Radiologia Medica最新文献

Introduction: The management of residual or new ground-glass nodule (GGN)-like lung cancer after video-assisted thoracoscopic surgery (VATS) is challenging for patients who are not suitable for reoperation. This retrospective, large-sample, multicenter study aimed to evaluate the feasibility, safety, and preliminary efficacy of microwave ablation (MWA) for residual GGN-like lung cancer after VATS in early-stage lung cancer.

Methods: A total of 216 patients with 216 residual GGN-like lung cancers who underwent 235 procedures of CT-guided percutaneous MWA after VATS (R0) of stage I-IIA lung adenocarcinoma from July 2016 to December 2023 were included in the study. The primary endpoints were technical success, complications, and pulmonary function test (PFT) variations after the MWA procedure. The secondary endpoints were local progression-free survival (LPFS) and overall survival (OS).

Results: The rate of technical success was 100%. The major complications after MWA included pneumothorax (12.3%, 29/235), pleural effusion (5.5%, 13/235), pulmonary infection (2.6%, 6/235), hydropneumothorax (1.3%, 3/235), intrathoracic hemorrhage (0.4%, 1/235), and bronchopleural fistula (0.4%, 1/235). No MWA procedure-related death was observed. The PFT at 1-3 months after MWA was not significantly different from the baseline. The median follow-up duration was 58.5 months, and the 1-, 3- and 5-year OS rates were 100%, 99.1% and 96.3%, respectively. The median follow-up period after MWA was 33.8 months, and the 1-, 2- and 3-year LPFS rates were 100%, 97.7% and 96.3%, respectively.

Conclusions: CT-guided percutaneous MWA is a safe, effective, and potentially curative approach for patients with residual GGN-like lung cancer after VATS.

Background: Next-generation imaging (NGI) (68 Ga-prostate-specific membrane antigen (PSMA)-PET) represents a cornerstone in biochemical recurrent prostate cancer management. PSICHE is a multicentric prospective study, aimed to assess oncological outcomes of a predefined tailored imaging-guided treatment.

Methods:  Patients with biochemical recurrence (BCR) after surgery (prostate-specific antigen [PSA] > 0.2 ≤ 1 ng/mL) underwent staging with PSMA-PET. A predefined treatment algorithm was proposed to all patients: prostate bed salvage radiotherapy (SRT) in case of negative or positive PET within the prostate bed, stereotactic body radiotherapy (SBRT) if pelvic nodal recurrences or oligometastatic disease were detected, and androgen deprivation therapy (ADT) was proposed in widespread polymetastatic disease. Chi-square test was used to evaluate the relationship between baseline features and the rate of positive PSMA-PET/CT.

Results: One hundred and fifty-nine patients were enrolled. One hundred and seven patients had a PSMA negative/positive in the prostate bed; pelvic nodal disease or oligometastatic metastatic disease was detected in 39 and 10 patients, respectively. Three patients had a polymetastatic disease. Seventeen patients underwent observation because of prior postoperative radiotherapy (RT)/treatment refusal. Eighty-eight patients were treated with SRT, and SBRT was performed in 49 patients with pelvic or extrapelvic oligometastatic disease. Stratifying patients according to EAU criteria (low risk: PSA doubling time > 12 months and Gleason score < 8; high risk: PSA doubling time ≤ 12 months or Gleason score ≥ 8) after a median follow-up of 19 months in the overall population, median BRFS and MFS were not significantly different between the two risk subgroups (p = 0.58 and p = 0.21, respectively). Median metastasis-free and ADT-free survival were not reached.

Conclusions: A PSMA-targeted treatment strategy led to promising results, avoiding unnecessary toxicity from ADT or standard SRT administered in unselected patients. Analysis after longer follow-up is needed to clarify survival outcomes.

Background: The CCM-ITALUNG2 pilot was implemented to evaluate the feasibility of an organized lung cancer (LC) screening programme in five Italian centres.

Methods: The screening pathway included invitation, recruitment, referral to Smoking Cessation Services (SCSs), and use of the Lung-RADS score for low-dose CT reading. Dedicated screening operators followed up participants from recruitment through the clinical follow-up established by multidisciplinary teams. Eligibility criteria included age 55-75 years, ever-smokers with ≥ 25 pack-years; quit within the past 10 years. Baseline round results are presented.

Results: From November 2022 to May 2024, 1,144 of the 1,971 invited individuals (58.0%) were recruited following different strategies including in-person invitation by general practitioners (GPs; 356 subjects, 31.9%) or other healthcare personnel (18.1%), self-presentation (36.3%), and phone invitation using GPs' patient lists (13.7%). Among current smokers, 38.5% accepted referral to SCSs. Eighteen subjects (77.8% in stage I-II) were diagnosed with LC (prevalent LC rate 1.57%). The mean time to surgery was 147 days (standard deviation 73); the false-positive rate was 1.38% (15/1,085).

Conclusions: By utilizing different organizational models, the pilot was tailored to the specific characteristics of each centre. Phone invitations from GPs' patient lists, in-person invitations by GPs and other healthcare personnel, and self-presentation might enhance equity of access in comparison with self-referral only. Dedicated screening operators, the use of the Lung-RADS scoring system, and a structured clinical follow-up supported participants throughout the screening pathway. Delivering brief advice for smoking cessation during recruitment and offering SCS referral were feasible within the screening pathway.

Purpose: The importance of multidisciplinary discussion (MDD) in interstitial lung diseases (ILDs) is well known. The aim of this study was to describe the 10-year experience of the MDD at the Pisa University Hospital in diagnosis and management of ILDs.

Material and methods: A single-center retrospective observational study was conducted at the Pisa University Hospital. A multidisciplinary group for ILDs diagnosis was instituted in 2012, and all patients referred till August 2022 were included.

Results: Altogether 1240 patients were evaluated. At baseline assessment, 772 common multidisciplinary diagnoses were achieved, while in 458 cases it was not possible to obtain a definite diagnosis. Most frequent multidisciplinary diagnoses were idiopathic pulmonary fibrosis (IPF), non-specific interstitial pneumonia (NSIP), and smoking-related ILDs. In 9% of cases a histological evaluation was performed, leading to a diagnosis in 75% of cases. One-thousand and fourty-eight cases with at least one year of follow-up after the MDD were revised. Common diagnoses were confirmed or modified, while "diagnostic hypotheses" were changed into "revised diagnoses" or left as hypothesis as they still could not be confirmed. Among common diagnoses, 61% were confirmed, while 36% were not confirmed as patients did not perform further examinations or visits. Eighteen diagnoses were modified (3%). Among the "diagnostic hypotheses," 57% changed into "revised diagnoses." Only in 15% of cases a definite diagnosis was not achieved after the revision.

Conclusion: The role of MDD in ILDs' assessment and diagnosis was confirmed. A multidisciplinary approach should be considered in the long-term follow-up of ILDs, as diagnosis may change on the basis of clinical course.

Purpose: To evaluate the prognostic value of the Neck Imaging Reporting and Data Systems (NI-RADS) in early post-operative imaging for predicting recurrence and survival outcomes in high-risk oral cavity squamous cell carcinoma (SCC) patients undergoing post-operative radiotherapy (PORT).

Methods: This retrospective study included 84 patients with high-risk oral cavity SCC who were scheduled for PORT after radical surgery between January 2013 and May 2024. Early imaging with contrast-enhanced CT or MRI was performed within 12 weeks post-surgery and scored using the NI-RADS system. Associations between NI-RADS scores, recurrence, and survival outcomes were analyzed using Kaplan-Meier and Cox proportional hazards models.

Results: Although NI-RADS was originally designed for post-treatment surveillance, we applied it to early post-operative imaging as an exploratory risk-stratification tool. NI-RADS scores significantly predicted regional disease-free survival (DFS) and overall survival (OS). Patients with higher NI-RADS T and N scores had poorer outcomes. Multivariable analysis confirmed early NI-RADS T as an independent predictor of OS (p = 0.01). Interobserver agreement for NI-RADS classifications was strong (Weighted Kappa: T = 0.837, N = 0.855). Although higher radiotherapy doses were administered to patients with NI-RADS 2-3 scores, these patients demonstrated worse outcomes, reflecting aggressive disease.

Conclusion: Early application of NI-RADS in post-operative imaging provides valuable prognostic insights, enabling risk stratification and tailored management in high-risk oral cavity SCC patients. Streamlining imaging workflows and exploring alternative therapeutic strategies for high-risk groups may further optimize outcomes.

Purpose: Digital Breast Tomosynthesis (DBT) has a diagnostic accuracy higher than 2D-FFDM, with a slightly higher Average Glandular Dose (AGD). Photon-counting technology was demonstrated to reduce AGD of 2D-FFDM, while preserving a high image quality; it therefore represents an interesting solution to significantly reduce the radiation dose of DBT. Our purpose is to compare the image quality and the AGD of a photon-counting DBT prototype with a conventional DBT unit in the detection of breast carcinoma.

Materials and methods: In this preliminary prospective study, 17 women with a suspicious breast finding (BI-RADS 4c/5) were enrolled. Before biopsy, they underwent bilateral 2-view DBT with a conventional unit and a photon-counting prototype. The AGD delivered by the two DBT units were compared. Three readers independently reviewed and compared the images (DBT and synthesized 2D) giving a density, BI-RADS and conspicuity score focusing on suspicious findings. All women underwent core-needle biopsy with imaging guidance and histology was used as standard reference.

Results: In 15 examinations at least one suspicious finding was detectable by both systems. Two exams were falsely negative with both units due to high density and small cancer size. All suspicious findings were histologically confirmed as malignant. There was no significant difference in density and BI-RADS scores. The conspicuity of findings was scored as equal or better for photon-counting DBT in 94% observations. The mean AGD delivered by photon-counting DBT was 55% lower than the conventional DBT.

Conclusion: According to these preliminary data, photon-counting DBT provides a high image quality, like a conventional DBT unit, with a drastic reduction of the AGD delivered.

Trial registration number: The clinical trial "Low Dose Tomosynthesis Compared to Traditional Tomosynthesis" has an identifier number NCT02771444 on the ClinicalTrials.gov website. It was first registered on 11.05.2016.

Purpose: Rotator cuff injury (RCI) is a prevalent cause of shoulder disability, with emerging evidence implicating localized inflammatory cascades as key mediators of nociceptive signaling. Recent studies suggest that preoperative central sensitization induced by exposure to inflammation serves as a predictor of persistent pain following surgery at one-year follow-up. However, the underlying mechanism between peripheral inflammation, central pain processing, and postsurgical pain remains poorly characterized in RCI. Therefore, we aim to characterize pain-elicited brain responses and identify brain mediators of pain hypersensitivity in RCI patients.

Materials and methods: Utilizing a case-control design, twenty-eight patients with right/bilateral RCI and twenty healthy controls underwent functional MRI during pressure noxious stimuli, with pain intensity quantified via the visual analog scale. Comprehensive analyses of preoperative resting-state fMRI, serum cytokine profiles, and postoperative neuroimaging were conducted in RCI patients.

Results: We found significantly higher level of pain sensitivity and IL-6 concentrations in RCI patients compared to controls. RCI patients exhibited higher activation within the left primary somatosensory cortex (S1), which mediated the relationship between IL-6 levels and pain sensitivity. Notably, preoperative S1 amplitude of low-frequency fluctuations (ALFF) exhibited a strong positive correlation with IL-6 concentrations (r = 0.62) and served as a robust predictor of postoperative pain reduction. These findings establish left S1 hyperactivation as a neuroplastic hub integrating peripheral inflammatory signaling (IL-6 elevation) and central pain sensitization in RCI.

Conclusion: The observed preoperative associations between S1 function, cytokine profiles, and postoperative pain resolution provide translational evidence for S1 as a predictive biomarker of pain chronification risk.

Purpose: To assess the objective and subjective image quality of hypovascular liver metastases on dual-energy CT (DECT) at various virtual monoenergetic imaging (VMI) levels compared to conventional CT, and to determine whether DECT identifies additional lesions or alters radiation exposure.

Material and methods: This retrospective study included patients with hypovascular liver metastasis who underwent DECT on portal venous phase. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and subjective image quality (5-point Likert scale) were analyzed. Radiation dose was compared to corresponding values from conventional CT performed on the same patients. Statistical analyses included the Friedman test for repeated measures, Wilcoxon signed-rank tests with Bonferroni correction for post-hoc comparisons, and the Mann-Whitney U test for radiation dose comparison. A p-value < 0.05 was considered statistically significant.

Results: A total of 45 patients with 128 metastases were evaluated. VMI at 40 keV demonstrated the highest SNR (5.08) and subjective quality (median score: 5.0), significantly outperforming conventional CT (SNR: 3.90, p = 0.001). CNR was highest at 40 keV but not statistically different across reconstructions (p = 0.42). Subjective scores differed significantly among all image types (p < 0.0001). No additional lesions were detected on DECT compared to conventional CT. Radiation dose was similar between DECT and conventional CT (CTDIvol: 45.4 vs. 45.39 mGy, p = 0.688).

Conclusion: While DECT with low-keV VMI improves objective and subjective image quality for hypovascular liver metastases, it does not increase lesion detection compared to conventional CT. The clinical utility of DECT in this setting may be limited to enhanced reader confidence rather than diagnostic gain.

Background: RAS mutational status is a critical prognostic biomarker in colorectal liver metastases (CRLM), traditionally assessed via tissue biopsy. This study evaluates the potential of radiomic features extracted from CT and MRI to non-invasively predict RAS mutations using machine learning algorithms.

Methods: In this study, 77 CRLM metastases (mean size 34.9; range 17-56 mm) with known RAS mutational status were analyzed. Radiomic features were extracted from hepatobiliary-phase MRI and portal venous-phase CT. After removing highly correlated features (Pearson |r| > 0.7) and applying z-score normalization, LASSO logistic regression with repeated tenfold cross-validation was used for feature selection. A total of 41 predictive features were identified. The dataset was split into training (70%) and testing (30%), ensuring that all lesions from a given patient were assigned exclusively to either the training or testing set. To address class imbalance in the training data, the Random Over Sampling Examples (ROSE) algorithm was applied exclusively to the training set. Six classification models (Stepwise Logistic Regression, LASSO, Random Forest, GBM, Neural Network, and CART) were trained and evaluated using ROC/AUC and other diagnostic metrics. DeLong's test was applied for pairwise AUC comparisons.

Results: MRI-derived features, particularly from wavelet-transformed gldm and first-order matrices, showed strong predictive power, with several achieving > 0.75 AUC individually. The gradient boosting machine (GBM) outperformed all other models with an AUC of 0.998 and an accuracy of 95.6%. Random forest and CART also demonstrated high discriminative performance (AUCs of 0.990 and 0.914, respectively). Nine features were consistently ranked among the top 20 predictors across all models, suggesting robust modality-independent imaging biomarkers. DeLong's test confirmed statistically significant AUC differences between GBM and logistic regression models (p < 0.05).

Conclusions: The results of this pilot study suggest that radiomic analysis combining CT and MRI modalities, particularly when processed through ensemble machine learning methods, holds the potential to accurately predict RAS mutational status in CRLM. While promising, these findings should be interpreted with caution, considering the study's limitations, including the small patient cohort and its design. These factors highlight the need for prospective validation in larger, multicenter cohorts to confirm the generalizability of the models. Nevertheless, these preliminary results support the use of multiparametric radiomics as a potential non-invasive tool for preoperative molecular stratification.

Brain metastases (BMs) are prevalent among patients diagnosed with human epidermal growth factor receptor 2 (HER2)positive metastatic breast cancer (BC), with the incidence rate exceeding 30%. The management of BMs typically involves multiple approaches, such as surgery, radiation therapy (RT), systemic treatments, and end-of life care. Standard brain RT includes stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) for limited disease and whole brain radiotherapy (WBRT) for extensive disease. Recent advancements in RT and systemic treatments may change the paradigm for patients who experience prolonged survival despite BMs, especially in HER2-positive, hormone receptor (HR) positive BC patients. In recent studies, SRT for multiple BM sites (more than 4) has shown similar efficacy compared to irradiation of a limited number of lesions (1 to 3) while not increasing toxicity. This systematic review summarizes the available literature data regarding the RT approach to BMs in HER2-positive BC patients and highlights the need to optimize treatment combinations with specific emphasis on RT.