Publications by authors named "Alessandro Beleù"

11 Publications

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An Overview of Artificial Intelligence Applications in Liver and Pancreatic Imaging.

Cancers (Basel) 2021 Apr 30;13(9). Epub 2021 Apr 30.

Department of Radiology, G.B. Rossi University Hospital, University of Verona, 37129 Verona, Italy.

Artificial intelligence (AI) is one of the most promising fields of research in medical imaging so far. By means of specific algorithms, it can be used to help radiologists in their routine workflow. There are several papers that describe AI approaches to solve different problems in liver and pancreatic imaging. These problems may be summarized in four different categories: segmentation, quantification, characterization and image quality improvement. Segmentation is usually the first step of successive elaborations. If done manually, it is a time-consuming process. Therefore, the semi-automatic and automatic creation of a liver or a pancreatic mask may save time for other evaluations, such as quantification of various parameters, from organs volume to their textural features. The alterations of normal liver and pancreas structure may give a clue to the presence of a diffuse or focal pathology. AI can be trained to recognize these alterations and propose a diagnosis, which may then be confirmed or not by radiologists. Finally, AI may be applied in medical image reconstruction in order to increase image quality, decrease dose administration (referring to computed tomography) and reduce scan times. In this article, we report the state of the art of AI applications in these four main categories.
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http://dx.doi.org/10.3390/cancers13092162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124771PMC
April 2021

CT Simplified Radiomic Approach to Assess the Metastatic Ductal Adenocarcinoma of the Pancreas.

Cancers (Basel) 2021 Apr 13;13(8). Epub 2021 Apr 13.

Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona, 37129 Verona, Italy.

The aim of this study was to perform a simplified radiomic analysis of pancreatic ductal adenocarcinoma based on qualitative and quantitative tumor features and to compare the results between metastatic and non-metastatic patients. A search of our radiological, surgical, and pathological databases identified 1218 patients with a newly diagnosed pancreatic ductal adenocarcinoma who were referred to our Institution between January 2014 and December 2018. Computed Tomography (CT) examinations were reviewed analyzing qualitative and quantitative features. Two hundred eighty-eight patients fulfilled the inclusion criteria and were included in this study. Overall, metastases were present at diagnosis in 86/288 patients, while no metastases were identified in 202/288 patients. Ill-defined margins and a hypodense appearance on portal-phase images were significantly more common among patients with metastases compared to non-metastatic patients ( < 0.05). Metastatic tumors showed a significantly larger size and significantly lower arterial index, perfusion index, and permeability index compared to non-metastatic tumors ( < 0.05). In the management of pancreatic ductal adenocarcinoma, early detection and correct staging are key elements. The study of computerized tomography characteristics of pancreatic ductal adenocarcinoma showed substantial differences, both qualitative and quantitative, between metastatic and non-metastatic disease.
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http://dx.doi.org/10.3390/cancers13081843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069159PMC
April 2021

Magnetic resonance (MR) for mural nodule detection studying Intraductal papillary mucinous neoplasms (IPMN) of pancreas: Imaging-pathologic correlation.

Pancreatology 2021 Jan 3;21(1):180-187. Epub 2020 Dec 3.

Department of Surgery, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Purpose: Magnetic Resonance (MR) is recommended to diagnose Intraductal Papillary Mucinous Neoplasms (IPMN) and in the follow-up of borderline lesions. The purpose of this work is to evaluate the diagnostic accuracy of dynamic MR with Diffusion Weighted Imaging (DWI) in the identification of mural nodules of pancreatic IPMN by using pathological analysis as gold standard.

Materials And Methods: Ninety-one preoperative MR with histopathological diagnosis of IPMN were reviewed by two radiologists. Presence, number and size of mural nodule, signal intensity of the nodule on T1-weighted imaging (T1-WI) after contrast medium administration and on DWI. Inter-observer agreement was evaluated.

Results: Significant correlation (p < 0.0001) were found for presence of nodules > 5 mm on MR and pathological specimen, size and number of mural nodules evaluated on pathological review and degree of dysplasia, size and number of mural nodules evaluated on MR and tumoral dysplasia, presence of nodule > 5 mm with enhancement after contrast medium administration and hyperintensity on DWI and degree of dysplasia. Interobserver agreement was moderate for the presence of mural nodule (K = 0.56), for the presence of high signal intensity on DWI (K = 0.57) and enhancement of mural nodule (K = 0.58). Apparent Diffusion Coefficient (ADC) map histogram analysis showed a correlation between Entropy of the entire cystic lesion and the degree of dysplasia (p < 0.034).

Conclusions: MR with dynamic and DWI sequences was an accurate method for the identification of ≥ 5 mm solid nodules of the IPMNs and correlate with the lesion malignancy. Entropy, calculated from the histogram analysis of the IPMN ADC map, correlated with the lesion dysplasia.
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http://dx.doi.org/10.1016/j.pan.2020.11.024DOI Listing
January 2021

US-Guided Percutaneous Radiofrequency Ablation of Locally Advanced Pancreatic Adenocarcinoma: A 5-Year High-Volume Center Experience.

Ultraschall Med 2020 Aug 14. Epub 2020 Aug 14.

Surgery, University of Verona, Italy.

Purpose:  The aim of this study was to investigate the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in locally advanced pancreatic cancer (LAPC) of the pancreatic body by assessing the overall survival of patients and evaluating the effects of the procedure in the clinical and radiological follow-up.

Materials And Methods:  Patients with unresectable LAPC after failed chemoradiotherapy for at least six months were retrospectively included. Percutaneous RFA was performed after a preliminary ultrasound (US) feasibility evaluation. Contrast-enhanced computed tomography (CT) and CA 19.9 sampling were performed before and 24 hours and 30 days after the procedure to evaluate the effects of the ablation. Patients were followed-up after discharge considering the two main endpoints: procedure-related complications and death.

Results:  35 patients were included, 5 were excluded. All patients underwent RFA with no procedure-related complications reported. The mean size of tumors was 49 mm before treatment. The mean dimension of the ablated necrotic zone was 32 mm, with a mean extension of 65 % compared to the whole tumor size. Tumor density was statistically reduced one day after the procedure (p < 0.001). The mean CA 19.9 levels before and 24 hours and 30 days after the procedure were 285.8 U/mL, 635.2 U/mL, and 336.0 U/mL, respectively, with a decrease or stability at the 30-day evaluation in 80 % of cases. The mean survival was 310 (65-718) days.

Conclusion:  Percutaneous RFA of LAPC is a feasible technique in patients who cannot undergo surgery, with great debulking effects and a very low complication rate.
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http://dx.doi.org/10.1055/a-1178-0474DOI Listing
August 2020

Liver Tumor Burden in Pancreatic Neuroendocrine Tumors: CT Features and Texture Analysis in the Prediction of Tumor Grade and F-FDG Uptake.

Cancers (Basel) 2020 Jun 7;12(6). Epub 2020 Jun 7.

Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy.

Pancreatic neuroendocrine tumors (p-NETs) are a rare group of neoplasms that often present with liver metastases. Histological characteristics, metabolic behavior, and liver tumor burden (LTB) are important prognostic factors. In this study, the usefulness of texture analysis of liver metastases in evaluating the biological aggressiveness of p-NETs was assessed. Fifty-six patients with liver metastases from p-NET were retrospectively enrolled. Qualitative and quantitative CT features of LTB were evaluated. Histogram-derived parameters of liver metastases were calculated and correlated with the tumor grade (G) and F-fluorodeoxyglucose (F-FDG) standardized uptake value (SUV). Arterial relative enhancement was inversely related with G (-0.37, = 0.006). Different metastatic spread patterns of LTB were not associated with histological grade. Arterial was significantly correlated to G (-0.368, = 0.038) and to Ki67 percentage (-0.421, = 0.018). The ROC curve for the Arterial reported an area under the curve (AUC) of 0.736 (95% confidence interval 0.545-0.928, = 0.035) in the identification of G1-2 tumors. Arterial values were correlated to G (0.346, = 0.005) and Ki67 levels (0.383, = 0.033). Arterial values were directly correlated with the SUV (0.449, = 0.047) which was inversely correlated with Arterial (-0.499, = 0.025). Skewness and kurtosis reported no significant correlations. In conclusion, histogram-derived parameters may predict adverse histological features and metabolic behavior of p-NET liver metastases.
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http://dx.doi.org/10.3390/cancers12061486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352332PMC
June 2020

Correlation of MR features and histogram-derived parameters with aggressiveness and outcomes after resection in pancreatic ductal adenocarcinoma.

Abdom Radiol (NY) 2020 11;45(11):3809-3818

Department of Radiology, Ospedale G.B. Rossi - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Purpose: To evaluate MR-derived histogram parameters in predicting aggressiveness and surgical outcomes in patients with PDAC, by correlating them to pathological features, recurrence-free survival (RFS), and overall survival (OS).

Methods: Pre-operative MR examinations of 103 patients with PDAC between July 2014 and September 2018 were retrospectively analyzed. Morphologic features and whole-tumor histogram-derived parameters were correlated to pathological features using Fisher's exact or Mann-Whitney U tests and receiver operating characteristic (ROC) curves were constructed for significant parameters. Cox regression analysis and Kaplan-Meier curves were used to determine the association of clinical-pathological variables, morphological features, and histogram-derived parameters with RFS and OS.

Results: T1, ADC, T2, and ADC had the highest area under the curve (AUC) for prediction of vascular infiltration, nodal metastases, microscopic vascular invasion, and peripancreatic fat invasion (.657, .742, .760, and .818, respectively). Poor tumor differentiation (P = 0.002, hazard ratio-HR = 4.08), nodal ratio (P = 0.034, HR 6.95), and ADC (P = 0.021, HR 1.01) were significant predictors of RFS. Poor tumor differentiation (P = 0.05, HR 2.82), ADC (P = 0.02, HR 3.32), and arterial (P = 0.02, HR 6.84) were the only significant predictors of death; patients with higher arterial had significantly shorter OS than patients who did not meet this criterion (P = 0.02; median OS 24 vs 31 months).

Conclusion: Histogram-derived parameters may predict adverse pathological features in PDACs. High arterial seems to be associated with short OS after surgery in patients with PDAC.
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http://dx.doi.org/10.1007/s00261-020-02509-3DOI Listing
November 2020

Totally percutaneous endoluminal ballooning of stuck hemodialysis catheters: One-year experience of a referral center.

J Vasc Access 2020 May 3;21(3):395-398. Epub 2019 Oct 3.

Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.

The stuck catheter is an uncommon but dreaded complication of dialysis line placement. It always finds the operator unaware and often requires procedure modification or reschedule. Hong pioneered the technique of endoballooning to expand a stuck central venous catheter, thus freeing it from wall adhesions. The purpose of the current study was to present a totally percutaneous variation of endoluminal stuck catheters ballooning, along with our experience in terms of safety and feasibility. A major difference presented in respect to previous techniques is that this modification does not require isolation of the distal line stump at the venous entry point by tissue dissection, thus reducing procedural time and difficulty. We presented a case series of five lines that were ballooned by navigating low-profile material directly from the cutaneous exit of the lines, with optimal results (100% success). The findings of this investigation provide additional evidence with respect to the safety and effectiveness of endoluminal ballooning of Tesio lines and offer a new variation of endoluminal ballooning which we found easy to perform, safe, and effective.
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http://dx.doi.org/10.1177/1129729819878622DOI Listing
May 2020

Galectin 3 and Galectin 3 Binding Protein Improve the Risk Stratification after Myocardial Infarction.

J Clin Med 2019 Apr 26;8(5). Epub 2019 Apr 26.

Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste and Department of Medical Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy.

Background: Acute myocardial infarction (AMI) survivors are at risk of major adverse cardiac events and their risk stratification is a prerequisite to tailored therapeutic approaches. Biomarkers could be of great utility in this setting.

Methods: We sought to evaluate the utility of the combined assessment of Galectin 3 (Gal-3) and Galectin 3 binding protein (Gal-3bp) for post-AMI risk stratification in a large, consecutive population of AMI patients. The primary outcomes were: Recurrent angina/AMI and all-cause mortality at 12 months after the index event.

Results: In total, 469 patients were included. The median Gal-3bp was 9.1 μg/mL (IQR 5.8-13.5 μg/mL), while median Gal-3 was 9.8 ng/mL (IQR 7.8-12.8 ng/mL). During the 12 month follow-up, 34 patients died and 41 had angina pectoris/reinfarction. Gal-3 was associated with all-cause mortality, while Gal-3bp correlated with the risk of angina/myocardial infarction even when corrected for other significant covariates. The final multivariable model for mortality prediction included patients' age, left ventricular ejection fraction (LVEF), Gal-3, and renal function. The ROC curve estimated for this model has an area under the curve (AUC) of 0.84 (95%CI 0.78-0.9), which was similar to the area under the ROC curve obtained using the GRACE score 1-year mortality.

Conclusions: The integrated assessment of Gal-3 and Gal-3bp could be helpful in risk stratification after AMI.
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http://dx.doi.org/10.3390/jcm8050570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571589PMC
April 2019

Preoperative Imaging Evaluation after Downstaging of Pancreatic Ductal Adenocarcinoma: A Multi-Center Study.

Cancers (Basel) 2019 Feb 25;11(2). Epub 2019 Feb 25.

Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy.

Introduction: Evaluation of pancreatic ductal adenocarcinoma (PDAC) after chemoradiotherapy downstaging is challenging due to computed tomography (CT) overestimation of tumor extension and residual vascular involvement, limiting access to surgery to some patients with potentially resectable tumors. With this study, we wanted to assess which radiological findings are most reliable at pre-operative imaging in the evaluation of PDAC after chemoradiotherapy in order to achieve complete resection.

Methods: We retrospectively enrolled 71 patients with locally advanced and borderline resectable PDAC who underwent neoadjuvant chemoradiotherapy. Pre-operative CT or magnetic resonance (MR) have been evaluated by three radiologists to assess major qualitative and quantitative parameters of lesions. Accuracy, sensitivity, and specificity compared to anatomopathological results were evaluated for each parameter. Cohen's K-coefficient has been calculated to evaluate the inter-observer agreement (IOA). Both single and consensus lecture have been tested. Different dimensional cut-offs were tested to categorize tumors according to their major axis and to compare with anatomopathological diameter, tumor persistence, and margin infiltration.

Results: A 25 mm cut-off was 67% sensitive, 90% specific, and 77% accurate in assessing real tumor dimension. 25 mm cut-off reported a 64% sensitivity, 78% specificity, and 69% accuracy in assessing R0 resection. Each 5 mm increment of major axis dimension there is an odds ratio (OR) 1.79 (95% CI 1.13⁻2.80, = 0.012) for R+ resection. Imaging presence of the perivascular cuff is not associated with tumor persistence and resection margin infiltration ( = 0.362). Lesion enhancement and pattern homogeneity were not accurate in determining tumor persistence. IOA was generally poor to fair, except for >25 mm cut-off classification where IOA was moderate. Diagnostic accuracy is superior in consensus lecture rather than single lecture.

Conclusion: Imaging methods tend to underestimate PDAC resectability after neoadjuvant-CRT. IOA is poor to fair in evaluating most of the qualitative parameters of downstaged pancreatic adenocarcinoma. Surgery should be considered for downstaged borderline resectable PDACs, independently from perivascular cuff presence, especially for tumors smaller than 25 mm.
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http://dx.doi.org/10.3390/cancers11020267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406608PMC
February 2019

Ultrasound-guided percutaneous procedures in pancreatic diseases: new techniques and applications.

Eur Radiol Exp 2019 Jan 22;3(1). Epub 2019 Jan 22.

PhD Programme in Inflammation, Immunity and Cancer, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Ultrasound (US) is not only an important diagnostic tool for the evaluation of the pancreas, but is also a fundamental imaging technique to guide percutaneous interventions for several pancreatic diseases (fluid aspiration and drainage; invasive diagnosis by means fine-needle aspiration and core-needle biopsy; tumour ablation by radiofrequency, microwaves, irreversible electroporation, cryoablation, and high-intensity focused US). Technical improvements, such as contrast media and fusion imaging, have recently increased precision and safety and reduced procedure-related complications. New treatment US techniques for the ablation of pancreatic tumours, such as contrast-enhanced US and multimodality fusion imaging, have been recently developed and have elicited a growing interest worldwide. The purpose of this article was to review the most up-to-date role of US in percutaneous procedures for pancreatic diseases.
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http://dx.doi.org/10.1186/s41747-018-0081-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342746PMC
January 2019

Left ventricular adverse remodeling after myocardial infarction and its association with vitamin D levels.

Int J Cardiol 2019 Feb 18;277:159-165. Epub 2018 Aug 18.

Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2018.08.052DOI Listing
February 2019