Choroidal Vascular Impairment in Intermediate Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) is a multifactorial disease, whose complete pathogenesis is still unclear. Local hemodynamics may play a crucial role in its manifestation and progression. To evaluate choroidal and retinal vascular parameters, a total of 134 eyes were analyzed, 100 with intermediate AMD and 34 age matched healthy controls. 131 eyes of 104 patients were eligible for complete image assessment and 3 eyes were excluded for insufficient image quality: Group 1: intermediate AMD (n = 97) and Group 2: healthy controls (n = 34). Spectral domain optic coherence tomography (SD-OCT) with enhanced depth imaging (EDI) and optic coherence tomography angiography (OCT-A) were acquired using Spectralis (Heidelberg Engineering). Choroid and retinal capillary plexus were evaluated and image binarization was used to obtain quantitative data. Mean age was 77.67 years old (YO) and 67.2% were women. Total subfoveal choroidal area and luminal area were significantly reduced in Group 1 compared with Group 2 (0.88 mm2 and 0.40 mm2 vs. 1.24 mm2 and 0.55 mm2, respectively) (p < 0.05). Regarding choriocapillary flow density, AMD eyes recorded reduced values (34.83%) compared with controls (36.25%) (p < 0.05). Chorioretinal vasculature is impaired in intermediate AMD patients and vascular parameters could be attractive new prognostic biomarkers. Future therapeutic approaches may target this vascular dysfunction and delay disease progression.

Early conformational changes at tumour bed and long term response after neoadjuvant therapy in locally-advanced rectal cancer.

OBJECTIVES: To evaluate how changes in tumour scar depth angle and thickness in the post-neoadjuvant period relate to long-term response in locally-advanced rectal cancer patients. METHODS: Informed consent was obtained from all patients and institutional review board approved this retrospective study. Sixty-nine consecutive locally-advanced rectal cancer patients who underwent neoadjuvant therapy and were selected for "Watch-and-Wait" were enrolled. Two radiologists, O1 and O2, blindly and independently reviewed the 1st and 2nd post-neoadjuvant therapy pelvic MRI T2-weighted images and recorded depth angle and thickness of the tumour scar. Value changes were calculated by simple subtraction (2nd-1st). Mann-Whitney U test was employed to assess for significant differences between sustained clinical complete responders (SCR), defined as patients with pathologic complete response or clinical complete response with a minimum follow-up of 1 year; and non-sustained complete responders (non-SCR). Interobserver agreement was estimated using intraclass correlation coefficient (ICC). Data on mrTRG, DWI and endoscopy at 1st and 2nd timepoints were retrieved for comparison. RESULTS: In SCR, depth angle change between 1st (med = 10 weeks after end of radiotherapy) and 2nd (med = 23 weeks after end of radiotherapy) timepoints was significantly different (O1:p = 0.004; O2:p = 0.010): the SCR group showed a depth angle reduction (O1:med=-4.45; O2:med=-2.35), whereas non-SCRs showed a depth angle increase (O1:med=+2.60; O2:med=+7.40). Also, at 2nd timepoint, SCR scars were significantly thinner both for O1 (p = 0.003; SCR:med = 7.05 mm; non-SCR:med = 9.4 mm) and O2 (p = 0.006; SCR:med = 6.45 mm; non-SCR:med = 8.2 mm). A depth angle increase >21º between 1st and 2nd timepoints and a scar thickness >10 mm at 2nd timepoint were not sensitive but were highly specific for a non-SCR (91/94 %) for both observers. Interobserver agreement was good for scar depth angle change (ICC = 0.65) and excellent for scar thickness at 2nd timepoint (ICC = 0.84). Of the retrieved data, only DWI at 2nd timepoint was discriminative (p = 0.043) providing a similar sensitivity (33 %) and a slightly lower specificity (87.5 %). CONCLUSION: Tumour scar expansion >21° between 1st and 2nd post-neoadjuvancy MRI and a scar thickness >10 mm at 2nd post-neoadjuvancy MRI may consistently indicate a non-SCR with high specificity in locally-advanced rectal cancer patients.

CT-guided percutaneous transthoracic biopsy in the evaluation of undetermined pulmonary lesions.

CT-guided Percutaneous Transthoracic Biopsies (PTB) performed in the Radiology Department of Garcia de Orta Hospital between 2002 and 2004 to evaluate undetermined pulmonary lesions were retrospectively analysed. 89 fine needle aspiration biopsies (FNAB) and 13 core needle biopsies (CNB) were performed on 92 patients (67 men, mean age: 64.4 years). 82 lesions (89%) were nodular lesions (mean diameter: 3.8+/-1.7 cm, 65 peripheral). We did not observe complications among patients who underwent CNB; minor complications and pneumothorax requiring drainage occurred in 11 FNAB. 72 FNAB were considered adequate for cytology diagnosis; 72% of them positive for malignancy. All CNB were adequate and conclusive. From the 7 CNB performed on patients with previous FNAB, 3 allowed a better histological characterization and in 3 cases of inadequate FNAB, CNB was conclusive. All malignant lesions were nodules: 20 adenocarcinoma, 13 non-small cell lung cancer (SCLC), 10 epidermoid tumours, 5 small-cell lung cancer, 2 carcinoids, 1 bronchiolo alveolar carcinoma, 1 malignant mesothelioma and 8 metastasis. Unspecific/inflammatory lesions (n=5) were the most frequent benign lesions. Malignant lesions were more prevalent in older patients (p=0.007) and were larger (p=0.006). Spiculated and lobulated contour (p=0.05) were more prevalent in malignant lesions while regular contour was more frequent among benign lesions (p=0.0001). Gender, smoking, location, pleural tag, homogenous attenuation, cavitation, calcification, necrosis and air bronchogram did not differ significantly between benign and malignant nodules. This study shows that CT-guided PTB is a safe and effective procedure in the evaluation of undetermined pulmonary lesions.