Vascular Enlargement as a Predictor of Nodal Involvement in Bladder Cancer.

In bladder cancer (BC), the evaluation of lymph node (LN) involvement at preoperative imaging lacks specificity. Since neoangiogenesis is paired with lymphatic involvement, this study aims to evaluate the presence of perivesical venous ectasia as an indirect sign of LN involvement, together with other conventional CT findings. All the patients who underwent radical cystectomy (RC) for BC between January 2017 and December 2019 with available preoperative contrast-enhanced CT (CECT) within 1 month before surgery were included. Patients without available pathological reports (and pTNM stage) or who underwent neoadjuvant treatments and palliative RC were excluded. Two readers in blind assessed the nodal shape and hilum, the short axis, and the contrast enhancement of suspicious pelvic LNs, the Largest Venous Diameter (LVD) efferent to the lesion, and the extravesical tumor invasion. In total, 38 patients (33 males) were included: 17 pT2, 17 pT3, 4 pT4; pN+: 20/38. LN short axis > 5 mm, LN enhancement, and LVD > 3 mm were significantly correlated with N+ at pathology. LVD > 3 mm had a significantly higher sensitivity and specificity (≥90%, AUC = 0.949) and was an independent predictor (p = 0.0016).

New Frontiers in Oncological Imaging With Computed Tomography: From Morphology to Function.

The latest evolutions in Computed Tomography (CT) technology have several applications in oncological imaging. The innovations in hardware and software allow for the optimization of the oncological protocol. Low-kV acquisitions are possible thanks to the new powerful tubes. Iterative reconstruction algorithms and artificial intelligence are helpful for the management of image noise during image reconstruction. Functional information is provided by spectral CT (dual-energy and photon counting CT) and perfusion CT.

Lymph Nodes Evaluation in Rectal Cancer: Where Do We Stand and Future Perspective.

The assessment of nodal involvement in patients with rectal cancer (RC) is fundamental in disease management. Magnetic Resonance Imaging (MRI) is routinely used for local and nodal staging of RC by using morphological criteria. The actual dimensional and morphological criteria for nodal assessment present several limitations in terms of sensitivity and specificity. For these reasons, several different techniques, such as Diffusion Weighted Imaging (DWI), Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Dynamic Contrast Enhancement (DCE) in MRI have been introduced but still not fully validated. Positron Emission Tomography (PET)/CT plays a pivotal role in the assessment of LNs; more recently PET/MRI has been introduced. The advantages and limitations of these imaging modalities will be provided in this narrative review. The second part of the review includes experimental techniques, such as iron-oxide particles (SPIO), and dual-energy CT (DECT). Radiomics analysis is an active field of research, and the evidence about LNs in RC will be discussed. The review also discusses the different recommendations between the European and North American guidelines for the evaluation of LNs in RC, from anatomical considerations to structured reporting.

Evidence Based Medicine (EBM) and Evidence Based Radiology (EBR) in the follow-up of the patients after surgery for lung and colon-rectal carcinoma.

PURPOSE: A) To define the role of diagnostic imaging modalities in the follow-up of patients after surgery for solid cancer, using an Evidence Based Medicine (EBM) approach; B) to assess the possible discrepancies between the theoretical model and the clinical protocols currently used for the follow-up of treated patients; c) to compare the real costs of the radiological examinations performed in a group of cancer patients followed up after surgery and the theoretical costs that would have been incurred had the patients been followed up according to the theoretical (evidence-based) follow-up programme. MATERIALS AND METHODS: We searched traditional and secondary databases for research papers and guidelines by international scientific societies published in the last 10 years and concerning the clinical impact of follow-up programs in patients operated on for colorectal and lung carcinoma. The papers were selected based on level of evidence using the systematic review approach of EBM. In each paper selected, we considered the overall survival and disease-free survival, quality of life, side and toxic effects of therapy, costs and psychological aspects to formulate a judgement on the usefulness of the radiological tests. Subsequently, the clinical and imaging follow-up of 40 patients who had undergone surgical resection for colorectal cancer (20 patients) and lung cancer (20 patients) between 1998 and 2004 were retrospectively reviewed, and the costs of the follow-up programs for the two groups were analysed and compared with those of the theoretical evidence-based programmes. RESULTS: Of the 41 papers selected after systematic review only nine datasets were considered for our final analysis. The majority of papers (7 out of 9) and all the guidelines published by international Scientific Societies agreed on the poor value of closed imaging in the follow-up of patients who have undergone surgery for colorectal and lung cancer. A significant difference was found between the real costs of the follow-up programmes implemented in the 40 patients considered and the theoretical costs derived from the guideline recommendations (an excess of 99.06% for lung cancer, and 93.6% for colon cancer). CONCLUSIONS: Our findings can serve as a basis to start a discussion within the scientific community about the role of radiological follow-up in cancer patients with the aim of defining a more rational use of resources.

Diagnostic considerations about visceral leishmaniasis. Two case report.

UNLABELLED: Two cases of visceral leishmaniasis (VL) in immunocompetent patients have been described. Both patients lived in endemicic areas for leishmaniasis in the south of Italy, tested positive for anti-Leishmania antibodies. A definitive diagnosis of VL was delayed by false negative microscopic examinations. Both patients were treated successfully with liposomal amphotericin B. CONCLUSIONS: Immuno Fluorescent Assay (IFA) performed as an available test. It helped to pursue the correct diagnosis and therapy. Microscopy is reported to be highly sensitive and specific in the diagnosis of VL, nevertheless it may yield false negative results when examined in laboratories without good expertness.