Publications by authors named "Angelo Vanzulli"

87 Publications

A retrospective single-centre analysis of the oncological impact of LI-RADS classification applied to Metroticket 2.0 calculator in liver transplantation: every nodule matters.

Transpl Int 2021 Sep;34(9):1712-1721

Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.

Although the diagnostic value of Liver Imaging Reporting and Data System (LI-RADS) protocol is well recognized in clinical practice, its role in liver transplant (LT) setting is under-explored. We sought to evaluate the oncological impact of LI-RADS classification applied to Metroticket 2.0 calculator in a single-centre retrospective cohort of transplanted hepatocellular carcinoma (HCC) patients, exploring which LI-RADS subclasses need to be considered in order to grant the best Metroticket 2.0 performance. The most recent pre-LT imaging of 245 patients undergoing LT for HCC between 2005 and 2015 was retrospectively and blindly reviewed, classifying all nodules according to LI-RADS protocol. Metroticket 2.0 accuracy was subsequently tested incorporating all vital nodules identified during multi-disciplinary team (MDT) meetings attended before LI-RADS reclassification of the latest pre-LT imaging, LR-5 and LR-treatment-viable (LR-TR-V), LR-4/5 and LR-TR-V, and LR-3/4/5 and LR-TR-V nodules respectively. Considering their extremely low probability for harbouring HCC, LR-1 and LR-2 nodules were not considered in this analysis. Incorporation of all HCCs identified during MDT meetings attended before LI-RADS reclassification of the latest pre-LT imaging resulted in a Metroticket 2.0 c-index of 0.72, [95% confidence interval (CI) 0.64-0.80]. Metroticket 2.0 c-index dropped to 0.60 [95% CI: 0.48-0.72] when LI-RADS-5 and LI-RADS-TR-V (P = 0.0089) or LI-RADS-5, LI-RADS-4 and LI-RADS-TR-V (P = 0.0068) nodules were entered in the calculator. Conversely, addition of LI-RADS-3 HCCs raised the Metroticket 2.0 c-index to 0.65 [95% CI: 0.54-0.86], resulting in a not statistically significant diversion from the original performance (0.72 vs. 0.65; P = 0.08). Exclusion of LR-3 and LR-4 nodules from Metroticket 2.0 calculator resulted in a significant drop in its accuracy. Every nodule with an intermediate-to-high probability of harbouring HCC according to LI-RADS protocol seems to contribute to tumour burden and should be entered in the Metroticket 2.0 calculator in order to grant appropriate performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/tri.13983DOI Listing
September 2021

Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology.

J Hepatol 2021 Jul 30. Epub 2021 Jul 30.

Gastroenterology Unit, ASL Latina, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Italy.

Background & Aims: Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model.

Methods: In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses.

Results: In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD.

Conclusions: In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed.

Lay Summary: While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhep.2021.07.018DOI Listing
July 2021

Machine Learning to Predict In-Hospital Mortality in COVID-19 Patients Using Computed Tomography-Derived Pulmonary and Vascular Features.

J Pers Med 2021 Jun 3;11(6). Epub 2021 Jun 3.

Department of General and Emergency Surgery, ASST Crema-Ospedale Maggiore, Largo Ugo Dossena 2, 26013 Crema, Italy.

Pulmonary parenchymal and vascular damage are frequently reported in COVID-19 patients and can be assessed with unenhanced chest computed tomography (CT), widely used as a triaging exam. Integrating clinical data, chest CT features, and CT-derived vascular metrics, we aimed to build a predictive model of in-hospital mortality using univariate analysis (Mann-Whitney test) and machine learning models (support vectors machines (SVM) and multilayer perceptrons (MLP)). Patients with RT-PCR-confirmed SARS-CoV-2 infection and unenhanced chest CT performed on emergency department admission were included after retrieving their outcome (discharge or death), with an 85/15% training/test dataset split. Out of 897 patients, the 229 (26%) patients who died during hospitalization had higher median pulmonary artery diameter (29.0 mm) than patients who survived (27.0 mm, < 0.001) and higher median ascending aortic diameter (36.6 mm versus 34.0 mm, < 0.001). SVM and MLP best models considered the same ten input features, yielding a 0.747 (precision 0.522, recall 0.800) and 0.844 (precision 0.680, recall 0.567) area under the curve, respectively. In this model integrating clinical and radiological data, pulmonary artery diameter was the third most important predictor after age and parenchymal involvement extent, contributing to reliable in-hospital mortality prediction, highlighting the value of vascular metrics in improving patient stratification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jpm11060501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230339PMC
June 2021

Inter-center agreement of mRECIST in transplanted patients for hepatocellular carcinoma.

Eur Radiol 2021 Jun 12. Epub 2021 Jun 12.

Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy.

Objectives: To evaluate the inter-observer reliability of modified Response Evaluation Criteria In Solid Tumours (mRECIST) of patients with hepatocellular carcinoma (HCC) undergoing neo-adjuvant treatments before liver transplant (LT). The agreement of tumor number, size, transplant criteria, and the radiological-pathological concordance were also assessed.

Methods: A total of 180 radiological studies before/after neo-adjuvant therapies performed on 90 patients prior to LT were reviewed from three expert centers. Kappa-statistic and intraclass correlation (ICC) were evaluated on mRECIST and on tumoral features. Complete radiological response (CR) was compared with complete pathological response (CPR).

Results: Before neo-adjuvant therapies, the agreement on tumor number, size, and transplant criteria ranged from moderate (defined as ICC of 0.41-0.60) to almost perfect (ICC of 0.81-0.99), being higher with magnetic resonance imaging (MRI) than CT (0.657-0.899 and 0.422-0.776, respectively). After neo-adjuvant therapies, the agreement decreased, as ICCs ranged between 0.518 and 0.663 with MRI and between 0.508 and 0.677 with CT. Concordant mRECIST pairs were 201 of 270 reviews (76.3%) with a kappa of 0.648 indicating substantial agreement. When the three observers completely agreed on CR, the positive predictive value for CPR was 51.6%. The negative predictive value was 94.2% with a kappa of 0.512 indicating fair agreement between radiology and pathology.

Conclusions: mRECIST agreement was substantial among the three observers involved. The agreement on tumor number, size, and transplant criteria ranged from moderate to almost perfect, with the highest ICCs obtained with MRI before neo-adjuvant therapies. Finally, the predictive value of mRECIST in the diagnosis of CPR was only fair.

Key Points: • The review of 180 radiological exams of patients with hepatocellular carcinoma before and after neo-adjuvant therapies showed that the concordance among three different raters on mRECIST diagnosis was substantial. • The inter-observer reliability on fulfilment of transplant criteria slightly decreased when evaluated through CT and after loco-regional therapies. • The radiological diagnosis of complete response after neo-adjuvant therapies was predictive of complete pathological response in only 51.6% of cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-021-08088-1DOI Listing
June 2021

Surgical Resection vs. Percutaneous Ablation for Single Hepatocellular Carcinoma: Exploring the Impact of Li-RADS Classification on Oncological Outcomes.

Cancers (Basel) 2021 Apr 1;13(7). Epub 2021 Apr 1.

Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, 20162 Milan, Italy.

: Single hepatocellular carcinoma (HCC) benefits from surgical resection (SR) or US-guided percutaneous ablation (PA), although the best approach is still debated. We evaluated the impact of Li-RADS classification on the oncological outcomes of SR vs. PA as single HCC first-line treatment. : We retrospectively and blindly classified treatment-naïve single HCC that underwent SR or PA between 2010 and 2016 according to Li-RADS protocol. Overall survival (OS), recurrence free survival (RFS) and local recurrence after SR and PA were compared for each Li-RADS subclass before and after propensity-score matching (PS-M). : Considering the general population, SR showed better 5-year OS (68.3% vs. 52.2%; = 0.049) and RFS (42.5% vs. 29.8%; = 0.002), with lower incidence of local recurrence (8.2% vs. 44.4%; < 0.001), despite a significantly higher frequency of clinically-relevant complications (12.8% vs. 1.9%; = 0.002) and a higher Comprehensive Complication Index (12.1 vs. 2.2; < 0.001). Focusing on different Li-RADS subclasses, we highlighted better 5-year OS (67.1% vs. 46.2%; = 0.035), RFS (45.0% vs. 27.0% RFS; < 0.001) and lower incidence of local recurrence (9.7% vs. 48.6%; < 0.001) after SR for Li-RADS-5 HCCs, while these outcomes did not differ for Li-RADS-3/4 subclasses; such results were confirmed after PS-M. : Our analysis suggests a potential prognostic role of Li-RADS classification, supporting SR over PA especially for Li-RADS-5 single HCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers13071671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038048PMC
April 2021

Grade IV Liver Injury Following Mechanical Cardiopulmonary Resuscitation with Postoperative Three-dimensional Evaluation.

J Emerg Trauma Shock 2020 Oct-Dec;13(4):306-308. Epub 2020 Dec 7.

Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.

A 48-year-old female presented to the emergency department with chest pain and collapsed at the front desk. She was reanimated with mechanical chest compression, and after coronary angiography, a left anterior descending/diagonal bifurcation mini-crush stenting was performed. Few hours after the procedure, the patient showed severe hypotension. Abdominal ultrasound and computed tomography (CT) scan evidenced a massive subcapsular liver hematoma (Grade IV, American association for the surgery of trauma (AAST) liver injury scale) of the right lobe with extrahepatic blushing. Transhepatic embolization was attempted but without benefit, so the patient underwent emergency laparotomy for damage control surgery with perihepatic packing. After hemodynamic stabilization, right hepatectomy was performed with a favorable outcome and full recovery. The patient CT scan was retrospectively processed to obtain a virtual model visualizable through a head-mounted display. The virtual reconstruction could improve the comprehension of the injury and the liver surgical anatomy for educational purpose, and it could represent a new tool for preoperative planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/JETS.JETS_28_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047959PMC
December 2020

Correlation between lung ultrasound and chest CT patterns with estimation of pulmonary burden in COVID-19 patients.

Eur J Radiol 2021 May 11;138:109650. Epub 2021 Mar 11.

Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy.

Purpose: The capability of lung ultrasound (LUS) to distinguish the different pulmonary patterns of COVID-19 and quantify the disease burden compared to chest CT is still unclear.

Methods: PCR-confirmed COVID-19 patients who underwent both LUS and chest CT at the Emergency Department were retrospectively analysed. In both modalities, twelve peripheral lung zones were identified and given a Severity Score basing on main lesion pattern. On CT scans the well-aerated lung volume (%WALV) was visually estimated. Per-patient and per-zone assessments of LUS classification performance taking CT findings as reference were performed, further revisioning the images in case of discordant results. Correlations between number of disease-positive lung zones, Severity Score and %WALV on both LUS and CT were assessed. The area under receiver operating characteristic curve (AUC) was calculated to determine LUS performance in detecting %WALV ≤ 70 %.

Results: The study included 219 COVID-19 patients with abnormal chest CT. LUS correctly identified as positive 217 (99 %) patients, but per-zone analysis showed sensitivity = 75 % and specificity = 66 %. The revision of the 121 (55 %) cases with positive LUS and negative CT revealed COVID-compatible lesions in 42 (38 %) CT scans. Number of disease-positive zones, Severity Score and %WALV between LUS and CT showed moderate correlations. The AUCs for LUS Severity Score and number of LUS-positive zones did not differ in detecting %WALV ≤ 70 %.

Conclusion: LUS in COVID-19 is valuable for case identification but shows only moderate correlation with CT findings as for lesion patterns and severity quantification. The number of disease-positive lung zones in LUS alone was sufficient to discriminate relevant disease burden.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2021.109650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948674PMC
May 2021

CT-derived Chest Muscle Metrics for Outcome Prediction in Patients with COVID-19.

Radiology 2021 08 16;300(2):E328-E336. Epub 2021 Mar 16.

From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.).

Background Lower muscle mass is a known predictor of unfavorable outcomes, but its prognostic impact on patients with COVID-19 is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in patients with COVID-19. Materials and Methods Clinical or laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed SARS-CoV-2 infection, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. The extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation by paravertebral muscles were measured on axial CT images at the T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation of odds ratios (ORs) with 95% CIs, were used to build four models to predict ICU admission and death, which were tested and compared by using receiver operating characteristic curve analysis. Results A total of 552 patients (364 men and 188 women; median age, 65 years [interquartile range, 54-75 years]) were included. In a CT-based model, lower-than-median T5 paravertebral muscle areas showed the highest ORs for ICU admission (OR, 4.8; 95% CI: 2.7, 8.5; < .001) and death (OR, 2.3; 95% CI: 1.0, 2.9; = .03). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle areas still showed the highest ORs for both ICU admission (OR, 4.3; 95%: CI: 2.5, 7.7; < .001) and death (OR, 2.3; 95% CI: 1.3, 3.7; = .001). At receiver operating characteristic analysis, the CT-based model and the model including clinical variables showed the same area under the receiver operating characteristic curve (AUC) for ICU admission prediction (AUC, 0.83; = .38) and were not different in terms of predicting death (AUC, 0.86 vs AUC, 0.87, respectively; = .28). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT images was independently associated with intensive care unit admission and in-hospital mortality. © RSNA, 2021
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2021204141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971428PMC
August 2021

Chest-CT mimics of COVID-19 pneumonia-a review article.

Emerg Radiol 2021 Jun 1;28(3):507-518. Epub 2021 Mar 1.

Radiology Unit, San Giuseppe Hospital Multimedica IRCCS, Milan, Italy.

Coronavirus disease 2019 (COVID-19) emerged in early December 2019 in China, as an acute lower respiratory tract infection and spread rapidly worldwide being declared a pandemic in March 2020. Chest-computed tomography (CT) has been utilized in different clinical settings of COVID-19 patients; however, COVID-19 imaging appearance is highly variable and nonspecific. Indeed, many pulmonary infections and non-infectious diseases can show similar CT findings and mimic COVID-19 pneumonia. In this review, we discuss clinical conditions that share a similar imaging appearance with COVID-19 pneumonia, in order to identify imaging and clinical characteristics useful in the differential diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10140-021-01919-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917172PMC
June 2021

MRI only in a patient with prostate cancer with bilateral metal hip prostheses: case study.

Tumori 2021 Feb 25:300891621997549. Epub 2021 Feb 25.

Medical Physics Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.

Objective: To outline a practical method of performing prostate cancer radiotherapy in patients with bilateral metal hip prostheses with the standard resources available in a modern general hospital. The proposed workflow is based exclusively on magnetic resonance imaging (MRI) to avoid computed tomography (CT) artifacts.

Case Description: This study concerns a 73-year-old man with bilateral hip prostheses with an elevated risk prostate cancer. Magnetic resonance images with assigned electron densities were used for planning purposes, generating a synthetic CT (sCT). Imaging acquisition was performed with an optimized Dixon sequence on a 1.5T MRI scanner. The images were contoured by autosegmentation software, based on an MRI database of 20 patients. The sCT was generated assigning averaged electron densities to each contour. Two volumetric modulated arc therapy plans, a complete arc and a partial one, where the beam entrances through the prostheses were avoided for about 50° on both sides, were compared. The feasibility of matching daily cone beam CT (CBCT) with MRI reference images was also tested by visual evaluations of different radiation oncologists.

Conclusions: The use of magnetic resonance images improved accuracy in targets and organs at risk (OARs) contouring. The complete arc plan was chosen because of 10% lower mean and maximum doses to prostheses with the same planning target volume coverage and OAR sparing. The image quality of the match between performed CBCTs and MRI was considered acceptable. The proposed method seems promising to improve radiotherapy treatments for this complex category of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0300891621997549DOI Listing
February 2021

Pitfalls and differential diagnosis on adrenal lesions: current concepts in CT/MR imaging: a narrative review.

Gland Surg 2020 Dec;9(6):2331-2342

Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.

The purpose of this pictorial essay is to review the imaging findings of adrenal lesions. Adrenal lesions could be divided into functioning or non-functioning masses, primary or metastatic, and benign or malignant. Imaging techniques have undergone significant advances in recent years. The most significant objective of adrenal imaging is represented by the detection and, when possible, characterization of adrenal lesions in order to direct patient management correctly. The detection and management of adrenal lesions is based on cross-sectional imaging obtained with non-contrast CT (tumour density), contrast-enhanced CT including delayed washout (either absolute percentage washout or relative percentage one) and finally with MR chemical shift analysis (loss of signal intensity between in-phase and out-of-phase images including both qualitative and quantitative estimates of signal loss). The small incidental adrenal nodules are benign, in most of cases; some tumors such as lipid-rich adenoma and myelolipoma have characteristic features that can be diagnosed accurately in CT. On contrary, if the presenting contrast-enhanced CT shows an adrenal mass with uncertain or malignant morphologic features, particularly in patients with a known history of malignancy, further evaluations should be considered. The most significative implications for radiologists are represented by how to assess risk of malignancy on imaging and what follow-up to indicate if an adrenal incidentaloma is not surgically removed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/gs-20-559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804564PMC
December 2020

Magnetic resonance severity index assessed by T1-weighted imaging for acute pancreatitis: correlation with clinical outcomes and grading of the revised Atlanta classification-a narrative review.

Gland Surg 2020 Dec;9(6):2312-2320

Department of Radiology, University "La Statale" of Milan, Milan, Italy.

Acute pancreatitis (AP) is a common disease that may involve pancreas and peripancreatic tissues with a prevalence of up to 50 per 100,000 individuals for year. The Atlanta classification was assessed for the first time in 1992 and modified in 2012 in order to describe morphological features of AP and its complications. AP can be morphologically distinguished in two main types: interstitial edematous pancreatitis (IEP) and necrotizing pancreatitis (NEP). This classification is very important because the presence of necrosis is directly linked to local or systemic complications, hospital stays and death. Magnetic resonance (MR) is very useful to characterize morphological features in AP and its abdominal complications. Particularly we would like to underline the diagnostic, staging and prognostic role of T1-weighted images with fat suppression that could be significant to assess many features of the AP inflammatory process and its complications (detection of the pancreatic contour, pancreatic necrosis, presence of haemorrhage). Signs of inflammatory and edema are instead observed by T1-weighted images. MR cholangiopancreatography (MRCP) is necessary to study the main pancreatic duct and the extrahepatic biliary tract and contrast-enhancement magnetic resonance imaging (MRI) allows to assess the extent of necrosis and vascular injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/gs-20-554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804529PMC
December 2020

Obstructive Uropathy Due to an Unusual Inguinal Hernia 35 Years After Kidney Transplant.

Exp Clin Transplant 2021 01;19(1):80-82

From the General Surgery and Abdominal Organ Transplantation Unit, ASST Niguarda Hospital, Milan, Italy.

In a kidney transplant recipient, bladder and graft ureter displacement into a groin hernia is a highly unusual cause of obstructive uropathy that may lead to graft dysfunction or graft loss. We report the case of a White man, 56 years old, who had previously, at the age of 19 years, undergone a kidney transplant from a deceased donor, to mitigate chronic glomerulonephritis. The patient presented to us with a reducible left inguinal hernia with worsening kidney function, and we used the Lichtenstein hernioplasty technique to surgically repair the hernia, which was followed by an uneventful postoperative course. Existing literature has identified few cases of kidney graft dysfunction due to inguinal hernias. Groin hernia repair of this type in this specific circumstance remains a subject of debate. However, in our opinion, with attention to appropriate reductions of immunosuppressive therapy, the Lichtenstein technique is safe for transplant recipients and the use of mesh greatly reduces the risk of hernia recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.6002/ect.2020.0487DOI Listing
January 2021

Impact of inter-reader contouring variability on textural radiomics of colorectal liver metastases.

Eur Radiol Exp 2020 11 10;4(1):62. Epub 2020 Nov 10.

Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.

Background: Radiomics is expected to improve the management of metastatic colorectal cancer (CRC). We aimed at evaluating the impact of liver lesion contouring as a source of variability on radiomic features (RFs).

Methods: After Ethics Committee approval, 70 liver metastases in 17 CRC patients were segmented on contrast-enhanced computed tomography scans by two residents and checked by experienced radiologists. RFs from grey level co-occurrence and run length matrices were extracted from three-dimensional (3D) regions of interest (ROIs) and the largest two-dimensional (2D) ROIs. Inter-reader variability was evaluated with Dice coefficient and Hausdorff distance, whilst its impact on RFs was assessed using mean relative change (MRC) and intraclass correlation coefficient (ICC). For the main lesion of each patient, one reader also segmented a circular ROI on the same image used for the 2D ROI.

Results: The best inter-reader contouring agreement was observed for 2D ROIs according to both Dice coefficient (median 0.85, interquartile range 0.78-0.89) and Hausdorff distance (0.21 mm, 0.14-0.31 mm). Comparing RF values, MRC ranged 0-752% for 2D and 0-1567% for 3D. For 24/32 RFs (75%), MRC was lower for 2D than for 3D. An ICC > 0.90 was observed for more RFs for 2D (53%) than for 3D (34%). Only 2/32 RFs (6%) showed a variability between 2D and circular ROIs higher than inter-reader variability.

Conclusions: A 2D contouring approach may help mitigate overall inter-reader variability, albeit stable RFs can be extracted from both 3D and 2D segmentations of CRC liver metastases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s41747-020-00189-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652946PMC
November 2020

Pertuzumab and trastuzumab emtansine in patients with HER2-amplified metastatic colorectal cancer: the phase II HERACLES-B trial.

ESMO Open 2020 09;5(5):e000911

Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milano, Italy; Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Milano, Italy. Electronic address:

Background: HER2 is a therapeutic target for metastatic colorectal cancer (mCRC), as demonstrated in the pivotal HERACLES-A (HER2 Amplification for Colo-rectaL cancer Enhanced Stratification) trial with trastuzumab and lapatinib. The aim of HERACLES-B trial is to assess the efficacy of the combination of pertuzumab and trastuzumab-emtansine (T-DM1) in this setting.

Methods: HERACLES-B was a single-arm, phase II trial, in patients with histologically confirmed wild-type and HER2+ mCRC refractory to standard treatments. HER2 positivity was assessed by immunohistochemistry and in situ hybridisation according to HERACLES criteria. Patients were treated with pertuzumab (840 mg intravenous load followed by 420 mg intravenous every 3 weeks) and T-DM1 (3.6 mg/kg every 3 weeks) until disease progression or toxicity. Primary and secondary end points were objective response rate (ORR) and progression-free survival (PFS). With a Fleming/Hern design (H0=ORR 10%; α=0.05; power=0.85), 7/30 responses were required to demonstrate an ORR ≥30% (H1).

Results: Thirty-one patients, 48% with ≥4 lines of previous therapies, were treated and evaluable. ORR was 9.7% (95% CI: 0 to 28) and stable disease (SD) 67.7% (95% CI: 50 to 85). OR/SD ≥4 months was associated with higher HER2 immunohistochemistry score (3+ vs 2+) (p = 0.03). Median PFS was 4.1 months (95% CI: 3.6 to 5.9). Drug-related grade (G) 3 adverse events were observed in two patients (thrombocytopaenia); G≤2 AE in 84% of cycles (n = 296), mainly nausea and fatigue.

Conclusions: HERACLES-B trial did not reach its primary end point of ORR; however, based on high disease control, PFS similar to other anti-HER2 regimens, and low toxicity, pertuzumab in combination with T-DM1 can be considered for HER2+mCRC as a potential therapeutic resource.

Trial Registration Number: 2012-002128-33 and NCT03225937.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/esmoopen-2020-000911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523198PMC
September 2020

Long-term Clinical Outcome of Trastuzumab and Lapatinib for HER2-positive Metastatic Colorectal Cancer.

Clin Colorectal Cancer 2020 12 27;19(4):256-262.e2. Epub 2020 Jun 27.

Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy. Electronic address:

Background: ERBB2 amplification occurs in 5% of RAS wild-type metastatic colorectal cancer (mCRC) and it has been shown to be a target for treatment with 2 HER2-directed combinations of trastuzumab and lapatinib or trastuzumab and pertuzumab. We present long-term clinical results of trastuzumab and lapatinib (HERACLES-A trial) at 6.7 years (82 months) follow-up and focus on central nervous system (CNS) recurrences.

Patients And Methods: Patients had histologically confirmed KRAS exon 2 (codons 12 and 13) wild-type and HER2-positive mCRC. HER2 positivity was assessed by immunohistochemistry and in situ hybridization HERACLES diagnostic criteria. Patients were treated with intravenous trastuzumab 4 mg/kg loading dose, then 2 mg/kg once per week, and oral lapatinib 1000 mg per day until disease progression or toxicity. Patients who presented with symptoms or signs of CNS disease received brain computed tomography scan or magnetic resonance imaging.

Results: A total of 35 patients received trastuzumab and lapatinib and 32 were evaluable for response. One patient (3%) achieved complete response (CR), 8 (25%) partial response, and 13 (41%) stable disease. Therefore, response rate was 28%. Median progression-free survival was 4.7 months (95% confidence interval [CI] 3.7-6.1). Median overall survival was 10.0 months (95% CI 7.9-15.8). One patient achieved sustained CR still maintained at 7 years of follow-up. Progression in the central nervous system (CNS) occurred in 6 (19%) of 32 patients.

Conclusions: Long-term (6.7 years) follow-up analysis of HERACLES-A supports using of trastuzumab and lapatinib as treatment reference for KRAS wild-type, chemorefractory HER2-positive mCRC. In this subset of patients, prolongation of survival is accompanied by CNS recurrences that will require diagnostic and therapeutic attention in future studies. Clinicaltrials. Gov identifier: NCT 03225937.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clcc.2020.06.009DOI Listing
December 2020

Radiomics predicts response of individual HER2-amplified colorectal cancer liver metastases in patients treated with HER2-targeted therapy.

Int J Cancer 2020 12 14;147(11):3215-3223. Epub 2020 Sep 14.

Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.

The aim of our study was to develop and validate a machine learning algorithm to predict response of individual HER2-amplified colorectal cancer liver metastases (lmCRC) undergoing dual HER2-targeted therapy. Twenty-four radiomics features were extracted after 3D manual segmentation of 141 lmCRC on pretreatment portal CT scans of a cohort including 38 HER2-amplified patients; feature selection was then performed using genetic algorithms. lmCRC were classified as nonresponders (R-), if their largest diameter increased more than 10% at a CT scan performed after 3 months of treatment, responders (R+) otherwise. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values in correctly classifying individual lesion and overall patient response were assessed on a training dataset and then validated on a second dataset using a Gaussian naïve Bayesian classifier. Per-lesion sensitivity, specificity, NPV and PPV were 89%, 85%, 93%, 78% and 90%, 42%, 73%, 71% respectively in the testing and validation datasets. Per-patient sensitivity and specificity were 92% and 86%. Heterogeneous response was observed in 9 of 38 patients (24%). Five of nine patients were carriers of nonresponder lesions correctly classified as such by our radiomics signature, including four of seven harboring only one nonresponder lesion. The developed method has been proven effective in predicting behavior of individual metastases to targeted treatment in a cohort of HER2 amplified patients. The model accurately detects responder lesions and identifies nonresponder lesions in patients with heterogeneous response, potentially paving the way to multimodal treatment in selected patients. Further validation will be needed to confirm our findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijc.33271DOI Listing
December 2020

An atypical presentation of biliary cast syndrome (BCS).

Dig Liver Dis 2021 Aug 17;53(8):1050. Epub 2020 Aug 17.

Radiology Unit, ASST Ospedale Niguarda, P.za Ospedale Maggiore 3, 20100 Milan, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dld.2020.07.030DOI Listing
August 2021

Standardization of CT radiomics features for multi-center analysis: impact of software settings and parameters.

Phys Med Biol 2020 09 29;65(19):195012. Epub 2020 Sep 29.

Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy. Department of Surgical Sciences, University of Turin, Turin, Italy.

The aim of this multicentric study is an inter-center benchmarking, to assess how different set tools applied to the same radiomics workflow affected the radiomics features (RFs) values. This topic is of key importance to start collaboration between different centers and to bring radiomic studies from benchmark to bedside. A per-lesion analysis was performed on 56 metastases (mts) selected from 14 patients. A single radiologist performed the segmentation of all mts, and RFs were extracted from the same segmentation of each mts, using two different software and file formats. Potential sources of discrepancies were evaluated. The intraclass correlation coefficient was used to describe how strongly the same radiomic measurements calculated in the two different centers resemble each other. Moreover, means of the relative changes of each RF were calculated, compared and gradually reduced. We showed that, after matching all formulas, discrepancies in RFs calculation between two centers ranged from 1% to 277%. Therefore, we evaluated other sources of variability using a stepwise approach, which led us to reduce the inter-center discrepancies to 0% for 22/25 RFs and below 2% for 3 RFs out of 25. In this study we demonstrated that different radiomic applications and masks formats might strongly impact the computation of some RFs. Therefore, when dealing with multi-center studies it is mandatory to adopt all strategies that can help in limiting the differences, thus keeping in mind the feasibility of these strategies in large cohort studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/1361-6560/ab9f61DOI Listing
September 2020

Immersive Virtual Reality in surgery and medical education: Diving into the future.

Am J Surg 2020 10 30;220(4):856-857. Epub 2020 Apr 30.

Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy; CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), Università degli Studi di Milano, via Celoria 16, 20133, Milan, Italy. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjsurg.2020.04.033DOI Listing
October 2020

Adrenal schwannoma: a case report.

BJR Case Rep 2020 Mar 12;6(1):20190044. Epub 2020 Feb 12.

Department of Biomedical Sciences for Health, University of Milan -Via Carlo Pascal 35, 20133, Milan, Italy.

Retroperitoneum is an uncommon site for Schwannoma tumors and among adrenal incidentaloma the Schwannoma is rare. This condition lacks of a specific clinical and radiological features, but correct diagnosis before pathological examination should be very important for clinical management and surgical decision. We describe a case of voluminous retroperitoneal incidental mass, that was proved to be an adrenal Schwannoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1259/bjrcr.20190044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068090PMC
March 2020

Including mRECIST in the Metroticket 2.0 criteria improves prediction of hepatocellular carcinoma-related death after liver transplant.

J Hepatol 2020 08 20;73(2):342-348. Epub 2020 Mar 20.

Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy; S.Orsola - Malpighi Hospital, Bologna, Italy.

Background & Aims: In the context of liver transplantation (LT) for hepatocellular carcinoma (HCC), prediction models are used to ensure that the risk of post-LT recurrence is acceptably low. However, the weighting that 'response to neoadjuvant therapies' should have in such models remains unclear. Herein, we aimed to incorporate radiological response into the Metroticket 2.0 model for post-LT prediction of "HCC-related death", to improve its clinical utility.

Methods: Data from 859 transplanted patients (2000-2015) who received neoadjuvant therapies were included. The last radiological assessment before LT was reviewed according to the modified RECIST criteria. Competing-risk analysis was applied. The added value of including radiological response into the Metroticket 2.0 was explored through category-based net reclassification improvement (NRI) analysis.

Results: At last radiological assessment prior to LT, complete response (CR) was diagnosed in 41.3%, partial response/stable disease (PR/SD) in 24.9% and progressive disease (PD) in 33.8% of patients. The 5-year rates of "HCC-related death" were 3.1%, 9.6% and 13.4% in those with CR, PR/SD, or PD, respectively (p <0.001). LogAFP (p <0.001) and the sum of number and diameter of the tumour/s (p <0.05) were determinants of "HCC-related death" for PR/SD and PD patients. To maintain the post-LT 5-year incidence of "HCC-related death" <30%, the Metroticket 2.0 criteria were restricted in some cases of PR/SD and in all cases with PD, correctly reclassifying 9.4% of patients with "HCC-related death", at the expense of 3.5% of patients who did not have the event. The overall/net NRI was 5.8.

Conclusion: Incorporating the modified RECIST criteria into the Metroticket 2.0 framework can improve its predictive ability. The additional information provided can be used to better judge the suitability of candidates for LT following neoadjuvant therapies.

Lay Summary: In the context of liver transplantation for patients with hepatocellular carcinoma, prediction models are used to ensure that the risk of recurrence after transplantation is acceptably low. The Metroticket 2.0 model has been proposed as an accurate predictor of "tumour-related death" after liver transplantation. In the present study, we show that its accuracy can be improved by incorporating information relating to the radiological responses of patients to neoadjuvant therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhep.2020.03.018DOI Listing
August 2020

Is Abdominal Fat Distribution Associated with Chronotype in Adults Independently of Lifestyle Factors?

Nutrients 2020 Feb 25;12(3). Epub 2020 Feb 25.

International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy.

Both abdominal obesity and its visceral component are independently associated with cardiometabolic diseases. Among the non-modifiable and modifiable determinants, lifestyle plays a central role, while chronotype is an emerging factor. Evening type (E-Type), more active and efficient in the last part of the day, has been associated with a health-impairing style, resulting in a higher risk of obesity and cardiometabolic diseases than morning type (M-Type). However, no study has examined the contribution of chronotype to abdominal fat distribution, even considering adherence to the Mediterranean diet (MD). We conducted a cross-sectional study on 416 adults (69.5% females, 50 ± 13 years). Waist circumference (WC), visceral fat (VAT) using ultrasonography, chronotype through the reduced Morningness-Eveningness Questionnaire (rMEQ), and adherence to MD were studied. Our results showed no differences in WC and VAT between chronotypes. However, adherence to MD resulted significantly lower in the E-Types compared to M-Types. WC decreased with increasing Mediterranean score and rMEQ score, and VAT decreased with increasing rMEQ score, indicating that E-Types have +2 cm of WC and +0.5 cm of VAT compared to M-Types. In conclusion, these results showed that chronotype is independently associated with abdominal obesity and visceral fat, underlining the potential implications of the individual circadian typology on abdominal obesity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu12030592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146439PMC
February 2020

Sensitivity of CE-MRI in detecting local recurrence after radical prostatectomy.

Radiol Med 2020 Jul 20;125(7):683-690. Epub 2020 Feb 20.

Department of Oncology and Hemato-Oncology, Grande Ospedale Metropolitano Niguarda, University of Milan, Milan, Italy.

Aim: The aim of our study was to evaluate the sensitivity of contrast-enhanced magnetic resonance (CE-MR) with phased array coil in the diagnosis of local recurrence in patients with prostate cancer after radical prostatectomy and referred for salvage radiotherapy (SRT).

Materials And Methods: This retrospective study included 73 patients treated with SRT after radical prostatectomy in the period between September 2006 and November 2017. All patients performed a CE-MRI with phased array coil before the start of SRT. A total of 213 patients treated at the ASST Grande Ospedale Metropolitano Niguarda in the period between September 2006 and November 2017 with SRT after radical prostatectomy were reviewed. Seventy-three patients with a CE-MRI with phased array coil of the pelvis before the start of SRT were included in the present study.

Results: At imaging review, recurrence local recurrent disease was diagnosed in 48 of 73 patients. By considering as reference standard the decrease in prostate-specific antigen (PSA) value after radiotherapy, we defined: 41 true positive (patients with MRI evidence of local recurrence and PSA value decreasing after SRT), 7 false positive (patients with MRI evidence of local recurrence without biochemical response after SRT), 3 true negative (patients without MRI evidence of local recurrence and stable or increased PSA value after SRT) and 22 false negative (patients without MRI evidence of local recurrence and PSA value decreasing after SRT) cases. The sensitivity values were calculated in relation to the PSA value before the start of treatment, obtaining a value of 74% for PSA above 0.2 ng/mL.

Conclusion: The sensitivity of CE-MRI in local recurrence detection after radical prostatectomy increases with increasing PSA values. CE-MRI with phased array coil can detect local recurrences after radical prostatectomy with a good sensitivity in patients with pre-RT PSA value above 0.2 ng/mL.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11547-020-01149-3DOI Listing
July 2020

Patient organ and effective dose estimation in CT: comparison of four software applications.

Eur Radiol Exp 2020 02 14;4(1):14. Epub 2020 Feb 14.

Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.

Background: Radiation dose in computed tomography (CT) has become a topic of high interest due to the increasing numbers of CT examinations performed worldwide. Hence, dose tracking and organ dose calculation software are increasingly used. We evaluated the organ dose variability associated with the use of different software applications or calculation methods.

Methods: We tested four commercial software applications on CT protocols actually in use in our hospital: CT-Expo, NCICT, NCICTX, and Virtual Dose. We compared dose coefficients, estimated organ doses and effective doses obtained by the four software applications by varying exposure parameters. Our results were also compared with estimates reported by the software authors.

Results: All four software applications showed dependence on tube voltage and volume CT dose index, while only CT-Expo was also dependent on other exposure parameters, in particular scanner model and pitch caused a variability till 50%. We found a disagreement between our results and those reported by the software authors (up to 600%), mainly due to a different extent of examined body regions. The relative range of the comparison of the four software applications was within 35% for most organs inside the scan region, but increased over the 100% for organs partially irradiated and outside the scan region. For effective doses, this variability was less evident (ranging from 9 to 36%).

Conclusions: The two main sources of organ dose variability were the software application used and the scan region set. Dose estimate must be related to the process used for its calculation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s41747-019-0130-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021892PMC
February 2020

Sex- and Age-Related Differences in the Contribution of Ultrasound-Measured Visceral and Subcutaneous Abdominal Fat to Fatty Liver Index in Overweight and Obese Caucasian Adults.

Nutrients 2019 12 9;11(12). Epub 2019 Dec 9.

International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Via Sandro Botticelli 21, 20133 Milan, Italy.

Differences in body fat distribution may be a reason for the sex-, age-, and ethnicity-related differences in the prevalence of fatty liver disease (FL). This study aimed to evaluate the sex- and age-related differences in the contribution of visceral (VAT) and subcutaneous (SAT) abdominal fat, measured by ultrasound, to fatty liver index (FLI) in a large sample of overweight and obese Caucasian adults, and to identify the VAT and SAT cut-off values predictive of high FL risk. A cross-sectional study on 8103 subjects was conducted. Anthropometrical measurements were taken and biochemical parameters measured. VAT and SAT were measured by ultrasonography. FLI was higher in men and increased with increasing age, VAT, and SAT. The sex*VAT, age*VAT, sex*SAT, and age*SAT interactions negatively contributed to FLI, indicating a lower VAT and SAT contribution to FLI in men and in the elderly for every 1 cm of increment. Because of this, sex- and age-specific cut-off values for VAT and SAT were estimated. In conclusion, abdominal adipose tissue depots are associated with FLI, but their contribution is sex- and age-dependent. Sex- and age-specific cut-off values of ultrasound-measured VAT and SAT are suggested, but they need to be validated in external populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu11123008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950624PMC
December 2019

Liquid biopsy for rectal cancer: A systematic review.

Cancer Treat Rev 2019 Sep 31;79:101893. Epub 2019 Aug 31.

Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Hemato-Oncology, Milan, Italy. Electronic address:

Background: The management of locally advanced rectal cancer (RC) is an evolving clinical field where the multidisciplinary approach can reach its best, and liquid biopsy for obtaining tumor-derived component such as circulating tumor DNA (ctDNA) might provide complementary informations.

Methods: A systematic review of studies available in literature of liquid biopsy in non-metastatic RC has been performed according to PRISMA criteria to assess the role of ctDNA as a diagnostic, predictive and prognostic biomarker in this setting.

Results: Twenty-five publications have been retrieved, of which 8 full-text articles, 7 abstracts and 10 clinical trials. Results have been categorized into three groups: diagnostic, predictive and prognostic. Few but promising data are available about the use of liquid biopsy for early diagnosis of RC, with the main limitation of sensitivity due to low concentrations of ctDNA in this setting. In terms of prediction of response to chemoradiation, still inconclusive data are available about the utility of a pre-treatment liquid biopsy, whereas some studies report a positive correlation with a dynamic (pre/post-treatment) monitoring. The presence of minimal residual disease by ctDNA was consistently associated with worse prognosis across studies.

Conclusions: The use of liquid biopsy for monitoring response to chemoradiation and assess the risk of disease recurrence are the most advanced potential applications for liquid biopsy in RC, with implications also in the context of non-operative management strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ctrv.2019.101893DOI Listing
September 2019

Torso computed tomography in blunt trauma patients with normal vital signs can be avoided using non-invasive tests and close clinical evaluation.

Emerg Radiol 2019 Dec 24;26(6):655-661. Epub 2019 Aug 24.

General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.

Purpose: To determine whether torso CT can be avoided in patients who experience high-energy blunt trauma but have normal vital signs.

Methods: High-energy blunt trauma patients with normal vital signs were retrieved retrospectively from our registry. We reviewed 1317 patients (1027 men and 290 women) and 761 (57.8%) fulfilled the inclusion criteria. All patients were initially evaluated at the emergency room (ER), with a set of tests, part of a specific protocol. Patients with at least one altered exam at initial examination or after six-hour observation received a torso CECT. Sensitivity, specificity, accuracy, positive (PPV) and negative predictive values (NPV), and likelihood ratio (LH) of the protocol were evaluated.

Results: Of 761 patients, 354 (46.5%) received torso CECT because of the positive ER test, with 330 being true positive and 24 being false positive. The remaining 407 patients were negative at ER tests and did not receive torso CECT, showing a significantly (P < 0.001) lower Injury Severity Score (ISS). The positive and negative LH of the protocol to detect torso injuries were respectively 16.5 and 0.01 (overall accuracy of 0.96).

Conclusions: Torso CT can be avoided without adverse clinical outcomes in patients who experience high-energy blunt trauma, are hemodynamically stable, and have normal initial laboratory and imaging tests.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10140-019-01712-0DOI Listing
December 2019

Postmortem imaging of perimortem skeletal trauma.

Forensic Sci Int 2019 Sep 8;302:109921. Epub 2019 Aug 8.

Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.

Various imaging modalities, including conventional radiography, computed tomography, magnetic resonance, and surface scanning have been applied in the examination of skeletal injuries in the forensic context. Although still not a substitute for a full medico-legal autopsy or the examination of skeletal remains, imaging is now increasingly used as a complementary tool in the postmortem analysis of perimortem skeletal trauma. Facilitated by the progress in general computational capacity, multimodal imaging has been proposed for comprehensive forensic documentation. A major advantage of these imaging approaches is that stored digital or physical 3D models of skeletal injuries can be reviewed at any time by various experts as well as be presented in court as evidence to clarify potentially complex medical and forensic aspects of the case. Due to constant technical progress in imaging techniques and software, continuous education, training, and sharing of expertise among engineers, computer scientists, and forensic experts, including forensic pathologists, anthropologists, and radiologists needs to be warranted to maintain high-quality expertise in the detection and interpretation of traumatic injuries on postmortem imaging. The technical developments and ever-improving user-friendliness of 3D imaging and modeling techniques present an atttactive alternative to traditional forensic approaches, but as long as the techniques have not been sufficiently tested and validated for forensic trauma analysis, and best practice manuals for forensic practice are lacking for both the technical procedures and method selection, the use of imaging techniques needs to be reevaluated on a case-by-case basis. In addition, ethical, legal, and financial aspects of the use of imaging and 3D modeling for forensic purposes need to be well understood by all parties in legal proceedings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.forsciint.2019.109921DOI Listing
September 2019

Analysis of a multicentre cloud-based CT dosimetric database: preliminary results.

Eur Radiol Exp 2019 07 16;3(1):27. Epub 2019 Jul 16.

Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.

Background: To manage and analyse dosimetric data provided by computed tomography (CT) scanners from four Italian hospitals.

Methods: A radiation dose index monitoring (RDIM) software was used to collect anonymised exams stored in a cloud server. Since hospitals use different names for the same procedure, digital imaging and communications in medicine (DICOM) tags more appropriate to describe exams were selected and associated to study common names (SCNs) from a radiology playbook according to scan region and use of contrast media. Retrospective analysis was carried out to describe population and to evaluate dosimetric indexes and inaccuracies associated with SCNs.

Results: More than 400 procedures were clustered into 95 SCNs, but 78% of exams on adults were described with only 10 SCNs. Median values of dose-length product (DLP) and volumetric CT dose index (CTDI) for three analysed SCNs were in agreement with those previously published. The percentage of inaccuracies does not heavily affect the dosimetric analysis on the whole cloud, since variations in median values reached at most 8%.

Conclusions: Implementation of a cloud-based RDIM software and related issues were described, showing the strength of the chosen playbook-based clustering and its usefulness for homogeneous data analysis. This approach may allow for optimisation actions, accurate assessment of the risk associated with radiation exposure, comparison of different facilities, and, last but not least, collection of information for the implementation of the 2013/59 Euratom Directive.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s41747-019-0105-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629733PMC
July 2019
-->