The edition · Radiology
RECIST struggles to restage pancreatic cancer after chemotherapy, pneumonitis prediction models are not ready, and image quality shapes bladder MRI accuracy
A scoping review finds no CT or PET restaging method reliably tracks resectability and survival in pancreatic cancer after systemic therapy, a meta-analysis of models predicting checkpoint inhibitor pneumonitis finds little external validation, and a retrospective study ties VI-RADS accuracy in small tumours to scan quality.
The edition in brief
A scoping review of 20 studies (15 CT, 5 PET/CT) of restaging localized pancreatic ductal adenocarcinoma after systemic therapy found inconsistent associations between imaging methods and R0 resection or survival; no method was consistently associated with both, and RECIST 1.1 was least reliable for partial response and stable disease. A meta-analysis of 12 models predicting checkpoint inhibitor pneumonitis in lung cancer (4,875 patients, 1,057 events) pooled a validation C-statistic of 0.82 (95% CI 0.75-0.88) with high heterogeneity (I-squared 90.7%) and a 95% prediction interval of 0.51 to 0.95; only two studies had external validation, certainty was low, and the authors judge the models unready for clinical use. The DENSE-2 report describes a Dutch randomised trial comparing contrast-enhanced mammography and abbreviated MRI with mammography alone for women with extremely dense breasts and a negative mammogram; the abstract gives design but not results. A retrospective study of 587 bladder MRI examinations found substantial agreement on the VI-RADS quality score (kappa 0.628-0.702); in tumours under 3 cm, higher quality was associated with higher positive predictive value (51.0% vs 22.7%) and accuracy (81.6% vs 71.7%) at VI-RADS 3 or more.
No imaging method reliably restaged pancreatic cancer after systemic therapy in a 20-study scoping review
Report vascular contact and other imaging features explicitly after systemic therapy for pancreatic cancer, and leave resectability decisions to the multidisciplinary meeting.
Models predicting checkpoint inhibitor pneumonitis show promise but little external validation
Do not use pneumonitis prediction models for clinical decisions yet; they need external validation and calibration data.
DENSE-2 is testing contrast mammography and abbreviated MRI in extremely dense breasts
Wait for DENSE-2 outcome data before changing local supplemental screening for dense breasts.
Say when image quality limits the report
When image quality limits the report, say so and say what to do next.
Bladder MRI quality score was linked to better VI-RADS accuracy in small tumours
Consider recording the VI-RADS quality score and treating a low-quality scan of a small tumour as a reason for caution or repeat imaging.
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