Radiology and Oncology最新文献

Background: Postoperative pneumonia (POP) remains a leading cause of mortality following lung surgery. Recent studies have confirmed that the respiratory tract below the vocal cords is not sterile and often harbours potentially pathogenic microorganisms (PPMs), putting patients with lung malignancies at an increased risk for pulmonary infections.

Patients and methods: The study analysed 149 patients who underwent bronchoscopy for lung lesions suspected to be lung cancer. Protected specimen brush (PSB) samples were obtained during bronchoscopy prior to any specific treatment. Bacterial identification and antimicrobial susceptibility testing were conducted on the isolated strains.

Results: Bacterial colonization was detected in 88.6% of patients, with 21.5% carrying PPMs. Notably, patients with type 2 diabetes exhibited a higher rate of PPM colonization compared to others. Antibiotic susceptibility testing showed no significant differences in efficacy between amoxicillin with clavulanic acid and first-generation cephalosporin in both colonized patients and those with PPMs. Importantly, no multidrug-resistant bacteria were identified.

Conclusions: Our findings indicate a slightly lower PPM colonization rate compared to previous studies, possibly due to the unique geographic characteristics of the study population. The absence of significant differences in bacterial susceptibility between the two tested antibiotics highlights the need for further research to refine perioperative infection management strategies.

Background: A considerable proportion of metastatic melanoma (mM) patients do not respond to immune checkpoint inhibitors (ICIs). There is a great need to develop noninvasive biomarkers to detect patients, who do not respond to ICIs early during the course of treatment. The aim of this study was to evaluate the role of early [¹⁸F]2fluoro-2-deoxy-D-glucose PET/CT (¹⁸F-FDG PET/CT) at week four (W4) and other possible prognostic biomarkers of survival in mM patients receiving ICIs.

Patients and methods: . In this prospective noninterventional clinical study, mM patients receiving ICIs regularly underwent ¹⁸F-FDG PET/CT: at baseline, at W4 after ICI initiation, at week sixteen and every 16 weeks thereafter. The tumor response to ICIs at W4 was assessed via modified European Organisation for Research and Treatment of Cancer (EORTC) criteria. Patients with progressive metabolic disease (PMD) were classified into the no clinical benefit group (no-CB), and those with other response types were classified into the clinical benefit group (CB). The primary end point was survival analysis on the basis of the W4 ¹⁸F-FDG PET/CT response. The secondary endpoints were survival analysis on the basis of LDH, the number of metastatic localizations, and immune-related adverse events (irAEs). Kaplan-Meier analysis and univariate Cox regression analysis were used to assess the impact on survival.

Results: Overall, 71 patients were included. The median follow-up was 37.1 months (952% CI = 30.1-38.0). Three (4%) patients had only baseline scans due to rapid disease progression and death prior to W4 ¹⁸F-FDG-PET/CT. Fifty-one (72%) patients were classified into the CB group, and 17 (24%) were classified into the no-CB group. There was a statistically significant difference in median overall survival (OS) between the CB group (median OS not reached [NR]; 95% CI = 17.8 months - NR) and the no-CB group (median OS 6.2 months; 95% CI = 4.6 months - NR; p = 0.003). Univariate Cox analysis showed HR of 0.4 (95% CI = 0.18 - 0.72; p = 0.004). median OS was also significantly longer in the group with normal serum LDH levels and the group with irAEs and cutaneous irAEs.

Conclusions: Evaluation of mM patients with early ¹⁸F-FDG-PET/CT at W4, who were treated with ICIs, could serve as prognostic imaging biomarkers. Other recognized prognostic biomarkers were the serum LDH level and occurrence of cutaneous irAEs.

Background: This study aimed to develop and validate 2-Dimensional (2D) and 3-Dimensional (3D) radiomics signatures based on contrast-enhanced computed tomography (CECT) images for preoperative prediction of the thymic epithelial tumors (TETs) risk and compare the predictive performance with conventional CT features.

Patients and methods: 149 TET patients were retrospectively enrolled from January 2016 to December 2018, and divided into high-risk group (B2/B3/TCs, n = 103) and low-risk group (A/AB/B1, n = 46). All patients were randomly assigned into the training (n = 104) and testing (n = 45) set. 14 conventional CT features were collected, and 396 radiomic features were extracted from 2D and 3D CECT images, respectively. Three models including conventional, 2D radiomics and 3D radiomics model were established using multivariate logistic regression analysis. The discriminative performances of the models were demonstrated by receiver operating characteristic (ROC) curves.

Results: In the conventional model, area under the curves (AUCs) in the training and validation sets were 0.863 and 0.853, sensitivity was 78% and 55%, and specificity was 88% and 100%, respectively. The 2D model yielded AUCs of 0.854 and 0.834, sensitivity of 86% and 77%, and specificity of 72% and 86% in the training and validation sets. The 3D model revealed AUC of 0.902 and 0.906, sensitivity of 75% and 68%, and specificity of 94% and 100% in the training and validation sets.

Conclusions: Radiomics signatures based on 3D images could distinguish high-risk from low-risk TETs and provide complementary diagnostic information.

Background: Electrochemotherapy (ECT) is a local nonsurgical effective tumor treatment in the hand of the clinician for the treatment of patients with liver tumors or metastases. The study aimed to test the technical feasibility and safety of intra-arterial (i.a.) bleomycin administration compared to the established intravenous (i.v.) administration in percutaneous electrochemotherapy (pECT). Furthermore, the equivalence hypothesis was tested between the 2 modalities in terms of local short-term response and progression-free survival.

Patients and methods: Forty-four patients have been recruited and treated by pECT for hepatocellular carcinoma, cholangiocarcinoma and liver metastatic lesions from cancers of different origin: 18 were treated with standard i.v., 26 with bleomycin i.a. administration.

Results: The 2 groups were similar for anagraphic and anamnestic data, as well as for most relevant disease specific characteristics. Technical success of the treatment was obtained in 95% and 100% of patients in i.v. and i.a. groups respectively. Short-term local response was similar in the 2 groups with a slightly higher complete remission (CR) rate in the i.a. group. There were 61.9% CR, 23.8% partial remission (PR), 4.8% stable disease (SD) in the i.v. group, and 80.6%, CR 12.9% PR, 3.2% PD (p = 0.3454). One-year progression free survival was 60% (C.I. 33%-88%) in the i.v. group and 67% (C.I. 42%-91%) in the i.a. group (p = 0.5849).

Conclusions: The results of this study confirmed the safety and feasibility of super-selective i.a. bleomycin administration. Analysis of local response and progression free survival confirmed the equivalence hypothesis of the new modality compared to standard i.v. administration in the treatment of primary and secondary liver malignancies by pECT.

Background: The aim of this study was to analyze the epidemiological aspects of diffuse idiopathic skeletal hyperostosis (DISH) patients in Slovenia, to evaluate the relationship between coronary CT angiography (CCTA)-derived epicardial adipose tissue (EAT) density and coronary artery calcifications (CAC) in patients with and without DISH, and study influencing factors of these parameters.

Patients and methods: The research comprised patients referred for CCTA due to a clinical suspicion of coronary artery disease. DISH, CAC score and EAT attenuation were quantified using non-contrast imaging. Diagnosis of DISH was based on Resnick criteria. The CCTA was assessed for the presence of obstructive coronary artery disease (CAD). The association between DISH and the extent of CAC was explored, using correlation analysis and multivariate regression.

Results: The study cohort included 219 participants. The prevalence of DISH was 7.8%. In univariate logistic regression, body mass index (BMI) (odds ratio [OR] 1.133, p = 0,005), age (OR 1.055, p = 0,032) and diabetes (OR 3.840, p = 0,015) were significantly associated with the condition. However, this association did not persist on multinomial multivariate analysis, but gender, age, hypertension and EAT attenuation were found to be significantly associated with the increasing CAC strata.

Conclusions: The prevalence of DISH found is comparable with prior literature. There was no independent relationship between the prevalence of DISH and CAC. Our data point to a more nuanced and perhaps non-causal link between coronary artery disease and DISH.

Background: Recurrent respiratory papillomatosis (RRP) is a condition caused by human papilloma virus (HPV) infection. Curative treatments aren't identifiable, and conservative surgery is often the best option to preserve respiratory functions. To date monoclonal antibodies are considered to be a treatment choice with both good efficacy and safety profile.

Materials and methods: A web-based search of MEDLINE/PubMed library from 2000 to 2024 of English-language papers was performed to identify articles by using "respiratory or laryngeal papillomatosis" and "HPV respiratory infection, papillomatosis treatment, papillomatosis vaccine immunization, papillomatosis systemic treatment". Furthermore, a manual screening of references from original articles was done to identify additional studies. We selected 34 articles.

Results: Since 2009, the systemic administration of Bevacizumab has been used to treat RRP not responding to surgical treatment. The efficacy of an anti-VEGF monoclonal antibody in RRP lesions can be related to their vascular nature. The major concern is the rebound papilloma growth within the cessation of treatment. An interesting solution could be the concomitant use of immunotherapy to both reduce the burden of residual disease and activate the immune system against the HPV-infected cells.

Conclusions: Bevacizumab has a safe profile with a short-term local eradication of HPV. Further prospective research with long-term follow-up is needed to better define its safety and results against the disease recurrence. Considering the role of the anti-HPV vaccine, both, in the prophylaxis of the infection and in the adjuvant setting, the actual data underline the need for evaluation of its therapeutic efficacy for the management of RRP.

Background: Focal ablation techniques are integral in the surgical intervention of diseased tissue, where it is necessary to minimize damage to the surrounding parenchyma and critical structures. Irreversible electroporation (IRE) and high-frequency IRE (H-FIRE), colloquially called pulsed-field ablation (PFA), utilize high-amplitude, low-energy pulsed electric fields (PEFs) to nonthermally ablate soft tissue. PEFs induce cell death through permeabilization of the cellular membrane, leading to loss of homeostasis. The unique nonthermal nature of PFA allows for selective cell death while minimally affecting surrounding proteinaceous structures, permitting treatment near sensitive anatomy where thermal ablation or surgical resection is contraindicated. Further, PFA is being used to treat tissue when tumor margins are not expected after surgical resection, termed margin accentuation. This review explores both the theoretical foundations of PFA, detailing how PEFs induce cell membrane destabilization and selective tissue ablation, the outcomes following treatment, and its clinical implications across oncology and cardiology.

Conclusions: Clinical experience is still progressing, but reports have demonstrated that PFA reduces complications often seen with thermal ablation techniques. Mounting oncology data also support that PFA produces a robust immune response that may prevent local recurrences and attenuate metastatic disease. Despite promising outcomes, challenges such as optimizing field delivery and addressing variations in tissue response require further investigation. Future directions include refining PFA protocols and expanding its application to other therapeutic areas like benign tissue hyperplasia and chronic bronchitis.

Background: Adrenocortical carcinoma (ACC) is a rare cancer that presents significant diagnostic and therapeutic challenges. We analyzed the management and estimated survival of ACC patients in Slovenia over a 17-year period.

Patients and methods: Patients registered in the National Cancer Registry and treated from 2000 to 2017 were included. The survival and prognostic factors were assessed using the Kaplan-Meier method and Cox regression, respectively.

Results: Forty-eight patients were included in our analysis. At the time of diagnosis, 6%, 42%, 25% and 27% had stage according European Network for the Study of Adrenal Tumors (ENSAT) I, II, III and IV, respectively. Adjuvant treatment with mitotane was assigned to 18 of 34 potentially eligible patients. High-risk patients treated with adjuvant mitotane showed a reduced probability of death, although the difference was not statistically significant. Relapses had numerically higher rate of R1 resection and higher Ki67. Eleven patients underwent first-line therapy with etoposide, doxorubicin, cisplatin and mitotane (EDP-M). Their median progression-free survival was 4.4 months. The median overall survival of entire cohort was 28.9 and the median disease-specific survival (DSS) was 36.2 months. The 5-year DSS rate of ENSAT I, II, III and IV were 100%, 56%, 50% and 0%, respectively. The prognostic value of ENSAT stage and Helsinki score regarding overall survival was confirmed with the multivariate analysis.

Conclusions: The 5-year DSS of our ENSAT II patients was worse than reported in contemporary cohorts. Suboptimal surgery and inconsistent adjuvant therapy with mitotane might have contributed to this outcome. Better outcomes of this rare disease might be accomplished with dedicated teams including various specialties, working towards optimal staging, diagnostic and therapeutic measures.

Background: This study evaluates the contouring variability among observers using MR images reconstructed by different sequences and quantifies the differences of automatic segmentation models for different sequences.

Patients and methods: Eighty-three patients with pelvic tumors underwent T1-weighted image (T1WI), contrast enhanced Dixon T1-weighted (T1dixonc), and T2-weighted image (T2WI) MR imaging on a simulator. Two observers performed manual delineation of the bladder, anal canal, rectum, and femoral heads on all images. Contour differences were used to analyze the interobserver and intersequence variability. A single-sequence automatic segmentation network was established using the U-Net network, and the segmentation results were analyzed.

Results: Variability analysis among observers showed that the bladder, rectum, and left femoral head on T1WI yielded the highest dice similarity coefficient (DSC) and the lowest 95% Hausdorff distance (HD) (all three sequences). Regarding sequence variability analysis for the same observer, the difference between T1WI and T2WI was the smallest. The DSC of the bladder, rectum, and femoral heads exceeded 0.88 for T1WI-T2WI. The differences between automatic segmentations and manual delineations were minimal on T2WI. The averaged DSC of automatic and manual segmentation of all organs on T2WI exceeded 0.81, and the averaged 95% HD value was lower than 7 mm. Similarly, the sequence variability analysis of automatic segmentation indicates that the automatic segmentation differences between T2WI and T1WI are minimal.

Conclusions: T1WI and T2WI yielded better results in manual delineation and automatic segmentation, respectively. The analysis of variability among three sequences indicates that the yielded good similarity outcomes between the T1WI and T2WI cases in manual and automatic segmentation. We infer that the T1WI and T2WI (or their combination) can be used for MR-only radiation therapy.

Background: The study aimed to investigate the reduction of hematoma risk during MRI-guided breast biopsies by evaluating position-dependent intervention parameters and characteristics of the target lesion.

Materials and methods: We retrospectively analyzed 252 percutaneous MRI-guided breast biopsies performed at a single center between January 2013 and December 2023. Two groups were built depending on the severity of relative hematoma formation (using a cut-off ≤ 7.62 cm³ or > 7.62 cm³). Potential influencing variables were assessed, such as patient demographics, interventional parameters related to anatomical landmarks, and lesion characteristics. Fisher's exact test and Mann-Whitney-U-Test were used to calculate the statistical difference between groups of categorical, dichotomous, and continuous variables. Multivariable logistic regression was used to identify the strongest association with relative hematoma formation.

Results: The univariate analysis showed that relatively larger hematoma occurred significantly more frequently when the patients were younger (P = 0.002), the relative distances from the target lesion to the nipple (P = 0.001) as well as alongside the access path (P = 0.001) were greater and when the vacuum-assisted biopsy system was used in contrast to the Spirotome® (P = 0.035). Multivariable logistic regression analysis also showed that these were independently associated with the occurrence of relatively larger hematomas. Epinephrine in the local anesthetic, lesion location classified by specific quadrant, and pathological findings did not influence the extent of the hematoma.

Conclusions: Our findings underscore the importance of strategic procedural planning to minimize hematoma occurrence and enhance patient safety during MRI-guided breast biopsy procedures.