RESUMO
Intraductal oncocytic papillary neoplasm (IOPN) of the pancreas is a recently recognized pancreatic tumor. Here, we aimed to determine its most essential features with the systematic review tool. PubMed, Scopus, and Embase were searched for studies reporting data on pancreatic IOPN. The clinicopathologic, immunohistochemical, and molecular data were extracted and summarized. Then, a comparative analysis of the molecular alterations of IOPN with those of pancreatic ductal adenocarcinoma and intraductal papillary mucinous neoplasm from reference cohorts (including The Cancer Genome Atlas) was conducted. The key findings from 414 IOPNs were as follows: 1) The male-to-female ratio was 1.5:1. Pancreatic head was the most common site (131/237; 55.3%), but a diffuse tumor extension involving more than one pancreatic segment was described in about 1 out of 5 cases (49/237; 20.6%). The mean size was 45.5 mm. An associated invasive carcinoma was present in 50% of cases (168/336). In those cases, most tumors were pT1 or pT2 and pN0 (>80%), and vascular invasion was uncommon (20.6%). Regarding survival, more than 90% of patients were alive after surgical resection. 2) Immunohistochemical and molecular features were as follows. The most commonly expressed mucins were MUC5AC (110/112; 98.2%) and MUC6 (78/84; 92.8%). Compared with pancreatic ductal adenocarcinoma and intraductal papillary mucinous neoplasm, the classic pancreatic drivers KRAS, TP53, CDKN2A, SMAD4, and GNAS were less altered in IOPN (P < .01). Moreover, fusions involving PRKACA or PRKACB gene were detected in all of the 68 cases examined, with PRKACB::ATP1B1 being the most common (27/68 cases; 39.7%). These genomic events emerged as an entity-defining molecular alteration of IOPN (P < .01). Thus, such fusions represent a promising biomarker for diagnostic purposes. Recent evidence also suggests their role in influencing the acquisition of oncocytic morphology. IOPN is a distinct pancreatic neoplasm with specific clinicopathologic and molecular features. Considering the clinical or prognostic implications, its recognition is essential for pathologists and, ultimately, patients' management.
RESUMO
BACKGROUND: High-grade neuroendocrine neoplasms (NENs) comprise both well-differentiated grade 3 neuroendocrine tumors (G3 NETs) and poorly differentiated neuroendocrine carcinomas (NECs). Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) nearly always include poorly differentiated NEC as the neuroendocrine component. The efficacy and safety of frontline mFOLFIRINOX chemotherapy has never been investigated in patients with high-grade NENs. PATIENTS AND METHODS: We conducted a multi-institutional retrospective analysis of patients with advanced high-grade NEN of the gastroenteropancreatic tract or of unknown origin seen between February 2016 and April 2023 who received treatment with frontline mFOLFIRINOX. RESULTS: A total of 35 patients were included (G3 NETs: n=2; NECs: n=25; MiNENs: n=8; stage III: n=5; stage IV: n=30). The objective response rate was 77% (complete response: 3%; partial response: 74%). Median progression-free survival was 12 months (95% CI, 9.2-16.2 months) and median overall survival was 20.6 months (95% CI, 17.2-30.6 months). No significant differences in efficacy were seen according to primary site, histopathology, and Ki-67 proliferative index. All 5 patients with stage III disease who received mFOLFIRINOX obtained an objective response and underwent radical surgery or definitive radiotherapy with curative intent, with a recurrence rate of 40%. Grade 3 or 4 adverse events were observed in 43% of patients (mainly neutropenia and diarrhea). Females were at significantly increased risk of developing severe toxicities. CONCLUSIONS: mFOLFIRINOX shows antitumor activity against high-grade NENs. Well-designed, prospective clinical trials are needed to assess the efficacy of mFOLFIRINOX in both the neoadjuvant and metastatic settings.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Irinotecano , Gradação de Tumores , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/patologia , Idoso , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/mortalidade , Estudos Retrospectivos , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Irinotecano/uso terapêutico , Irinotecano/farmacologia , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/patologia , Neoplasias Intestinais/mortalidade , Oxaliplatina/uso terapêutico , Oxaliplatina/farmacologia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Fluoruracila/uso terapêutico , Leucovorina/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND/OBJECTIVES: To analyze the diagnostic performance of three short magnetic resonance imaging (MRI) protocols for the follow-up of pancratic intraductal papillary mucinous neoplasms (IPMN). METHODS: Follow-up MRI examinations of 287 patients with IPMN performed in two centers were retrospectively retrieved. Four MRI protocols were identified as follows: T1-weighted (T1w), T2-weighted (T2w), and MRCP sequences (protocol 1); T1w, T2w, MRCP, and diffusion-weighted (DWI) sequences (protocol 2); T1w, T2w, MRCP, and post-contrast T1w-sequences (protocol 3); and a comprehensive protocol including all previous sequences (protocol 4). Three radiologists with different experience in abdominal imaging expressed their opinion upon the optimal patient's management upon the evaluation of each protocol. Intra-and inter-observer agreement and concordance with the clinical decision expressed by a pancreatic surgeon were calculated with Cohen's kappa test. RESULTS: 223 patients were included (66±10 years; 92 men, 131 women). 143 patients had branch-duct-IPMNs, 25 main-duct-IPMNs and 55 mixed-type-IPMNs. 79 patients underwent surgery, resulting in 52 high-grade dysplasia (HGD) and 27 low-grade dysplasia (LGD). Concordance for the expert reader between protocols 1, 2 and 3 and the actual clinical decision were 0.63, 0.72, and 0.74 respectively (95% CI, 0.53-0.73, 0.63-0.81, and 0.65-0.83). Inter-observer agreement between reader 1 and reader 2, reader 1 and reader 3, and reader 2 and reader 3 were: 0.71, 0.50, and 0.75 for protocol 1 (95% CI, 0.63-0.81, 0.40-0.60, and 0.66-0.84);0.68, 0.54, and 0.84 for protocol 2 (95% CI, 0.59-0.77, 0.44-0.64, and 0.76-0.91); and 0.77, 0.65, and 0.86 for protocol 3 (95% CI, 0.69-0.86, 0.55-0.74, and 0.80-0.93). CONCLUSIONS: Short MRI protocol is suitable for IPMN surveillance.
RESUMO
BACKGROUND: Upfront surgery followed by postoperative treatment is a commonly adopted treatment for resectable pancreatic ductal adenocarcinoma (rPDAC). However, the risk of positive surgical margins, the poor recovery that often impairs postoperative treatments, and the risk of recurrence might limit the outcome of this strategy. This study evaluated the safety and the activity of liposomal irinotecan 50â¯mg/m2 +â¯5-fluorouracil 2400â¯mg/m2 +â¯leucovorin 400â¯mg/m2 +â¯oxaliplatin 60â¯mg/m2 (NALIRIFOX) in the perioperative treatment of patients with rPDAC. METHODS: Eligible patients had a rPDAC with <â¯180° interface with major veins' wall. Patients received 3 cycles before and 3 cycles after resection with NALIRIFOX, days 1 and 15 of a 28-day cycle. The primary endpoint was the proportion of patients undergoing an R0 resection. RESULTS: 107 patients began preoperative treatment. Nine patients discontinued the treatment because of related or unrelated adverse events. Disease-control rate was 92.9%. 87 patients underwent surgical exploration, 11 had intraoperative evidence of metastatic disease, and 1 died for surgical complications. R0 resection rate was 65.3%. 49 patients completed the three postoperative cycles. The most common grade ≥â¯3 adverse events were diarrhea and neutropenia. Median overall survival (OS) of ITT patients was 32.3 months (95% CI 27.8-44.3). Median disease-free and OS from surgery of resected patients were 19.3 (95% CI 12.6-34.1) and 40.3 months (95% CI 29-NA), respectively. CONCLUSION: Perioperative NALIRIFOX was manageable and active, and deserves further investigation in randomized trials comparing it with standard upfront surgery followed by adjuvant therapy.
Assuntos
Adenocarcinoma , Neoplasias Pancreáticas , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Fluoruracila , Irinotecano/efeitos adversos , Adenocarcinoma/patologia , Leucovorina , Terapia Neoadjuvante/efeitos adversosRESUMO
BACKGROUND: Accurately predicting the risk of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy before surgery may assist surgeons in making more informed treatment decisions and improved patient counselling. The aim was to evaluate the predictive accuracy of a radiomics-based preoperative-Fistula Risk Score (RAD-FRS) for clinically relevant postoperative pancreatic fistula. METHODS: Radiomic features were derived from preoperative CT scans from adult patients after pancreatoduodenectomy at a single centre in the Netherlands (Amsterdam, 2013-2018) to develop the radiomics-based preoperative-Fistula Risk Score. Extracted radiomic features were analysed with four machine learning classifiers. The model was externally validated in a single centre in Italy (Verona, 2020-2021). The radiomics-based preoperative-Fistula Risk Score was compared with the Fistula Risk Score and the updated alternative Fistula Risk Score. RESULTS: Overall, 359 patients underwent a pancreatoduodenectomy, of whom 89 (25 per cent) developed a clinically relevant postoperative pancreatic fistula. The radiomics-based preoperative-Fistula Risk Score model was developed using CT scans of 118 patients, of which three radiomic features were included in the random forest model, and externally validated in 57 patients. The model performed well with an area under the curve of 0.90 (95 per cent c.i. 0.71 to 0.99) and 0.81 (95 per cent c.i. 0.69 to 0.92) in the Amsterdam test set and Verona data set respectively. The radiomics-based preoperative-Fistula Risk Score performed similarly to the Fistula Risk Score (area under the curve 0.79) and updated alternative Fistula Risk Score (area under the curve 0.79). CONCLUSION: The radiomics-based preoperative-Fistula Risk Score, which uses only preoperative CT features, is a new and promising radiomics-based score that has the potential to be integrated with hospital CT report systems and improve patient counselling before surgery. The model with underlying code is readily available via www.pancreascalculator.com and www.github.com/PHAIR-Consortium/POPF-predictor.
Assuntos
Fístula Pancreática , Pancreaticoduodenectomia , Adulto , Humanos , Pancreaticoduodenectomia/efeitos adversos , Fístula Pancreática/etiologia , Pâncreas/cirurgia , Fatores de Risco , Tomografia Computadorizada por Raios X , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
PURPOSE: To compare ultrasound (US) and US-derived fat fraction (UDFF) with magnetic resonance proton density fat fraction (MRI-PDFF) for the detection of hepatic steatosis and quantification of liver fat content. MATERIALS AND METHODS: Between October and December 2022, 149 patients scheduled for an abdominal MRI agreed to participate in this study and underwent MRI-PDFF, US and UDFF. Inclusion criteria were: (a) no chronic liver disease or jaundice; (b) no MRI motion artifacts; (c) adequate liver examination at US. Exclusion criteria were: (a) alcohol abuse, chronic hepatitis, cirrhosis, or jaundice; (b) MRI artifacts or insufficient US examination. The median of 10 MRI-PDFF and UDFF measurements in the right hepatic lobe was analyzed. UDFF and MRI-PDFF were compared by Bland-Altman difference plot and Pearson's test. Sensitivity, specificity, positive and negative predictive values, accuracy, and area under the receiver-operator curve (AUC-ROC) of US and UDFF were calculated using an MRI-PDFF cut-off value of 5%. p values ≤ 0.05 were statistically significant. RESULTS: 122 patients were included (61 men, mean age 60 years, standard deviation 15 years). The median MRI-PDFF value was 4.1% (interquartile range 2.9-6); 37.7% patients had a median MRI-PDFF value ≥ 5%. UDFF and MRI-PDFF had high agreement (p = 0.11) and positive correlation (â´ = 0.81, p < 0.001). UDFF had a higher diagnostic value than US for the detection of steatosis, with AUC-ROCs of 0.75 (95% CI 0.65, 0.84) and 0.53 (95% CI 0.42, 0.64), respectively. CONCLUSIONS: UDFF reliably quantifies liver fat content and improves the diagnostic value of US for the detection of hepatic steatosis.
Assuntos
Hepatopatia Gordurosa não Alcoólica , Masculino , Humanos , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/patologia , Fígado/diagnóstico por imagem , Fígado/patologia , Imageamento por Ressonância Magnética , Abdome/patologia , UltrassonografiaRESUMO
Acinar cystic transformation (ACT) of the pancreas, previously called acinar cell cystadenoma, is a poorly understood and rare entity among pancreatic cystic lesions. This study aims to clarify its real nature. This research cohort included 25 patients with pancreatic ACT, representing the largest series in the literature. We describe their clinicopathological features and molecular profile using next-generation sequencing. ACT arose more often in women (F/M≃2:1), in the body-tail region, with a mean size of ~4 cm. At the latest follow-up, all patients were alive and disease free. Histologically, a typical acinar epithelium lined all cysts, intermingled with ductal-like epithelium in 11/25 (44%) cases. All the cases lacked any evidence of malignancy. Three ACT showed peculiar features: 1 showed an extensive and diffuse microcystic pattern, and the other 2 harbored foci of low-grade pancreatic intraepithelial neoplasia (PanIN) in the ductal-like epithelium. Next-generation sequencing revealed the presence of 2 pathogenic/likely pathogenic mutations in 2 different cases, 1 with ductal-like epithelium and 1 with PanIN, and affecting KRAS (c.34G>C, p.G12R) and SMO (c.1685G>A, p.R562Q) genes, respectively. The other case with PanIN was not available for sequencing. Overall, our findings support that ACT is a benign entity, potentially arising from heterogeneous conditions/background, including: (1) acinar microcysts, (2) malformations, (3) obstructive/inflammatory setting, (4) genetic predisposition, (5) possible neoplastic origin. Although all indications are that ACT is benign, the potential occurrence of driver mutations suggests discussing a potential role of long-term surveillance for these patients.
Assuntos
Carcinoma in Situ , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Humanos , Feminino , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Carcinoma in Situ/patologia , Epitélio , Carcinoma Ductal Pancreático/patologia , Células Acinares/patologiaRESUMO
Background: A non-invasive method to improve the prognostic stratification would be clinically beneficial in patients with resectable pancreatic adenocarcinoma (PDAC). The aim of this study was to correlate conventional magnetic resonance (MR) features and the metrics derived from the histogram analysis of apparent diffusion coefficient (ADC) maps, with the risk and the time to metastases (TTM) after surgery in patients with PDAC. Methods: pre-operative MR examinations of 120 patients were retrospectively analyzed. Patients were grouped according to the presence (M+) or absence (M−) of metastases during follow-up. Conventional MR features and histogram-derived metrics were compared between M+ and M− patients using the Fisher's or Mann−Whitney tests; receiver operating characteristic (ROC) curves were constructed for the features that showed a significant difference between groups. A Cox regression analysis was performed to identify the features with a significant effect on the TTM, and Kaplan−Meier curves were constructed for significant features. Results: 68.3% patients developed metastases over a mean follow-up time of 29 months (range, 3−54 months). ADC skewness and kurtosis were significantly higher in M+ than in M− patients (p < 0.001). Skewness had a significant effect on the risk of metastases (hazard ratioHR = 5.22, p < 0.001). Patients with an ADC skewness ≥0.23 had a significantly shorter TTM than those with a skewness <0.22 (11.7 vs. 30.8 months, p < 0.001). Conclusions: pre-operative histogram analysis of ADC maps provides parameters correlated to the metastatic potential of PDAC. Higher ADC skewness seems to be associated with a significantly shorter TTM in patients with resectable PDAC.
RESUMO
PURPOSE: To develop a predictive model for liver metastases in patients with pancreatic ductal adenocarcinoma (PDAC) based on textural features of the primary tumor extracted by computed tomography (CT) images. MATERIALS AND METHODS: Patients with a pathologically proved PDAC who underwent CT between December 2020 and January 2022 were retrospectively identified. Treatment-naïve patients were included. Sex, age, tumor size, vascular infiltration and 39 arterial and portal phase textural features were analyzed. The variables significantly correlated to tumor size according to the Pearson's product-moment correlation test were excluded from analysis; the remaining variables were compared between metastatic (M +) and non-metastatic (M-) patients using Fisher's or Mann-Whitney test. The features with a significant difference between groups were entered into a binomial logistic regression test to develop a predictive model for liver metastases. RESULTS: This study included 220 patients. Eight variables (tumor size, arterial HU_MAX, arterial GLRLM_LRLGE, arterial GLZLM_SZHGE, arterial GLZLM_LZLGE, portal GLCM_CORRELATION, portal GLRLM_LRLGE, and portal GLZLM_SZHGE) were significantly different between groups. The logistic regression model was statistically significant (χ2 = 81.6, p < .001) and correctly classified 80.9% of cases. Sensitivity, specificity, positive and negative predictive values of the model were 58.6%, 91.3%, 75.9% and 82.5%, respectively. The area under the ROC curve of the model was 0.850 (95% CI, 0.793-0.907). Tumor size, arterial HU_MAX, arterial GLZLM_SZHGE and portal GLCM_CORRELATION were significant predictors of the likelihood of liver metastases, with odds ratios of 1.1, 0.9, 1, and 1.49, respectively. CONCLUSIONS: CT texture analysis of PDAC can identify features that may predict the likelihood of liver metastases.
Assuntos
Carcinoma Ductal Pancreático , Neoplasias Hepáticas , Neoplasias Pancreáticas , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/patologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Neoplasias PancreáticasRESUMO
PURPOSE: To investigate the role of CT-texture analysis of liver ablation area to predict local recurrence after HCC ablation. METHODS: Patients treated with liver ablation were retrospectively enrolled. CT-texture analysis was performed on the core and borders of ablation area 1-2 months after procedure. Tumors were grouped according to the onset of local recurrence at follow-up (persistence, recurrence-free, short- or long-term recurrence). Differences in texture parameters and which parameters were predictive of recurrence risk were assessed using a Cox regression model. RESULTS: 151 HCCs were treated in 98 patients (72 ± 9 years, 83 men). 68 HCCs reported no disease recurrence, 32 persistent disease, 19 short-term and 32 long-term recurrence. Median follow-up was 280 [IQR: 156-569] days. Venous phase (Ven)Skewness (HR 6.07, 1.29-28.6, p =.02) and VenKurtosis (HR 2.27, 1.23-4.21, p =.01) of the ablation core were predictive of short-term recurrence. VenHUmean (HR 0.30, 0.11-0.81, p =.02) and VenGLRLM_HGRE (HR 1.06, 1.01-1.11, p =.02) of the core were independent predictors of tumor recurrence (C-index 0.64, CI 0.52-0.76, p =.03). Arterial phase (Art)Entropy of ablation border predicted the recurrence risk (HR 3.15, 1.05-9.42, p =.04) and values higher than 3.71 reported an increased recurrence incidence (p =.05). ArtHUstd (HR 1.14, 1.04-1.24, p =.01), LateHUmean (HR 8.69, 1.11-68.23, p =.04), LateGLRLM_HGRE (HR 0.9, 0.82-0.99, p =.03), LateGLZLM_HGZE (HR 1.01, 1.00-1.02, p <.01) and LateGLZLM_SZHGE (HR 0.99, 0.99-1.00, p =.02) of ablation border were independent predictors of local recurrence risk (C-index 0.73, CI 0.61-0.86, p <.01). CONCLUSIONS: CT texture analysis of ablation area performed at 1-2 months follow-up could estimate the risk of local recurrence of hepatocellular carcinoma treated by radiofrequency ablation.
Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Acute sialadenitis is a rare adverse reaction to iodine-based contrast agents. Ultrasound (US) is usually the preferred imaging method to evaluate the salivary glands; along with clinical and anamnestic data, US allows the diagnosis of contrast-induced sialadenitis. We present a case of acute bilateral submandibular sialadenitis induced by intravenous administration of iodine-based contrast media for a contrast-enhanced computed tomography scan diagnosed by US.
Assuntos
Iodo , Sialadenite , Meios de Contraste/efeitos adversos , Humanos , Iodetos , Sialadenite/induzido quimicamente , Sialadenite/diagnóstico por imagem , Glândula Submandibular/diagnóstico por imagemRESUMO
PURPOSE: The aim of this study was to investigate the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in locally advanced pancreatic cancer (LAPC) of the pancreatic body by assessing the overall survival of patients and evaluating the effects of the procedure in the clinical and radiological follow-up. MATERIALS AND METHODS: Patients with unresectable LAPC after failed chemoradiotherapy for at least six months were retrospectively included. Percutaneous RFA was performed after a preliminary ultrasound (US) feasibility evaluation. Contrast-enhanced computed tomography (CT) and CA 19.9 sampling were performed before and 24 hours and 30 days after the procedure to evaluate the effects of the ablation. Patients were followed-up after discharge considering the two main endpoints: procedure-related complications and death. RESULTS: 35 patients were included, 5 were excluded. All patients underwent RFA with no procedure-related complications reported. The mean size of tumors was 49âmm before treatment. The mean dimension of the ablated necrotic zone was 32âmm, with a mean extension of 65â% compared to the whole tumor size. Tumor density was statistically reduced one day after the procedure (pâ<â0.001). The mean CA 19.9 levels before and 24 hours and 30 days after the procedure were 285.8 U/mL, 635.2 U/mL, and 336.0 U/mL, respectively, with a decrease or stability at the 30-day evaluation in 80â% of cases. The mean survival was 310 (65-718) days. CONCLUSION: Percutaneous RFA of LAPC is a feasible technique in patients who cannot undergo surgery, with great debulking effects and a very low complication rate.
Assuntos
Adenocarcinoma , Ablação por Cateter , Neoplasias Pancreáticas , Ablação por Radiofrequência , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Ablação por Radiofrequência/métodos , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias PancreáticasRESUMO
The purpose of the work described here was to evaluate the use of ultrasound fusion imaging (US-FI) in percutaneous ablation of hepatic malignancies with respect to its global usefulness, improvement of conspicuity, confidence increment, needle route changes, and time savings. Thirty-four hepatic tumors (28 hepatocellular carcinomas, 6 metastases) were prospectively ablated in 16 consecutive patients (64 ± 11 y, 75% males), first simulating B-mode-only planning and then synchronizing computed tomography/magnetic resonance images with US and proceeding to needle insertion and tumor ablation under US-FI guidance. Surveys were administered to the operators to evaluate their perception of US-FI advantages. First treatment and local recurrence were also compared. US-FI was judged useful in 91% of cases and more useful when the tumor was not conspicuous in B-mode (p < 0.001), in particular for ablation of local recurrences (p = 0.021). Forty-one percent of tumors were undetectable at B-mode evaluation, and 93% of them were completely ablated under US-FI guidance. The confidence of the operator was highly increased by US-FI in 68% of cases. In 71% of cases, the radiologist saved time using US-FI, especially in treatment of local recurrences (p = 0.024). In conclusion, US-FI significantly increases the detection of target tumors, improves the confidence of the operator and is a time-saving method, especially in the treatment of local recurrences.
Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Meios de Contraste , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
Newer biologic drugs and immunomodulatory agents, as well as more tolerated and effective radiation therapy schemes, have reduced treatment toxicity in oncology patients. However, although imaging assessment of tumor response is adapting to atypical responses like tumor flare, expected changes and complications of chemo/radiotherapy are still routinely encountered in post-treatment imaging examinations. Radiologists must be aware of old and newer therapeutic options and related side effects or complications to avoid a misinterpretation of imaging findings. Further, advancements in oncology research have increased life expectancy of patients as well as the frequency of long-term therapy-related side effects that once could not be observed. This pictorial will help radiologists tasked to detect therapy-related complications and to differentiate expected changes of normal tissues from tumor relapse.
RESUMO
Artificial intelligence (AI) is one of the most promising fields of research in medical imaging so far. By means of specific algorithms, it can be used to help radiologists in their routine workflow. There are several papers that describe AI approaches to solve different problems in liver and pancreatic imaging. These problems may be summarized in four different categories: segmentation, quantification, characterization and image quality improvement. Segmentation is usually the first step of successive elaborations. If done manually, it is a time-consuming process. Therefore, the semi-automatic and automatic creation of a liver or a pancreatic mask may save time for other evaluations, such as quantification of various parameters, from organs volume to their textural features. The alterations of normal liver and pancreas structure may give a clue to the presence of a diffuse or focal pathology. AI can be trained to recognize these alterations and propose a diagnosis, which may then be confirmed or not by radiologists. Finally, AI may be applied in medical image reconstruction in order to increase image quality, decrease dose administration (referring to computed tomography) and reduce scan times. In this article, we report the state of the art of AI applications in these four main categories.
RESUMO
The aim of this study was to perform a simplified radiomic analysis of pancreatic ductal adenocarcinoma based on qualitative and quantitative tumor features and to compare the results between metastatic and non-metastatic patients. A search of our radiological, surgical, and pathological databases identified 1218 patients with a newly diagnosed pancreatic ductal adenocarcinoma who were referred to our Institution between January 2014 and December 2018. Computed Tomography (CT) examinations were reviewed analyzing qualitative and quantitative features. Two hundred eighty-eight patients fulfilled the inclusion criteria and were included in this study. Overall, metastases were present at diagnosis in 86/288 patients, while no metastases were identified in 202/288 patients. Ill-defined margins and a hypodense appearance on portal-phase images were significantly more common among patients with metastases compared to non-metastatic patients (p < 0.05). Metastatic tumors showed a significantly larger size and significantly lower arterial index, perfusion index, and permeability index compared to non-metastatic tumors (p < 0.05). In the management of pancreatic ductal adenocarcinoma, early detection and correct staging are key elements. The study of computerized tomography characteristics of pancreatic ductal adenocarcinoma showed substantial differences, both qualitative and quantitative, between metastatic and non-metastatic disease.
RESUMO
PURPOSE: Magnetic Resonance (MR) is recommended to diagnose Intraductal Papillary Mucinous Neoplasms (IPMN) and in the follow-up of borderline lesions. The purpose of this work is to evaluate the diagnostic accuracy of dynamic MR with Diffusion Weighted Imaging (DWI) in the identification of mural nodules of pancreatic IPMN by using pathological analysis as gold standard. MATERIALS AND METHODS: Ninety-one preoperative MR with histopathological diagnosis of IPMN were reviewed by two radiologists. Presence, number and size of mural nodule, signal intensity of the nodule on T1-weighted imaging (T1-WI) after contrast medium administration and on DWI. Inter-observer agreement was evaluated. RESULTS: Significant correlation (pâ¯<â¯0.0001) were found for presence of nodulesâ¯>â¯5â¯mm on MR and pathological specimen, size and number of mural nodules evaluated on pathological review and degree of dysplasia, size and number of mural nodules evaluated on MR and tumoral dysplasia, presence of noduleâ¯>â¯5â¯mm with enhancement after contrast medium administration and hyperintensity on DWI and degree of dysplasia. Interobserver agreement was moderate for the presence of mural nodule (Kâ¯=â¯0.56), for the presence of high signal intensity on DWI (Kâ¯=â¯0.57) and enhancement of mural nodule (Kâ¯=â¯0.58). Apparent Diffusion Coefficient (ADC) map histogram analysis showed a correlation between Entropy of the entire cystic lesion and the degree of dysplasia (pâ¯<â¯0.034). CONCLUSIONS: MR with dynamic and DWI sequences was an accurate method for the identification of ≥ 5â¯mm solid nodules of the IPMNs and correlate with the lesion malignancy. Entropy, calculated from the histogram analysis of the IPMN ADC map, correlated with the lesion dysplasia.
Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Neoplasias Intraductais Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Imagem de Difusão por Ressonância Magnética , Entropia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: To perform an online survey aimed at evaluating the impact of COVID-19 on Italian radiology departments. METHODS: We launched a survey composed of 25 questions about how COVID-19 has changed the safety and organization of daily activity in Italian radiology units. RESULTS: A total of 2136/10,564 (20.2%) radiologists of the Italian Society of Medical and Interventional Radiology participated. Two-thirds performed at least one diagnostic/interventional procedure on COVID-19 patients. The 88.1% reported a reduction in the elective imaging volumes, with US, mammography, and MRI having shown the greater decrease (41.1%, 23.9%, and 21.1%, respectively). In 69.6% of cases, institutions had trouble getting personal protective equipment (PPE), especially public hospitals and southern institutions. Less than 30% of participants were subjected to RT-PCR swab test, although 81.5% believed that it should be done on all health workers and 70% suggested it as the most important measure to improve safety at work. Slightly more than half of participants declared to work safely and felt to be adequately protected by their institutions. Up to 20% of northern participants were redeployed to clinical services. The first imaging examination performed by admitted COVID-19 patients was chest radiography in 76.3% of cases. Almost half of participants reported that less than 30% of health workers were infected in their radiology department, with higher rates in northern regions and public institutions. CONCLUSIONS: This snapshot of the current situation in Italian radiology departments could be used to harmonize the organization of working activity in order to safely and effectively face this pandemic. KEY POINTS: ⢠More than two-thirds of institutions had trouble getting PPE for health workers, with public hospitals and southern institutions that presented more procurement problems ⢠A substantial drop of imaging volumes was observed in the vast majority of Italian radiology departments, mostly due to the decrease of ultrasound, mammography, and MRI, especially in private practice were working activity was stopped in 13.3% of institutions ⢠RT-PCR swab to health workers was reported as the most suggested measure by Italian radiologists to improve safety at work, as more than 80% of them believed that it should be performed to all health workers, although less than 30% were subjected to this test.