorable than the initial MRI T-stage in 24 of 25 patients. The second MRI was not more accurately predictive than the initial MRI for ypT-staging or distance to CRM (p > 0.05). Vm correlated significantly to Vs, as did RVs to RVm, although the former was always smaller than the latter. Vm and RVm correlated well with ypT-stage (p < 0.001). Volumetry seems to correlate with ypT-stage after preoperative radiotherapy for resectable rectal cancer. The value of a second MRI after radiotherapy for assessment of distance to CRM and ypT-staging is, however, not apparent.
29.	Torkzad, Michael R., et al. (författare) MRI for assessment of anal fistula 2010 Ingår i: Insights into Imaging. - : Springer Science and Business Media LLC. - 1869-4101. ; 1:2, s. 62-71 Tidskriftsartikel (refereegranskat)abstract Magnetic resonance imaging (MRI) is the best imaging modality for preoperative assessment of patients with anal fistula. MRI helps to accurately demonstrate disease extension and predict prognosis. This in turn helps make therapy decisions and monitor therapy. The pertinent anatomy, fistula classification and MRI findings will be discussed.
30.	Torkzad, Michael R. (författare) Nyheter inom lever-MRT 2011 Annan publikation (övrigt vetenskapligt/konstnärligt)
31.	Torkzad, Michael R., et al. (författare) Significance of mesorectal volume in staging of rectal cancer with magnetic resonance imaging and the assessment of involvement of the mesorectal fascia 2007 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 17:7, s. 1694-1699 Tidskriftsartikel (refereegranskat)abstract The aim was to study the influence of mesorectal volume, as estimated by magnetic resonance imaging (MRI), that is to be removed during total mesorectal excision (TME), on the accuracy of the first preoperative MRI of rectal cancer compared to histopathology, and its correlation to locoregional prognostic factors. A total of 267 rectal cancer patients from a multinational study (MERCURY or MRI equivalence study) had their mesorectal volume retrospectively estimated by researchers without knowledge of the assessments made by the radiologist or the pathologist. The evaluations made by the pathologist and the radiologist were then compared, including T- and N-staging, assessment of extent of extramural tumor invasion (the largest portion of the tumor beyond the muscularis propria or EMI) and distance to mesorectal fascia; the discrepancies in the results were correlated to the mesorectal volume. T- or N-staging accuracy by MRI and the difference between the EMI as measured by the pathologist and the radiologist were not dependent on individual mesorectal volume. There was no correlation between assessment of involvement of mesorectal fascia or local neighboring organs by MRI and histopathology with mesorectal volume. Mesorectal volume does not affect locoregional prognostic factors or the accuracy of local staging of rectal cancer.
32.	Torkzad, Michael R., et al. (författare) Stereology : a novel technique for rapid assessment of liver volume 2012 Ingår i: Insights into Imaging. - : Springer Science and Business Media LLC. - 1869-4101. ; 3:4, s. 387-393 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:The purpose of this study was to test the stereology method using several grid sizes for measuring liver volume and to find which grid provides an accurate estimate of liver volume.MATERIALS AND METHODS:Liver volume was measured by volumetry in 41 sets of liver MRI. MRI was performed before and after different weight-reducing regimens. Grids of 3, 4, 5, and 6 cm were used to measure liver volume on different occasions by stereology. The liver volume and the changes in volume before and after treatment were compared between stereology and volumetry.RESULTS:There was no significant difference in measurements between stereology methods and volumetry (p > 0.05). The mean differences in liver volume between stereology based on 3-, 4-, 5-, and 6-cm grids and volumetry were 37, 3, 132, and 23 mL, respectively, and the differences in measurement of liver volume change were 21, 2, 19, and 76 mL, respectively. The mean time required for measurement by stereology was 59-190 s.CONCLUSION:Stereology employing 3- and 4-cm grids can rapidly provide accurate results for measuring liver volume and changes in liver volume.MAIN MESSAGES:• Statistical methods can be used for measuring area/volume in radiology.• Measuring liver volume by stereology by 4-cm grids can be done in less than two minutes.• Follow-up of liver volume is highly accurate with stereological methods.
33.	Torkzad, Michael R., et al. (författare) The Clinical Perspective on Value of 3D, Thin Slice T2-Weighted Images in 3T Pelvic MRI for Tumors 2012 Ingår i: Current Medical Imaging Reviews. - : Bentham Science Publishers Ltd.. - 1573-4056. ; 8:2, s. 76-81(6) Tidskriftsartikel (refereegranskat)abstract Pelvic imaging is undergoing rapid changes due to increased use of 3-Tesla (3T) magnetic resonance imaging (3T MRI). One of the advantages of 3T could be the possibility for thin section 3-dimensional (3D) imaging which could improve accuracy and at the same time reduce the need for multi-planar imaging needed for conventional T2 imaging (TSE). In the following text we review the advantages of 3D thin section imaging for assessment of pelvic tumors.
34.	Torkzad, Michael R., et al. (författare) Value of cine MRI for better visualization of the proximal small bowel in normal individuals 2007 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 17:11, s. 2964-2968 Tidskriftsartikel (refereegranskat)abstract While enteroclysis seems to be the most efficacious method in achieving bowel distension, enterographic methods have become widespread due to the unpleasantness of enteroclysis and the radiation involved with positioning the catheter. Cine images in MRI can be done without radiation. Our aim is to see if and how cine MR imaging can improve visualization of bowel loops by capturing them while distended. Ten healthy individuals were asked to drink up to 2,000 ml of an oral solution made locally over a 60-min period. Then they underwent MRI using coronal balanced fast field echo (b-FFE) covering small bowel loops. If the initial exam revealed collapsed bowel loops an additional 50 mg of erythromycine was given intravenously with the subject still in the scanner and then cine imaging was performed. The degree of distension of different segments of the small bowel was measured before and after cine imaging and compared. The distension score was significantly higher after addition of the cine images as well, being only significant for depiction of the duodenum and jejunum. Our preliminary study suggests that cine MRI can give better image depiction of the proximal small bowel in healthy volunteers, perhaps circumventing the need for enteroclysis in some cases. There is a need for validation of these results in patients with small bowel disease.

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