Publications by authors named "Lorenzo Bonomo"

189 Publications

COVID-19 pneumonia: current evidence of chest imaging features, evolution and prognosis.

Chin J Acad Radiol 2021 4;4(4):229-240. Epub 2021 May 4.

Bracco Diagnostics Inc., Global Medical and Regulatory Affairs, Monroe Twp, NJ USA.

COVID-19 pneumonia represents a global threatening disease, especially in severe cases. Chest imaging, with X-ray and high-resolution computed tomography (HRCT), plays an important role in the initial evaluation and follow-up of patients with COVID-19 pneumonia. Chest imaging can also help in assessing disease severity and in predicting patient's outcome, either as an independent factor or in combination with clinical and laboratory features. This review highlights the current knowledge of imaging features of COVID-19 pneumonia and their temporal evolution over time, and provides recent evidences on the role of chest imaging in the prognostic assessment of the disease.
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http://dx.doi.org/10.1007/s42058-021-00068-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093598PMC
May 2021

ESR EuroSafe Imaging and its role in promoting radiation protection - 6 years of success.

Insights Imaging 2021 Jan 7;12(1). Epub 2021 Jan 7.

Medical Exposure Regulatory Infrastructure Team, CRCE, Public Health England, Chilton, Didcot, UK.

This article introduces the European Society of Radiology's EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative's Call for Action in successfully achieving international radiation protection goals as set out by those frameworks is detailed.
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http://dx.doi.org/10.1186/s13244-020-00949-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790974PMC
January 2021

Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe.

Cancers (Basel) 2020 06 24;12(6). Epub 2020 Jun 24.

Department of Bioimaging and Radiological Sciences, Catholic University, 00168 Rome, Italy.

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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http://dx.doi.org/10.3390/cancers12061672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352874PMC
June 2020

Exploring technical issues in personalized medicine: NSCLC survival prediction by quantitative image analysis-usefulness of density correction of volumetric CT data.

Radiol Med 2020 Jul 3;125(7):625-635. Epub 2020 Mar 3.

Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy.

The aim of this study was to apply density correction method to the quantitative image analysis of non-small cell lung cancer (NSCLC) computed tomography (CT) images, determining its influence on overall survival (OS) prediction of surgically treated patients. Clinicopathological (CP) data and preoperative CT scans, pre- and post-contrast medium (CM) administration, of 57 surgically treated NSCLC patients, were retrospectively collected. After CT volumetric density measurement of primary gross tumour volume (GTV), aorta and tracheal air, density correction was conducted on GTV (reference values: aortic blood and tracheal air). For each resulting data set (combining CM administration and normalization), first-order statistical and textural features were extracted. CP and imaging data were correlated with patients 1-, 3- and 5-year OS, alone and combined (uni-/multivariate logistic regression and Akaike information criterion). Predictive performance was evaluated using the ROC curves and AUC values and compared among non-normalized/normalized data sets (DeLong test). The best predictive values were obtained when combining CP and imaging parameters (AUC values: 1 year 0.72; 3 years 0.82; 5 years 0.78). After normalization resulted an improvement in predicting 1-year OS for some of the grey level size zonebased features (large zone low grey level emphasis) and for the combined CP-imaging model, a worse performance for grey level co-occurrence matrix (cluster prominence and shade) and first-order statistical (range) parameters for 1- and 5-year OS, respectively. The negative performance of cluster prominence in predicting 1-year OS was the only statistically significant result (p value 0.05). Density corrections of volumetric CT data showed an opposite influence on the performance of imaging quantitative features in predicting OS of surgically treated NSCLC patients, even if no statistically significant for almost all predictors.
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http://dx.doi.org/10.1007/s11547-020-01157-3DOI Listing
July 2020

ESR/ERS statement paper on lung cancer screening.

Eur Radiol 2020 Jun 12;30(6):3277-3294. Epub 2020 Feb 12.

7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece.

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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http://dx.doi.org/10.1007/s00330-020-06727-7DOI Listing
June 2020

ESR/ERS statement paper on lung cancer screening.

Eur Respir J 2020 02 12;55(2). Epub 2020 Feb 12.

7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece.

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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http://dx.doi.org/10.1183/13993003.00506-2019DOI Listing
February 2020

CT Radiomics Signature of Tumor and Peritumoral Lung Parenchyma to Predict Nonsmall Cell Lung Cancer Postsurgical Recurrence Risk.

Acad Radiol 2020 04 6;27(4):497-507. Epub 2019 Jul 6.

Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy; Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.

Rationale And Objectives: To estimate recurrence risk after surgery in nonsmall cell lung cancer (NSCLC) patients by employing tumoral and peritumoral radiomics analysis.

Materials And Methods: One-hundred twenty-four surgically treated stage IA-IIB NSCLC patients' data from 2008 to 2013 were retrospectively collected. Patient outcome was defined as local recurrence (LR), distant metastasis (DM), and (sum of LR and DM) total recurrence (TR) at follow-up. Volumetric region of interests (ROIs) were drawn for the tumor, peritumoral lung parenchyma (2 cm around the tumor) and involved lobe on CT images. Ninety-four (morphological, first-order, textural, fractal-based) radiomics features were extracted from the ROIs and datasets were created from single or combined ROIs. Predictive models were built with radiomics signature (RS) and clinicopathological data, and the area under the curve (AUC) was used to evaluate the performance. Radiomics score was calculated with the best models' feature coefficients, low- and high-risk groups of patients defined accordingly. Kaplan-Meier curves were built, and the log-rank test was used for comparison among low- and high-risk groups. Differences in recurrence risk among the two risk groups were calculated (chi-square test).

Results: Fifty-six patients developed TR (25 LR, 31 DM). The tumor-node-metastasis (TNM) stage recurrence predictability (AUC 0.680; AUC 0.672; AUC 0.580) was substantially improved when RS was added to the predictive model (AUC 0.760; AUC 0.759; AUC 0.750). Seventy-five percent of high-risk patients developed TR. Recurrence risk of the high-risk group was 16-fold higher than that of the low-risk group (p < 0.001).

Conclusion: Combination of the tumoral and peritumoral RS with TNM staging system outperformed TNM staging alone in individualized recurrence risk estimation of patients with surgically treated NSCLC.
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http://dx.doi.org/10.1016/j.acra.2019.05.019DOI Listing
April 2020

Management of incidental pulmonary nodule in CT: a survey by the Italian College of Chest Radiology.

Radiol Med 2019 Jul 11;124(7):602-612. Epub 2019 Mar 11.

Dipartimento di Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy.

Objectives: The aim of this study is to present the results of the Italian survey on the management of pulmonary nodules incidentally identified at computed tomography (CT).

Materials And Methods: An online electronic survey, consisting of 23 multiple-choice questions, was created using the SurveyMonkey web-based tool. The questionnaire was developed by the Board of the Italian College of Chest Radiology of the Italian Society of Medical and Interventional Radiology (SIRM) and by an experienced group of Italian Academic Chest Radiologists. The link to the online electronic survey was submitted by email to all the SIRM members.

Results: A total of 767 radiologists, corresponding to 7.5% of all the SIRM members, participated in the online survey. The majority of participants (92%) routinely describe the attenuation of pulmonary nodules in the report, and 84.1% recommend the further follow-up, with 92.7% of respondents taking CT nodule morphological features into consideration. The 57.7% of participants adhere to the Fleischner Society guidelines for the management of incidental pulmonary nodules. However, 56.6% and 75.6% of respondents have a more cautious approach than that recommended by the guidelines and tend to use a shorter follow-up for both solid and ground-glass nodules, respectively. Finally, 94.5% of participants favor congresses and refresher courses dedicated to insights on lung nodule diagnosis and management.

Conclusions: This survey demonstrates that the management of pulmonary nodules incidentally detected on CT is still complex and controversial. The majority of SIRM members express a need for an update on this topic.
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http://dx.doi.org/10.1007/s11547-019-01011-1DOI Listing
July 2019

Lung nodules: size still matters.

Eur Respir Rev 2017 Dec 20;26(146). Epub 2017 Dec 20.

Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.

The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.
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http://dx.doi.org/10.1183/16000617.0025-2017DOI Listing
December 2017

Multifunctional Assessment of Non-Small Cell Lung Cancer: Perfusion-Metabolic Correlation.

Clin Nucl Med 2018 Jan;43(1):e18-e24

Purpose: The aim of this study was to investigate the relationship between whole-tumor CT perfusion and FDG PET/CT parameters in non-small cell lung cancer (NSCLC).

Methods: Twenty-five patients with NSCLC were prospectively included. CT perfusion parameters calculated were blood flow (BF), blood volume (BV), mean transit time, and peak enhancement intensity. SUVmax, SUVpeak, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated for PET/CT. Tumor diameter and volume were measured, and lesions were divided according to maximum axial diameter in more than 3 cm and 3 cm or less. The correlations between CT perfusion and PET/CT parameters were assessed in all tumors, as well as according to tumor diameter and volume.

Results: Lesion diameter and volume showed a negative correlation with BF and BV (r = -0.78, -0.78, -0.57, -0.48, respectively) and a positive correlation with mean transit time (r = 0.55, 0.65, respectively). The negative correlation between BF and lesion diameter and volume was confirmed in the subgroup of lesions of more than 3 cm (r = -0.68, -0.68, respectively). A positive correlation between SUVmax, SUVpeak, SUVmean, and lesion volume was observed (r = 0.50, 0.50, 0.46, respectively) and confirmed in lesions 3 cm or less (r = 0.81, 0.79, 0.78, respectively). Metabolic tumor volume and TLG showed a positive correlation with lesion diameter and volume in the overall population (r = 0.93, 0.87, 0.88, 0.90, respectively) and in lesions of more than 3 cm (r = 0.89, 0.84, 0.84, 0.79, respectively). Blood flow and BV showed a negative correlation with MTV and TLG (r = -0.77, -0.74, and -0.58, -0.48, respectively) in the overall population and with MTV in lesions of more than 3 cm (r = -0.69, -0.62, respectively).

Conclusions: Perfusion and metabolic parameters seem to depend on tumor size. The bigger the tumor, the lower the BF and the BV and, conversely, the higher the SUVpeak, MTV, and TLG. This information would be useful in the clinical setting when diagnosing or treating NSCLC, especially with novel therapies and/or for radiation treatment modulation.
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http://dx.doi.org/10.1097/RLU.0000000000001888DOI Listing
January 2018

Aging Airways: between Normal and Disease. A Multidimensional Diagnostic Approach by Combining Clinical, Functional, and Imaging Data.

Aging Dis 2017 Jul 21;8(4):471-485. Epub 2017 Jul 21.

3Department of Geriatrics, Campus Bio Medico University, 00128 Roma, Italy.

The lack of data on lung function decline in the aging process as well as the lack of gold standards to define obstructive and restrictive respiratory disease in older people point out the need for a multidimensional assessment and interpretation of the aging airways. By integrating clinical data together with morphologic and morphometric findings clinicians can assess the airways with a more comprehensive perspective, helpful in the interpretation of the "grey zone" between normal aging and disease. This review focuses on the value of a multidimensional approach in the study of the aging airways, including clinical findings, respiratory function tests, and imaging as parts of a whole. Nowadays this multidimensional diagnostic approach can be used in daily clinical practice. In next future, it can be implemented by the analysis of exhaled gases, post-processing imaging techniques, and genetic analysis, that will hopefully reduce the gaps in knowledge of normal aging and airway disease in older people.
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http://dx.doi.org/10.14336/AD.2016.1215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524809PMC
July 2017

Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis.

Diagn Interv Radiol 2017 Jul-Aug;23(4):272-281

Institute of Radiology, Diagnostic Area, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.

Endometriosis is a disease distinguished by the presence of endometrial tissue outside the uterine cavity with intralesional recurrent bleeding and resulting fibrosis. The most common locations for endometriosis are the ovaries, pelvic peritoneum, uterosacral ligaments, and torus uterinus. Typical symptoms are secondary dysmenorrhea and cyclic or chronic pelvic pain. Unusual sites of endometriosis may be associated with specific symptoms depending on the localization. Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments, ureter, and nerves. Moreover, rare extrapelvic endometriosis implants can be localized in the upper abdomen, subphrenic fold, or in the abdominal wall. Magnetic resonance imaging (MRI) represents a problem-solving tool among other imaging modalities. MRI is an advantageous technique, because of its multiplanarity, high contrast resolution, and lack of ionizing radiation. Our purpose is to remind the radiologists the possibility of atypical pelvic and extrapelvic endometriosis localizations and to illustrate the specific MRI findings. Endometriotic tissue with hemorrhagic content can be distinguished from adherences and fibrosis on MRI imaging. Radiologists should keep in mind these atypical localizations in patients with suspected endometriosis, in order to achieve the diagnosis and to help the clinicians in planning a correct and complete treatment strategy.
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http://dx.doi.org/10.5152/dir.2017.16364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508950PMC
February 2018

Erratum to: Persistent Urogenital Sinus: Diagnostic Imaging for Clinical Management. What Does the Radiologist Need to Know?

Am J Perinatol 2016 04 21;33(5):e1. Epub 2017 Jun 21.

Department of Radiological Sciences, Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy.

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http://dx.doi.org/10.1055/s-0037-1604062DOI Listing
April 2016

Imaging after treatment in uterine malignancies: Spectrum of normal findings and most common complications.

J Med Imaging Radiat Oncol 2017 Dec 18;61(6):777-790. Epub 2017 May 18.

Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy.

Uterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.
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http://dx.doi.org/10.1111/1754-9485.12624DOI Listing
December 2017

The morbidly adherent placenta: when and what association of signs can improve MRI diagnosis? Our experience.

Diagn Interv Radiol 2017 May-Jun;23(3):180-186

Department of Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.

Purpose: We aimed to verify whether combination of specific signs improves magnetic resonance imaging (MRI) accuracy in morbidly adherent placenta (MAP).

Methods: MRI findings for MAP were retrospectively evaluated in 27 women. Histopathology was the reference standard, showing MAP in eight of 27 cases. Specificity, sensitivity, positive predictive value, and negative predictive value were calculated for all MRI signs. Two skilled radiologists analyzed MRI findings, resolving discrepancies by consensus, using three alternative diagnostic criteria during three consecutive sections. First criterion: at least one of reported MRI signs indicates MAP and the absence of any sign is normal; second criterion: at least one statistically significant sign indicates MAP and no sign or nonsignificant sign is normal; third criterion: at least two statistically significant signs indicate MAP and no sign, nonsignificant sign, or only one significant sign is normal.

Results: Using the first criterion yielded an unacceptable rate of false positive results (78.9%). Using the second criterion there were less false positive results (31.5%), and diagnostic accuracy of the second criterion was significantly higher than the first; the third criterion correctly classified 100% of cases.

Conclusion: Only specific MRI signs can correctly predict MAP at histopathology, particularly when multiple (at least two) specific signs are observed together.
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http://dx.doi.org/10.5152/dir.2017.16275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410997PMC
January 2018

Effect of Needle Size in Ultrasound-guided Core Needle Breast Biopsy: Comparison of 14-, 16-, and 18-Gauge Needles.

Clin Breast Cancer 2017 11 6;17(7):536-543. Epub 2017 Mar 6.

Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy.

Introduction: The aim of the present study was to assess the diagnostic accuracy of ultrasound-guided core needle biopsy (US-CNB) of breast lesions, comparing smaller needles (16- and 18-gauge) with the 14-gauge needle, and to analyze the lesion characteristics influencing US-CNB diagnostic performance.

Patients And Methods: All the patients provided informed consent before the biopsy procedure. The data from breast lesions that had undergone US-CNB in our institution from January 2011 to January 2015 were retrospectively reviewed. The inclusion criterion was the surgical histopathologic examination findings of the entire lesion or radiologic follow-up data for ≥ 24 months. The exclusion criterion was the use of preoperative neoadjuvant therapy. The US-CNB results were compared with the surgical pathologic results or with the follow-up findings in the 3 needle size groups (14-, 16-, and 18-gauge). The needle size- and lesion characteristic-specific diagnostic accuracy parameters were evaluated. Statistical analysis was performed using a dedicated software program, and P ≤ .01 was considered significant.

Results: A total of 1118 US-CNB cases (1042 patients) were included. Of the 1118 cases, 630 (56.3%) were in the 14-gauge group, 136 (12.2%) in the 16-gauge, and 352 (31.5%) in the 18-gauge needle group. Surgery was performed on 800 lesions (71.6%). Of these, 619 were malignant, 77 were high risk, and 104 were benign. The remaining 318 lesions (28.4%) underwent follow-up imaging studies. All the lesions were stable and, therefore, were considered benign. No differences were observed in the diagnostic accuracy parameters among the 3 needle size groups (P > .01). The false-negative rate was greater for lesions < 10 mm (7.2%) (P < .01) but without statistically significant differences among the 3 gauges (P > .01).

Conclusion: US-CNB performed with small needles (16 and 18 gauge) had the same diagnostic accuracy as that performed with 14-gauge needles, regardless of the lesion characteristics.
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http://dx.doi.org/10.1016/j.clbc.2017.02.008DOI Listing
November 2017

Ultrasound Molecular Imaging With BR55 in Patients With Breast and Ovarian Lesions: First-in-Human Results.

J Clin Oncol 2017 07 14;35(19):2133-2140. Epub 2017 Mar 14.

Jürgen K. Willmann, Keerthi S. Valluru, Amelie M. Lutz, and Sanjiv S. Gambhir, Stanford University, Stanford, CA; and Lorenzo Bonomo, Antonia Carla Testa, Pierluigi Rinaldi, Guido Rindi, Gianluigi Petrone, and Maurizio Martini, Universitary Policlinic A. Gemelli-Foundation, Catholic University, Rome, Italy.

Purpose We performed a first-in-human clinical trial on ultrasound molecular imaging (USMI) in patients with breast and ovarian lesions using a clinical-grade contrast agent (kinase insert domain receptor [KDR] -targeted contrast microbubble [MB]) that is targeted at the KDR, one of the key regulators of neoangiogenesis in cancer. The aim of this study was to assess whether USMI using MB is safe and allows assessment of KDR expression using immunohistochemistry (IHC) as the gold standard. Methods Twenty-four women (age 48 to 79 years) with focal ovarian lesions and 21 women (age 34 to 66 years) with focal breast lesions were injected intravenously with MB (0.03 to 0.08 mL/kg of body weight), and USMI of the lesions was performed starting 5 minutes after injection up to 29 minutes. Blood pressure, ECG, oxygen levels, heart rate, CBC, and metabolic panel were obtained before and after MB administration. Persistent focal MB binding on USMI was assessed. Patients underwent surgical resection of the target lesions, and tissues were stained for CD31 and KDR by IHC. Results USMI with MB was well tolerated by all patients without safety concerns. Among the 40 patients included in the analysis, KDR expression on IHC matched well with imaging signal on USMI in 93% of breast and 85% of ovarian malignant lesions. Strong KDR-targeted USMI signal was present in 77% of malignant ovarian lesions, with no targeted signal seen in 78% of benign ovarian lesions. Similarly, strong targeted signal was seen in 93% of malignant breast lesions with no targeted signal present in 67% of benign breast lesions. Conclusion USMI with MB is clinically feasible and safe, and KDR-targeted USMI signal matches well with KDR expression on IHC. This study lays the foundation for a new field of clinical USMI in cancer.
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http://dx.doi.org/10.1200/JCO.2016.70.8594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493049PMC
July 2017

Missed lung cancer: when, where, and why?

Diagn Interv Radiol 2017 Mar-Apr;23(2):118-126

Institute of Radiology, Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, Italy.

Missed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer on chest radiographs and on CT, often very similar in nature to each other. Observer error is the most significant one and comprises scanning error, recognition error, decision-making error, and satisfaction of search. Tumor characteristics such as lesion size, conspicuity, and location are also crucial in this context. Even technical aspects can contribute to the probability of skipping lung cancer, including image quality and patient positioning and movement. Albeit it is hard to remove missed lung cancer completely, strategies to reduce observer error and methods to improve technique and automated detection may be valuable in reducing its likelihood.
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http://dx.doi.org/10.5152/dir.2016.16187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338577PMC
September 2017

The potential predictive value of MRI and PET-CT in mucinous and nonmucinous rectal cancer to identify patients at high risk of metastatic disease.

Br J Radiol 2017 Jan 15;90(1069):20150836. Epub 2016 Nov 15.

1 Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.

Objective: To correlate imaging parameters from baseline MRI diffusion-weighted imaging (DWI) and fludeoxyglucose (FDG) positron emission tomography (PET)-CT with synchronous and metachronous metastases in mucinous carcinoma (MC) and non-mucinous carcinoma (NMC) rectal cancer.

Methods: 111 patients with extraperitoneal locally advanced rectal cancer, who underwent pelvic MRI, DWI and FDG PET-CT, were stratified into MC (n = 23) and NMC (n = 88). We correlated adverse morphologic features on MRI [mT4, mesorectal fascia involvement, extramural venous invasion (mEMVI), mN2] and quantitative imaging parameters [minimum apparent diffusion coefficient (ADC), maximum standardized uptake value, total lesion glycolysis, metabolic tumour volume, T weighted and DWI tumour volumes] with the presence of metastatic disease. All patients underwent pre-operative chemoradiation therapy (CRT); 100/111 patients underwent surgery after CRT and were classified as pathological complete response (PCR) and no PCR [tumour regression grade (TRG)1 vs TRG2-5] and as ypN0 and ypN1-2. Median follow-up time was 48 months. Metastases were confirmed on FDG PET-CT and contrast-enhanced multidetector CT.

Results: The percentage of mucin measured by MRI correlates with that quantified by histology. On multivariate analysis, the synchronous metastases were correlated with mEMVI [odds ratio (OR) = 21.48, p < 0.01] and low ADC (OR = 0.04, p = 0.038) in NMC. The difference of metachronous recurrence between the MC group (10-90% mucin) and NMC group was significant (p < 0.01) (OR = 21.67, 95% confidence interval 3.8-120.5). Metachronous metastases were correlated with ypN2 (OR = 8.24, p = 0.01) in MC and in NMC. In NMC, mEMVI correlated with no PCR (p = 0.018) and ypN2 (p < 0.01).

Conclusion: mEMVI could identify patients with NMC, who are at high risk of synchronous metastases. The MC group is at a high risk of developing metachronous metastases. Advances in knowledge: Patients at high risk of metastases are more likely to benefit from more aggressive neoadjuvant therapy.
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http://dx.doi.org/10.1259/bjr.20150836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605010PMC
January 2017

Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings.

Diagn Interv Radiol 2016 Nov-Dec;22(6):534-541

Department of Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.

Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.
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http://dx.doi.org/10.5152/dir.2016.15593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098948PMC
May 2017

Sensitivity of breast MRI for ductal carcinoma in situ appearing as microcalcifications only on mammography.

Clin Imaging 2016 Nov - Dec;40(6):1207-1212. Epub 2016 Aug 6.

Catholic University of Sacred Heart, Policlinico A. Gemelli, Department of Radiology, 8, Largo Francesco Vito, 00168, Rome, Italy.

Purpose: This study aims to investigate sensitivity of breast magnetic resonance imaging (MRI) for mammographic microcalcifications-only ductal carcinoma in situ (DCIS), based on its histopathology and mammographic extent of microcalcifications.

Methods: Mammograms were reviewed to measure the extent of microcalcifications. Sensitivity of MRI was calculated in the overall study population and in groups differing for DCIS nuclear grade, microinvasivity, and microcalcifications' extent.

Results: Overall sensitivity of MRI was 78.3% for dynamic contrast enhanced and 66.7% for diffusion-weighted imaging and did not vary with nuclear grade and microinvasivity, while it increased with larger extent of microcalcifications (ExpB=1.063-1.046, P=.037-.013).

Conclusions: Mammographic extent of microcalcifications positively affects sensitivity of breast MRI.
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http://dx.doi.org/10.1016/j.clinimag.2016.08.001DOI Listing
January 2017

Hypervascularity Predicts Complete Pathologic Response to Chemotherapy and Late Outcomes in Breast Cancer.

Clin Breast Cancer 2016 12 23;16(6):e193-e201. Epub 2016 Jun 23.

Department of Radiological Sciences, Catholic University, Rome, Italy.

Background: Our objective was to investigate the relationship between asymmetric increase in breast vascularity (AIBV) and pathologic profiles of breast cancer. We also addressed the prognostic performance of AIBV and of vascular maps reduction after neoadjuvant chemotherapy (NAC) in predicting pathologic complete response (pCR) at surgery and outcome at follow-up.

Materials And Methods: Two hundred nineteen patients with unilateral locally advanced breast cancer (LABC) underwent magnetic resonance imaging before and after NAC. Axial, sagittal, and coronal maximum intensity projections were obtained in a subjective comparative evaluation. Asymmetrical versus symmetrical breast vascularity was defined through number of vessels, diameter, and signal intensity. Kaplan-Meier methodology was employed for late survival (31.4 ± 18 months follow-up).

Results: AIBV ipsilateral to LABC occurred in 62.5% (P < .001). AIBV was significantly associated with invasive ductal carcinoma, G3, triple-negative, HER2+, and hybrid phenotypes (P < .001). pCR was more frequent among patients with AIBV (24%) (P = .001). After NAC, the vascular map was significantly reduced, particularly in patients with pCR (P < .001). At follow-up, the recurrence rate was 22% (6.1% mortality). AIBV after NAC was associated with worse late survival (P = .036). A trend towards worse late survival existed among patients with AIBV before NAC. We did not observe statistically different survival according to the variation of vascularity after NAC.

Conclusion: LABC with ipsilateral AIBV before NAC is associated with more aggressive pathologic profiles. Nonetheless, it is more sensitive to NAC and shows a higher frequency of pCR. The persistence of AIBV after NAC entails a worse late prognosis and should prompt more aggressive therapeutic strategies.
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http://dx.doi.org/10.1016/j.clbc.2016.06.007DOI Listing
December 2016

Can Breast Cancer Biopsy Influence Sentinel Lymph Node Status?

Clin Breast Cancer 2016 12 14;16(6):e153-e157. Epub 2016 Jun 14.

Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy.

Introduction: We evaluated whether the needle size could influence metastasis occurrence in the axillary sentinel lymph node (SLN) in ultrasound-guided core needle biopsy (US-CNB) of breast cancer (BC).

Materials And Methods: The data from all patients with breast lesions who had undergone US-CNB at our institution from January 2011 to January 2015 were retrospectively reviewed. A total of 377 BC cases were included using the following criteria: (1) percutaneous biopsy-proven invasive BC; and (2) SLN dissection with histopathologic examination. The patients were divided into 2 groups according to the needle size used: 14 gauge versus 16 or 18 gauge. SLN metastasis classification followed the 7th American Joint Committee on Cancer (2010) TNM pathologic staging factors: macrometastases, micrometastases, isolated tumor cells, or negative. Only macrometastases and micrometastases were considered positive, and the positive and negative rates were calculated for the overall population and for both needle size groups.

Results: Of the 377 BC cases, 268 US-CNB procedures were performed using a 14-gauge needle and 109 with a 16- or 18-gauge needle, respectively. The negative rate was significantly related statistically with the needle size, with a greater prevalence in the 14-gauge group on both extemporaneous analysis (P = .019) and definitive analysis (P = .002). The macrometastasis rate was 17% (63 of 377) for the 14-gauge and 3% (12 of 377) for the 16- and 18-gauge needles, respectively.

Conclusion: Our preliminary results have suggested that use of a large needle size in CNB does not influence SLN status; thus, preoperative breast biopsy can be considered a safe procedure in the diagnosis of malignant breast lesions.
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http://dx.doi.org/10.1016/j.clbc.2016.06.005DOI Listing
December 2016

Magnetic resonance imaging appearance of oxidized regenerated cellulose in breast cancer surgery.

Radiol Med 2016 Sep 4;121(9):688-95. Epub 2016 Jun 4.

Department of Radiology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy.

Purpose: To describe magnetic resonance imaging (MRI) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in surgical cavity.

Materials And Methods: We retrospectively reviewed 51 MRI examinations performed between January 2009 and January 2014 in 51 patients who underwent BCS with ORC implantation.

Results: In 29/51 (57 %) cases, MRIs showed abnormal findings with three main MRI patterns: (1) complex masses: hyperintense collections on T2-weighted (w) images with internal round hypointense nodules without contrast enhancement (55 %); (2) completely hyperintense collections (17 %); and (3) completely hypointense lesions (28 %). All lesions showed rim enhancement on T1w images obtained in the late phase of the dynamic study with a type 1 curve. Diffusion-weighted imaging was negative in all MRIs and, in particular, 22/29 (76 %) lesions were hyperintense but showing ADC values >1.4 × 10(-3) mm(2)/s, while the remaining 7/29 (24 %) lesions were hypointense. In four cases, linear non-mass-like enhancement was detected at the periphery of surgical cavity; these patients were addressed to a short-term follow-up, and the subsequent examinations showed the resolution of these findings.

Conclusion: When applied to surgical residual cavity, ORC can lead alterations in surgical scar. This could induce radiologists to misinterpret ultrasonographic and mammographic findings, addressing patients to MRI or biopsy; so knowledge of MRI specific features of ORC, it is essential to avoid misdiagnosis of recurrence.
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http://dx.doi.org/10.1007/s11547-016-0656-zDOI Listing
September 2016

MRI anatomy of parametrial extension to better identify local pathways of disease spread in cervical cancer.

Diagn Interv Radiol 2016 Jul-Aug;22(4):319-25

Department of Radiological Sciences, Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy.

This paper highlights an updated anatomy of parametrial extension with emphasis on magnetic resonance imaging (MRI) assessment of disease spread in the parametrium in patients with locally advanced cervical cancer. Pelvic landmarks were identified to assess the anterior and posterior extensions of the parametria, besides the lateral extension, as defined in a previous anatomical study. A series of schematic drawings and MRI images are shown to document the anatomical delineation of disease on MRI, which is crucial not only for correct image-based three-dimensional radiotherapy but also for the surgical oncologist, since neoadjuvant chemoradiotherapy followed by radical surgery is emerging in Europe as a valid alternative to standard chemoradiation.
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http://dx.doi.org/10.5152/dir.2015.15282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956016PMC
May 2017

Performances of low-dose dual-energy CT in reducing artifacts from implanted metallic orthopedic devices.

Skeletal Radiol 2016 Jul 31;45(7):937-47. Epub 2016 Mar 31.

Department of Radiological Sciences, Institute of Radiology, Catholic University of Rome, School of Medicine, University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy.

Objectives: The objective was to evaluate the performances of dose-reduced dual-energy computed tomography (DECT) in decreasing metallic artifacts from orthopedic devices compared with dose-neutral DECT, dose-neutral single-energy computed tomography (SECT), and dose-reduced SECT.

Materials And Methods: Thirty implants in 20 consecutive cadavers underwent both SECT and DECT at three fixed CT dose indexes (CTDI): 20.0, 10.0, and 5.0 mGy. Extrapolated monoenergetic DECT images at 64, 69, 88, 105, 120, and 130 keV, and individually adjusted monoenergy for optimized image quality (OPTkeV) were generated. In each group, the image quality of the seven monoenergetic images and of the SECT image was assessed qualitatively and quantitatively by visually rating and by measuring the maximum streak artifact respectively.

Results: The comparison between SECT and OPTkeV evaluated overall within all groups showed a significant difference (p <0.001), with OPTkeV images providing better images. Comparing OPTkeV with the other DECT images, a significant difference was shown (p <0.001), with OPTkeV and 130-keV images providing the qualitatively best results. The OPTkeV images of 5.0-mGy acquisitions provided percentages of images with scores 1 and 2 of 36 % and 30 % respectively, compared with 0 % and 33.3 % of the corresponding SECT images of 10- and 20-mGy acquisitions. Moreover, DECT reconstructions at the OPTkeV of the low-dose group showed higher CT numbers than the SECT images of dose groups 1 and 2.

Conclusions: This study demonstrates that low-dose DECT permits a reduction of artifacts due to metallic implants to be obtained in a similar manner to neutral-dose DECT and better than reduced or neutral-dose SECT.
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http://dx.doi.org/10.1007/s00256-016-2377-8DOI Listing
July 2016

Combined locoregional treatment of patients with hepatocellular carcinoma: State of the art.

World J Gastroenterol 2016 Feb;22(6):1935-42

Roberto Iezzi, Alessandro Posa, Giuseppe Coppola, Lorenzo Bonomo, Department of Bioimaging, Institute of Radiology, "A. Gemelli" Hospital - Catholic University, 00168 Rome, Italy.

In recent years, a combination of intervention therapies has been widely applied in the treatment of hepatocellular carcinoma (HCC). One such combined strategy is based on the combination of the percutaneous approach, such as radiofrequency ablation (RFA), and the intra-arterial locoregional approach, such as trans-arterial chemoembolization (TACE). Several types of evidence have supported the feasibility and benefit of combined therapy, despite some studies reporting conflicting results and outcomes. The aim of this review was to explain the technical aspects of different combined treatments and to comprehensively analyze and compare the clinical efficacy and safety of this combined treatment option and monotherapy, either as TACE or RFA alone, in order to provide clinicians with an unbiased opinion and valuable information. Based on a literature review and our experience, combined treatment seems to be a safe and effective option in the treatment of patients with early/intermediate HCC when surgical resection is not feasible; furthermore, this approach provides better results than RFA and TACE alone for the treatment of large HCC, defined as those exceeding 3 cm in size. It can also expand the indication for RFA to previously contraindicated "complex cases", with increased risk of thermal ablation related complications due to tumor location, or to "complex patients" with high bleeding risk.
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http://dx.doi.org/10.3748/wjg.v22.i6.1935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726669PMC
February 2016

Enterography CT without and with water enema in patients with Crohn's disease: Results from a comparative observational study in comparison with endoscopy.

Eur J Radiol 2016 Feb 26;85(2):404-13. Epub 2015 Nov 26.

Catholic University of Sacred Heart, Department of Bio-Imaging and Radiological Sciences, Rome, Italy.

Objectives: CT is nowadays an examination routinely performed in Crohn's disease (CD) patients. However, there are several ways to assess gastro-intestinal tract, in particular colonic segments. Aim of this study is to compare enterography-CT (E-CT), performed after oral administration of polyethylene-glycol solution (PEG-CT) versus enterography-CT performed also with water enema via rectum (ECT-WE) in patients with CD.

Methods: We have studied 79 patients with CD undergone to enterography-CT (42 evaluated with PEG-CT and 37 with ECT-WE) who have performed a lower endoscopy within 15 days before CT. CT results concerning large bowel were compared with endoscopic findings. Intestinal distension, discomfort of the patients, sensitivity, specificity and diagnostic accuracy were evaluated. Pearson test was used for statistical analysis.

Results: Degree of abdominal pain was significantly higher in patients underwent to ECT-WE compared to PEG-CT. Distension of the colon was significantly greater in patients studied with ECT-WE compared to those studied with PEG-CT. Values of sensitivity, specificity and diagnostic accuracy of PEG-CT and ECT-WE were respectively 77, 86.5 and 81%, and 89, 100 and 92% in comparison with endoscopy.

Conclusions: In patients with CD, ECT-WE allows the evaluation of large bowel in addition to small bowel better than PEG-CT.
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http://dx.doi.org/10.1016/j.ejrad.2015.11.028DOI Listing
February 2016

Cervical cancer response to neoadjuvant chemoradiotherapy: MRI assessment compared with surgery.

Acta Radiol 2016 Sep 29;57(9):1123-31. Epub 2015 Nov 29.

Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.

Background: Imaging findings of residual cervical tumor after chemoradiotherapy can closely resemble those of post-irradiation inflammation.

Purpose: To determine the diagnostic performance of magnetic resonance imaging (MRI) in evaluating residual disease after chemoradiotherapy in patients with locally advanced cervical carcinoma (LACC).

Material And Methods: Retrospective analysis of prospectively collected data from 41 patients with histopathologically proven LACC (International Federation of Gynecology and Obstetrics stage ≥IB2) who underwent MRI before and after chemoradiotherapy. At each examination, a qualitative and semi-quantitative analysis of primary tumor, including tumor volume and signal intensity were assessed on T2-weighted (T2W) images. All patients had surgery after post-chemoradiotherapy MRI. MRI and histopathologic results were compared.

Results: All patients showed significant difference in tumor volume and signal intensity between pre- and post-chemoradiotherapy MRI (P < 0.0001). According to pathology, 27/41 (66%) patients had true negative and 2/41 (5%) had true positive post-chemoradiotherapy MRI. Eleven out of 41 (27%) patients showed inflammation with false positive post-chemoradiotherapy MRI and 1/41 (2%) had a false negative post-chemoradiotherapy MRI. Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values of post-chemoradiotherapy MRI in predicting residual disease were 69%, 71%, 71%, 15%, and 96%, respectively.

Conclusion: The differentiation of residual tumor from post-irradiation inflammation with early post- chemoradiotherapy MRI (within 28-60 days) is difficult with a high risk of false positive results. Combination of qualitative and semi-quantitative analysis does not improve the accuracy. Conversely, post-chemoradiotherapy MRI has a high negative predictive value with a low risk of false negative results. The role of conventional MRI combined with functional techniques should be evaluated.
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http://dx.doi.org/10.1177/0284185115617346DOI Listing
September 2016

Lung cancer screening white paper: a slippery step forward?

Eur Respir J 2015 Nov;46(5):1521-2

Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.

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http://dx.doi.org/10.1183/13993003.01103-2015DOI Listing
November 2015
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