ObjectivesTo evaluate the additional diagnostic benefit of diffusion weighted imaging (DWI) and contrast enhanced (CE) images during MR enterography (MRE) of Crohn's disease.MethodsDatasets 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. For each sequence block, sensitivity and specificity (readers combined) was calculated against an outcome-based construct reference standard.Results59/73 patients had small bowel disease. Per-patient sensitivity for disease detection was essentially identical (80 % [95 % CI 72, 86], 81 % [73,87], and 79 % [71,86] for T2^, T2 + DWI^and T2 + DWI + CE^respectively). Specificity was identical (82 % [64 to 92]). Per patient sensitivity for disease extent was 56 % (47,65), 56 % (47,65) and 52 % (43 to 61) respectively, and specificity was 82 % (64 to 92) for all blocks. Sensitivity for active disease was 97 % (90,99), 97 % (90,99) and 98 % (92,99), and specificity was also comparable between all sequence combination reads. Results were consistent across segments and newly diagnosed/relapse patients.ConclusionThere is no additional diagnostic benefit of adding either DWI or CE to T2 FSE and SSFP sequences for evaluating small bowel Crohn's disease, suggesting MRE protocols can be simplified safely.

Introduction: Pseudomyxoma peritonei (PMP) is a rare neoplastic disease that causes mucinous ascites or deposits in the peritoneal cavity. It is caused by a ruptured appendiceal mucinous neoplasm but can also be rarely caused by ovarian, urachus, or GI-related cancers. Symptoms can vary from asymptomatic to abdominal pain, ascites, weight loss, and digestive issues. Early diagnosis through CT or MRI is crucial. We present a rare case of advanced PMP caused by gastric adenocarcinoma. Case Description/Methods: A 66-year-old woman with a history of GERD presented to the hospital with 2 months of worsening abdominal pain, decreased appetite, and unintentional weight loss. Lab tests showed elevated ALP, CA 19-9, and CEA. Abdominal CT scan showed a lobulated liver with thin rim enhancement extending into porta hepatis with small nodular foci in the greater omentum consistent with PMP, completely encasing the liver. Evidence of gastric body thickening and periaortic and pericaval lymphadenopathy suggested gastric malignancy with intraperitoneal metastatic disease. The appendix was normal. GI was consulted. Patient underwent an IR-guided biopsy and EGD showing an 8 cm fungating, polypoid, and ulcerated partially circumferential mass. Gastric biopsies confirmed adenocarcinoma of the stomach. CT-guided liver biopsy in the perihepatic mass showed metastatic mucinous adenocarcinoma with signet ring cells consistent with metastatic disease. Oncology was consulted, and a chemotherapy port with plan for outpatient follow up with surgical oncology for PET/CT and debulking. Discussion: PMP has an incidence of 1-2 per million per year, more commonly affecting women, with a mean incidence age of 53. PMP is often found in appendiceal and ovarian tumors but rarely in digestive system tumors. PMP is caused by tumor rupture in the peritoneal cavity causing the spread of mucin-containing tumor cells or peritoneal metastasis of mucinous adenocarcinoma. Copious mucinous fluid gradually fills the peritoneal cavity, resulting in a “jelly belly” abdomen. Elevated tumor markers such as CEA, CA 19-9, and CA 125 indicate advanced disease. Diagnosis with CT or MRI shows low or proteinaceous attenuation ascites, liver scalloping, splenic margins, and peritoneal implants that cause extrinsic pressure on the bowel. Treatment is maximal cytoreduction surgery completed and chemotherapy. Few data for survival in gastric-origin PMP is available. However, without treatment, gastric-origin PMP has a median survival of 3 to 4 months.

Introduction: Commercial insecticides have excellent safety profiles. N, N-diethyl-meta-toluamide (DEET) is a repellent used since the 1950s and is metabolized by the liver and excreted in urine. DEET toxidrome ranges from GI upset to neurologic toxicity. However, liver injury is not a commonly attributed phenomenon. We present a rare case of liver injury associated with DEET exposure. Case Description/Methods: We present a 65 y/o man with a prior medical history of PUD, HTN, and HLD presented to the emergency department with 3 days of worsening epigastric abdominal pain, nausea, vomiting, and diarrhea. He reported inhalation of DEET while spraying a wasp's nest. Laboratory values revealed leukocytosis, elevated lactate, AST 5648, ALT 3300, ALP 123, total bilirubin 1.2, and INR 1.7. Computed tomography revealed esophagitis, atrophic pancreas, perinephric fat stranding, and hepatic steatosis. RUQ Doppler ultrasound revealed no evidence of portal vein thrombosis. Patient was started on IV antibiotics and pantoprazole. GI was consulted, patient was started on N-acetylcysteine, and patient's statin was discontinued. Further workup revealed normal acetaminophen, salicylate, and ceruloplasmin. Anti-smooth muscle antibody, anti-mitochondrial antibody, hepatitis viral panel, monospot, hemochromatosis, and urine drug screen were negative. Patient underwent an IR-guided liver biopsy which revealed severe subacute zone 3 necrosis, consistent with toxic etiology. An iron stain was negative, and no evidence of portal fibrosis with trichrome staining. The acute liver injury was attributed to pesticide toxicity. After three days, AST/ALT normalized, and patient's symptoms resolved with supportive treatment. The patient was discharged home with GI outpatient follow-up. Discussion: Many commercial wasp sprays contain permethrin or pyrethroid synthetics similar to DEET. The mechanism is similar to acetaminophen toxicity through molecule-induced oxidative stress through reactive oxygen species, leading to reduced glutathione levels. The constellation of GI symptoms are due to cholinergic excess seen in the DEET toxidrome. Given the temporal association with DEET exposure, symptom onset, and the liver biopsy findings, this patient's acute liver injury was likely secondary to DEET toxicity. Acute transaminitis is a unique presentation of intoxication of commercially available insecticides. While not classically associated with DEET or other insecticides, this case highlights a rare complication of pesticide exposure.

Abdominal MRI is critical for diagnosing a wide variety of diseases. However, due to respiratory motion and other organ motions, it is challenging to obtain motion-free and isotropic MRI for clinical diagnosis. Imaging patients with inflammatory bowel disease (IBD) can be especially problematic, owing to involuntary bowel movements and difficulties with long breath-holds during acquisition. Therefore, this paper proposes a deep adversarial super-resolution (SR) reconstruction approach to address the problem of multi-task degradation by utilizing cycle consistency in a staged reconstruction model. We leverage a low-resolution (LR) latent space for motion correction, followed by super-resolution reconstruction, compensating for imaging artefacts caused by respiratory motion and spontaneous bowel movements. This alleviates the need for semantic knowledge about the intestines and paired data. Both are examined through variations of our proposed approach and we compare them to conventional, model-based, and learning-based MC and SR methods. Learned image reconstruction approaches are believed to occasionally hide disease signs. We investigate this hypothesis by evaluating a downstream task, automatically scoring IBD in the area of the terminal ileum on the reconstructed images and show evidence that our method does not suffer a synthetic domain bias.

Introduction: Hepatic decompensation, such as ascites, HRS, variceal bleeding, is an important landmark in the natural history of cirrhosis. Ascites is often the first decompensation-defined event with significant effect on survival. Spontaneous bacterial peritonitis (SBP) is a common complication of ascites due to extraintestinal bacterial translocation and decreased host defenses. Diagnosis of SBP is defined as ascitic fluid cell count > 250/mm3. A diagnostic paracentesis should be performed as soon as a patent with cirrhosis and ascites is hospitalized emergently for any reason. Ascitic fluid culture is essential in the evaluation of SBP and should be performed before administrating the first dose of antibiotics. Methods: We conducted a retrospective, single center study including patients admitted to Parkview Health System in Pueblo, Colorado with suspected SBP over 1-year period (03/31/2022 - 04/01/2023). The primary endpoint was to assess the percentage of patients who underwent paracentesis prior to receiving antibiotics. A secondary endpoint was to assess the percentage of patients who received secondary SBP prophylaxis on discharge. All adult patients with history of cirrhosis and ascites hospitalized for a concern of SBP were included. Exclusion criteria were contraindications to paracentesis, or patients who had a failed attempt or declined paracentesis. A total of 25 patients were identified as potential participants. Results: 21 patients met the inclusion criteria and were included in the study. Out of those patients, 8 (38.1%) diagnostic paracentesis were done prior to receiving antibiotics, 10 (47.6%) done after, and 3 (14.3%) were not done. The mean time for paracentesis done after admission was 3.4 days. Out of the 18 patients who underwent paracentesis, 12 (66.7%) had a positive diagnosis of SBP, and 6 (33.3%) tested negative for SBP. Of those who tested positive for SBP, 3 (25%) were discharged on SBP prophylaxis, while 5 (41.7%) received no prophylactic antibiotics and 4 (33.3%) transitioned to comfort care. Conclusion: Our project aimed to improve adherence to current recommendations as this may affect immediate patient care and eventually overall prognosis. Many efforts were made in this regards such as multiple educational conferences. We also created an EMR order set for ascitic fluid analysis to facilitate ordering for providers. Our goal is to increase the percentage to more than 60% in the next 6 months.

Introduction: Colorectal cancer (CRC) is the third leading cause of cancer death worldwide, and incidence is steadily rising, especially in developing nations. CRC most commonly metastasizes to the liver and lungs; osseous metastases, specifically of the vertebral column, is an exceedingly rare manifestation of colorectal cancers and usually represents late-stage disease with poor prognosis. Case Description/Methods: A 60-year-old man presented with severe right leg pain, weakness, numbness and diminished relexes in the L5-S1 distribution. MRI revealed L5 vertebral body tumor causing severe central and neuroforaminal compression at L5-S1. Patient underwent neurosurgical resection of mass and was admitted to the hospital for postoperative observation, where he reported that he had been having fevers on and off for the preceding 2 weeks. Patient additionally reported an episode of bloody stools that same evening and began bowel preparation for colonoscopy the following morning. CT imaging revealed extensive metastatic disease involving liver, lungs, multiple bones, mediastinum and chest wall, and irregular thickening of the sigmoid colon. Spine tumor pathology returned showing metastatic adenocarcinoma most consistent with colorectal primary. Colonoscopy revealed frond-like, villous, ulcerated, 2/3 circumferential, rectosigmoid mass, for which biopsy was consistent adenocarcinoma. Patient notably denied any prior obstructive bowel symptoms or significant weight loss. Patient declined chemotherapy, but is considering radiation therapy. On discharge, the patient did report significant improvement in his neurological symptoms (Figure 1). Discussion: Of all metastatic spinal disease, only 16% of patients have spinal cord compression and only 1.5% to 4.7% of all cases are due to colorectal adenocarcinoma, which is associated with one of the lowest overall mean survival rate. Medical management of colorectal metastases most commonly consists of chemotherapy with 5-fluorouracil and leucovorin, oxaliplatin or irinotecan, and bevacizumab, cetuximab, or panitumumab where indicated. With recent improvements in medical management, survival following colorectal metastasis has been reported to be greater than 20 months. The main goal of surgical resection is symptomatic and quality of life improvement. Modifiable risk factors for development of CRC include obesity, sedentary lifestyle, and consumption of red meat, alcohol, or tobacco. Advances in early detection screenings and treatment options have reduced CRC mortality.Figure 1.: CRC mets imaging.

Objectives The simple ultrasound activity score for Crohn’s disease (SUS-CD) and bowel ultrasound score (BUSS) are promising intestinal ultrasound (IUS) indices of CD, but studied mainly in small settings with few sonographers. We compared SUS-CD and BUSS against histological and magnetic resonance enterography (MRE) reference standards in a post hoc analysis of a prospective multicentre, multireader trial. Methods Participants recruited to the METRIC trial (ISRCTN03982913) were studied, including those with available terminal ileal (TI) biopsies. Sensitivity and specificity of SUS-CD and BUSS for TI CD activity were calculated with 95% confidence intervals (CI), from the prospective observations of the original METRIC trial sonographers against the histological activity index (HAI) and the simplified magnetic resonance index of activity (sMARIA). Results We included 284 patients (median 31.5 years, IQR 23–46) from 8 centres, who underwent IUS and MRE. Of these, 111 patients had available terminal ileal biopsies with HAI scoring. Against histology, sensitivity and specificity for active disease were 79% (95% CI 69–86%) and 50% (31–69%) for SUS-CD, and 66% (56–75%) and 68% (47–84%) for BUSS, respectively. Compared to sMARIA, the sensitivity and specificity for active CD were 81% (74–86%) and 75% (66–83%) for SUS-CD, and 68% (61–74%) and 85% (76–91%) for BUSS, respectively. The sensitivity of SUS-CD was significantly greater than that of BUSS against HAI and sMARIA ( p < 0.001), but its specificity was significantly lower than of BUSS against the MRE reference standard ( p = 0.003). Conclusions Particularly when compared to MRE activity scoring, SUS-CD and BUSS are promising tools in a real-world clinical setting. Clinical relevance statement When tested using data from a multicentre, multireader diagnostic accuracy trial, the simple ultrasound activity score for Crohn’s disease (SUS-CD) and bowel ultrasound score (BUSS) were clinically viable intestinal ultrasound indices that were reasonably sensitive and specific for terminal ileal Crohn’s disease, especially when compared to a magnetic resonance reference standard. Key Points The simple ultrasound activity score for Crohn’s disease and bowel ultrasound score are promising intestinal ultrasound indices of Crohn’s disease but to date studied mainly in small settings with few sonographers. Compared to histology and the magnetic resonance reference standard in a multicentre, multireader setting, the sensitivity of simple ultrasound activity score for Crohn’s disease is significantly greater than that of bowel ultrasound score. The specificity of simple ultrasound activity score for Crohn’s disease was significantly lower than that of bowel ultrasound score compared to the magnetic resonance enterography reference standard. The specificity of both indices was numerically higher when the magnetic resonance enterography reference standard was adopted.

Introduction: Bezlotoxumab is a monoclonal antibody shown to reduce the recurrence of CDI. The 2021 IDSA/SHEA focused update of guidelines for management C Diff recommends use of bezlotoxumab as a co-intervention, along with standard of care antibiotics, in patients with recurrent CDI within 6 months. Furthermore, use of bezlotoxumab is also suggested in patients with primary CDI with high risk of recurrence - Age >65, immunocompromised host and severe CDI on presentation. In this retrospective analysis, we aim to assess the rate of utilization of bezlotoxumab and adherence to IDSA/SHEA guidelines in a community hospital. Methods: EMR data abstraction tolls were utilized to identify patients diagnosed with CDI and admitted to the hospital between June 1, 2022, and May 31st, 2023. Chart review was performed to determine eligibility for bezlotoxumab infusion at an outpatient infusion center. Since exacerbation of congestive heart failure is a potential side effect of bezlotoxumab, patients with heart failure were excluded from the analysis. Results: Data from hospitalizations of patients with C diff colitis (June2022→June2023- N 81) were collected. We further excluded patients who either left Against medical advice (3) or expired during the same hospital visit (2) and patients with history of heart failure (9). Out of the remaining 67 patients identified as having CDI, 37 (55%) patients were considered appropriate candidates for bezlotuxamab infusion for prevention of CDI. However, bezlotoxumab infusion was recommended in only 3 patients (8%). Conclusion: Two randomized controlled trials have shown reduced CID recurrence after initial cure at 12 weeks with use of bezlotoxumab. However, bezlotoxumab remains underutilized for prevention of CDI. Increase in awareness about this intervention may reduce CDI recurrence.

Introduction: Vanishing Bile Duct Syndrome (VBDS) is a disease involving bile duct injury and ductopenia progressing to liver failure. Typical presentation includes nausea, vomiting, fatigue, and elevated liver enzymes. Etiology is multifactorial, including autoimmune destruction. Histologically, periportal neutrophils, lymphocytes, eosinophils, cholangiocyte swelling, and ductular lymphocytic infiltration are seen in the acute phase. Progressive bile duct loss may result in liver failure and death. Case Description/Methods: A 57-year-old African-American female initially presented for evaluation of left breast mass. She was diagnosed with stage IIB triple-negative breast cancer. Patient was started on Paclitaxel, Carboplatin, and Pembrolizumab combination. A week later, she was switched to Nab-paclitaxel due to an adverse reaction to taxol. Three weeks after, she developed worsening renal function: BUN 74, sCr 9.4. She had nausea, vomiting, and diarrhea and required hospitalization. After IV fluid resuscitation, her renal function declined, eventually requiring dialysis. Two weeks later, liver function tests: Bilirubin 8 mg/dl, AST 208 U/L, ALT 400 U/L, ALP 315 U/L. Prothrombin, albumin, and platelet count were normal. Chemotherapy was stopped due to immunotherapy-associated adverse effects. She clinically continued to worsen. Viral Hepatitis panel and autoimmune antibodies (ANA, SMA, AMA) were negative. No alcohol use was reported. She continued to develop edema progressing to anasarca with intractable nausea, vomiting, and encephalopathy. RUQ US showed borderline dilated 6 mm CBD. S/p cholecystectomy. No choledocholithiasis. Mild ascites. Coarse echotexture of the liver due to cirrhosis and hepatocellular disease. MRCP showed mildly dilated CBD with distal tapering in the ampulla. The liver biopsy showed significant ductopenia with minimal portal tract inflammation and no significant fibrosis, consistent with drug-related VBDS. After stopping chemotherapy, she underwent comfort measures and expired (Figure 1). Discussion: There is limited data regarding the optimal treatment for VBDS. Treatment is supportive and focused on reducing symptoms associated with prolonged cholestasis. Though Pembrolizumab-induced VBDS has been rarely reported, close LFT monitoring, liver biopsy, and cessation of therapy are warranted if there is suspicion of VBDS. Some insight is provided by the Drug-Induced Liver Injury Network (DILIN) study. Early biopsy and cessation of therapy might play a role in improved outcomes.Figure 1.: High power of portal tract with no definitive bile duct.

AIM: To describe the clinical presentation, imaging evaluation, endovascular management, and outcomes of multifocal renal capsular haemorrhage, "weeping sponge kidney", and to identify associated risk factors and the pathophysiological mechanism behind this condition.MATERIALS AND METHODS: This is a case series in which clinical information for each of the cases was collected retrospectively from electronic patient notes as well as the radiology in-formation and picture archiving and communication systems.RESULTS: Four consecutive cases were included in the series. All of the cases were treated successfully with embolisation. Three of the four patients had chronic renal failure with renal atrophy, which are patient factors that appear to be associated with multifocal renal capsular haemorrhage. Based on the procedural findings and the published literature, a pathophysio-logical mechanism is described to explain this condition and the relevance of the collateral arterial supply to the kidney in such cases is discussed.CONCLUSION: Small subcapsular haematomas are usually self-limiting but in patients with renal failure, there may be an increased risk of developing a weeping sponge kidney, which can be life-threatening. The endovascular treatment for multifocal haemorrhage differs from that for a single bleeding point, especially if preservation of renal function is not a priority.(c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Introduction: Gastric ischemia is rare due to the extensive collateral blood supply to the stomach. However, vascular insufficiency caused by hypotension, vasculitis, or, as we present here, disseminated septic embolism can lead to gastric ischemia. Case Description/Methods: We present a 75-year-old man who presented with abdominal pain, nausea, vomiting, and diarrhea. Two weeks prior, the patient was discharged from the hospital for streptococcus agalactiae bacteremia secondary to right first metatarsal osteomyelitis, later requiring amputation and PICC line placement for prolonged antibiotics. Patient later returned to the hospital with post-prandial abdominal discomfort and early satiety, with no other GI symptoms. CT abdomen pelvis revealed gas in the mesenteric and portal veins and thickening of the gastric wall, concerning for gastric wall ischemia and infarction. An EGD was performed, which showed ischemic changes along the lesser curvature, cardia, and proximal area of the greater curvature of the stomach (Figure 1). Due to evidence of ischemia, a CTA abdomen pelvis and dopplers were obtained, ruling out any evidence of stenosis or vascular compromise. It was suggested that the patient's bacteremia may have contributed to the patient's gastric ischemia. The patient's antibiotics were escalated, which resulted in clinical improvement. The patient tolerated an oral diet without post-prandial pain and was discharged with outpatient GI follow-up. Discussion: Gastric ischemia is very rare due to its rich vascular supply. Minimal literature is available on the topic of ischemic gastritis, and has been underreported in the past. Multiple causes of gastric ischemia have been reported, including shock, sepsis, splanchnic hypoperfusion, thrombosis, endoscopic interventions (endoscopic submucosal dissection, injection sclerotherapy), embolism, vasculitis vasoconstriction, and vessel ligation. Evaluation of gastric ischemia is crucial as it can rapidly worsen. Initial evaluation requires early clinical suspicion, imaging, and endoscopy that estimates the extent and severity of gastric ischemia. Endoscopic findings include gastric mucosal discoloration, loss of mucosal vascular pattern, erosions, and ulcerations. Treatment is supportive, requiring high-dose PPI, IV fluid, and antibiotics. Surgical intervention is indicated if endoscopy results in gastric perforation. The prognosis remains poor. However, in our case, due to the septic mycotic etiology, the patient responded well to aggressive antibiotics and PPI.Figure 1.: Gastric wall ischemia visualized on EGD.

Introduction: Iatrogenic causes of pathology should always be considered when evaluating a patient complaint. We present a case of insidious onset diarrhea in a 74-year-old woman with a history of hypertension treated with olmesartan. Case Description/Methods: We present a 74-year-old woman who endorsed worsening watery diarrhea over one year with up to 4 to 5 bowel movements daily. She denied fevers, abdominal pain, nausea, vomiting, and hematochezia but endorsed worsening diarrhea with oral intake. She had seen her primary care physician for medication reconciliation, which included: levothyroxine, duloxetine, atorvastatin, aspirin, famotidine, chlorthalidone, and olmesartan, all for which she had been taking greater than 2 years. Initial workup included CBC, stool ova and parasites, Clostridioides difficile toxin, pancreatic elastase, stool culture, fecal fat, TSH, ferritin, celiac disease panel, SARS-COV-2 test, giardia, cryptosporidium, all of which were negative. Gastroenterology was consulted, who performed EGD and colonoscopy with multiple random biopsies of the duodenum, gastric region, and colon. Her endoscopic studies were grossly normal, and biopsies demonstrated mild gastric inflammation without pathological abnormalities of villi. Due to her unremarkable workup, her medications were reviewed, and olmesartan was transitioned to amlodipine. At 6-week follow-up, the patient was found to have a complete resolution of her chronic diarrhea. Discussion: Olmesartan is an angiotensin receptor blocker (ARB) commonly used as an antihypertensive medication that has been reported to be associated with enteropathy. Although a chronic medication, patient’s symptoms resolved 6 weeks after discontinuation. Time for resolution is variable, including anywhere from 1 to 8 weeks. The incidence of this rare side effect is not well known, although the physiology causing the above symptom appears to be due to villous blunting in the small bowel. This enteropathy seems to have a highly variable onset, and its cause may go unnoticed due to insidious worsening over months to years. Although biopsy results in the above case did not demonstrate villous changes, further diagnostic testing or additional biopsies may have demonstrated this pathology. Many olmesartan-associated diarrhea studies illustrate that the majority of biopsy samples return pathology consistent with villous changes. This case emphasizes that possible iatrogenic causes for medical concerns should never be overlooked.

The management of HR+/HER2- breast cancer is rapidly developing with a wealth of data being presented and published continuously. The objective of this study was to measure the impact of an educational curriculum developed in 2020 on the knowledge, competence and confidence of oncologists regarding the latest advances in HR+/HER2- early and metastatic breast cancer. A series of 10 continuing medical educational (CME) programs in various audio/video formats were analyzed. Educational impact was assessed with repeated pairs design, participants were asked pre-education and post-education knowledge/competence and confidence questions. These questions were designed to assess if certain learning objectives were met, which in turn were designed to cover the educational gaps identified. Data were collected from September 17, 2020, till October 25, 2021. Statistical significance was assessed using McNemar's test (P < .05 level). A total of 29,363 HCPs participated in these activities, of whom 6,247 were oncologists. The assessment questions and the outcomes data were divided into 8 themes: 3 themes for HR+/HER2- early breast cancer and 5 themes for HR+/HER2- metastatic breast cancer. The number of oncologist learners assessed per theme varied from 40 to 636.Table: 83PTheme HR+/HER2- early breast cancer (EBC)Relative percent increase in correct responses/confidence after educationP valueHR+/HER2- early breast cancer (EBC)Identification of high risk of recurrence in HR+/HER2- EBC7<.001Clinical trial data in HR+/HER2- EBC84<.001Management of HR+/HER2- EBC-10.85HR+/HER2- metastatic breast cancer (MBC)Clinical trial data in HR+/HER2- MBC38<.001Implications of trial data in HR+/HER2- MBC21<.001Optimizing treatment of HR+/HER2- MBC20<.001Adverse events of CDK4/6 inhibitors26<.001Optimizing treatment of HR+/HER2- MBC during COVID104<.001 Open table in a new tab The activities in this curriculum using a mix of various formats resulted in a significant increase in oncologists' knowledge, competence, and confidence across 7 out of the 8 assessed themes. The baseline knowledge regarding the management of HR+/HER2- EBC was high (73% correct responses/confidence before education) compared to that of clinical trial data in HR+/HER2- EBC (31% correct responses/confidence before education). However, as the management of patients evolves due to the insights gained from the clinical trial data in HR+/HER2- EBC, oncologists would require further education regarding how to implement these new developments.

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. Per patient percentage agreement for disease presence and extent were calculated against an outcome based construct reference standard (averaged between pairs of readers). Prevalence-adjusted bias-adjusted Kappa (PABAK) was calculated. Results: Agreement for small bowel disease presence for new diagnosis/relapsed patients was 68%(lc = 0.36)/ 78% (lc = 0.56) and 43%(lc = 0.14)/ 53% for disease extent (lc = 0.07), respectively. For disease presence, all three radiologists agreed correctly with the reference standard in 41/59 (69%) of patients with small bowel involvement, and in 8/14 (57%) cases of without small bowel disease. Agreement was highest for multisegment disease, greater than 5 cm in length, with mural thickness>6 mm, and increased mural T2 signal. Agreement for colonic disease presence was 61% (lc = 0.21 fair agreement) for new diagnosis/ 60% (lc = 0.20, slight agreement) for relapsed patients. Conclusion: There is a reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed Crohn's disease, and patients with suspected relapse, respectively. Agreement is lower for disease extent. Advances in knowledge: There is reasonable agreement between radiologists for small bowel disease presence using MRE for newly diagnosed (68%) Crohn's disease, and patients with suspected relapse (78%). Agreement is lower for disease extent (43% new diagnosis and 53% suspected relapse).