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PURPOSE: To evaluate the impact of a four-month training program on radiology residents' diagnostic accuracy in assessing deep myometrial invasion (DMI) in endometrial cancer (EC) using MRI. METHOD: Three radiology residents with limited EC MRI experience participated in the training program, which included conventional didactic sessions, case-centric workshops, and interactive classes. Utilizing a training dataset of 120 EC MRI scans, trainees independently assessed subsets of cases over five reading sessions. Each subset consisted of 30 scans, the first and the last with the same cases, for a total of 150 reads. Diagnostic accuracy metrics, assessment time (rounded to the nearest minute), and confidence levels (using a 5-point Likert scale) were recorded. The learning curve was obtained plotting the diagnostic accuracy of the three trainees and the average over the subsets. Anatomopathological results served as the reference standard for DMI presence. RESULTS: The three trainees exhibited heterogeneous starting point, with a learning curve and a trend to more homogeneous performance with training. The diagnostic accuracy of the average trainee raised from 64 % (56 %-76 %) to 88 % (80 %-94 %) across the five subsets (p < 0.001). Reductions in assessment time (5.92 to 4.63 min, p < 0.018) and enhanced confidence levels (3.58 to 3.97, p = 0.12) were observed. Improvements in sensitivity, specificity, positive predictive value, and negative predictive value were noted, particularly for specificity which raised from 56 % (41 %-68 %) in the first to 86 % (74 %-94 %) in the fifth subset (p = 0.16). Although not reaching statistical significance, these advancements aligned the trainees with literature performance benchmarks. CONCLUSIONS: The structured training program significantly enhanced radiology residents' diagnostic accuracy in assessing DMI for EC on MRI, emphasizing the effectiveness of active case-based training in refining oncologic imaging skills within radiology residency curricula.
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Competência Clínica , Neoplasias do Endométrio , Internato e Residência , Curva de Aprendizado , Imageamento por Ressonância Magnética , Miométrio , Invasividade Neoplásica , Radiologia , Humanos , Feminino , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Imageamento por Ressonância Magnética/métodos , Radiologia/educação , Miométrio/diagnóstico por imagem , Miométrio/patologia , Sensibilidade e Especificidade , Reprodutibilidade dos TestesRESUMO
Retroperitoneal sarcomas (RPSs) are rare findings that can grow into large masses without eliciting severe symptoms. At present, surgical resection is the only radical therapy, whenever it can be performed with the aim to achieve a complete removal of the tumor. The present report describes two consecutive cases of RPSs that resulted in dedifferentiated liposarcomas (DDLPSs) and these patients underwent R0 surgical resection with and without a nephron-sparing procedure. The diagnostic workup, the surgical approach, the impact of late surgical management due to the COVID pandemic and the latest literature on the topic are discussed and analyzed. The patients, who refused to undergo any medical examination during the prior 2 years due to the COVID pandemic, were admitted to Federico II University Hospital (Naples, Italy) complaining about weight loss and general abdominal discomfort. In the first case, a primitive giant abdominal right neoplasm of retroperitoneal origin enveloping and medializing the right kidney was observed. The second patient had a similar primitive retroperitoneal giant left neoplasm, which did not affect the kidney. Given the characteristics of the masses and the absence of distant metastases, after a multidisciplinary discussion, radical surgical removal was carried out for both patients. The lesions appeared well-defined from the surrounding tissues, and markedly compressed all the adjacent organs, without signs of infiltration. In the first patient, the right kidney was surrounded and undetachable from the tumor and it was removed en bloc with the mass. The second patient benefited from a nephron-sparing resection, due to the existence of a clear cleavage plane. The postoperative courses were uneventful. Both the histological examinations were oriented towards a DDLPS and both patients benefited from adjuvant chemotherapy. In conclusion, the treatment of giant RPS is still challenging and requires multidisciplinary treatment as well as, when possible, radical surgical removal. The lack of tissue infiltration and the avoidance of excision or reconstruction of major organs (including the kidney) could lead to an easier postoperative course and an improved prognosis. When possible, surgical management of recurrences or incompletely resected masses must be pursued. Since the COVID pandemic caused limited medicalization of a number of population groups and delayed diagnosis of other oncologic diseases, an increased number of DDLPSs could be expected in the near future.
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BACKGROUND: Indeterminate adrenal masses (AM) pose a diagnostic challenge, and 2-[18F]FDG PET-CT serves as a problem-solving tool. Aim of this study was to investigate whether CT radiomics features could be used to predict the 2-[18F]FDG SUVmax of AM. METHODS: Patients with AM on 2-[18F]FDG PET-CT scan were grouped based on iodine contrast injection as CT contrast-enhanced (CE) or CT unenhanced (NCE). Two-dimensional segmentations of AM were manually obtained by multiple operators on CT images. Image resampling and discretization (bin number = 16) were performed. 919 features were calculated using PyRadiomics. After scaling, unstable, redundant, and low variance features were discarded. Using linear regression and the Uniform Manifold Approximation and Projection technique, a CT radiomics synthetic value (RadSV) was obtained. The correlation between CT RadSV and 2-[18F]FDG SUVmax was assessed with Pearson test. RESULTS: A total of 725 patients underwent PET-CT from April 2020 to April 2021. In 150 (21%) patients, a total of 179 AM (29 bilateral) were detected. Group CE consisted of 84 patients with 108 AM (size = 18.1 ± 4.9 mm) and Group NCE of 66 patients with 71 AM (size = 18.5 ± 3.8 mm). In both groups, 39 features were selected. No statisticallyf significant correlation between CT RadSV and 2-[18F]FDG SUVmax was found (Group CE, r = 0.18 and p = 0.058; Group NCE, r = 0.13 and p = 0.27). CONCLUSIONS: It might not be feasible to predict 2-[18F]FDG SUVmax of AM using CT RadSV. Its role as a problem-solving tool for indeterminate AM remains fundamental.
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Gastrinoma , Neoplasia Endócrina Múltipla Tipo 1 , Neoplasias Pancreáticas , Síndrome de Zollinger-Ellison , Humanos , Gastrinoma/diagnóstico por imagem , Gastrinoma/patologia , Neoplasias Pancreáticas/patologia , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/patologia , Síndrome de Zollinger-Ellison/patologiaRESUMO
Endometrial cancer (EC) is intricately linked to obesity and diabetes, which are widespread risk factors. Medical imaging, especially magnetic resonance imaging (MRI), plays a major role in EC assessment, particularly for disease staging. However, the diagnostic performance of MRI exhibits variability in the detection of clinically relevant prognostic factors (e.g., deep myometrial invasion and metastatic lymph nodes assessment). To address these challenges and enhance the value of MRI, radiomics and artificial intelligence (AI) algorithms emerge as promising tools with a potential to impact EC risk assessment, treatment planning, and prognosis prediction. These advanced post-processing techniques allow us to quantitatively analyse medical images, providing novel insights into cancer characteristics beyond conventional qualitative image evaluation. However, despite the growing interest and research efforts, the integration of radiomics and AI to EC management is still far from clinical practice and represents a possible perspective rather than an actual reality. This review focuses on the state of radiomics and AI in EC MRI, emphasizing risk stratification and prognostic factor prediction, aiming to illuminate potential advancements and address existing challenges in the field.
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(1) Background: Sarcopenia has a high incidence in Crohn's disease (CD) with considerable heterogeneity among ethnicities and variable impact on clinical outcomes. Aim: to assess the impact of sarcopenia on clinical outcomes in a cohort of Caucasian patients with active CD undergoing CT-enterography (CTE) for clinical assessment. We further investigated the prevalence of sarcopenia and its predictors. (2) Methods: Caucasian CD patients with moderate−severe clinical activity, who underwent CTE in an emergency setting, were retrospectively recruited. The skeletal muscle index (SMI) at the third lumbar vertebra was used to detect sarcopenia in the early stages. Clinical malnutrition was defined according to global clinical nutrition criteria. Clinical outcomes included the rate of surgery and infections within one year. (3) Results: A total of 63 CD patients (34 M; aged 44 ± 17 years) were recruited, and 48 patients (68.3%) were sarcopenic. Malnutrition occurred in 28 patients (44.4%) with a significant correlation between body mass index (BMI) and sarcopenia (r = 0.5, p < 0.001). The overall rate of surgery was 33%, without a significant difference between sarcopenic and non-sarcopenic (p = 0.41). The rate of infection in patients with sarcopenia was significantly higher than in non-sarcopenic (42%vs15%, p = 0.03). BMI (OR 0.73,95%, CI 0.57−0.93) and extraintestinal manifestations (EIM) (OR 19.2 95%, CI 1.05−349.1) were predictive of sarcopenia (p < 0.05). (4) Conclusions: Sarcopenia was associated with an increased rate of infections, and it was observed in 68.3% of the Caucasian cohort with active CD.
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Doença de Crohn , Desnutrição , Sarcopenia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Humanos , Desnutrição/complicações , Músculo Esquelético/diagnóstico por imagem , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Sarcopenia/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Sarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia. In cancer patients, a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage. AIM: To evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer (mCRC) undergoing first-line chemotherapy. METHODS: Our retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital. Computerized scans were performed before starting chemotherapy and at the first disease reassessment. Sarcopenia was assessed using the skeletal mass index = muscle area in cm2/(height in m2) calculated at the L3 vertebra. Overall survival and objective response rate were evaluated. Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0. A loss of skeletal muscle mass ≥ 5% was considered indicative of deterioration in muscle condition. RESULTS: Median age was 67 years and 35.7% of patients were ≥ 70 years old. Fourteen patients (25%) were sarcopenic at baseline computed tomography (CT) scan (7/33 men; 7/23 women); 5/14 sarcopenic patients were ≥ 70 years old. Median follow-up was 26.8 mo (3.8-66.8 mo) and median overall survival was 27.2 mo (95%CI: 23.3-37.3). Sarcopenia was not correlated to overall survival (P = 0.362), to higher toxicities reported during the first 4 cycles of chemotherapy (P = 1.0) or to response to treatment (P = 0.221). At the first disease reassessment, a skeletal muscle loss (SML) ≥ 5% was found in 17 patients (30.3%) 3 of whom were already sarcopenic at baseline CT scan, while 7 patients became sarcopenic. SML was not correlated to overall survival (P = 0.961). No statistically significant correlation was found between baseline sarcopenia and age (P = 1.0), body mass index (P = 0.728), stage at diagnosis (P = 0.355) or neutrophil/lymphocyte ratio (P = 0.751). CONCLUSION: Neither baseline sarcopenia nor SML affected survival. In addition, baseline sarcopenia was not related to worse treatment toxicity. However, these results must be interpreted with caution due to the limited sample size.
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BACKGROUND: MRI is a useful imaging modality to assess the presence of pancreatic neuroendocrine tumors (PNETs), allowing repeat monitoring examinations in multiple endocrine neoplasia type 1 (MEN-1) patients. OBJECTIVES: We aimed to compare the diagnostic accuracy of conventional MRI sequences to identify which sequence better depicts the presence of PNETs in MEN-1 patients. METHOD: We performed a retrospective analysis of consecutive MEN-1 patients who underwent a conventional MRI protocol to monitor previously proven PNETs. MRI sequences T1-w chemical shift (CS), T2-w HASTE, fat-suppressed (FS) T2-w HASTE, diffusion-weighted imaging (DWI), and pre- and post-contrast FS T1-w sequences were independently analyzed by 2 experienced radiologists using a 3-grade score (no lesion, uncertain lesion, and certain lesion); lesion size and signal intensity were recorded. A Friedman ANOVA and a Wilcoxon pairwise test for the post hoc analysis were used. The sensitivity of each sequence was measured, and the results were analyzed with the χ2 test. RESULTS: We included 21 patients with a total of 45 PNETs proven by histology, endoscopic ultrasonography-guided fine-needle aspiration, CT, and nuclear medicine studies. A statistically significant (p < 0.01) difference was observed in the detection performance of each MRI sequence, particularly between DWI (91%) and T2-w FS (85%) sequences in comparison to the others (T1-w CS, T2-w, and pre- and post-contrast FS T1-w, ≤56% for all); no significant (p = 0.5) difference was found between the detection performance of DWI and T2-w FS sequences. No correlation was observed between the qualitative score of each sequence and lesion tumor size. CONCLUSIONS: DWI and T2-w FS sequences proved to be the most accurate in the detection of PNETs, thus suggesting a role for an abbreviated MRI protocol without contrast medium administration for monitoring MEN-1 patients.
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Imageamento por Ressonância Magnética/normas , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Ascites can develop as a consequence of a number of diseases in childhood. Despite chronic liver disease is the most common cause, several conditions can lead to ascites also in the absence of liver dysfunction. As non-cirrhotic ascites shows a high degree of overlapping sign and symptoms it is still a challenge for physicians. CASE PRESENTATION: A 8-year-old Caucasian girl was referred for fever, vomit and diarrhea occurred over the past few weeks. Physical examination showed timpanitic distension of the abdomen with marked tenderness and increased abdominal wall rigidity. Abdominal imaging showed diffuse ascites and thickened omentum and bowel wall. Blood tests showed increased C- reactive protein levels and decreased lymphocyte count. Specific treatment for inflammatory bowel disease was started. Persisting of ascites required additional investigations. Positive tuberculin skin test and Interferon Gamma release assay (IGRA) as well as increased Ca125 serum concentrations were found. Computed tomography scan showed mediastinal and mesenteric adenopathies and diffuse smooth thickening of the omentum with significant enhancement (omental cake-like). Ascitic fluid analysis revealed high leucocytes and protein levels. Presumptive diagnosis of peritoneal tuberculosis (PTB) was made. Antituberculous treatment resulted in the resolution of ascites and normalization of lymphocyte count and Ca125 serum concentrations. CONCLUSIONS: PTB is still possible in low-prevalence countries. As it is a great mimicker of other abdominal pathology whose treatment might worsen tuberculosis progression, clinical suspicion and adequate screening are required to avoid unnecessary interventions and delayed treatment. Ca125 is a non-specific marker of peritoneal inflammation but it might be helpful in monitoring the treatment response.
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Ascite/tratamento farmacológico , Peritonite Tuberculosa/diagnóstico , Antituberculosos/uso terapêutico , Ascite/diagnóstico , Biomarcadores/sangue , Carcinoma/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Itália , Peritonite Tuberculosa/tratamento farmacológicoRESUMO
PURPOSE: To compare multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) with cholangiopancreatography (MRCP) findings in the diagnostic evaluation of patients with cholangiocarcinoma (CCA) to establish tumour resectability. METHODS: Thirty patients (22 M, 8 F) with pathologically proven CCA by post-surgical specimens (n = 20), core biopsy (n = 6) or cytology (n = 4) underwent both MDCT and MRI with MRCP. CCA lesions were classified on the basis of anatomical locations in intra-hepatic (iCCA), peri-hilar (pCCA) and distal (dCCA) tumours. Morphological tumour pattern, lesion size, biliary dilatation, tumour contrast enhancement type, lymph node involvement and vascular infiltration were directly compared between MDCT and MRI with MRCP. As a rule, a tumour resectability judgement for each patient was formulated by both imaging techniques comparing imaging results with direct surgical assessment (n = 20) or interventional procedures (n = 10). RESULTS: In terms of anatomical location, 14 iCCA, 8 pCCA and 8 dCCA were observed; both imaging techniques were concordant about the identification and morphological characterization of tumour lesions and in the evaluation of tumour features (lesion size, contrast enhancement pattern, capsular retraction, biliary dilatation, lymph node involvement and vascular infiltration) as well as in assessing lesion resectability; an excellent agreement (k = 1) for the assessment of all the parameters included in imaging analysis was observed. CONCLUSIONS: The comparative concordant results of our study suggest that MRI with MRCP represents a valid alternative to MDCT for the diagnostic evaluation of patients with CCA to establish tumour resectability providing multiplanar scanning of high-contrast imaging quality; MDCT should be preferred in uncooperative patients, in the presence of biliary stents or when MRI is absolutely contraindicated for incompatible medical devices.
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Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodosRESUMO
PURPOSE: Pancreatic neuroendocrine tumors (pNETs) are frequent in multiple endocrine neoplasia type 1 (MEN1) syndrome. They are usually not surgically treated unless larger than 1 to 2 cm or a growth rate > 0.5 cm per year. Somatostatin analogues represent one of the main therapeutic options in pNETs, but they have never been prospectively investigated in MEN1-related pNETs. The aim of this study was to prospectively evaluate the effectiveness of lanreotide in patients with MEN1-related pNETs < 2 cm. METHODS: MEN1 patients with 1 or more pNETs < 2 cm of maximal diameter were considered. Study design was prospective observational, comparing patients treated with lanreotide autogel 120 mg every 28 days (LAN group) and patients in active surveillance, not receiving any therapy (AS group). RESULTS: Forty-two patients were enrolled: 23 in LAN and 19 in AS group. Median follow-up was 73 months. Initial imaging identified a total of 91 pNETs. The median progression-free survival was significantly longer in the LAN than in the AS group (median not reached vs 40 months, P < 0.001). In the LAN group, 4 patients had an objective tumor response, 15 patients had stable disease, while 4 had tumor progression. In the AS group, 13 patients had pNET progression, while 6 were stable. CONCLUSIONS: This is the first prospective study evaluating the efficacy of somatostatin analogues in MEN1-related pNETs. These findings highlight that lanreotide autogel is effective as antiproliferative therapy in MEN1-related pNETs < 2cm, suggesting the utility of somatostatin analogues to arrest the development of tumor lesions as well as to delay or avoid pancreatic surgery.
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Antineoplásicos/uso terapêutico , Neoplasia Endócrina Múltipla Tipo 1/complicações , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Peptídeos Cíclicos/uso terapêutico , Somatostatina/análogos & derivados , Conduta Expectante/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/etiologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/etiologia , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Prospectivos , Somatostatina/uso terapêutico , Carga Tumoral , Adulto JovemRESUMO
Background Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are a heterogeneous group of tumours. An effective diagnosis requires a multimodal approach that combines evaluation of clinical symptoms, hormonelevels, radiological and nuclear imaging, and histological confirmation. Imaging plays a critical role in NETs diagnosis, prognosis and management, so the radiologists are important members of the multidisciplinary team. During diagnostic work-up two critical issues are present: firstly the need to identify tumor presence and secondly to define the primary site and assess regional and distant metastases. Conclusions The most appropriate imaging technique depends on the type of neuroendocrine tumour and the availability of specialized imaging techniques and expertise. There is no general consensus on the most efficient imaging pathway, reflecting the challenge in reliably detection of these tumours.
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Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Estadiamento de Neoplasias/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Receptores de Somatostatina/metabolismo , Neoplasias Gástricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Guias como Assunto , Humanos , Comunicação Interdisciplinar , Neoplasias Intestinais/patologia , Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Equipe de Assistência ao Paciente , Radiologistas , Reprodutibilidade dos Testes , Sociedades Médicas , Neoplasias Gástricas/patologiaRESUMO
PURPOSE: To prospectively evaluate image quality and diagnostic efficacy of a low radiation-high contrast (LR-HC) CT Enterography (CTE) in active Inflammatory Bowel Disease (IBD). MATERIALS AND METHODS: Eighty-five (36M; 49F; 17-75â¯yrs) patients with active IBD underwent contrast-enhanced CTE and were stratified in two groups according to age (< or ≥45â¯yrs): Group A (Nâ¯=â¯45; 32⯱â¯9â¯yrs; 58⯱â¯10â¯kg) and Group B (Nâ¯=â¯40; 58⯱â¯10â¯yrs; 61⯱â¯13â¯kg). Each group received a different amount of radiation (Noise Index, NI) and non-ionic iodinated contrast media (LOCM) as follows: Group A (NIâ¯=â¯15; 2.5â¯ml/kg) and Group B (NIâ¯=â¯12.5; 2â¯ml/kg). Thyroid functional tests were performed in all patients of group A at 4-6 wks. Signal- and contrast-to-noise ratios were calculated for liver (L) and abdominal aorta (A). Statistical analysis was performed by Student's t- or Chi-square test for continuous and categorical data, respectively. RESULTS: No patient of Group A developed signs of thyrotoxicosis. SNRL, CNRL and diagnostic accuracy of CTE were 8.4⯱â¯1.7 vs 8.9⯱â¯2.1 (pâ¯=â¯0.256), 5.4⯱â¯1.5 vs 5.6⯱â¯1.7 (pâ¯=â¯0.486) and 91.1 vs 92.5% (pâ¯=â¯0.764) whereas the effective dose and the LOCM administered were 6.7⯱â¯2.2 vs 13.9⯱â¯6.0â¯mSv (pâ¯<â¯0.001) and 144⯱â¯25 vs 122⯱â¯25â¯ml (pâ¯<â¯0.001) for Group A and B, respectively. CONCLUSION: LR-HC CTE is a dose-effective protocol in the evaluation of active IBD in young patients.
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Meios de Contraste , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Doenças Inflamatórias Intestinais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND: Septic pulmonary embolism (SPE) may be a frequently undetected complication of central venous catheter (CVC)-related bloodstream infections (CRBSIs). MATERIALS AND METHODS: The incidence of SPE was evaluated in a cohort of non-oncological patients on home parenteral nutrition (HPN) who were hospitalized for a CRBSI from January 2013 to December 2017. The main clinical, microbiological, and radiological features and the therapeutic approach were also described. RESULTS: Twenty-three infections over 51,563 days of HPN therapy were observed, corresponding to an infection rate of 0.45/1000. In 10 out of the 23 cases (43.5%), pulmonary lesions compatible with SPE were identified. CONCLUSION: Our results demonstrated that a CRBSI can produce asymptomatic SPE with lung infiltrates in 43.5% of the cases, suggesting the need to check for secondary lung infections to choose the most appropriate antimicrobial therapy.
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Infecções Bacterianas/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Enteropatias/terapia , Nutrição Parenteral no Domicílio/efeitos adversos , Embolia Pulmonar/etiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: Medullary thyroid cancer (MTC) is a neuroendocrine tumour of the thyroid C cells. Pasireotide, a multi-receptor targeted somatostatin analogue, and everolimus, an inhibitor of mTOR, showed antitumour properties in neuroendocrine tumours. Aim of this study was to evaluate pasireotide alone and in combination with everolimus in patients with MTC. METHODS: Patients with progressive metastatic or persistent postoperative MTC received pasireotide LAR 60 mg/m for at least 6 months. Patients exhibiting progressive disease received everolimus 10 mg/d as combination therapy. Primary endpoint was progression free survival (PFS). Secondary endpoints included, overall survival, objective response rates, change in circulating markers, safety. Study registration no. NCT01625520. RESULTS: Nineteen consecutive patients were enrolled. Median follow-up was 31 months. Median PFS with pasireotide was 36 months (95% CI: 19.5-52.5). Nine patients (47%) had tumour progression: seven of them started everolimus in combination with pasireotide, achieving a median PFS of 9.0 months (95% CI: 0-21.83). Five of them (71%) had further tumour progression, one objective response (14.3%), one stopped treatment because of pulmonary embolism. Pasireotide alone and with everolimus was safe and required withdrawal only in one case. Diarrhoea and hyperglycaemia were the most frequent adverse events with pasireotide (grade 3 in 5.3% each). Hyperglycaemia was the most frequent grade 3 toxicity with the combination therapy (28.6%). CONCLUSIONS: Pasireotide therapy shows antiproliferative effects in persistent postoperative MTC suggesting further investigation on larger series of patients. In progressive MTC lesions, the combination pasireotide plus everolimus may be of benefit. Both schemes were safe and well tolerated.
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Antineoplásicos/uso terapêutico , Carcinoma Medular/tratamento farmacológico , Everolimo/uso terapêutico , Somatostatina/análogos & derivados , Neoplasias da Glândula Tireoide/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Medular/mortalidade , Carcinoma Medular/patologia , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Somatostatina/uso terapêutico , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the diagnostic efficacy of single-pass contrast-enhanced multidetector CT (CE-MDCT) performed with a low-radiation high-contrast (LR-HC) dose protocol in selected patients with non-traumatic acute bowel disease. METHODS: 65 (32 males, 33 females; aged 20-67 years) consecutive patients with non-traumatic acute bowel disease underwent single-pass CE-MDCT performed 70-100 s after i.v. bolus injection of a non-ionic iodinated contrast medium (CM) (370 mgI ml-1). In 46 (70%) patients with a clinical and/or ultrasonographic suspicion of inflammatory bowel disease, up to 1.2-1.4 l of a 7% polyethylene-glycol solution was orally administered 45-60 mins prior to the CT examination. Patients were then divided into two groups according to age: Group A (20-44 years; n = 34) and Group B (45-70 years; n = 31). Noise index (NI) and CM dose were selected as follows: Group A (NI = 15; 2.5 ml kg-1) and Group B (NI = 12.5; 2 ml kg-1). All patients of Group A underwent thyroid functional tests at 4-6 weeks. Final diagnoses were obtained by open (n = 12) or laparoscopic surgery (n = 4), endoscopy w/without biopsy (n = 24) and clinical (n = 19) and/or instrumental (ultrasonography) (n = 6) follow-up at 11 ± 4 months (range 6-18 mo.). Statistical analysis was performed by χ2 and Student's t-test for categorical and continuous variables, respectively. RESULTS: Sensitivity and specificity were 91.3 vs 95.4% (p = 0.905) and 90.9 vs 88.8% (p = 0.998) with an overall diagnostic accuracy of 91.1 vs 93.5% (p = 0.756), whereas the radiation (in millisievert) and CM dose (in millilitre) were 7.5 ± 2.8 mSv and 155 ± 30 ml for Group A and 14.1 ± 5.3 mSv and 130 ± 24 ml for Group B (p < 0.001), respectively. No patients of Group A showed laboratory signs of thyrotoxicosis at follow-up. CONCLUSION: The LR-HC has proved to be a safe and a dose-effective protocol in the evaluation of selected young patients with non-traumatic acute bowel disease. Advances in knowledge: (1) As reaching the highest diagnostic benefit to risk ratio (AHARA) appears to be the current principle of MDCT imaging, an increased amount of iodinated CM (0.7-0.9 gI ml-1) can be safely administered to young patients (<40 years) with normal thyroid and renal function to compensate for the lower image quality resulting from low-dose CT protocols performed with the standard filter back-projection algorithm. Such an approach will result in a significant reduction of the radiation dose, which could be otherwise achieved only using iterative reconstruction algorithms combined with either low tube voltage and/or low tube current protocols. (2) An optimal scan delay (Tdelay) for a venous phase caudocranial acquisition can be calculated by the following formula: Tdelay = CI + 25 - TSD, where CI is the duration of the contrast injection, 25 is the average of the sum of abdominal aortic and peak hepatic arrival times and TSD is the scan duration. With such an approach, the radiation exposure resulting from bolus tracking, albeit performed with low-dose scans, can be spared in patients with normal transit times.
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Doenças do Colo/diagnóstico por imagem , Colonoscopia/métodos , Tomografia Computadorizada Multidetectores/métodos , Doença Aguda , Adulto , Idoso , Colonoscopia/normas , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/normas , Estudos Prospectivos , Doses de Radiação , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: The aim of our study was to determine the role of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) and indium-111 Octreotide single photon emission tomography ((111)In-Octreotide SPECT) in the evaluation of metastatic medullary thyroid carcinoma (MMTC). METHODS: Twenty-five MMTC patients were retrospectively evaluated. All patients had undergone whole-body (18)F-FDG-PET/CT including 20 who had also undergone (111)In-Octreotide SPECT within a maximum interval of 6 weeks. Diagnostic contrast-enhanced computed tomography (CT) alone or as part of (18)F-FDG-PET/CT examination was performed in all patients. RESULTS: Contrast-enhanced CT detected a total of 131 lesions including 79 enlarged lymph nodes and 14 bone lesions. (18)F-FDG-PET/CT visualized a total of 92 true positive lesions (SUVmax range 1.1-10.0, mean 4.0 ± 1.7) including 66 lymph nodes, 7 of which were not enlarged on CT, and 8 bone metastases. In the 20 patients studied with both techniques, a total of 64 and 46 true positive lesions were detected by (18)F-FDG-PET/CT and (111)In-Octreotide SPECT, respectively. In particular, (18)F-FDG uptake was found in 43 lymph nodes and in 7 bone metastases whereas (111)In-Octreotide uptake was detected in 27 lymph nodes and in 10 bone metastases. CONCLUSIONS: In MMTC patients, (18)F-FDG-PET/CT provides a useful contribution mainly in evaluating lymph node involvement whereas (111)In-Octreotide SPECT can contribute to the detection and somatostatin receptor characterization especially of bone lesions.
Assuntos
Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/patologia , Fluordesoxiglucose F18 , Imagem Multimodal , Octreotida/análogos & derivados , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos , Adulto JovemRESUMO
Multiple endocrine neoplasia type 1 (MEN1) is a hereditary syndrome predisposing to many endocrine and neuroendocrine tumors (NET). Conventional imaging (CI) cannot provide satisfactory results for all the different types of MEN1-related tumors. Objective of this prospective observational study was to evaluate the role of (68)Ga-DOTATATE PET/CT in MEN1 compared to CI. Diagnostic performance of (68)Ga-DOTATATE PET/CT for the detection of NET was evaluated as well as the prognostic role of SUVmax. Eighteen patients with genetically confirmed MEN1 were evaluated by (68)Ga-DOTATATE PET/CT, endoscopic ultrasounds, multidetector-row computed tomography, magnetic resonance imaging, and hormone/markers serum measurements. Four MEN1-related tumor sites (pancreas, pituitary, parathyroids, adrenals) were considered. Sensitivity and specificity of (68)Ga-DOTATATE PET/CT for the detection of NET were calculated. There was (68)Ga-DOTATATE PET/CT uptake in 11/11 patients with pancreatic lesions, in 9/12 with pituitary adenoma, in 5/15 with parathyroid enlargements, and in 5/7 with adrenal lesions. (68)Ga-DOTATATE PET/CT showed sensitivity and specificity of 100 and 100 % in pancreas, 75 and 83 % in pituitary, 28 and 100 % in parathyroids, and 62.5 and 100 % in adrenals, respectively. Compared with CI, no significant difference in sensitivity for pancreas, pituitary, and adrenals was found, while CI had a better sensitivity for parathyroids (p = 0.002). On the ROC analysis, progression of pancreatic lesions was significantly associated to SUVmax <12.3 (p < 0.05). (68)Ga-DOTATATE PET/CT is greatly helpful in the work-up of MEN1 providing a panoramic view of MEN1-related lesions. There is also a prognostic role of (68)Ga-PET in patients with MEN1-pancreatic lesions.
Assuntos
Neoplasia Endócrina Múltipla Tipo 1/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Compostos Organometálicos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adolescente , Adulto , Feminino , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
RATIONALE AND OBJECTIVES: As both contrast and radiation dose affect the quality of CT images, a constant image quality in abdominal contrast-enhanced multidetector computed tomography (CE-MDCT) could be obtained balancing radiation and contrast media dose according to the age of the patients. MATERIALS AND METHODS: Seventy-two (38 Men; 34 women; aged 20-83 years) patients underwent a single-pass abdominal CE-MDCT. Patients were divided into three different age groups: A (20-44 years); B (45-65 years); and C (>65 years). For each group, a different noise index (NI) and contrast media dose (370 mgI/mL) was selected as follows: A (NI, 15; 2.5 mL/kg), B (NI, 12.5; 2 mL/kg), and C (NI, 10; 1.5 mL/kg). Radiation exposure was reported as dose-length product (DLP) in mGy × cm. For quantitative analysis, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated for both the liver (L) and the abdominal aorta (A). Statistical analysis was performed with a one-way analysis of variance. Standard imaging criteria were used for qualitative analysis. RESULTS: Although peak hepatic enhancement was 152 ± 16, 128 ± 12, and 101 ± 14 Hounsfield units (P < .001) for groups A, B, and C, respectively, no significant differences were observed in the corresponding SNRL with 9.2 ± 1.4, 9.1 ± 1.2, and 9.2 ± 3. Radiation (mGy × cm) and contrast media dose (mL) administered were 476 ± 147 and 155 ± 27 for group A, 926 ± 291 and 130 ± 16 for group B, and 1981 ± 451 and 106 ± 15 for group C, respectively (P < .001). None of the studies was graded as poor or inadequate by both readers, and the prevalence-adjusted bias-adjusted kappa ranged between 0.48 and 0.93 for all but one criteria. CONCLUSIONS: A constant image quality in CE-MDCT can be obtained balancing radiation and contrast media dose administered to patients of different age.