Transarterial radioembolization (TARE) is a treatment option for patients with colorectal cancer liver metastases (mCRC). The CIRSE Registry for SIR-Spheres Therapy (CIRT, NCT02305459) was designed to evaluate the clinical outcomes of patients treated with TARE with SIR-Spheres Y-90 resin microspheres in primary and metastatic malignant liver tumours in the multi-institutional real-life clinical setting. The study, which included a large mCRC cohort, was conducted by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). CIRT was a European-wide, prospective, multi-centre, observational study which enrolled patients between Jan 2015 and Dec 2017. Eligible patients were adults treated with TARE with Y-90 resin microspheres for primary and metastatic malignant liver tumours. This analysis included a subset of the larger cohort – mCRC patients. Baseline characteristics and treatment-related data were collected. Follow-up data was collected every 3 months up to 24-month follow-up, including overall survival (OS), progression-free survival (PFS), hepatic progression free survival (hPFS), and safety data. 237 mCRC patients from 24 sites in 8 European countries were included in the analysis. Median age was 63 (range 31-86) and 62.0% were male. Median tumour to liver percentage was 8.9%. Median prescribed activity was 1.50 GBq for whole liver treatments (n=73), 1.20 GBq for right lobe treatments (n=147), and 0.70 GBq for left lobe treatments (n=104). 93.7% of the delivered activity was within 90% of the prescribed activity. Systemic therapy prior to TARE was administered in 95.4% of the patients (1 line 30.1%, 2-5 lines 46.4%, ≥6 lines 22.4%), while 36.3% received prior locoregional treatments, of which 76.7% were surgical and 31.4% ablative procedures. The investigator-assessed treatment intent was predominantly palliative (74.3%) or tumour downsizing (17.3%). Following TARE, 36.7% of the patients received further systemic treatment and 14.8% received locoregional treatments (surgery 28.6%, ablation 31.4%, trans-arterial chemoembolization 17.1%). Median OS was 9.8 months (95% CI 8.3-12.9), median PFS was 3.4 months (95% CI 3.1-4.1) and median hPFS was 4.2 months (95% CI 3.4-4.7). 40.1% of the patients experienced 197 adverse events, with 10 (4.1%) patients having a grade 3 or higher adverse events: abdominal pain 1.7%, nausea 0.4%, gastrointestinal ulceration 0.8%, gastritis 0.8%, radiation cholecystitis 0.4%. The results from this large, prospective, multi-centre, observational study shows that in the real-world context, patients with mCRC receive TARE in the palliative setting, with a small subgroup receiving further treatment after TARE. TARE is well tolerated with low occurrences of severe adverse events.

Die Autoimmunpankreatitis (AIP) ist eine seltene Erkrankung, deren Verständnis sich in den letzten Jahren deutlich vertieft hat. Die häufigste Form, die Typ-1-AIP, gehört zu den IgG4-assoziierten Erkrankungen, die viel seltenere Typ-2-AIP ist hiervon zu differenzieren und steht mit chronisch entzündlichen Darmerkrankungen in Verbindung. Bildgebend und klinisch besteht eine Überlappung zum Pankreaskarzinom. Aufgabe der Bildgebung und weiterer Parameter wie Serologie und Histologie ist es deshalb, eine Differenzierung zwischen den beiden Erkrankungsentitäten zu schaffen, um sie jeweils der adäquaten Therapie zuzuführen und die geringe, aber letztlich unnötige Anzahl an Pankreatektomien wegen einer AIP zu verhindern.

Autoimmune pancreatitis (AIP) is a rare disease, the pathophysiological understanding of which has been greatly improved over the last years. The most common form, type 1 AIP belongs to the IgG4-related diseases and must be distinguished from type 2 AIP, which is a much rarer entity associated with chronic inflammatory bowel disease. Clinically, there is an overlap with pancreatic cancer. Imaging and further criteria, such as serological and histological parameters are utilized for a differentiation between both entities in order to select the appropriate therapy and to avoid the small but ultimately unnecessary number of pancreatectomies.The diagnostics of AIP are complex, whereby the consensus criteria of the International Association of Pancreatology have become accepted as the parameters for discrimination. These encompass five cardinal criteria and one therapeutic criterion. By applying these criteria AIP can be diagnosed with a sensitivity of 84.9 %, a specificity of 100 % and an accuracy of 93.8 %.The diagnosis of AIP is accomplished by applying several parameters of which two relate to imaging. As for the routine diagnostics of the pancreas these are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Important for the differential diagnosis is the exclusion of signs of local and remote tumor spread for which CT and MRI are established. The essential diagnostic parameter of histology necessitates sufficient sample material, which cannot usually be acquired by a fine needle biopsy. CT or MRI are the reference standard methods for identification of the optimal puncture site and imaging-assisted (TruCut) biopsy.In patients presenting with unspecific upper abdominal pain, painless jaundice combined with the suspicion of a pancreatic malignancy in imaging but a mismatch of secondary signs of malignancy, AIP should also be considered as a differential diagnosis. As the diagnosis of AIP only partially relies on imaging radiologists also have to be aware of the clinical, serological and histological parameters for AIP in order to guide clinicians towards the correct diagnosis. Only in this way can the highly efficient steroid therapy be initiated and otherwise possibly severe forms of therapy be avoided.

To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents.

CLINICAL/METHODICAL ISSUE:Autoimmune pancreatitis (AIP) is a rare disease, the pathophysiological understanding of which has been greatly improved over the last years. The most common form, type 1 AIP belongs to the IgG4-related diseases and must be distinguished from type 2 AIP, which is a much rarer entity associated with chronic inflammatory bowel disease. Clinically, there is an overlap with pancreatic cancer. Imaging and further criteria, such as serological and histological parameters are utilized for a differentiation between both entities in order to select the appropriate therapy and to avoid the small but ultimately unnecessary number of pancreatectomies.PERFORMANCE:The diagnostics of AIP are complex, whereby the consensus criteria of the International Association of Pancreatology have become accepted as the parameters for discrimination. These encompass five cardinal criteria and one therapeutic criterion. By applying these criteria AIP can be diagnosed with a sensitivity of 84.9%, a specificity of 100% and an accuracy of 93.8%.ACHIEVEMENTS:The diagnosis of AIP is accomplished by applying several parameters of which two relate to imaging. As for the routine diagnostics of the pancreas these are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Important for the differential diagnosis is the exclusion of signs of local and remote tumor spread for which CT and MRI are established. The essential diagnostic parameter of histology necessitates sufficient sample material, which cannot usually be acquired by a fine needle biopsy. CT or MRI are the reference standard methods for identification of the optimal puncture site and imaging-assisted (TruCut) biopsy.PRACTICAL RECOMMENDATIONS:In patients presenting with unspecific upper abdominal pain, painless jaundice combined with the suspicion of a pancreatic malignancy in imaging but a mismatch of secondary signs of malignancy, AIP should also be considered as a differential diagnosis. As the diagnosis of AIP only partially relies on imaging radiologists also have to be aware of the clinical, serological and histological parameters for AIP in order to guide clinicians towards the correct diagnosis. Only in this way can the highly efficient steroid therapy be initiated and otherwise possibly severe forms of therapy be avoided.