Publications by authors named "Massimo Galia"

91 Publications

Long-Term Brain Disorders in Post Covid-19 Neurological Syndrome (PCNS) Patient.

Brain Sci 2021 Apr 2;11(4). Epub 2021 Apr 2.

Centro Medico di Fisioterapia "Villa Sarina", 91011 Alcamo, Italy.

In the recent pandemic disease, called COVID-19, the role of neurologists and neurobiologists represents a chance to study key features of brain infection and deepen neurological manifestations of COVID-19 and other coronavirus infections. In fact, many studies suggest brain damage during infection and persistent neurological symptoms after COVID-19 infection. Reverse transcription PCR test, antibody tests, Computed Tomography (CT) of the lung, and Magnetic Resonance (MR) of the brain of the patient were periodically performed during this case report for eight months after infection. The aim of this article is to describe the prolonged neurological clinical consequences related to COVID-19. We believe it is clinically clear that we can define a post-acute COVID-19 neurological syndrome. Therefore, in patients after a severe clinical condition of COVID-19, a deepening of persistent neurological signs is necessary.
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http://dx.doi.org/10.3390/brainsci11040454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066611PMC
April 2021

Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses.

Radiol Med 2021 Apr 21. Epub 2021 Apr 21.

IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.

Purpose: No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses.

Methods: Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes.

Results: Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters.

Conclusion: Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
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http://dx.doi.org/10.1007/s11547-021-01354-8DOI Listing
April 2021

Multiple sclerosis: prevalence of the 'central vein' sign in white matter lesions on gadolinium-enhanced susceptibility-weighted images.

Neuroradiol J 2021 Apr 19:19714009211008750. Epub 2021 Apr 19.

Department of Radiology, University of Palermo, Italy.

Aims: To evaluate prospectively whether an intravenous gadolinium injection could improve the detection of the central vein sign on susceptibility-weighted imaging sequences obtained with a 1.5 T magnetic resonance scanner in patients with multiple sclerosis compared to unenhanced susceptibility-weighted images.

Materials And Methods: This prospective, institution review board-approved study included 19 patients affected by multiple sclerosis (six men; 13 women; mean age 40.8 years, range 20-74 years). Patients had the relapsing-remitting clinical subtype in 95% of cases, and only one (5%) patient had the primary progressive clinical subtype of multiple sclerosis. T2-weighted images, fluid-attenuated inversion recovery images, unenhanced and contrast-enhanced susceptibility-weighted images were evaluated in consensus by two neuroradiologists for the presence of the central vein sign. The readers were blinded to magnetic resonance imaging reports, clinical information, the presence and the localisation of focal hyperintense white matter lesions. Any discordance between readers was resolved through a joint review of the recorded images with an additional neuroradiologist.

Results: A total of 317 multiple sclerosis lesions were analysed. The central vein sign had a higher prevalence detection rate on gadolinium-enhanced susceptibility-weighted images (272 of 317 lesions, 86%) compared to unenhanced susceptibility-weighted images (172 of 317 lesions, 54%).

Conclusion: Gadolinium-enhanced susceptibility-weighted imaging improves the detection rate of the central vein sign in multiple sclerosis lesions.
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http://dx.doi.org/10.1177/19714009211008750DOI Listing
April 2021

Imaging the COVID-19: a practical guide.

Monaldi Arch Chest Dis 2021 Mar 19. Epub 2021 Mar 19.

Department of Radiology, Policlinico "Paolo Giaccone", University of Palermo.

The Coronavirus Disease 2019 (COVID-19) represents the first medical catastrophe of the new millennium. Although imaging is not a screening test for COVID-19, it plays a crucial role in evaluation and follow-up of COVID-19 patients. In this paper, we will review typical and atypical imaging findings of COVID-19.
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http://dx.doi.org/10.4081/monaldi.2021.1630DOI Listing
March 2021

The Seurat spleen.

Abdom Radiol (NY) 2021 Mar 2. Epub 2021 Mar 2.

Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy.

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http://dx.doi.org/10.1007/s00261-021-02993-1DOI Listing
March 2021

Difficult laparoscopic cholecystectomy and preoperative predictive factors.

Sci Rep 2021 Jan 28;11(1):2559. Epub 2021 Jan 28.

Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.

Laparoscopic cholecystectomy (LC) is the standard technique for treatment of gallbladder disease. In case of acute cholecystitis we can identify preoperative factors associated with an increased risk of conversion and intraoperative complications. The aim of our study was to detect preoperative laboratory and radiological findings predictive of difficult LC with potential advantages for both the surgeons and patients in terms of options for management. We designed a retrospective case-control study to compare preoperative predictive factors of difficult LC in patients treated in emergency setting between January 2015 and December 2019. We included in the difficult LC group the surgeries with operative time > 2 h, need for conversion to open, significant bleeding and/or use of synthetic hemostats, vascular and/or biliary injuries and additional operative procedures. We collected 86 patients with inclusion criteria and difficult LC. In the control group, we selected 86 patients with inclusion criteria, but with no operative signs of difficult LC. The analysis of the collected data showed that there was a statistically significant association between WBC count and fibrinogen level and difficult LC. No association were seen with ALP, ALT and bilirubin values. Regarding radiological findings significant differences were noted among the two groups for irregular or absent wall, pericholecystic fluid, fat hyperdensity, thickening of wall > 4 mm and hydrops. The preoperative identification of difficult laparoscopic cholecystectomy provides an important advantage not only for the surgeon who has to perform the surgery, but also for the organization of the operating block and technical resources. In patients with clinical and laboratory parameters of acute cholecystitis, therefore, it would be advisable to carry out a preoperative abdominal CT scan with evaluation of features that can be easily assessed also by the surgeon.
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http://dx.doi.org/10.1038/s41598-021-81938-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844234PMC
January 2021

Technical development in cardiac CT: current standards and future improvements-a narrative review.

Cardiovasc Diagn Ther 2020 Dec;10(6):2018-2035

Department of Radiology, SDN IRCCS, Naples, Italy.

Non-invasive depiction of coronary arteries has been a great challenge for imaging specialists since the introduction of computed tomography (CT). Technological development together with improvements in spatial, temporal, and contrast resolution, progressively allowed implementation of the current clinical role of the CT assessment of coronary arteries. Several technological evolutions including hardware and software solutions of CT scanners have been developed to improve spatial and temporal resolution. The main challenges of cardiac computed tomography (CCT) are currently plaque characterization, functional assessment of stenosis and radiation dose reduction. In this review, we will discuss current standards and future improvements in CCT.
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http://dx.doi.org/10.21037/cdt-20-527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758763PMC
December 2020

Feasibility and Safety of Laparoscopic Complete Mesocolic Excision (CME) for Right-Sided Colon Cancer: Short-Term Outcomes. A Randomized Clinical Study.

Ann Surg 2020 Nov 9. Epub 2020 Nov 9.

Department of Surgical, Oncological and Oral Sciences, University of Palermo.

Objective: The aim of this prospective clinical study is compare short-term outcome of laparoscopic right hemicolectomy using the Complete Mesocolic Excision (CME group) with patients who underwent conventional right-sided colonic resection (NCME group).

Summary Background Data: Although CME with central vascular ligation in laparoscopic right hemicolectomy is associated with a significant decrease in local recurrence rates and improvements in cancer-related 5-year survival, there may be additional risks associated with this technique because of increased surgical complications. As a result, there is controversy surrounding its use.

Methods: In this randomized controlled trial, several primary endpoints (operative time, intraoperative blood loss, other complications, conversion rate, and anastomotic leak) and secondary endpoints (overall postoperative complications) were evaluated. In addition, we evaluated histopathologic data, including specimen length and the number of lymph nodes harvested, as objective signs of the quality of CME, related to oncological outcomes.

Results: The CME group had a significantly longer mean operative time than the NCME group (216.3 min versus 191.5 min, p = 0.005). However, the CME group had a higher number of lymph nodes (23.8 versus 16.6; p < 0.001) and larger surgical specimens (34.3 cm versus 29.3 cm; p = 0002). No differences were reported with respect to intraoperative blood loss, conversion rate, leakage, or other postoperative complications.

Conclusions: In this study laparoscopic CME were a safe and feasible technique with improvement in lymph nodes harvesting and length of surgical specimens with no increase of surgical intraoperative and postoperative complications.
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http://dx.doi.org/10.1097/SLA.0000000000004557DOI Listing
November 2020

TAVI imaging: over the echocardiography.

Radiol Med 2020 Nov 18;125(11):1148-1166. Epub 2020 Sep 18.

Department of Biomedicine, Neuroscience and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy.

Aortic valve stenosis (AS) is a common valvular heart disease. Recently, transcatheter aortic valve implantation (TAVI) has changed the treatment of severe AS in elderly patients with contraindications to traditional surgical replacement. Echocardiography is conventionally used as the first imaging modality to assess the presence and severity of AS and to provide anatomical and functional information. Nowadays, imaging techniques play a crucial role in the planning of TAVI to define suitable candidates. Computed tomography (CT) is essential to display the anatomy of the aortic valve complex (including aortic annulus, Valsalva sinuses, coronary arteries ostia, sinotubular junction), thoracoabdominal aorta, and vascular access. Cardiac CT may also provide the evaluation of coronary arteries in alternative to conventional coronary angiography. Magnetic resonance imaging may be alternative or supplementary in selected cases, providing detailed information of cardiac function and myocardial wall characteristics. More recently, advanced computer modeling image-based techniques can be used to support the evaluation of the feasibility and safety of TAVI procedures.
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http://dx.doi.org/10.1007/s11547-020-01281-0DOI Listing
November 2020

T2 mapping of the sacroiliac joints in patients with axial spondyloarthritis.

Eur J Radiol 2020 Oct 29;131:109246. Epub 2020 Aug 29.

Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127 Palermo, Italy.

Purpose: To test whether T2 mapping of the sacro-iliac joints (SIJs) might help identifying patients with spondyloarthritis.

Method: This study included 20 biologic-naive patients with axial spondyloarthritis (10 females; mean age: 38 ± 9years; range, 19-47) and 27 controls (16 males; mean age = 39 ± 13years; range = 28-71) who prospectively underwent SIJs MRI at 1.5 T, including a multislice multiecho spin-echo sequence. Standard MRIs were reviewed to assess the SIJs according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and SPondyloArthritis Research Consortium of Canada (SPARCC) MRI index. T2 maps obtained from multiecho sequences were used to draw regions of interests in the cartilaginous part of the SIJs. Disease activity was assessed using BASDAI questionnaire. Bland-Altman method, ROC curve analysis, Chi square, Mann-Whitney U, Pearson's and Spearman's correlation coefficient were used for data analysis.

Results: According to ASAS criteria, MRI was positive for sacroiliitis in 5/20 patients (25 %). Inter-observer reproducibility of T2 values was 87 % (coefficient of repeatability = 7.0; bias = 0.49; p < .001). Mean T2 values of patients (58.5 ± 4.4 ms, range: 52.6-68.2 ms) were significantly higher (p < .001) than those of controls (44.1 ± 6.6 ms, range: 33.6-67.2 ms). A T2 value of 52.51 ms yielded 100 % sensitivity and 91.7 % specificity to differentiate patients from controls. No statistically significant association/correlation was found between T2 values and BASDAI (r=-.026, p = .827), disease duration (r = .024, p = .871), SPARCC (r=-.004, p = .981), ASAS criteria (p = .476), HLA-B27-positivity (p = .139), age (r=-.2.53, p = .891), and gender (p = .404).

Conclusions: T2 relaxation times of the SIJs were significantly higher in patients than in healthy controls, making this tool potentially helpful to early identify patients with spondyloarthritis.
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http://dx.doi.org/10.1016/j.ejrad.2020.109246DOI Listing
October 2020

Outcome of LR-3 and LR-4 observations without arterial phase hyperenhancement at Gd-EOB-DTPA-enhanced MRI follow-up.

Clin Imaging 2020 Dec 12;68:169-174. Epub 2020 Aug 12.

Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy. Electronic address:

Objective: The aim of this study was to retrospectively analyze the outcome of LR-3 and LR-4 without arterial phase hyperenhancement (APHE), and identify which features could predict LR-5 progression on serial Gd-EOB-DTPA-enhanced MRI follow-up.

Methods: Forty-nine cirrhotic patients with 55 LR-3 and 19 LR-4 without APHE were evaluated. Observations were classified as decreased, stable or increased in category at follow-up. Observation size and LI-RADS major and ancillary features were evaluated.

Results: Seventeen/fifty-five (31%) LR-3 and 8/19 (42%) LR-4 progressed to LR-5 at follow-up. Baseline LI-RADS major and ancillary features were not significantly different among LR-3 and LR-4. A diameter ≥ 10 mm significantly increased LR-5 progression risk of LR-3 (OR = 6.07; 95% CI: 0.12; 60.28]; P < .001). LR-4 with a diameter ≥ 10 mm more likely become LR-5 at follow-up (OR = 8.95; 95% CI: 0.73; 111.8; P = .083]).

Conclusion: LR-3 and LR-4 without APHE were often downgraded or remained stable in category on Gd-EOB-DTPA-enhanced MRI follow-up.
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http://dx.doi.org/10.1016/j.clinimag.2020.08.003DOI Listing
December 2020

Ultrasound-Guided Percutaneous Irrigation of Rotator Cuff Calcific Tendinopathy (US-PICT): Patient Experience.

Biomed Res Int 2020 10;2020:3086395. Epub 2020 Jun 10.

IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy.

Purpose: To assess patients' experience of ultrasound-guided percutaneous irrigation of rotator cuff calcific tendinopathy (US-PICT).

Methods: Ninety-one patients (58 females; mean age: 50.5 ± 8.3 years) treated by US-PICT (local anesthesia, single-needle lavage, and intrabursal steroid injection) answered to a list of questions regarding their experience of the procedure before treatment, immediately after treatment, and three months later. The Borg CR10 scale was used to evaluate perceived pain, discomfort during anesthetic injection, and anxiety. The Wilcoxon, Spearman's rho, linear regression, and chi-square statistics were used.

Results: 81/91 patients complained mild discomfort during the injection of anesthetics (2, 1-2). Pain scores during US-PICT were very low (0, 0-1), with 70% patients having not experienced pain. After treatment, we found a significant reduction of pain (before: 8, 7-8; 3-month: 3, 1-6; < .001) and anxiety (before: 5, 2-7; during treatment: 2, 1-7; = 0.010), with high overall satisfaction (immediately after: 10, 9-10; 3-month: 9, 7-10) and confidence in the possibility of recovery (immediately after: 9, 8-10; 3-month: 10, 8-10), respectively. Treatments performed before US-PICT were not statistically associated with pain relief ( = 0.389) and clinical improvement ( = 0.937). We found a correlation between satisfaction immediately postprocedure and confidence in the possibility of recovery ( = 0.002) and between satisfaction three months after treatment and clinical improvement ( < 0.001) and patients' reminds about the description of the procedure ( = 0.005) and of the potential complications ( = 0.035).

Conclusions: US-PICT is a mildly painful, comfortable, and well-tolerated procedure, regardless of any previous treatments. Patients' satisfaction is correlated with clinical benefit and full explanation of the procedure and its complications.
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http://dx.doi.org/10.1155/2020/3086395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303755PMC
March 2021

Whole-body magnetic resonance imaging (WB-MRI) in oncology: an Italian survey.

Radiol Med 2021 Feb 22;126(2):299-305. Epub 2020 Jun 22.

Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy.

Purpose: To perform a survey among all members of the Italian Society of Medical and Interventional Radiology (SIRM) to assess how whole-body MRI (WB-MRI) is performed in oncologic patients in Italy.

Methods: On March 2019, we administered an online poll to all SIRM members about their use of WB-MRI in 2018 asking 15 questions regarding oncologic indications, imaging protocol, use of contrast media, experience in WB-MRI, duration of scan time and reporting time.

Results: Forty-eight members participated to the survey. WB-MRIs/total MRIs ratio was 1%. Lymphoma was the most common indication (17/48, 35%), followed by myeloma and prostate cancer, with these three tumors representing the most common indication in 39/48 of cases (81%). WB-MRI acquisition time and reporting time were 46-60 min in 22/48 centers (46%) and 20-30 min in 19/48 (40%), respectively. WB-MRIs were mostly performed in 1.5T scanners (43/48, 90%), with surface coils (22/48, 46%) being preferred to Q-body (15/48, 31%) and integrated coils (11/48, 23%). Contrast media were injected in 22/48 of the centers (46%), mainly used for breast cancer (13/22, 59%). DWI was the most used sequence (45/48, 94%), mostly with b800 (27/48, 56%), b0 (24/48, 50%) and b1000 (20/48, 42%) values. In about half of cases, radiologists started evaluating WB-MRI non-contrast morphologic sequences, then checking DWI and post-contrast images.

Conclusion: WB-MRI was mainly performed at 1.5T unit, with lymphoma, myeloma and prostate cancer having been the most common indications. The extreme variability in the choice of imaging protocols and use of contrast agents demonstrates the need of a standardization of WB-MRI application in clinical practice.
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http://dx.doi.org/10.1007/s11547-020-01242-7DOI Listing
February 2021

Predictive role of ankle MRI for tendon graft choice and surgical reconstruction.

Radiol Med 2020 Aug 28;125(8):763-769. Epub 2020 Mar 28.

IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Purpose: Tendon transfers have become a common surgical procedure around the ankle. In this study, we sought to evaluate the existence of a correlation between specific anthropometric parameters and the size of some ankle tendons measured on MRI, in particular those mostly used as graft in ankle surgery.

Methods: We recorded gender, height, weight, and body mass index (BMI) of 113 patients (57 females; mean age: 42 ± 18) who underwent ankle MRI. MRI measurements performed by a radiologist were: axial shortest diameter of Achilles (AT), posterior tibialis (PTT), flexor digitorum longus (FDLT), flexor hallucis longus (FHLT), peroneus longus (PLT), and anterior tibialis (ATT) tendons, intermalleolar distance (ID) and talus width (TW). Mann-Whitney U test and Pearson's correlation coefficient were used. After applying the Bonferroni correction for multiple comparisons, statistical significance was set at p < 0.002.

Results: The mean patient height, weight and BMI were 169 ± 9.8 cm (range: 140-193), 72.4 ± 16.4 kg (range: 44-142), and 25 ± 5.7 (range: 16-50), respectively. The mean ankle measurements were: AT = 5.3 ± 1.4 mm, PTT = 3.3 ± 0.6 mm, FDLT = 2.6 ± 0.4 mm, FHLT = 2.7 ± 0.4 mm, PLT = 2.9 ± 0.5 mm, ATT = 3±0.6 mm, ID = 62.9 ± 4.5 mm, and TW = 28.8 ± 2.5 mm. A statistical difference between male and female patients was observed regarding ID (z = -6.955, p < .001), TW (z = -6.692, p < .001), AT (z = -3.587, p < .001), PTT (z = -3.783, p < .001), and FDLT (z = -3.744, p < .001). Both PTT and FDLT showed a significant correlation with ID (p < .001) and TW (p < .001). ATT size was significantly correlated with weight, ID and TW (all with p < 0.001). PLT and AT showed a significant correlation only with ID and weight (p ≤ .001), respectively.

Conclusion: Our data might help orthopaedists in preoperative planning to identify the best graft for ankle surgical procedures including tendon transfers.
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http://dx.doi.org/10.1007/s11547-020-01177-zDOI Listing
August 2020

The Changing Epidemiology of Hepatocellular Carcinoma :  Experience of a Single Center.

Biomed Res Int 2020 27;2020:5309307. Epub 2020 Feb 27.

Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.

Aims: To analyze the main etiological factors and some clinical features of patients with hepatocellular carcinoma (HCC) at diagnosis and to compare them with those we described ten years ago. . We compared two groups of patients with HCC, Group 1 consisting of 132 patients (82 M, 50 F) diagnosed in the 2003-2008 period and Group 2 including 119 patients (82 M, 37 F) diagnosed in the 2013-2018 period. For all patients, age, sex, viral markers, alcohol consumption, serum alpha-fetoprotein (AFP) levels, and the main liver function parameters were recorded. The diagnosis of HCC was based on AASLD, EASL guidelines. The staging was classified according to the "Barcelona Clinic Liver Cancer staging system" (BCLC).

Results: Mean age was 69.0 ± 8 years in Group 1 and 71.0 ± 9 in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 ( < 0.05). HCV subjects were significantly older in Group 2 (.

Conclusions: This study shows that over the last decade a number of features of patients with HCC in our region have changed, particularly age at onset, etiological factors, and staging of HCC.
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http://dx.doi.org/10.1155/2020/5309307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063180PMC
November 2020

CT and MR imaging of cystic renal lesions.

Insights Imaging 2020 Jan 3;11(1). Epub 2020 Jan 3.

Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.

Cystic renal lesions are a common incidental finding on routinely imaging examinations. Although a benign simple cyst is usually easy to recognize, the same is not true for complex and multifocal cystic renal lesions, whose differential diagnosis includes both neoplastic and non-neoplastic conditions. In this review, we will show a series of cases in order to provide tips to identify benign cysts and differentiate them from malignant ones.
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http://dx.doi.org/10.1186/s13244-019-0826-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942066PMC
January 2020

PI-RADS 3 Lesions: Role of Prostate MRI Texture Analysis in the Identification of Prostate Cancer.

Curr Probl Diagn Radiol 2021 Mar-Apr;50(2):175-185. Epub 2019 Oct 31.

Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Palermo, Italy.

Purpose: To determine the diagnostic performance of texture analysis of prostate MRI for the diagnosis of prostate cancer among Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions.

Materials And Methods: Forty-three patients with at least 1 PI-RADS 3 lesion on prostate MRI performed between June 2016 and January 2019 were retrospectively included. Reference standard was pathological analysis of radical prostatectomy specimens or MRI-targeted biopsies. Texture analysis extraction of target lesions was performed on axial T2-weighted images and apparent diffusion coefficient (ADC) maps using a radiomic software. Lesions were categorized as prostate cancer (Gleason score [GS] ≥ 6), and no prostate cancer. Statistical analysis was performed using the generalized linear model (GLM) regression and the discriminant analysis (DA). AUROC with 95% confidence intervals were calculated to assess the diagnostic performance of standalone features and predictive models for the diagnosis of prostate cancer (GS ≥ 6) and clinically-significant prostate cancer (GS ≥ 7).

Results: The analysis of 46 PI-RADS 3 lesions (ie, 27 [58.7%] no prostate cancers; 19 [41.3%] prostate cancers) revealed 9 and 6 independent texture parameters significantly correlated with the final histopathological results on T2-weighted and ADC maps images, respectively. The resulting GLM and DA predictive models for the diagnosis of prostate cancer yielded an AUROC of 0.775 and 0.779 on T2-weighted images or 0.815 and 0.821 on ADC maps images. For the diagnosis of clinically-significant prostate cancer, the resulting GLM and DA predictive models for the diagnosis of prostate cancer yielded an AUROC of 0.769 and 0.817 on T2-weighted images or 0.749 and 0.744 on ADC maps images.

Conclusion: Texture analysis of PI-RADS 3 lesions on T2-weighted and ADC maps images helps identifying prostate cancer. The good diagnostic performance of the combination of multiple radiomic features for the diagnosis of prostate cancer may help predicting lesions where aggressive management may be warranted.
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http://dx.doi.org/10.1067/j.cpradiol.2019.10.009DOI Listing
October 2019

Clinical and Prognostic Value of F-FDG-PET/CT in the Restaging Process of Recurrent Cutaneous Melanoma.

Curr Radiopharm 2020 ;13(1):42-47

Nuclear Medicine Unit, Fondazione Istituto G.Giglio, Ct.da Pietra Pollastra-pisciotto, Cefalu, Italy.

Background: Several studies on 18F-FDG-PET/CT have investigated the prognostic role of this imaging modality in different tumors after treatment. Nevertheless, its role in restaging patients with recurrent CM still needs to be defined.

Objective: The aim of this retrospective multicenter study was to evaluate the clinical and prognostic impact of 18F-FDG-PET/CT on the restaging process of cutaneous melanoma (CM) after surgery in patients with suspected distant recurrent disease or suspected metastatic progression disease.

Materials And Methods: 74 patients surgically treated for CM underwent 18F-FDG-PET/CT for suspected distant recurrent disease or suspected metastatic progression disease. The diagnostic accuracy of visually interpreted 18F-FDG-PET/CT was obtained by considering histology (n=21 patients), other diagnostic imaging modalities performed within 2 months of PET/CT (CT in 52/74 patients and Whole-Body MRI in 18/74 patients) and clinical follow-up (n=74 patients) for at least 24 months containing all the clinical and diagnostic information useful for the PET performance assessment and outcome. Progression-free survival (PFS) and overall survival (OS) were assessed by using the Kaplan- Meier method. The risk of progression (Hazard Ratio-HR) was computed by the Cox regression analysis.

Results: Suspicion of recurrent CM was confirmed in 24/27 patients with a positive 18F-FDG-PET/CT scan. Overall, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG-PET/CT were 82%, 93%, 88%, 89%, and 89%, respectively, with area under the curve being 0.87 (95%IC 0.78-0.97; p<0.05). 18F-FDG-PET/CT findings significantly influenced the therapeutic management in 18 patients (modifying therapy in 10 patients; guiding surgery in 8 patients). After 2 years of follow-up, PFS was significantly longer in patients with a negative vs. a positive 18F-FDG-PET/CT scan (90% vs 46%, p<0.05; Fig. 1). Moreover, a negative scan was associated with a significantly longer OS than a positive one (76% vs 39% after 2 years, p<0.05; Fig. 2). In addition, a positive 18F-FDG-PET/CT scan was associated with an increased risk of disease progression (HR=8.2; p<0,05).

Conclusion: 18F-FDG-PET/CT showed a valuable diagnostic performance in patients with suspicion of recurrent CM. This imaging modality might have an important prognostic value in predicting the survival outcomes, assessing the risk of disease progression, and guiding treatment decision making.
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http://dx.doi.org/10.2174/1874471012666191009161826DOI Listing
November 2020

Whole-body magnetic resonance imaging (WB-MRI) in lymphoma: State of the art.

Hematol Oncol 2020 Feb 13;38(1):12-21. Epub 2019 Nov 13.

Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy.

The improvements in magnetic resonance imaging (MRI) technology and the concern related to the increased cancer risk in patients with lymphoma, also due to radiation exposure associated with imaging examinations, have led to the introduction of whole-body MRI (WB-MRI) as a radiation-free alternative to standard imaging procedures. WB-MRI seems a less histology-dependent functional imaging test than F-fluorodeoxyglucose-positron emission tomography/CT ( F-FDG-PET/CT). In patients with FDG-avid lymphomas, such as diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), F-FDG-PET/CT remains the imaging reference standard for staging, with WB-MRI potentially being a complementary modality that could replace CT, especially in young patients. On the other hand, WB-MRI is a valuable imaging procedure for lymphoma surveillance and in lymphomas with variable/low FDG avidity and nonfollicular indolent lymphomas. The aim of this paper is to discuss the current state of the art of WB-MRI in lymphoma by evaluating its diagnostic performance in different lymphoma subtypes: Hodgkin, aggressive, and indolent lymphomas.
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http://dx.doi.org/10.1002/hon.2676DOI Listing
February 2020

Role of computed tomography and magnetic resonance imaging in local complications of acute pancreatitis.

Gland Surg 2019 Apr;8(2):123-132

Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy.

Acute pancreatitis (AP) represents a pancreas inflammation of sudden onset that can present different degrees of severity. AP is a frequent cause of acute abdomen and its complications are still a cause of death. Biliary calculosis and alcohol abuse are the most frequent cause of AP. Computed tomography (CT) and magnetic resonance imaging (MRI) are not necessary for the diagnosis of AP but they are fundamental tools for the identification of the cause, degree severity and AP complications. AP severity assessment is in fact one of the most important issue in disease management. Contrast-enhanced CT is preferred in the emergency setting and is considered the gold standard in patients with AP. MRI is comparable to CT for the diagnosis of AP but requires much more time so it is not usually chosen in the emergency scenario. Complications of AP can be distinguished in localized and generalized. Among the localized complications, we can identify: acute peripancreatic fluid collections (APFC), pseudocysts, acute necrotic collections (ANC), walled off pancreatic necrosis (WOPN), venous thrombosis, pseudoaneurysms and haemorrhage. Multiple organ failure syndrome (MOFS) and sepsis are possible generalized complications of AP. In this review, we focus on CT and MRI findings in local complications of AP and when and how to perform CT and MRI. We paid also attention to recent developments in diagnostic classification of AP complications.
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http://dx.doi.org/10.21037/gs.2018.12.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534767PMC
April 2019

Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes.

BMC Surg 2019 Apr 24;18(Suppl 1):128. Epub 2019 Apr 24.

Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy.

Background: laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (< 5-6 cm), instead there are still open questions in literature regarding the correct management of larger lesions (> 6 cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery.

Methods: at the University Hospital Policlinico "P. Giaccone" of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications.

Results: Mean size of adrenal neoplasm was 7,5 cm (range 1.5 to 18 cm). The mean operative time was 145 min (range 75-240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p < 0.05) but not with pre-operative features or histological results. 5 intraoperative complications occurred. Among these patients 4 presented bleeding and 1 a diaphagmatic lesion. No conversion to open surgery was necessary and no intraoperative blood transfusion were required. Mean estimated blood loss was 95 ml (range 50-350). There was no capsular disruption during adrenal dissection. Mean length of hospital stay was 3.7 days (range 3-6 days).

Conclusions: Laparoscopic adrenalectomy is a safe procedure with low rate of morbidity. An accurate preoperative radiological examination is fundamental to obtain a stringent patients selection. The lesion diameter is related to longer operative time and appeares as the main predictive parameter of intraoperative complications but these results are not statistically significant. On the other side secreting adrenal tumors require more attention in operative management without increased rate of postoperative complications.
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http://dx.doi.org/10.1186/s12893-018-0456-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402565PMC
April 2019

Dedifferentiated retroperitoneal large liposarcoma and laparoscopic treatment: Is it possible and safe? The first literature case report.

Int J Surg Case Rep 2019 26;57:113-117. Epub 2019 Mar 26.

Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy. Electronic address:

Introduction: Soft tissue sarcomas are rare neoplasms often characterized by local invasiveness and distant metastasis with poor prognosis for affected patients. Among the most frequent sarcomas we find well-differentiated and dedifferentiated liposarcomas characterized by a better survival compared to the other histological types. When it is possible the only curative treatment for these neoplasms is surgical resection.

Case Report: We report a case of a 62-year-old caucasian woman with CT abdominal scan that demonstrated a voluminous solid oval mass in the left perirenal space with dislocation of the kidney and in continuity with the anterior renal fascia. After a percutaneous CT-guided biopsy of the mass the histopathological diagnosis was a dedifferentiated retroperitoneal liposarcoma. We performed a laparoscopic surgical resection of the retroperitoneal mass in block with kidney and left adrenal gland.

Discussion: When possible, surgical resection with adequate margins represents the only curative therapeutic option for this pathology. Only a few papers are available in literature which take into consideration the possibility of laparoscopic approach for retroperitoneal masses with better vision of surgical field, reduction of post-operative pain and better cosmesis.

Conclusion: A retroperitoneal mass represents a serious diagnostic challenge. The choice of the best surgical procedure can benefit to the patient prognosis. To our opinion laparoscopy can be a safe and successful treatment and it can represent a valid alternative to open surgery. However, we have no randomized controlled trials that compare laparoscopic versus open resection for retroperitoneal liposarcomas.
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http://dx.doi.org/10.1016/j.ijscr.2019.03.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446056PMC
March 2019

CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain.

Insights Imaging 2019 Feb 22;10(1):26. Epub 2019 Feb 22.

Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.

Epiploic appendagitis is a rare cause of acute abdominal pain, determined by a benign self-limiting inflammation of the epiploic appendages. It may manifest with heterogeneous clinical presentations, mimicking other more severe entities responsible of acute abdominal pain, such as acute diverticulitis or appendicitis. Given its importance as clinical mimicker, imaging plays a crucial role to avoid inaccurate diagnosis that may lead to unnecessary hospitalization, antibiotic therapy, and surgery. CT represents the gold standard technique for the evaluation of patients with indeterminate acute abdominal pain. Imaging findings include the presence of an oval lesion with fat-attenuation surrounded by a thin hyperdense rim on CT ("hyperattenuating ring sign") abutting anteriorly the large bowel, usually associated with inflammation of the adjacent mesentery. A central high-attenuation focus within the fatty lesion ("central dot sign") can sometimes be observed and is indicative of a central thrombosed vein within the inflamed epiploic appendage. Rarely, epiploic appendagitis may be located within a hernia sac or attached to the vermiform appendix. Chronically infarcted epiploic appendage may detach, appearing as an intraperitoneal loose calcified body in the abdominal cavity. In this review, we aim to provide an overview of the clinical presentation and key imaging features that may help the radiologist to make an accurate diagnosis and guide the clinical management of those patients.
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http://dx.doi.org/10.1186/s13244-019-0715-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386757PMC
February 2019

Imaging features of adrenal masses.

Insights Imaging 2019 Jan 25;10(1). Epub 2019 Jan 25.

Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.

The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign and malignant conditions, thus helping clinicians and surgeons in the management of patients. The purpose of this paper is to provide an overview of the main imaging features of adrenal masses and tumor-like conditions recalling the strengths and weaknesses of imaging modalities commonly used in adrenal imaging.
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http://dx.doi.org/10.1186/s13244-019-0688-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349247PMC
January 2019

Role of apparent diffusion coefficient values in prostate diseases characterization on diffusion-weighted magnetic resonance imaging.

Minerva Urol Nefrol 2019 Apr 7;71(2):154-160. Epub 2018 Nov 7.

Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy.

Background: To evaluate if normal and pathological prostate tissue can be distinguished by using apparent diffusion coefficient (ADC) values on magnetic resonance imaging (MRI) and to understand if it is possible to differentiate among pathological prostate tissues using ADC values.

Methods: Our population consisted in 81 patients (mean age 65.4 years) in which 84 suspicious areas were identified. Regions of interest were placed over suspicious areas, detected on MRI, and over areas with normal appearance, and ADC values were recorded. Statistical differences between ADC values of suspicious and normal areas were evaluated. Histopathological diagnosis, obtained from targeted biopsy using MRI-US fusion biopsies in 39 patients and from prostatectomy in 42 patients, were correlated to ADC values.

Results: Histopathological diagnosis revealed 58 cases of prostate cancer (PCa), 19 patients with indolent PCa (Gleason Score ≤6) and 39 patients with clinically significant PCa (Gleason Score ≥7), 16 of high-grade prostatic intraepithelial neoplasia (HG-PIN) and 10 of atypical small acinar proliferation (ASAP). Significant statistical differences between mean ADC values of normal prostate tissue versus PCa (P<0.00001), HG-PIN (P<0.00001) and ASAP (P<0.00001) were found. Significant differences were observed between mean ADC values of PCa versus HG-PIN (P<0.00001) and ASAP (P<0.00001) with many overlapping values. Differences between mean ADC values of HG-PIN versus ASAP (P=0.015) were not significant. Significant differences of ADC values were also observed between patients with indolent and clinically significant PCa (P<0.00001).

Conclusions: ADC values allow differentiation between normal and pathological prostate tissue and between indolent and clinically significant PCa but do not allow a definite differentiation between PCa, HG-PIN, and ASAP.
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http://dx.doi.org/10.23736/S0393-2249.18.03065-5DOI Listing
April 2019

Superior Mesenteric Artery Syndrome: Clinical, Endoscopic, and Radiological Findings.

Gastroenterol Res Pract 2018 27;2018:1937416. Epub 2018 Aug 27.

Department of Radiology, DIBIMED, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.

Background: The superior mesenteric artery (SMA) syndrome is a rare entity presenting with upper gastrointestinal tract obstruction and weight loss. Studies to determine the optimal methods of diagnosis and treatment are required.

Aims And Methods: This study aims at analyzing the clinical presentation, diagnosis, and management of SMA syndrome. Ten cases of SMA syndrome out of 2074 esophagogastroduodenoscopies were suspected. A contrast-enhanced computed tomography (CECT) scan was performed to confirm the diagnosis. After, a gastroenterologist and a nutritionist personalized the therapy. Furthermore, we compared the demographical, clinical, endoscopic, and radiological parameters of these cases with a control group consisting of 10 cases out of 2380 EGDS of initially suspected (but not radiologically confirmed) SMA over a follow-up 2-year period (2015-2016).

Results: The prevalence of SMA syndrome was 0.005%. Median age and body mass index were 23.5 years and 21.5 kg/m, respectively. Symptoms developed between 6 and 24 months. Median aortomesenteric angle and aorta-SMA distance were 22 and 6 mm, respectively. All patients improved on conservative treatment. In our series, a marked (>5 kg) weight loss ( = 0.006) and a long-standing presentation (more than six months in 80% of patients) ( = 0.002) are significantly related to a diagnosis of confirmed SMA syndrome at CECT after an endoscopic suspicion. A "resembling postprandial distress syndrome dyspepsia" presentation may be helpful to the endoscopist in suspecting a latent SMA syndrome ( = 0.02). The narrowing of both the aortomesenteric angle ( = 0.001) and the aortomesenteric distance ( < 0.001) was significantly associated with the diagnosis of SMA after an endoscopic suspicion; however, the narrowing of the aortomesenteric distance seemed to be more accurate, rather than the narrowing of the aortomesenteric angle.

Conclusion: SMA syndrome represents a diagnostic and therapeutic challenge. Our results show the following findings: the importance of the endoscopic suspicion of SMA syndrome; the preponderance of a long-standing and chronic onset; a female preponderance; the importance of the nutritional counseling for the treatment; no need of surgical intervention; and better diagnostic accuracy of the narrowing of the aorta-SMA distance. Larger prospective studies are needed to clarify the best diagnosis and management of the SMA syndrome.
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http://dx.doi.org/10.1155/2018/1937416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129792PMC
August 2018

Osteonecrosis in Hodgkin lymphoma treated by BEACOPP.

Intern Med J 2018 06;48(6):747-748

Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Palermo, Italy.

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http://dx.doi.org/10.1111/imj.13813DOI Listing
June 2018

Whole-body diffusion-weighted MR and FDG-PET/CT in Hodgkin Lymphoma: Predictive role before treatment and early assessment after two courses of ABVD.

Eur J Radiol 2018 Jun 17;103:90-98. Epub 2018 Apr 17.

Department of Radiology, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy. Electronic address:

Purpose: To evaluate whether imaging features of pathologic lymph nodes on whole-body diffusion-weighted MR have a predictive role before treatment and may assess the response after two courses of chemotherapy in comparison to FDG-PET/CT in Hodgkin Lymphoma.

Materials And Methods: We reviewed the whole-body MR and FDG-PET/CT performed on 41 patients with Hodgkin Lymphoma before and after two Doxorubicin-Bleomycin-Vinblastine-Dacarbazine (ABVD). Responder and non-responder lesions were identified on interim-FDG-PET/CT performed after two ABVD. We used Multivariate Generalized Estimating Equations model to assess statistical association between being-responder and baseline-Maximum Standard Uptake Value (SUV), baseline and interim-Apparent Diffusion Coefficient (ADC) and size, ADC and size changes during chemotherapy, site of disease, bulky, and stage.

Results: 10/41 (24%) patients were positive on interim-FDG-PET/CT. The interim-FDG-PET/CT positivity was associated with worse cumulative survival rate at 24 months in comparison to interim-FDG-PET/CT negativity (P < .05); 3/10 patients with positive interim-FDG-PET/CT and 1/31 with negative interim-FDG-PET/CT experienced disease progression. Baseline-SUV was 11.18 ± 5.58 (3.1-28.0) and baseline-ADC was 0.70 ± 0.14 × 10 mm/s (0.39-0.98). There was a significant difference between responder and non-responder lesions based on interim-ADC (1.83 ± 0.34 × 10 mm/s vs. 1.01 ± 0.27 × 10 mm/s;p <.001), interim-size (3.1 cm vs. 9.4 cm;p = .009), and bulky (8.2% vs. 66.7%;p = .002). There was no significant difference between responder and non-responder lesions based on baseline-SUV (p = .713), baseline-ADC (p = .253), ADC changes (p = .058), size changes (p = .085), site (p = .209), stage (p = .290), baseline-size (p = .064).

Conclusions: Interim-ADC is helpful for identifying non-responder lesions, while size changes are not useful. Baseline-SUV and ADC have no predictive role. Bulky is the most useful imaging parameter to predict suboptimal response to chemotherapy.
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http://dx.doi.org/10.1016/j.ejrad.2018.04.014DOI Listing
June 2018

Clinical and prognostic value of 18F-FDG-PET/CT in restaging of pancreatic cancer.

Nucl Med Commun 2018 Aug;39(8):741-746

Nuclear Medicine Unit, Department of Radiological Sciences.

Aim: The aim of this retrospective multicentre study was to evaluate the clinical and prognostic effect of fluorine-18-fluorodeoxyglucose (F-FDG)-PET/computed tomography (CT) in the restaging process of pancreatic cancer (PC).

Materials And Methods: Data from patients treated for primary PC, who underwent F-FDG-PET/CT for suspicious of disease progression, were collected. Accuracy was assessed employing conventional diagnostic procedures, multidisciplinary team case notes, further F-FDG-PET/CT scans and/or follow-up. Receiver operating characteristic curve and likelihood ratio (LR+/-) analyses were used for completion of accuracy definition. Progression-free survival (PFS) and overall survival were assessed by using Kaplan-Meier method. The Cox proportional hazards model was used to identify predictors of outcome.

Results: Fifty-two patients (33 males and 19 females, with mean age of 59 years and range: 42-78 years) with PC were finally included in our study. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-FDG-PET were 85, 84, 90, 76, and 84%, respectively. Area under the curve was 0.84 (95% confidence intervals: 0.72-0.96; P<0.05). LR+ and LR- were 5.3 and 0.17, respectively. F-FDG-PET/CT revealed new metastatic foci in 5/52 patients (10%) and excluded suspicious lesions in 11/52 (21%). Analysis of PFS revealed F-FDG-PET/CT positivity to be associated with a worse cumulative survival rate over a 6 and 12-month period in comparison with F-FDG-PET/CT negativity (6-month PFS 95 vs. 67%, P<0.05; 12-month PFS 81 vs. 29%, P<0.05). A negative F-FDG-PET/CT result was associated with a significantly longer overall survival than a positive one (70 vs. 26% after 2 years, P<0.05). In addition, a positive F-FDG-PET/CT scan result and an maximum standardized uptake value (SUVmax) value more than 6 were significantly associated with an increased risk of disease progression (PET positivity hazard ratio=3.9, P=0.01; SUVmax>6 h=4.2, P=0.02) and death (PET positivity hazard ratio=3.5, P=0.02; SUVmax>6 h=3.7, P=0.01).

Conclusion: F-FDG-PET/CT showed high diagnostic accuracy for restaging process of PC, proving also its potential value in predicting clinical outcome after primary treatment.
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http://dx.doi.org/10.1097/MNM.0000000000000862DOI Listing
August 2018