The sensitivity of MIPs of 3D contrast-enhanced VIBE T1-weighted imaging for the detection of small brain metastases (≤ 5 mm) on 1.5 tesla MRI.

OBJECTIVES: To evaluate whether the use of Maximum Intensity Projection (MIP) images derived from contrast-enhanced 3D-T1-weighted volumetric interpolated breath-hold examination (VIBE) would allow more sensitive detection of small (≤5 mm) brain metastases (BM) compared with source as well as 2D-T1-weighted spin-echo (SE) images. METHODS: We performed a single center retrospective study on subjects with BM who underwent 1.5 tesla brain magnetic resonance imaging. Two readers counted the number of small BM for each of the seven sets of contrast-enhanced images created: axial 2D-T1-weighted SE, 3D-T1-weighted VIBE, 2.5 mm-thick-MIP T1-weighted VIBE, and 5 mm-thick-MIP T1-weighted VIBE; sagittal 3D-T1-weighted VIBE, 2.5 mm-thick-MIP T1-weighted VIBE, and 5 mm-thick-MIP T1-weighted VIBE. Total number of lesions detected on each image type was compared. Sensitivity, the average rates of false negatives and false positives, and the mean discrepancy were evaluated. RESULTS: A total of 403 small BM were identified in 49 patients. Significant differences were found: in the number of true positives and false negatives between the axial 2D-T1-weighted SE sequence and all other imaging techniques; in the number of false positives between the axial 2D-T1-weighted SE and the axial 3D-T1-weighted VIBE sequences. The two image types that combined offered the highest sensitivity were 2D-T1-weighted SE and axial 2.5 mm-thick-MIP T1-weighted VIBE. The axial 2D-T1-weighted SE sequence differed significantly in sensitivity from all other sequences. CONCLUSION: MIP images did not show a significant difference in sensitivity for the detection of small BM compared with native images.

Radiogenomics and Texture Analysis to Detect von Hippel-Lindau (VHL) Mutation in Clear Cell Renal Cell Carcinoma.

Radiogenomics, a burgeoning field in biomedical research, explores the correlation between imaging features and genomic data, aiming to link macroscopic manifestations with molecular characteristics. In this review, we examine existing radiogenomics literature in clear cell renal cell carcinoma (ccRCC), the predominant renal cancer, and von Hippel-Lindau (VHL) gene mutation, the most frequent genetic mutation in ccRCC. A thorough examination of the literature was conducted through searches on the PubMed, Medline, Cochrane Library, Google Scholar, and Web of Science databases. Inclusion criteria encompassed articles published in English between 2014 and 2022, resulting in 10 articles meeting the criteria out of 39 initially retrieved articles. Most of these studies applied computed tomography (CT) images obtained from open source and institutional databases. This literature review investigates the role of radiogenomics, with and without texture analysis, in predicting VHL gene mutation in ccRCC patients. Radiogenomics leverages imaging modalities such as CT and magnetic resonance imaging (MRI), to analyze macroscopic features and establish connections with molecular elements, providing insights into tumor heterogeneity and biological behavior. The investigations explored diverse mutations, with a specific focus on VHL mutation, and applied CT imaging features for radiogenomic analysis. Moreover, radiomics and machine learning techniques were employed to predict VHL gene mutations based on CT features, demonstrating promising results. Additional studies delved into the relationship between VHL mutation and body composition, revealing significant associations with adipose tissue distribution. The review concludes by highlighting the potential role of radiogenomics in guiding targeted and selective therapies.

Exploring the ADAM12 Expression in Clear Cell Renal Cell Carcinoma: A Radiogenomic Analysis on CT Imaging.

RATIONALE AND OBJECTIVES: Radiogenomics of clear cell renal cell carcinoma (ccRCC) has been developed thanks to the availability of genomic data, both gene expressions and gene mutations, obtained through the sequencing of ccRCC genome. These data are collected in the Cancer Genome Atlas (TCGA) Research Network-work. Disintegrin and metalloproteinase domain-containing protein 12 (ADAM12) gene belongs to the family of genes coding for multidomain and multifunctional type I transmembrane proteins ADAMs. These proteins are fundamental for regulating cell adhesion and mediating proteolysis of a series of cell surface receptors and signal molecules extracellular domains. Recently, a correlation was detected between ADAM12 expression in ccRCC and tumor aggressiveness in terms of cell proliferation, migration, invasion, tumor progression, metastases, and poor prognosis, suggesting ADAM12 as a prognostic marker and therapeutic target in ccRCC. The computed tomography (CT) imaging phenotype of ADAM12 expression in ccRCC has never been studied. The aim of this study is to investigate the CT imaging phenotype of ADAM12 expression in ccRCC patients. MATERIALS AND METHODS: In this retrospective study, we enrolled 202 ccRCC patients divided into two groups: ccRCC patients with ADAM12 expression (n = 35) and ccRCC patients without ADAM12 expression (n = 167). Different imaging features were evaluated on CT scan at first diagnosis. The statistical significance threshold was set at p < 0.05. RESULTS: A statistically significant correlation was found with larger primary tumor size (p = 0.020), ill-defined tumor margins (p = 0.044), tumor necrosis (p = 0.011), and collecting system invasion (p = 0.014). CONCLUSION: This study demonstrates CT imaging features associated to ADAM12 expression in ccRCC. These results could help delve into ADAM12 gene status through CT approach and to further investigate towards the development of targeted therapies in ccRCC.

Temporal Bone High Resolution Computed Tomography Findings in a Case of Postpartum Otosclerosis.

We describe temporal bone high resolution computed tomography (HRCT) findings in a case of bilateral mixed fenestral and retrofenestral otosclerosis with onset in the postpartum period. This condition should be considered in women complaining of postpartum hearing loss and temporal bone HRCT is a fundamental tool leading to the diagnosis.

Overview of the Current Knowledge and Conventional MRI Characteristics of Peri- and Para-Vascular Spaces.

Brain spaces around (perivascular spaces) and alongside (paravascular or Virchow-Robin spaces) vessels have gained significant attention in recent years due to the advancements of in vivo imaging tools and to their crucial role in maintaining brain health, contributing to the anatomic foundation of the glymphatic system. In fact, it is widely accepted that peri- and para-vascular spaces function as waste clearance pathways for the brain for materials such as ß-amyloid by allowing exchange between cerebrospinal fluid and interstitial fluid. Visible brain spaces on magnetic resonance imaging are often a normal finding, but they have also been associated with a wide range of neurological and systemic conditions, suggesting their potential as early indicators of intracranial pressure and neurofluid imbalance. Nonetheless, several aspects of these spaces are still controversial. This article offers an overview of the current knowledge and magnetic resonance imaging characteristics of peri- and para-vascular spaces, which can help in daily clinical practice image description and interpretation. This paper is organized into different sections, including the microscopic anatomy of peri- and para-vascular spaces, their associations with pathological and physiological events, and their differential diagnosis.

Sarcopenia does not impact the outcome of patients with Multiple Mieloma consolidated with autologous Hematopoietic Stem Cell Transplantation.

Sarcopenia has been associated with chronic diseases and cancer. Aim of this study was to evaluate sarcopenia in Multiple Myeloma patients undergoing autologous stem cell trans-plantation. In 68 eligible patients' measurement of skeletal muscle area (cm2) on computed tomography scans at the level of the L3 vertebra (L3-SMI) was performed. 37(54%) patients were categorized as sarcopenic: 26 males with L3-SMI values < 52.4 cm2/m2, and 11 women with L3-SMI values < 38.9 cm2/m2. The majority of sarcopenic patients included were older than 60 years (69%, p=0.0005), and with BMI <25 (75%; p=0.0000). A significant association was found between sarcopenia and Sorror score value > 1 (p=0.02). The Kaplan Meyer curve showed a median OS of 73.5 months for non-sarcopenic patients vs. 86.5 months for sarcopenic patients, suggesting that sarcopenia is not an independent prognostic factor in this cohort of patients.

Late/delayed gadolinium enhancement in MRI after intravenous administration of extracellular gadolinium-based contrast agents: is it worth waiting?

The acquisition of images minutes or even hours after intravenous extracellular gadolinium-based contrast agents (GBCA) administration ("Late/Delayed Gadolinium Enhancement" imaging; in this review, further termed LGE) has gained significant prominence in recent years in magnetic resonance imaging. The major limitation of LGE is the long examination time; thus, it becomes necessary to understand when it is worth waiting time after the intravenous injection of GBCA and which additional information comes from LGE. LGE can potentially be applied to various anatomical sites, such as heart, arterial vessels, lung, brain, abdomen, breast, and the musculoskeletal system, with different pathophysiological mechanisms. One of the most popular clinical applications of LGE regards the assessment of myocardial tissue thanks to its ability to highlight areas of acute myocardial damage and fibrotic tissues. Other frequently applied clinical contexts involve the study of the urinary tract with magnetic resonance urography and identifying pathological abdominal processes characterized by high fibrous stroma, such as biliary tract tumors, autoimmune pancreatitis, or intestinal fibrosis in Crohn's disease. One of the current areas of heightened research interest revolves around the possibility of non-invasively studying the dynamics of neurofluids in the brain (the glymphatic system), the disruption of which could underlie many neurological disorders.

Fat Matters: Exploring Cancer Risk through the Lens of Computed Tomography and Visceral Adiposity.

Obesity is an established risk factor for cancer. However, conventional measures like body mass index lack precision in assessing specific tissue quantities, particularly of the two primary abdominal fat compartments, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Computed tomography (CT) stands as the gold standard for precisely quantifying diverse tissue types. VAT, distinguished by heightened hormonal and metabolic activity, plays a pivotal role in obesity-related tumor development. Excessive VAT is linked to aberrant secretion of adipokines, proinflammatory cytokines, and growth factors, fostering the carcinogenesis of obesity-related tumors. Accurate quantification of abdominal fat compartments is crucial for understanding VAT as an oncological risk factor. The purpose of the present research is to elucidate the role of CT, performed for staging purposes, in assessing VAT (quantity and distribution) as a critical factor in the oncogenesis of obesity-related tumors. In the field of precision medicine, this work takes on considerable importance, as quantifying VAT in oncological patients becomes fundamental in understanding the influence of VAT on cancer development-the potential "phenotypic expression" of excessive VAT accumulation. Previous studies analyzed in this research showed that VAT is a risk factor for clear cell renal cell carcinoma, non-clear cell renal cell carcinoma, prostate cancer, and hepatocarcinoma recurrence. Further studies will need to quantify VAT in other oncological diseases with specific mutations or gene expressions, in order to investigate the relationship of VAT with tumor genomics.

CT-Based Radiogenomics of P4HA3 Expression in Clear Cell Renal Cell Carcinoma.

RATIONALE AND OBJECTIVES: The sequencing of the renal cell carcinoma (RCC) genome identified several mutations with prognostic significance. Genomic analysis, collected in The Cancer Genome Atlas Research Network, revealed several clear cell renal cell carcinoma (ccRCC) gene mutations and gene expressions. Radiogenomics is a new branch of diagnostic imaging based on the association between imaging phenotypes and genomics of diseases. P4HA3 expression has recently been shown to correlate with increased aggressiveness of ccRCC, with poor prognosis, proliferation, migration, invasion, and metastases, suggesting P4HA3 as a prognostic marker and therapeutic target in ccRCC. The aim of this study is to investigate the computed tomography (CT) imaging phenotype of P4HA3 expression in ccRCC patients. MATERIALS AND METHODS: In this retrospective study we enrolled 196 ccRCC patients divided into two groups: ccRCC patients with P4HA3 expression (n = 13) and ccRCC patients without P4HA3 expression (n = 183). Several imaging features were evaluated on preoperative CT scan. The statistical significance threshold was set at P < .05. RESULTS: A statistically significant association was found with larger primary tumor size (P = .033), tumor infiltration (P = .023), ill-defined tumor margins (P = .025), and advanced tumor stage American Joint Committee of Cancer (P = .014). CONCLUSION: This study demonstrates CT imaging features associated with P4HA3 expression in ccRCC. These results could contribute to better understand P4HA3 expression with a noninvasive approach and could be applied to the development of targeted therapies.

The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS).

Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.

Interrater reliability of Brain Tumor Reporting and Data System (BT-RADS) in the follow up of adult primary brain tumors: a single institution experience in Italy.

Background: In 2018, a new system was proposed for classifying and reporting post-treatment adult brain tumor on magnetic resonance imaging, named as Brain Tumor Reporting and Data System (BT-RADS), that needs a validation by means of agreement studies. Methods: A retrospective study was designed with the aim of identifying contrast-enhanced magnetic resonance imaging (MRI) of adult patients on follow-up for primary brain tumor at Fondazione Policlinico Campus Bio-Medico. Four radiologists (2 radiology residents, 1 general radiologist, 1 neuroradiologist) read and scored each study using the BT-RADS scoring tool, blinded to the MRI original report. Interobserver agreement and Fleiss' k were calculated to assess the level of diagnostic agreement. It was assessed how many times the assignment of different scoring of BT-RADS would have led to a different patient management. Results: The total number of patients included in the study was 23 with 147 MRIs and a total of 588 BT-RADS scores retrospectively evaluated. The two most frequent tumor types were astrocytoma grade 4 (62%) and oligodendroglioma grade 3 (21%). The overall agreement rate for all 4 radiologists was 82% with a Fleiss' k of 0.70. The overall agreement rate between general radiologist and neuroradiologist was 91% with a Fleiss' k of 0.86. The overall agreement rate between 2 radiology residents and neuroradiologist was 80% with a Fleiss' k of 0.66. Astrocytoma grade 3 (k: 0.51) and oligodendroglioma grade 2 (k: 0.32) showed a poor agreement while higher values of agreement were found for astrocytoma grade 4 (k: 0.70), astrocytoma grade 2 (k: 0.78) and oligodendroglioma grade 3 (k: 0.78). All the radiologists agreed on BT-RADS assignment in 70% patients, three radiologists agreed in 17% and two radiologists agree in 13%. In no cases there was a complete disagreement among the readers. In 18% of cases the discrepancy in the estimated BT-RADS would have led to a different follow-up management. Conclusions: BT-RADS can be considered a valid tool for neuroradiologists and radiologists even with little experience in the interpretation of patients' images during follow-up for adult primary brain tumors supporting standardized interpretation, reporting and clinical management.

Interest in mammography across European countries: a retrospective "Google Trends" comparative study.

Background: Breast cancer is currently the most prevalent and impacting cancer among women and mammography has been recommended for screening by The European Commission Initiative on Breast Cancer since 2003. The objective of this study is to estimate the interest in breast cancer screening breast cancer in European countries by analyzing data from online searches for the term "mammography" obtained via Google Trends. Methods: The relative search volumes (RSVs) of the term "mammography" translated into various languages and relating to the January 2010-December 2022 period were downloaded from Google Trends. The between-countries differences growth of interest was estimated by a regression model in which the country-time interaction term was introduced. Results: France [coefficient (coeff): 0.23; 95% confidence interval (CI): 0.18-0.28], United Kingdom (coeff: 0.22; 95% CI: 0.18-0.27) and Germany (coeff: 0.21; 95% CI: 0.16-0.25) showed the higher growth in mammography interest when compared to the average growth. The lowest growths were observed in Eastern European countries: Croatia (coeff: -0.13; 95% CI: -0.18 to -0.09), Serbia (coeff: -0.14; 95% CI: -0.18 to -0.09), Greece (coeff: -0.14; 95% CI: -0.18 to -0.09), Slovenia (coeff: -0.15; 95% CI: -0.2 to -0.11) and Bosnia-Herzegovina (coeff: -0.15; 95% CI: -0.2 to -0.11). Conclusions: These exploratory findings suggest that online interest in mammography is lower in countries with lower screening coverage and higher breast cancer mortality. These countries could adopt strategies to raise awareness of breast cancer prevention.

Relationship between chronic kidney disease and cerebral white matter hyperintensities: a systematic review.

Background: This systematic review summarizes available evidence on the relationship between white matter hyperintensities (WMH) volumetric quantification on brain MRI scans and chronic kidney disease (CKD). Methods: The literature search was performed in March 2022 using MEDLINE PubMed Central, Scopus and Web of Science - Publons as search engines. Relevant articles investigating, with a quantitative volumetric approach, the link between WMH and CKD patients were selected. Results: The database search strategy found 987 articles, after excluding duplicates, the titles and abstracts of the remaining 320 articles were examined. Subsequently 276 articles were excluded as they were not relevant to the topic. Of the 44 articles evaluated for eligibility, 36 were excluded because the quantitative analysis of WMH was not volumetric. Finally, 8 articles were included in this systematic review. Conclusions: Literature on this topic is extremely heterogeneous in terms of methodology and samples. However, evidence shows that there is a relationship between CKD and WMH volume of the brain. We recommend that quantifiable biomarkers such as estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR) should be included in studies dealing with cerebrovascular disease. The biological and molecular mechanisms underlying cerebrovascular damage in patients with chronic renal failure deserve to be further explored.

The role of iodinated contrast media in computed tomography structured Reporting and Data Systems (RADS): a narrative review.

Background and Objective: In recent years, there has been a large-scale dissemination of guidelines in radiology in the form of Reporting & Data Systems (RADS). The use of iodinated contrast media (ICM) has a fundamental role in enhancing the diagnostic capabilities of computed tomography (CT) but poses certain risks. The scope of the present review is to summarize the current role of ICM only in clinical reporting guidelines for CT that have adopted the "RADS" approach, focusing on three specific questions per each RADS: (I) what is the scope of the scoring system; (II) how is ICM used in the scoring system; (III) what is the impact of ICM enhancement on the scoring. Methods: We analyzed the original articles for each of the latest versions of RADS that can be used in CT [PubMed articles between January, 2005 and March, 2023 in English and American College of Radiology (ACR) official website]. Key Content and Findings: We found 14 RADS suitable for use in CT out of 28 RADS described in the literature. Four RADS were validated by the ACR: Colonography-RADS (C-RADS), Liver Imaging-RADS (LI-RADS), Lung CT Screening-RADS (Lung-RADS), and Neck Imaging-RADS (NI-RADS). One RADS was validated by the ACR in collaboration with other cardiovascular scientific societies: Coronary Artery Disease-RADS 2.0 (CAD-RADS). Nine RADS were proposed by other scientific groups: Bone Tumor Imaging-RADS (BTI-RADS), Bone­RADS, Coronary Artery Calcium Data & Reporting System (CAC-DRS), Coronavirus Disease 2019 Imaging-RADS (COVID-RADS), COVID-19-RADS (CO-RADS), Interstitial Lung Fibrosis Imaging-RADS (ILF-RADS), Lung-RADS (LU-RADS), Node-RADS, and Viral Pneumonia Imaging-RADS (VP-RADS). Conclusions: This overview suggests that ICM is not strictly necessary for the study of bones and calcifications (CAC-DRS, BTI-RADS, Bone-RADS), lung parenchyma (Lung-RADS, LU-RADS, COVID-RADS, CO-RADS, VP-RADS and ILF-RADS), and in CT colonography (C-RADS). On the other hand, ICM plays a key role in CT angiography (CAD-RADS), in the study of liver parenchyma (LI-RADS), and in the evaluation of soft tissues and lymph nodes (NI-RADS, Node-RADS). Future studies are needed in order to evaluate the impact of the new iodinated and non-iodinate contrast media, artificial intelligence tools and dual energy CT in the assignment of RADS scores.

Imaging of knee osteoarthritis: a review of multimodal diagnostic approach.

Knee osteoarthritis (KOA) is a common chronic condition among the elderly population that significantly affects the quality of life. Imaging is crucial in the diagnosis, evaluation, and management of KOA. This manuscript reviews the various imaging modalities available until now, with a little focus on the recent developments with Artificial Intelligence. Currently, radiography is the first-line imaging modality recommended for the diagnosis of KOA, owing to its wide availability, affordability, and ability to provide a clear view of bony components of the knee. Although radiography is useful in assessing joint space narrowing (JSN), osteophytes and subchondral sclerosis, it has limited effectiveness in detecting early cartilage damage, soft tissue abnormalities and synovial inflammation. Ultrasound is a safe and affordable imaging technique that can provide information on cartilage thickness, synovial fluid, JSN and osteophytes, though its ability to evaluate deep structures such as subchondral bone is limited. Magnetic resonance imaging (MRI) represents the optimal imaging modality to assess soft tissue structures. New MRI techniques are able to detect early cartilage damage measuring the T1ρ and T2 relaxation time of knee cartilage. Delayed gadolinium-enhanced MRI of cartilage, by injecting a contrast agent to enhance the visibility of the cartilage on MRI scans, can provide information about its integrity. Despite these techniques can provide valuable information about the biochemical composition of knee cartilage and can help detect early signs of osteoarthritis (OA), they may not be widely available. Computed tomography (CT) has restricted utility in evaluating OA; nonetheless, weight-bearing CT imaging, using the joint space mapping technique, exhibits potential in quantifying knee joint space width and detecting structural joint ailments. PET-MRI is a hybrid imaging technique able to combine morphological information on bone and soft tissue alterations with the biochemical changes, but more research is needed to justify its high cost and time involved. The new tools of artificial intelligence, including machine learning models, can assist in detecting patterns and correlations in KOA that may be useful in the diagnosis, grading, predicting the need for arthroplasty, and improving surgical accuracy.

Radiogenomic Features of GIMAP Family Genes in Clear Cell Renal Cell Carcinoma: An Observational Study on CT Images.

GTPases of immunity-associated proteins (GIMAP) genes include seven functional genes and a pseudogene. Most of the GIMAPs have a role in the maintenance and development of lymphocytes. GIMAPs could inhibit the development of tumors by increasing the amount and antitumor activity of infiltrating immunocytes. Knowledge of key factors that affect the tumor immune microenvironment for predicting the efficacy of immunotherapy and establishing new targets in ccRCC is of great importance. A computed tomography (CT)-based radiogenomic approach was used to detect the imaging phenotypic features of GIMAP family gene expression in ccRCC. In this retrospective study we enrolled 193 ccRCC patients divided into two groups: ccRCC patients with GIMAP expression (n = 52) and ccRCC patients without GIMAP expression (n = 141). Several imaging features were evaluated on preoperative CT scan. A statistically significant correlation was found with absence of endophytic growth pattern (p = 0.049), tumor infiltration (p = 0.005), advanced age (p = 0.018), and high Fuhrman grade (p = 0.024). This study demonstrates CT imaging features of GIMAP expression in ccRCC. These results could allow the collection of data on GIMAP expression through a CT-approach and could be used for the development of a targeted therapy.

Right Condylar Jugular Diverticulum: Contrast-enhanced Computed Tomography Findings of a Rare Anatomical Variant of Jugular Bulb.

This is the first description of condylar jugular diverticulum (CJD) by means of contrast-enhanced computed tomography scan in the medical literature. CJD is a rare anatomical variant of jugular bulb that should be known to avoid radiological and surgical errors and achieve an appropriate pre-surgical planning of skull base pathologies.