Ovarian cancer: An update on imaging in the era of radiomics.

Tumor heterogeneity in ovarian cancer has been reported at the histological and genetic levels and is associated with adverse clinical outcomes. Tumor evaluation using standard computed tomography or magnetic resonance imaging techniques does not account for the intra- or inter-tumoral heterogeneity in advanced ovarian cancer with peritoneal carcinomatosis. As such, computational approaches in assessing tumor heterogeneity have been proposed using radiomics and radiogenomics in order to analyze the whole tumor heterogeneity as opposed to single biopsy sampling. As part of radiomics, texture analysis, which includes the extraction of multiple data from images has been proposed recently to evaluate advanced ovarian tumor heterogeneity. In this short review, we explain the basics of radiomics, how to perform texture analysis, and its applications to ovarian cancer imaging.

A stable open-shell redox active ditopic ligand.

Herein we describe the synthesis, structure and electronic properties of an unusual redox-active ditopic ligand with a stable open-shell configuration. This stable phenoxyl radical features intense and very low energy electronic transitions in the near infrared (NIR) part of the spectrum and is structurally set up to strongly spin couple coordinated transition metal ions in [2 × 2] grid-type structures.

Muscle uptake of 99mtechnetium pyrophosphate in patients with neuromuscular disorder. A quantitative study.

99mTechnetium pyrophosphate (99mTc PYP) muscular scanning was carried out in 28 patients affected by neuromuscular diseases. To express the muscle tracer retention quantitatively, the soft tissue to bone uptake ratio was calculated in the thigh and in the lower leg. Significantly increased ratio values were found in all the patients with polymyositis and in most patients with different types of muscular dystrophy, while high values were seen in a few subjects with myasthenia gravis and with neurogenic disorders. These findings are compared with those of previous studies, and the factors playing a role in determining some discrepant observations are discussed. The use of 99mTc muscular scanning in the investigation of patients with suspected inflammatory myopathy is suggested.

Short-term effectiveness of low-dose radioiodune ablative treatment of thyroid remnants after thyroidectomy for differentiated thyroid cancer.

Twenty-five patients from a marginally iodine-deficient area with differentiated thyroid cancer who were referred to our unit between 1991 and 1997 had a residual thyroid uptake (RTU) at 24 hours of 5% or more after surgery. None of them underwent reoperation: 8 of 25 had RTU between 5% and 10% and were considered at low risk for both local recurrences and/or distant metastases; 17 of 25 had RTU greater than 10% and up to 30% and refused re-intervention. After detection of their cervical uptake by using a 131I tracer dose of 3.7 MBq (100 microCi), all 25 were treated with 1110 MBq (30 mCi) of 131I. A whole-body scan (WBS) performed 5 days later revealed 131I uptake corresponding to metastatic lymph nodes in the anterior part of the neck in 1 patient and the persistence of only RTU in 24 of 25 patients. RTU and thyroglobulin (Tg) levels were reevaluated 6 months later in all patients and compared to preradioiodine treatment values. RTU, ranging at presentation between 5% and 30%, decreased to below 1% in all but one patient. Serum Tg values, ranging between 1.6 and 108 ng/mL before radioiodine treatment, decreased to below 1.6 ng/mL in all but 4 of them (whose serum Tg was between 2 and 3.4 ng/mL). Our data indicate that 1,110 MBq of 131I can permit complete ablation of 80% of thyroid remnants concentrating up to 30% of radioiodine activity. A relation between this high success rate and iodine deficiency can be hypothesized because an increasing uptake of radioiodine by thyroid remnants could result in overestimation of their size. Therefore, our observations suggest that in iodine deficient areas, a hasty decision to carry out complete thyroidectomy should be avoided, even in the case of thyroid remnants with RTU up to 30%.

Büschke-Lowenstein tumour in pregnancy.

During pregnancy a localised human papillomavirus (HPV) lesion may, in rare cases, develop into a Büschke-Lowenstein tumour. The choice of treatment is crucial as standard systemic treatment is teratogenic. We performed laser CO2 microsurgery because it has a low incidence of complications.

Gastric motility disorders in patients operated on for esophageal atresia and tracheoesophageal fistula: long-term evaluation.

BACKGROUND/PURPOSE: Disturbed peristalsis is reported frequently after successful repair of esophageal atresia (EA). Delayed gastric emptying could be considered a cause of symptoms of gastroesophageal reflux (GER) in patients with repaired EA. The aim of the current study was to evaluate the incidence of and to characterize gastric motility disorders in a long-term follow-up of patients operated on for EA-tracheoesophageal fistula (TEF) by studying gastric emptying with scintigraphic techniques and comparing the results with gastric manometric data. METHODS: Eleven patients, between 12 and 23 years of age (median, 17) operated on for EA-TEF between 1975 and 1985, were studied. The scinthigraphic study was undertaken using a standard solid meal. The manometric study was performed using a 2.3-mm probe with 3 solid-state transducers. RESULTS: Dysphagia was present in about 20% of patients. Dyspepsia was recorded in 40% of the patients. A pathological reflux was present in 2 patients. Delayed gastric emptying (T1/2 > 90') was present in 4 patients (36%). Manometric data showed alteration of gastric peristaltic activity in 5 patients (45%). CONCLUSIONS: Delayed gastric emptying is frequent in long-term follow-up of patients operated on for EA-TEF. In these patients antral hypomotility also is recorded manometrically. Abnormal gastric motility can be considered as an important factor predisposing to symptoms of GER. A thorough evaluation of gastric function is recommended in symptomatic patients after EA repair.

Diagnostic possibilities and clinical indications of policlonal labeled Ig in the bowel inflammatory disease.

BACKGROUND/AIMS: Ulcerative colitis (UC) and Crohn's disease (CD) represent the more common forms of idiopathic inflammatory bowel disease. They have a peculiar course, which is characterized by exacerbation and submissions, and a symptomatology that changes in relation to severity and extension of the lesions. The aim of this study is to establish the diagnostic usefulness of 99m Tc human policlonal immunoglobulin (HIG) imaging in patients with inflammatory bowel disease (IBD). METHODOLOGY: During the period between September 1995 and September 1997 we submitted a group of 32 patients affected by UC (n = 22) and CD (n = 10), to Human Immunoglobulin labeled with Technetium 99m (99m Tc-HIG) scintigraphy. The diagnosis of IBD was obtained in all cases by endoscopy with biopsy. RESULTS: Scintigraphic examination with labeled HIG showed an abnormal intestinal fixation (ileal or colic) of the marked immunoglobulins in 17 patients (77.2%) affected by UC and in 8 patients (80%) affected by CD. In 5 (22.7%) and 2 (20%) patients, respectively, the scintigraphic examination revealed a normal distribution of the immunoglobulins without appreciable focal accumulation. Among the patients with a negative scintigraphic examination, only one presented an endoscopic and histologic report that documented UC in an active stage. The histologic and endoscopic findings observed in all cases of CD were similar to that of HIG scintigraphy in 7 of the 8 scintigraphic-positive cases and in 1 of the 2 scintigraphic-negative patients. CONCLUSIONS: The authors, on the basis of their results, suggest that this diagnostic strategy may have a significant role in the diagnostic protocol and in the follow-up of chronic inflammatory bowel disease.

[A simple method for the measurement of human gastric emptying: standardization of operative parameters]. / Un semplice metodo per la misura dello svuotamento gastrico nell'uomo: standardizzazione dei parametri operativi.

The radioisotopic techniques used for the measurement of gastric emptying in man require complex and expensive scintiscanners or gamma-cameras. In this investigation, a simple method utilizing a single and inexpensive detector was evaluated; in addition, the suitability of 99Tcm sulphur colloid as a label for solid meals was assessed. The procedure was found to be accurate and its reproducibility high. The calculated absorbed dose to the gut was very low. Both in vitro and in vivo studies indicate that the radiocolloid used is a food non adsorbable marker for determining gastric emptying of solids. In a group of 50 healthy volunteers the emptying half-time (t1/2) ranged between 40 and 110 min, with a mean of 71.7 +/- 10.1 min, the male subjects exhibiting a significant lower t1/2 than females. In 5 volunteers with t1/2 within the normal range, the effect of drugs acting on gastric motility was evaluated. Hyoscine N-butyl bromide (20 mg) significantly delayed gastric emptying of solids, whereas metoclopramide (20 mg) was ineffective in these subjects. On the contrary, this drug was able to accelerate gastric emptying only in some patients with abnormally delayed emptying. On the whole, the method is simple, inexpensive and reproducible. It may be of great clinical value to investigate abnormalities of gastric function and to perform a better pharmacological approach to the medical treatment.

[Experimental evaluations of ther preferential use of Tc99m and In113m in hepatic scintiscanning]. / Valutazioni sperimentali sull'impiego preferenziale del 99mTc e del 113mIn en epatoscintigrafia.

A hollow perspex dummy was filled with radioactive fluid to simulate the liver, cold nodes being represented by paraffin balls of diameter varying from 2.5 to 4.0 cm, variously located. Scans were carried out with a linear scanner using 99mTc and 113mIn as tracers. Advantages and drawbacks of the two tracers in demonstrating cold areas in the liver are compared and discussed.

Diagnosis of hepatic hemangiomas with 99mTc-labeled red blood cell scanning: value of SPECT.

99mTc-labeled red blood cell (RBC) scanning is considered a highly specific technique for the study of hepatic hemangiomas. However, planar imaging displays poor sensitivity for the identification of small lesions. The authors consider a survey group of 119 patients, of whom 66 with a presumed diagnosis of hepatic hemangioma, for a total of 77 lesions ranging from 0.8 to 15 cm in diameter. The study was conducted with three-phase planar imaging and single photon emission computed tomography (SPECT). The results, which confirm a high specificity of 99mTc-RBC scanning (100%) in the study of hepatic hemangiomas, show that SPECT significantly improves the detection of these lesions (71%) compared to the delayed static study (52%), with the largest gain for lesions between 2-3.5 cm (83% versus 51%). However, also SPECT has difficulty in detecting lesions of less than 2 cm. With regard to three-phase imaging, the authors point out that the pattern considered characteristic for hepatic hemangiomas (perfusion blood-pool mismatch) is infrequent (13%).

[Radioimmunologic analysis of insulin (IRI) in glucose metabolism in uremic patients]. / Il dosaggio radioimmunologico dell'insulina (IRI) nello studio del comportamento glicometabolico dei pazienti uremici.

Glucose intolerance in uremic patients is often reported in literature. This condition is characterized by an unbalance between production and utilization of glucose as for a trouble of the mechanism of gluco-metabolic regulation. Insulin radioimmunoassay (IRI) is measured to know the amount of hormone incretion and to verify its efficacy in the glucose utilization. The glucagon load and the double glucagon load are tests employed to study IRI response and glucose metabolism in uremia. With the double administration of glucagon is possible to assess the degree of glycogenolysis, but also the neo-glycogenesis stimulated by the first glucagon injection. This aspect is important because it reflects the sensitivity for the agent of counter-regulation hormonal (especially glucagon). The test performed by double glucagon load produces in uremic subjects IRI curves characterized by two peaks and unbalance amount between the 1st and the 2nd area correspondent to glucagon loads. Both the phases are higher than phases of normal subjects and the ratio 2nd/1st is 1.5. The behaviour of all the responsive IRI curves is similar and sufficiently homogeneous to permit its representation by medium values observed step by step in the group. The plasma glucose responses are dishomogeneous and it is possible to emphasize different types of involvement in the glucose intolerance.

[The vasoactive effects of captopril (SQ 14225). Preliminary research]. / Effetti vasoattivi del captopril (SQ 14225). Ricerche preliminari.

The Authors examined the behaviour of the humeral arterial pressure, of the heart frequency and of the muscular blood flow in inferior limbs. This study was performed before and after treatment with Captopril (SQ 14225), 100 mg per os, a selective inhibitor of the converting enzyme. Both resting blood flow (RBF) and maximal blood flow (NBF) were studied by Xenon 133 clearance. The A.A. observed that the drug induced a significant (P less than 0.01) increase of both RBF and MBF. Therefore, the Authors hypothesize that the Captopril is able to produce peripheral vasodilatation, without any significant variation of the cardiac index and frequency. Such an effect is considered to depend not only upon the inhibited angiotensin II production, but also upon stimulation of bradikinins and prostaglandins.