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Conte P, Ascierto PA, Patelli G, Danesi R, Vanzulli A, Sandomenico F, Tarsia P, Cattelan A, Comes A, De Laurentiis M, Falcone A, Regge D, Richeldi L, Siena S. Drug-induced interstitial lung disease during cancer therapies: expert opinion on diagnosis and treatment. ESMO Open 2022; 7:100404. [PMID: 35219244 PMCID: PMC8881716 DOI: 10.1016/j.esmoop.2022.100404] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/05/2023] Open
Abstract
Background Drug-induced interstitial lung disease (DIILD) is a form of interstitial lung disease resulting from exposure to drugs causing inflammation and possibly interstitial fibrosis. Antineoplastic drugs are the primary cause of DIILD, accounting for 23%-51% of cases, with bleomycin, everolimus, erlotinib, trastuzumab-deruxtecan and immune checkpoint inhibitors being the most common causative agents. DIILD can be difficult to identify and manage, and there are currently no specific guidelines on the diagnosis and treatment of DIILD caused by anticancer drugs. Objective To develop recommendations for the diagnosis and management of DIILD in cancer patients. Methods Based on the published literature and their clinical expertise, a multidisciplinary group of experts in Italy developed recommendations stratified by DIILD severity, based on the Common Terminology Criteria for Adverse Events. Results The recommendations highlight the importance of multidisciplinary interaction in the diagnosis and management of DIILD. Important components of the diagnostic process are physical examination and careful patient history-taking, measurement of vital signs (particularly respiratory rate and arterial oxygen saturation), relevant laboratory tests, respiratory function testing with spirometry and diffusing capacity of the lung for carbon monoxide and computed tomography/imaging. Because the clinical and radiological signs of DIILD are often similar to those of pneumonias or interstitial lung diseases, differential diagnosis is important, including microbial and serological testing to exclude or confirm infectious causes. In most cases, management of DIILD requires the discontinuation of the antineoplastic agent and the administration of short-term steroids. Steroid tapering must be undertaken slowly to prevent reactivation of DIILD. Patients with severe and very severe (grade 3 and 4) DIILD will require hospitalisation and often need oxygen and non-invasive ventilation. Decisions about invasive ventilation should take into account the patient’s cancer prognosis. Conclusions These recommendations provide a structured step-by-step diagnostic and therapeutic approach for each grade of suspected cancer-related DIILD. There is a lack of guidance for the management of DIILD in cancer patients. A multidisciplinary team in Italy developed step-by-step diagnostic and therapeutic guidelines for DIILD in cancer patients. Differential diagnosis of DIILD is critical to exclude other forms of interstitial lung disease or infectious causes. Usually the antineoplastic agent is discontinued, steroids started and further management dictated by DIILD severity.
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Affiliation(s)
- P Conte
- DiSCOG, University of Padova and Medical Oncology 2, IOV-Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - P A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - G Patelli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - R Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Vanzulli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Radiology Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - F Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy
| | - P Tarsia
- Pneumology Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Cattelan
- Tropical and Infectious Diseases Unit, Padua University Hospital, Padua, Italy
| | - A Comes
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M De Laurentiis
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - A Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - D Regge
- Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy
| | - L Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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De Mattia C, Calderoni F, Colombo P, Defeudis A, Giannini V, Mazzetti S, Regge D, Rizzetto F, Vanzulli A, Torresin A. CT textural features in multi-center analysis: an example of tuning effort. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Sartore-Bianchi A, Tosi F, Bergamo F, Amatu A, Ghezzi S, Martino C, Bonazzina E, Bencardino K, Fenocchio E, Mauri G, Ardizzoni A, Torri V, Valtorta E, Bonoldi E, Vanzulli A, Regge D, Ciardiello F, Zagonel V, Marsoni S, Siena S. 507P Central nervous system recurrence in HER2-positive metastatic colorectal cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Giannini V, Mazzetti S, Bertotto I, Chiarenza C, Cauda S, Delmastro E, Bracco C, Di Dia A, Leone F, Medico E, Pisacane A, Ribero D, Stasi M, Regge D. Predicting locally advanced rectal cancer response to neoadjuvant therapy with 18F-FDG PET and MRI radiomics features. Eur J Nucl Med Mol Imaging 2019; 46:878-888. [PMID: 30637502 DOI: 10.1007/s00259-018-4250-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/26/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Pathological complete response (pCR) following neoadjuvant chemoradiotherapy or radiotherapy in locally advanced rectal cancer (LARC) is reached in approximately 15-30% of cases, therefore it would be useful to assess if pretreatment of 18F-FDG PET/CT and/or MRI texture features can reliably predict response to neoadjuvant therapy in LARC. METHODS Fifty-two patients were dichotomized as responder (pR+) or non-responder (pR-) according to their pathological tumor regression grade (TRG) as follows: 22 as pR+ (nine with TRG = 1, 13 with TRG = 2) and 30 as pR- (16 with TRG = 3, 13 with TRG = 4 and 1 with TRG = 5). First-order parameters and 21 second-order texture parameters derived from the Gray-Level Co-Occurrence matrix were extracted from semi-automatically segmented tumors on T2w MRI, ADC maps, and PET/CT acquisitions. The role of each texture feature in predicting pR+ was assessed with monoparametric and multiparametric models. RESULTS In the mono-parametric approach, PET homogeneity reached the maximum AUC (0.77; sensitivity = 72.7% and specificity = 76.7%), while PET glycolytic volume and ADC dissimilarity reached the highest sensitivity (both 90.9%). In the multiparametric analysis, a logistic regression model containing six second-order texture features (five from PET and one from T2w MRI) yields the highest predictivity in distinguish between pR+ and pR- patients (AUC = 0.86; sensitivity = 86%, and specificity = 83% at the Youden index). CONCLUSIONS If preliminary results of this study are confirmed, pretreatment PET and MRI could be useful to personalize patient treatment, e.g., avoiding toxicity of neoadjuvant therapy in patients predicted pR-.
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Affiliation(s)
- V Giannini
- Imaging Unit, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy. .,Department of Surgical Sciences, University of Turin, 10124, Turin, Italy.
| | - S Mazzetti
- Imaging Unit, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Surgical Sciences, University of Turin, 10124, Turin, Italy
| | - I Bertotto
- Imaging Unit, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - C Chiarenza
- Imaging Unit, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy
| | - S Cauda
- Nuclear Medicine Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - E Delmastro
- Radiation Therapy Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - C Bracco
- Medical Physics Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - A Di Dia
- Medical Physics Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - F Leone
- Medical Oncology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - E Medico
- Laboratory of Oncogenomics, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - A Pisacane
- Pathology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - D Ribero
- Hepatobilio-Pancreatic and Colorectal Surgery Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - M Stasi
- Medical Physics Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - D Regge
- Imaging Unit, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 km 3.95, 10060, Candiolo, TO, Italy.,Department of Surgical Sciences, University of Turin, 10124, Turin, Italy
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Mazzetti S, Giannini V, Di Dia A, Bracco C, Bresciani S, Cauda S, Varetto T, Mastro ED, Gabriele P, Regge D, Stasi M. 228. Predicting neoadjuvant therapy response in locally advanced rectal cancer using texture features. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mazzetti S, Giannini V, Di Dia A, Bracco C, Bresciani S, Cauda S, Varetto T, Del Mastro E, Gabriele P, Regge D, Stasi M. 16. Predicting neoadjuvant therapy response in locally advanced rectal cancer using texture features. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mazzetti S, Giannini V, Russo F, Regge D. Computer-aided diagnosis of prostate cancer using multi-parametric MRI: comparison between PUN and Tofts models. Phys Med Biol 2018; 63:095004. [PMID: 29570456 DOI: 10.1088/1361-6560/aab956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Computer-aided diagnosis (CAD) systems are increasingly being used in clinical settings to report multi-parametric magnetic resonance imaging (mp-MRI) of the prostate. Usually, CAD systems automatically highlight cancer-suspicious regions to the radiologist, reducing reader variability and interpretation errors. Nevertheless, implementing this software requires the selection of which mp-MRI parameters can best discriminate between malignant and non-malignant regions. To exploit functional information, some parameters are derived from dynamic contrast-enhanced (DCE) acquisitions. In particular, much CAD software employs pharmacokinetic features, such as K trans and k ep, derived from the Tofts model, to estimate a likelihood map of malignancy. However, non-pharmacokinetic models can be also used to describe DCE-MRI curves, without any requirement for prior knowledge or measurement of the arterial input function, which could potentially lead to large errors in parameter estimation. In this work, we implemented an empirical function derived from the phenomenological universalities (PUN) class to fit DCE-MRI. The parameters of the PUN model are used in combination with T2-weighted and diffusion-weighted acquisitions to feed a support vector machine classifier to produce a voxel-wise malignancy likelihood map of the prostate. The results were all compared to those for a CAD system based on Tofts pharmacokinetic features to describe DCE-MRI curves, using different quality aspects of image segmentation, while also evaluating the number and size of false positive (FP) candidate regions. This study included 61 patients with 70 biopsy-proven prostate cancers (PCa). The metrics used to evaluate segmentation quality between the two CAD systems were not statistically different, although the PUN-based CAD reported a lower number of FP, with reduced size compared to the Tofts-based CAD. In conclusion, the CAD software based on PUN parameters is a feasible means with which to detect PCa, without affecting segmentation quality, and hence it could be successfully applied in clinical settings, improving the automated diagnosis process and reducing computational complexity.
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Affiliation(s)
- S Mazzetti
- Department of Surgical Sciences, University of Torino, 10124 Turin, Italy. Department of Radiology, Candiolo Cancer Institute-FPO, IRCCS, 10060 Candiolo, Turin, Italy
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Siena S, Sartore-Bianchi A, Trusolino L, Martino C, Bencardino K, Lonardi S, Zagonel V, Leone F, Martinelli E, Ciardiello F, Racca P, Amatu A, Palmeri L, Valtorta E, Cassingena A, Vanzulli A, Regge D, Veronese S, Bardelli A, Marsoni S. Final Results of the HERACLES trial in HER2 amplified colorectal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Traverso A, Torres EL, Bracco C, Campanella D, Fantacci M, Regge D, Saletta M, Stasi M, Vassallo L, Cerello P. 90P: Clinical validation of the M5L lung computer-assisted detection system. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Traverso A, Torres EL, Bagnasco S, Bracco C, Campanella D, Fantacci M, Lusso S, Regge D, Saletta M, Stasi M, Vallero S, Vassallo L, Cerello P. Clinical validation of the M5L lung computer-assisted detection system. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lopez Torres E, Traverso A, Bagnasco S, Bracco C, Campanella D, Fantacci M, Lusso S, Regge D, Saletta M, Stasi M, Vallero S, Vassallo L, Cerello P. Clinical validation of the M5L lung Computer-Assisted Detection system. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30045-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Giannini V, Vignati A, De Luca M, Mazzetti S, Russo F, Armando E, Stasi M, Bollito E, Porpiglia F, Regge D. A Novel and Fully Automated Registration Method for Prostate Cancer Detection Using Multiparametric Magnetic Resonance Imaging. J Med Imaging Hlth Inform 2015. [DOI: 10.1166/jmihi.2015.1518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vignati A, Mazzetti S, Giannini V, Russo F, Bollito E, Porpiglia F, Stasi M, Regge D. Texture features on T2-weighted magnetic resonance imaging: new potential biomarkers for prostate cancer aggressiveness. Phys Med Biol 2015; 60:2685-701. [PMID: 25768265 DOI: 10.1088/0031-9155/60/7/2685] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To explore contrast (C) and homogeneity (H) gray-level co-occurrence matrix texture features on T2-weighted (T2w) Magnetic Resonance (MR) images and apparent diffusion coefficient (ADC) maps for predicting prostate cancer (PCa) aggressiveness, and to compare them with traditional ADC metrics for differentiating low- from intermediate/high-grade PCas. The local Ethics Committee approved this prospective study of 93 patients (median age, 65 years), who underwent 1.5 T multiparametric endorectal MR imaging before prostatectomy. Clinically significant (volume ≥0.5 ml) peripheral tumours were outlined on histological sections, contoured on T2w and ADC images, and their pathological Gleason Score (pGS) was recorded. C, H, and traditional ADC metrics (mean, median, 10th and 25th percentile) were calculated on the largest lesion slice, and correlated with the pGS through the Spearman correlation coefficient. The area under the receiver operating characteristic curve (AUC) assessed how parameters differentiate pGS = 6 from pGS ≥ 7. The dataset included 49 clinically significant PCas with a balanced distribution of pGS. The Spearman ρ and AUC values on ADC were: -0.489, 0.823 (mean); -0.522, 0.821 (median); -0.569, 0.854 (10th percentile); -0.556, 0.854 (25th percentile); -0.386, 0.871 (C); 0.533, 0.923 (H); while on T2w they were: -0.654, 0.945 (C); 0.645, 0.962 (H). AUC of H on ADC and T2w, and C on T2w were significantly higher than that of the mean ADC (p = 0.05). H and C calculated on T2w images outperform ADC parameters in correlating with pGS and differentiating low- from intermediate/high-risk PCas, supporting the role of T2w MR imaging in assessing PCa biological aggressiveness.
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Affiliation(s)
- A Vignati
- Department of Radiology of Candiolo Cancer Institute-FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Italy
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Vignati A, Giannini V, Carbonaro LA, Bertotto I, Martincich L, Sardanelli F, Regge D. A new algorithm for automatic vascular mapping of DCE-MRI of the breast: Clinical application of a potential new biomarker. Comput Methods Programs Biomed 2014; 117:482-488. [PMID: 25262335 DOI: 10.1016/j.cmpb.2014.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Vascularity evaluation on breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has a potential diagnostic value, but it represents a time consuming procedure, affected by intra- and inter-observer variability. This study tests the application of a recently published method to reproducibly quantify breast vascularity, and evaluates if the vascular volume of cancer-bearing breast, calculated from automatic vascular maps (AVMs), may correlate with pathologic tumor response after neoadjuvant chemotherapy (NAC). METHODS Twenty-four patients with unilateral locally advanced breast cancer underwent DCE-MRI before and after NAC, 8 responders and 16 non-responders. A validated algorithm, based on multiscale 3D Hessian matrix analysis, provided AVMs and allowed the calculation of vessel volume before the initiation and after the last NAC cycle for each breast. For cancer bearing breast, the difference in vascular volume before and after NAC was compared in responders and non-responders using the Wilcoxon two-sample test. A radiologist evaluated the vascularity on the subtracted images (first enhanced minus unenhanced), before and after treatment, assigning a vascular score for each breast, according to the number of vessels with length ≥30mm and maximal transverse diameter ≥2mm. The same evaluation was repeated with the support of the simultaneous visualization of the AVMs. The two evaluations were compared in terms of mean number of vessels and mean vascular score per breast, in responders and non-responders, by use of Wilcoxon two sample test. For all the analysis, the statistical significance level was set at 0.05. RESULTS For breasts harboring the cancer, evidence of a difference in vascular volume before and after NAC for responders (median=1.71cc) and non-responders (median=0.41cc) was found (p=0.003). A significant difference was also found in the number of vessels (p=0.03) and vascular score (p=0.02) before or after NAC, according to the evaluation supported by the AVMs. CONCLUSIONS The encouraging, although preliminary, results of this study suggest the use of AVMs as new biomarker to evaluate the pathologic response after NAC, but also support their application in other breast DCE-MRI vessel analysis that are waiting for a reliable quantification method.
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Affiliation(s)
- A Vignati
- Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy.
| | - V Giannini
- Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
| | - L A Carbonaro
- Radiology Unit, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - I Bertotto
- Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
| | - L Martincich
- Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
| | - F Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Piazza E. Malan, 20097 San Donato Milanese, Italy
| | - D Regge
- Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142 km 3.95, 10060 Candiolo, Torino, Italy
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Giannini V, Vignati A, Mirasole S, Mazzetti S, Russo F, Stasi M, Regge D. MR-T2-weighted signal intensity: a new imaging biomarker of prostate cancer aggressiveness. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization 2014. [DOI: 10.1080/21681163.2014.910476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mazzetti S, Bracco C, Regge D, Caivano R, Russo F, Stasi M. Choline-containing compounds quantification by 1H NMR spectroscopy using external reference and noise measurements. Phys Med 2013; 29:677-83. [DOI: 10.1016/j.ejmp.2012.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/22/2012] [Accepted: 07/01/2012] [Indexed: 11/26/2022] Open
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Mazzetti S, Gliozzi AS, Bracco C, Russo F, Regge D, Stasi M. Comparison between PUN and Tofts models in the quantification of dynamic contrast-enhanced MR imaging. Phys Med Biol 2012. [PMID: 23202297 DOI: 10.1088/0031-9155/57/24/8443] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dynamic contrast-enhanced study in magnetic resonance imaging (DCE-MRI) is an important tool in oncology to visualize tissues vascularization and to define tumour aggressiveness on the basis of an altered perfusion and permeability. Pharmacokinetic models are generally used to extract hemodynamic parameters, providing a quantitative description of the contrast uptake and wash-out. Empirical functions can also be used to fit experimental data without the need of any assumption about tumour physiology, as in pharmacokinetic models, increasing their diagnostic utility, in particular when automatic diagnosis systems are implemented on the basis of an MRI multi-parametric approach. Phenomenological universalities (PUN) represent a novel tool for experimental research and offer a simple and systematic method to represent a set of data independent of the application field. DCE-MRI acquisitions can thus be advantageously evaluated by the extended PUN class, providing a convenient diagnostic tool to analyse functional studies, adding a new set of features for the classification of malignant and benign lesions in computer aided detection systems. In this work the Tofts pharmacokinetic model and the class EU1 generated by the PUN description were compared in the study of DCE-MRI of the prostate, evaluating complexity of model implementation, goodness of fitting results, classification performances and computational cost. The mean R² obtained with the EU1 and Tofts model were equal to 0.96 and 0.90, respectively, and the classification performances achieved by the EU1 model and the Tofts implementation discriminated malignant from benign tissues with an area under the receiver operating characteristic curve equal to 0.92 and 0.91, respectively. Furthermore, the EU1 model has a simpler functional form which reduces implementation complexity and computational time, requiring 6 min to complete a patient elaboration process, instead of 8 min needed for the Tofts model analysis.
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Affiliation(s)
- S Mazzetti
- Institute for Cancer Research and Treatment, Strada Provinciale 142, km 3.95, 10060 Candiolo, Torino, Italy.
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Agliozzo S, De Luca M, Bracco C, Vignati A, Giannini V, Martincich L, Carbonaro LA, Bert A, Sardanelli F, Regge D. Computer-aided diagnosis for dynamic contrast-enhanced breast MRI of mass-like lesions using a multiparametric model combining a selection of morphological, kinetic, and spatiotemporal features. Med Phys 2012; 39:1704-15. [DOI: 10.1118/1.3691178] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Anselmetti G, Manca A, Chiara G, Iussich G, Guzzetta M, Russo F, Regge D. Abstract No. 188: Peek endovertebral implant assisted vertebroplasty in painful ostelytic metastases with vertebral wall involvement: clinical experience on 30 patients. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Russo F, Mazzetti S, Grignani G, De Rosa G, Aglietta M, Anselmetti GC, Stasi M, Regge D. In vivo characterisation of soft tissue tumours by 1.5-T proton MR spectroscopy. Eur Radiol 2011; 22:1131-9. [DOI: 10.1007/s00330-011-2350-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 10/07/2011] [Accepted: 10/15/2011] [Indexed: 12/25/2022]
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Anselmetti G, Manca A, Chiara G, Iussich G, Liotti M, Regge D. Abstract No. 194: Peek endovertebral implant assisted vertebroplasty: Early clinical experience on 25 patients. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gliozzi AS, Mazzetti S, Delsanto PP, Regge D, Stasi M. Phenomenological universalities: a novel tool for the analysis of dynamic contrast enhancement in magnetic resonance imaging. Phys Med Biol 2011; 56:573-86. [PMID: 21212471 DOI: 10.1088/0031-9155/56/3/004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Dynamic contrast enhancement in magnetic resonance imaging (DCE-MRI) is a promising tool for the clinical diagnosis of tumors, whose implementation may be improved through the use of suitable hemodynamic models. If one prefers to avoid assumptions about the tumor physiology, empirical fitting functions may be adopted. For this purpose, in this paper we discuss the exploitation of a recently proposed phenomenological universalities (PUN) formalism. In fact, we show that a novel PUN class may be used to describe the time-signal intensity curves in both healthy and tumoral tissues, discriminating between the two cases and thus potentially providing a convenient diagnostic tool. The proposed approach is applied to analysis of the DCE-MRI data relative to a study group composed of ten patients with spine tumors.
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Affiliation(s)
- A S Gliozzi
- Physics Department, Politecnico di Torino, Torino, Italy.
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Sali L, Falchini M, Della Monica P, Regge D, Bonanomi AG, Castiglione G, Grazzini G, Zappa M, Mungai F, Volpe C, Mascalchi M. CT colonography before colonoscopy in subjects with positive faecal occult blood test. Preliminary experience. Radiol Med 2010; 115:1267-78. [PMID: 20680499 DOI: 10.1007/s11547-010-0569-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/06/2009] [Indexed: 01/22/2023]
Abstract
PURPOSE We report a preliminary evaluation of the performance of computed tomography colonography (CTC) systematically obtained before optical colonoscopy (OC) in subjects with positive faecal occult blood test (FOBT) within a population-based screening programme for colorectal cancer (CRC). MATERIALS AND METHODS Seventy-nine subjects with positive FOBT from a regional screening programme were invited to perform same day CTC and OC. CTC was performed with standard bowel preparation. OC with segmental unblinding was the reference standard. A per-patient per-adenoma analysis was performed. RESULTS Forty-nine of 79 subjects (62%) with positive FOBT adhered to the study and completed both examinations. Twenty-two (44.9%) of the 49 had a cancer or an adenoma ≥6 mm. Per-patient sensitivity, specificity, negative predictive value and positive predictive value for cancer or adenoma ≥6 mm were 95.5% (95%CI:77.2%-99.9%), 51.9% (95%CI:32.0%-71.3%), 93.3% (95%CI:68.1%-99.8%) and 61.8% (95%CI:43.6%-77.8%). CONCLUSIONS In the setting of a FOBT-based screening programme for CRC, CTC showed a high sensitivity, but relatively low specificity and positive predictive value, for cancer and adenoma ≥6 mm. Probably performing CTC without faecal tagging as second line test after a positive FOBT is not a cost-effective strategy.
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Affiliation(s)
- L Sali
- Radiodiagnostic Section--Department of Clinical Physiopathology, University of Florence, Viale G.B. Morgagni 85, Florence, Italy.
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Anselmetti G, Manca A, Chiara G, Iussich G, Isaia G, Regge D. Abstract No. 16: Percutaneous vertebroplasty (PV) in the osteporotic patients: Optimal indications and patient selection to improve clinical outcome. Personal experience in 1542 patients over 7 years experience. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Anselmetti G, Manca A, Chiara G, Liotti M, Petracchini M, Regge D. Abstract No. 36: Percutaneous Osteoplasty Performed in Painful Extraspinal Osteolytic Lesions. Personal Experience in 81 Patients Treated for Benign Diseases and Metastases. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Anselmetti G, Manca A, Chiara G, Liotti M, Martincich L, Regge D. Abstract No. 250: Metallic Stents in the Klatskin's Tumor: “T” and “Y” Stenting Technique with Right Monolateral Percutaneous Approach. Personal Experience in 51 Patients. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Anselmetti G, Manca A, Chiara G, Liotti M, Russo F, Regge D. Abstract No. 5: Percutaneous Vertebroplasty (PV)in the Cervical Spine from C1 to C7: Results and Complications in Benign and Malignant Lesions. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Anselmetti G, Manca A, Chiara G, Petracchini M, Liotti M, Regge D. Abstract No. 17: Percutaneous Radiofrequency Thermal Ablation (RFA) of Lung Cancer Performed in the Angiography Suite. Usefulness of Combined Fluoroscopic and CT-Like Guidance of a New Generation Rotational Flat Panel C-Arm. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cirillo S, Petracchini M, Della Monica P, Gallo T, Tartaglia V, Vestita E, Ferrando U, Regge D. Value of endorectal MRI and MRS in patients with elevated prostate-specific antigen levels and previous negative biopsies to localize peripheral zone tumours. Clin Radiol 2008; 63:871-9. [PMID: 18625351 DOI: 10.1016/j.crad.2007.10.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 10/16/2007] [Accepted: 10/21/2007] [Indexed: 01/02/2023]
Abstract
AIM To evaluate prospectively the role of endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in detecting peripheral zone tumour in patients with total prostate-specific antigen (PSA) values>or=4 ng/ml and one or more negative transrectal ultrasound (TRUS) biopsy rounds. MATERIAL AND METHODS Fifty-four consecutive men (mean age 65.4+/-5.2 years, mean total PSA 10.8+/-7.5 ng/ml), underwent a combined MRI-MRS examination with endorectal coil. MRI included transverse, coronal, and sagittal T2-weighted and transverse T1-weighted fast spin-echo sequences. MRS data were acquired using a double spin-echo point resolved spectroscopy (PRESS) sequence. A 10-site scheme was adopted to evaluate the prostate peripheral zone. A peripheral prostatic site was classified as suspicious if low intensity signal was present on T2-weighted images and/or if the choline+creatine/citrate ratio was >0.86. Following MRI-MRS all patients were submitted to a standard 10-core biopsy scheme to which from one to three supplementary samples were added from suspicious MRI and/or MRS sites. In per-patient analysis findings were considered true-positive if biopsy positive patients were classified as suspicious, irrespectively of lesion site indication. RESULTS Prostate cancer (PC) was detected in 17 of 54 patients (31.5%); median Gleason score was 6 (range 4-8). On a per-patient basis sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were respectively 100, 64.9, 56.7, 100, and 75.9% for MRI; 82.2, 70.3, 57.7, 92.9, and 75.9% for MRS; and 100, 51.4, 48.6, 100, and 66.7% for combined MRI-MRS. In all the 17 PC patients, combined MRI-MRS correctly indicated the sites harbouring cancer, whereas both MRI and MRS gave erroneous indications in two patients. CONCLUSION The results of the present study show that MRI alone might be able to select negative patients in whom further biopsies are unnecessary. The combination of MRI and MRS might be able to drive biopsies in suspicious sites and increase the cancer detection rate. Further studies are required to confirm these data.
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Affiliation(s)
- S Cirillo
- Unit of Radiology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy.
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Anselmetti G, Manca A, Russo F, Chiara G, Regge D. Abstract No. 182: Percutaneous Vertebroplasty in the Osteoporotic Patients: 5 Years Prospective Follow-Up in 884 Consecutive Patients. J Vasc Interv Radiol 2008. [DOI: 10.1016/j.jvir.2007.12.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bracco C, Martincich L, Regge D, Becchio M, Persano D, Bert A, Rizzo G. Visualization of quantitative breast DCE-MRI functional parametric maps by dedicated image processing. ACTA ACUST UNITED AC 2007; 2007:55-8. [PMID: 18001887 DOI: 10.1109/iembs.2007.4352221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
DCE-MRI is a diagnostic method that can visualize neoangiogenic-induced vascular changes. Typically, the analysis of these data is time-consuming and the visualization of the quantitative information on tumor vasculature, derivable from DCE-MRI, is not easy and comfortable. In this study, we propose a method to accelerate computation and analysis of DCE-MRI data, while making easy to use the functional information obtained from model-based functional analysis.
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Affiliation(s)
- C Bracco
- Institute for Cancer Research and Treatment, Candiolo, Turin, Italy.
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Regge D, Campanella D. RE: Diagnostic accuracy of portal-phase CT and MRI with mangafodipir trisodium in detecting liver metastases from colorectal carcinoma. A reply. Clin Radiol 2007. [DOI: 10.1016/j.crad.2007.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The use of computed tomographic colonography (CTC) as a screening test for colorectal cancer is being advocated with growing enthusiasm by physicians and the public as stronger evidence of its validity and limited invasiveness emerges from the literature. Because the approach to surveillance of colorectal cancer depends on an individual's degree of risk category, which depends on familial and personal histories, it seems logical that the diagnostic performance and cost efficacy of screening CTC may differ according to the characteristics of the target population. Although CTC seems a valid option in low- to average-risk populations, pending a careful assessment of its cost and estimates of its cost efficacy, there are some important issues that should be addressed when it comes to considering its use in high-risk patients. The expected larger number of induced colonoscopies and higher false-positive rates are likely to have a great influence on CTC costs, but if its implementation causes a dramatic increase in the number of patients willing to undergo screening, thanks to its acceptability, then the cost efficacy ratio may ultimately become competitive with all other screening strategies for colorectal cancer. We strongly feel that large and well-conducted trials are needed to clarify the role of CTC in screening patients at increased risk of developing colorectal cancer.
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Affiliation(s)
- T M Gallo
- Radiology Unit, Institute for Cancer Research and Treatment, Strada Provinciale 142 Km 3.95, Candiolo, Turin 10026, Italy.
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Regge D, Campanella D, Anselmetti G, Cirillo S, Gallo T, Muratore A, Capussotti L, Galatola G, Floriani I, Aglietta M. Diagnostic accuracy of portal-phase CT and MRI with mangafodipir trisodium in detecting liver metastases from colorectal carcinoma. Clin Imaging 2006. [DOI: 10.1016/j.clinimag.2006.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Regge D, Campanella D, Anselmetti GC, Cirillo S, Gallo TM, Muratore A, Capussotti L, Galatola G, Floriani I, Aglietta M. Diagnostic accuracy of portal-phase CT and MRI with mangafodipir trisodium in detecting liver metastases from colorectal carcinoma. Clin Radiol 2006; 61:338-47. [PMID: 16546464 DOI: 10.1016/j.crad.2005.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Revised: 12/06/2005] [Accepted: 12/21/2005] [Indexed: 12/23/2022]
Abstract
AIM To compare the diagnostic accuracy of single section spiral computed tomography (CT) and magnetic resonance imaging (MRI) with tissue-specific contrast agent mangafodipir trisodium (MnDPDP) in the detection of colorectal liver metastases. MATERIAL AND METHODS One hundred and twenty-five consecutive patients undergoing surgery for primary and/or metastatic disease were evaluated using CT (5 mm collimation and reconstruction interval, pitch 2), two-dimensional fast spoiled gradient echo (2D FSPGR) T1 and single shot fast-spin echo (SSFSE) T2 weighted breath-hold MRI sequences, performed before and after intravenous administration of MnDPDP. The reference standards were intraoperative ultrasound and histology. RESULTS The per-patient accuracy of CT was 72.8 versus 78.4% for unenhanced MRI (p = 0.071) and 82.4% for MnDPDP-enhanced MRI (p = 0.005). MnDPDP-enhanced MRI appeared to be more accurate than unenhanced MRI but this was not significant (p = 0.059). The sensitivity of CT was 48.4% versus 58.1% for unenhanced MRI (p = 0.083) and 66.1% for MnDPDP-enhanced MRI (p = 0.004). The difference in specificity between procedures was not significant. The per-lesion sensitivity was 71.7, 74.9 and 82.7% for CT, unenhanced MRI, and MnDPDP-enhanced MRI, respectively; the positive predictive value of the procedures was respectively 84.0, 96.0 and 95.8%. MnDPDP-enhanced MRI provided a high level diagnostic confidence in 92.5% of the cases versus 82.5% for both unenhanced MRI and CT. The kappa value for inter-observer variability was >0.75 for all procedures. CONCLUSIONS The diagnostic accuracy and sensitivity of MnDPDP-enhanced MRI is significantly higher than single section spiral CT in the detection of colorectal cancer liver metastases; no significant difference in diagnostic accuracy was observed between unenhanced MRI and MnDPDP-enhanced MRI.
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Affiliation(s)
- D Regge
- Radiology Unit, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy.
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36
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Arduino C, Salacone P, Pasini B, Brusco A, Salmin P, Bacillo E, Robecchi A, Cestino L, Cirillo S, Regge D, Cappello N, Gaia E. Association of a new cationic trypsinogen gene mutation (V39A) with chronic pancreatitis in an Italian family. Gut 2005; 54:1663-4. [PMID: 16227369 PMCID: PMC1774735 DOI: 10.1136/gut.2004.062992] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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37
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Magnino A, Gatti M, Massucco P, Sperti E, Faggiuolo R, Regge D, Capussotti L, Gabriele P, Aglietta M. Phase II Trial of Primary Radiation Therapy and Concurrent Chemotherapy for Patients with Locally Advanced Pancreatic Cancer. Oncology 2005; 68:493-9. [PMID: 16020980 DOI: 10.1159/000086993] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Accepted: 01/30/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Primary chemoradiotherapy for locally advanced pancreatic cancer (LAPC) may improve local control, curative resection rate and long-term survival. We performed a phase II study to evaluate toxicity and activity of primary radiation therapy and concurrent chemotherapy with gemcitabine (GEM) twice weekly in patients (pts) with LAPC. METHODS From 6/1999 to 6/2003, 23 LAPC pts received GEM 100 mg/m2 twice weekly in the first 15 pts and 50 mg/m2 in the last 8 pts, concurrently with radiotherapy (1.8 Gy/day for a total dose of 45 Gy). RESULTS The treatment was completed in 19/23 pts. Toxicities: G3-4 hematological toxicity occurred in 35 and 4% respectively; G3 nausea and vomiting and gastrointestinal toxicity in 30%. Clinical benefit was found in 10/18 pts (55%). Overall response: partial response rate 4/18 (22%); stable disease 13/18 (72%); progressive disease 1/18 (6%). Six pts underwent pancreaticoduodenectomy with extended lymphadenectomy (5/6 pts pT3, 1/6 pts microscopic cancer foci, 1/6 N+, 5/6 negative retroperitoneal margin). MEDIAN SURVIVAL: 14 months for the entire group, 12 months for unresected pts, 20 months for resected pts. CONCLUSIONS The treatment with GEM twice weekly at 50 mg/m2 associated with radiotherapy (45 Gy) is feasible and permits to obtain clinical benefit in a good percentage of pts. Objective response, median survival, and local and systemic control are similar to other studies and need further improvement.
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Affiliation(s)
- A Magnino
- Unit of Medical Oncology and Hematology, Institute for Research and Cure of Cancer, Candiolo, Italy
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Cirillo S, Tosetti I, Gaita F, Bianchi F, Gandini G, Regge D. Magnetic Resonance angiography of the pulmonary veins before and after radiofrequency ablation for atrial fibrillation. Radiol Med 2005; 109:488-99. [PMID: 15973222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To study the usefulness of magnetic resonance angiography (MRA) in imaging of the pulmonary veins (PV) before and after radiofrequency ablation procedures in patients with atrial fibrillation. MATERIALS AND METHODS Between July 2002 and April 2003, 50 patients with atrial fibrillation underwent MRA prior to ablation; 18 patients also underwent post-procedure MRA. Images were acquired with 3D-spoiled gradient echo sequences after intravenous administration of the paramagnetic contrast medium gadopentetate dimeglumine; an automatic triggering device was used to start the angiographic sequence (Smartprep, General Electric Medical Systems). Postprocessing was performed with maximum intensity projection (MIP) and virtual endoscopy (VE) software (Navigator, GEMS). RESULTS The venoatrial junction was visualised with MRA VE in 49 of 50 patients (98.0%). Twenty-seven patients out of 49 (55.1%) had two PV ostia on both sides, 13 (26.5%) had two right ostia and a single common left ostium, 5 (10.2%) had supernumerary PV and 4 (8.2%) had both a supernumerary right PV and a single common left ostium. Flythrough navigation showed the number and spatial arrangement of second-order PV branches in 48 out of 49 patients (98.0%). In postablation examinations, mild stenosis was detected with MIP and VE in 17 out of 83 PV examined (20.5%). CONCLUSIONS This study confirms the clinical value of magnetic resonance imaging for visualising PV ostia in patients undergoing radiofrequency ablation for atrial fibrillation. Before the ablation procedure, MRA allows an accurate evaluation of PV number, shape and size; after the procedure, MRA is useful in screening for post-ablation stenosis and describing the location and severity of stenosis when present.
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Affiliation(s)
- S Cirillo
- Servizio di Radiologia, IRCC, Candiolo, (Torino), Italy
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39
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Regge D, Gallo TM, Nieddu G, Galatola G, Fracchia M, Neri E, Vagli P, Bartolozzi C. Ileocecal valve imaging on computed tomographic colonography. ACTA ACUST UNITED AC 2004; 30:20-5. [PMID: 15647867 DOI: 10.1007/s00261-004-0225-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 03/17/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of our study was to describe the visualization, normal anatomy, and variations of the ileocecal valve with computed tomographic (CT) colonography to provide information about its optimal imaging. METHODS We analyzed data in two- and three-dimensional rendering mode in 71 consecutive patients who underwent routine CT colonoscopy followed by conventional colonoscopy for confirmation of the radiologic findings. RESULTS Complete visualization of the ileocecal valve was better achieved in the supine than in the prone position (82% vs. 62%, respectively); the ileocecal valve appeared in 64% of cases in the supine position when it was invisible in prone position (p < 0.0001). Partial visualization of the ileocecal valve was possible in 94% of cases. The ileocecal valve was of labial type in 76%, papillary type in 21%, and lipomatous in 3% of cases. The orifice was identified in 53% of ileocecal valves; in two cases of cecal carcinoma, the normal ileocecal valve morphology was grossly disrupted. CONCLUSION The ileocecal valve was at least partly visualized by CT colonoscopy in 94% of cases, more frequently in the supine position. Its most common normal morphology is the labial type. The absence of orifice visualization alone is not a specific sign for neoplasia, but its presence helps distinguish physiologic bulging from neoplasia.
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Affiliation(s)
- D Regge
- Radiology Department, Institute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95, I-10060 Candiolo, Italy.
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Cirillo S, Bonamini R, Gaita F, Tosetti I, De Giuseppe M, Longo M, Bianchi F, Vivalda L, Regge D. Magnetic resonance angiography virtual endoscopy in the assessment of pulmonary veins before radiofrequency ablation procedures for atrial fibrillation. Eur Radiol 2004; 14:2053-60. [PMID: 15258825 DOI: 10.1007/s00330-004-2406-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 05/25/2004] [Accepted: 06/07/2004] [Indexed: 11/29/2022]
Abstract
Magnetic resonance angiography (MRA) is a safe and non-invasive imaging method that can readily depict the pulmonary veins (PV), whose imaging has acquired momentum with the advent of new techniques for radiofrequency ablation of atrial fibrillation (AF). We evaluated whether virtual endoscopy from 3D MRA images (MRA-VE) is feasible in studying the morphology of PV. Fifty patients with AF underwent pre-ablative MRA (1.5 T). Images were acquired with axial T-2 weighted and 3D-SPGR sequences after intravenous administration of Gd-DTPA and automatic triggering. Postprocessing was performed by an experienced radiologist with maximum intensity projection (MIP) and virtual endoscopy software (Navigator, GEMS). The venoatrial junction was visualized with MRA-VE in 49 of 50 patients (98.0%). Twenty-seven patients (55.1%) had two ostia on both sides, 13 patients (26.5%) had two ostia on the right and a single common ostium on the left, 5 patients (10.2%) had accessory PV and 4 patients (8.2%) had both an accessory right PV and a single common ostium on the left. Flythrough navigation showed the number and spatial disposition of second-order PV branches in 48 out of 49 patients (98.0%). MRA-VE is an excellent tool for at-a-glance visualization of ostia morphology, navigation of second-generation PV branches and easy endoluminal assessment of left atrial structures in pre-ablative imaging.
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Affiliation(s)
- S Cirillo
- Unit of Radiology, Institute for Cancer Research and Treatment, Strada provinciale n 142, Km 3.95, 10060, Candiolo (Torino), Italy
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Morris DL, Glenn D, King J, Lencioni R, Regge D, Suh R, Gilliams A, Helmberger T, Dereskewitz C. Radiofrequency ablation (RFA) of pulmonary colorectal metastases. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. L. Morris
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - D. Glenn
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - J. King
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - R. Lencioni
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - D. Regge
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - R. Suh
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - A. Gilliams
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - T. Helmberger
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
| | - C. Dereskewitz
- The University of New South Wales, Sydney, NSW, Australia; St George Hospital, Sydney, NSW, Australia; University of Pisa, Italy; Institute for the Research and Treatment of Cancer, Turin, Italy; UCLA, Los Angeles, CA; Middlesex Hospital, London, United Kingdom; Ludwig Maximilians University, Munich, Germany; University of Essen, Germany
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Montemurro F, Russo F, Martincich L, Cirillo S, Gatti M, Aglietta M, Regge D. Dynamic contrast enhanced magnetic resonance imaging in monitoring bone metastases in breast cancer patients receiving bisphosphonates and endocrine therapy. Acta Radiol 2004; 45:71-4. [PMID: 15164782 DOI: 10.1080/02841850410003374] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To study the role of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in monitoring the response of bone metastases to endocrine therapy combined with bisphosphonates in patients with breast cancer. MATERIAL AND METHODS Ten breast cancer patients with bone metastases who were to receive endocrine therapy and bisphosphonates were investigated prospectively by DCE-MRI. We chose a reference lesion for each patient who was studied at baseline, within 3 weeks from the second administration of bisphosphonates, and after 4 and 8 months from the initiation of medical treatment. Time/intensity curves, representing temporal changes of signal intensity in areas of interest in the context of the target lesions (ROI), were obtained for each DCE-MRI. RESULTS Changes in the shape of the T/I curves suggesting tumor regression were seen shortly after the initiation of medical treatment in the three patients who had the most durable responses. CONCLUSION DCE-MRI has the potential to detect early changes related to medical treatment in bone metastases from breast cancer. If confirmed in larger series, these data identify DCE-MRI as a diagnostic tool for evaluating new bone targeting antineoplastic agents.
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Affiliation(s)
- F Montemurro
- Units of Medical Oncology, Diagnostic Imaging and Radiation Therapy, Institute for Cancer Research and Treatment, IRCC, Candiolo, Torino, Italy.
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Veltri A, Anselmetti GC, Bartoli G, Martina MC, Regge D, Galli J, Bertini M. Percutaneous treatment with amphotericin B of mycotic lung lesions from invasive aspergillosis: results in 10 immunocompromised patients. Eur Radiol 2001; 10:1939-44. [PMID: 11305575 DOI: 10.1007/s003300000469] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the efficacy of percutaneous treatment of pulmonary lesions from invasive aspergillosis in immunocompromised patients. From 1992 to 1998, ten patients (seven men and three women; mean age 56 years) affected by hematological neoplasms (8 acute myeloid leukemias, 2 non-Hodgkin's lymphomas) and post-chemotherapy prolonged neutropenia developed pulmonary lesions from invasive aspergillosis. A total of 13 lesions (diameter 2-7 cm, median 5 cm) were treated percutaneously due to insufficiency of the high-dose i.v. therapy; under CT guidance, a median of 10 cm3 per session of a 1 mg/cm3 diluted solution of amphotericin B was injected through a fine needle (21-22 G); 45 sessions overall were performed (one to five per lesion, median four), according to the volume of the nodules, tolerance, and complications. The results were retrospectively evaluated either radiologically or clinically. Complications were cough, mild hemoptysis, and small pneumothorax and/or pleural effusion. No major complications occurred. One month after the beginning of treatment, 8 lesions completely resolved, 4 greatly improved, and 1 was not significantly reduced. In all ten patients symptoms improved (eight of ten could restart chemotherapy as scheduled). After antiblastic retreatment, 1 patient had mycotic recurrence. In our experience transthoracic topical treatment with amphotericin B of single or few lung lesions from invasive aspergillosis was effective, affording a rapid improvement of the lesions and symptoms, and allowing continuation of chemotherapy as scheduled, thereby reducing the risk of recurrences.
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Affiliation(s)
- A Veltri
- Dipartimento di Discipline Medico-Chirurgiche, Università di Torino, Italy
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Regge D, Galatola G, Martincich L, Gallo T, Pollone M, Rivolta A, Secreto P, Pera A. [Use of virtual endoscopy with computerized tomography in the identification of colorectal neoplasms. Prospective study with symptomatic patients]. Radiol Med 2000; 99:449-55. [PMID: 11262822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Aim of this study was to evaluate the sensitivity of virtual colonoscopy (CT colonography) in the identification of colorectal cancer and to define the limitations and the advantages of this imaging modality, as well as indications to the examination. MATERIAL AND METHODS We examined prospectively 62 symptomatic patients aged 36 to 82 years (28 women and 34 men). All patients underwent both conventional and virtual colonoscopy on the same day; the conventional examination allowed exploration of the entire colon. RESULTS Conventional colonoscopy identified 89 lesions 3-50 mm in diameter, namely 84 benign and 5 malignant lesions. No lesions were identified in 12 patients. CT colonography identified 52 of the 89 lesions, with 57.1% diagnostic accuracy. There were 11 false positives (82.5% positive predictive value and 52.2% specificity) and 37 false negatives (24.5% negative predictive value and 58.4% sensitivity). Sensitivity was significantly higher (85.7%) for polyps > or = 1 cm. CONCLUSIONS Virtual colonoscopy is an imaging modality with good diagnostic yield, well tolerated by patients and with great potentials for further development. We suggest that the examination be performed in symptomatic patients who cannot undergo total colonoscopy or refuse the other imaging modalities. Further studies are warranted in larger series of patients, possibly introducing it in screening programs.
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Affiliation(s)
- D Regge
- Reparto di Radiologia dell'Istituto per la Ricerca e la Cura del Cancro, Ordine Mauriziano, Candiolo TO.
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Abstract
We report a case of gastric lipoma which manifested with an episode of acute gastrointestinal hemorrhage. Preoperative diagnosis was based on the US, CT, and MRI findings, as the results of gastrointestinal endoscopy were inconclusive. The role of current imaging methods, and particularly of MRI, is discussed.
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Affiliation(s)
- D Regge
- Institute for Research and Cure of Cancer, Strada Provinciale 142, Turin CAP, Italy
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Veltri A, Robba T, Anselmetti GC, Martina MC, Regge D, Grosso M, Fava C. [Computerized tomography with lipiodol in hepatocarcinoma. Assessment of its diagnostic accuracy with anatomo-pathological control]. Radiol Med 1998; 96:81-6. [PMID: 9819623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE To assess the diagnostic accuracy and predictive value of Lipiodol CT for hepatocellular carcinoma (HCC) before liver transplantation (OLT). MATERIAL AND METHODS Seventy-eight cirrhotic patients awaiting OLT underwent Lipiodol CT to demonstrate the presence and extent of possible HCC. Radiologically, focal uptake areas with dense, homogeneous or "mosaic" iodized oil uptake were considered to be neoplastic nodules. All patients underwent OLT within 4 months of Lipiodol CT. Pathologic examination of the explanted livers was performed using the standard technique and, if necessary, with additional slices. Pathologic findings were compared with radiologic results to calculate the diagnostic accuracy and predictive value of Lipiodol CT in relation to both patients and lesions. RESULTS Lipiodol CT depicted 61 focal areas of iodized oil uptake in 48 patients; pathologic examinations detected 57 HCC lesions in 42 patients (diameter .8 cm, mean 2.2 cm); agreement with radiologic diagnosis was found in 35 patients only. Patient by patient, Lipiodol CT had 83.3% sensitivity, 63.8% specificity, 74.3% diagnostic accuracy, 72.9% positive predictive value (PPV), and 76.6% negative predictive value. Lesion by lesion, Lipiodol CT showed overall sensitivity and PPV of 75.4-70.5%, 74-69.8% for "small" HCCs (diameter < or = 3 cm), and 72.9-71.1% for nodules < or = 2 cm in size. Eighteen uptake areas in 13 patients were diagnosed as HCC by Lipiodol CT but the finding was not confirmed at histology: 4 were hemangiomas and 14 corresponded to cirrhotic tissue without neoplastic foci. CONCLUSIONS Our study, as the few others comparing radiologic results and pathologic findings of whole explanted liver, demonstrates that Lipiodol CT has relatively low diagnostic accuracy; particularly, specificity and PPV were limited by possible false positives, with HCC overstaging and mistakes in the indications/contraindications for OLT.
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Affiliation(s)
- A Veltri
- Dipartimento di Discipline Medico-Chirurgiche dell'Università, Torino.
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Lo Bello G, Bianchi G, Benech F, Martincich L, Regge D. [A case of meningioma appearing as a cyst with solid parietal nodule. Evaluation using computerized tomography and magnetic resonance]. Radiol Med 1997; 94:678-80. [PMID: 9524611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- G Lo Bello
- Servizio di Radiologia, Ospedale di Rivoli, USSL n. 5, Rivoli TO
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48
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Affiliation(s)
- G Gerbino
- Divisione di chirurgia maxillo-facciale, Università di Torino, Italia
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Lo Bello G, Bianchi G, Raviolo P, Ponzio S, Regge D, Martinich L, Di Paola A. [Osteosarcomatosis with pleural involvement. Report of a case]. Radiol Med 1997; 93:778-80. [PMID: 9411528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Lo Bello
- Servizio di Radiologia, Ospedale Degli Infermi, Rivoli, TO
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50
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Garretti L, Cassinis MC, Regge D, Drogo M, Trovato C. [Role of endorectal ultrasonography and CT in preoperative staging of rectal cancer. Personal experience]. MINERVA CHIR 1997; 52:717-25. [PMID: 9324653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report our personal experience on endorectal US and CT in the preoperative staging of rectal carcinoma. Our series includes 64 cases (38 male and 26 female) evaluated with intrarectal sonography; 38 of these patients underwent also CT-study of the lower abdomen. Using both imaging techniques infiltration of the rectal wall and adjacent structures and lymph node involvement were studied. The results of our study refer to 58 patients who underwent endorectal US, 31 of whom studied also with CT. Referring to the T-parameter with ultrasound 41 correct diagnosis were obtained, in 13 cases the lesion was over-staged and in 4 cases understaged. The sensitivity, specificity and diagnostic accuracy was respectively 89.5%, 60% and 79.3%. With CT 23 diagnosis were correct, in 1 case the lesion was overstaged and in 7 cases understaged; sensitivity, specificity and diagnostic accuracy concerning rectal wall infiltration were respectively 72%, 83.3% and 74.2%. The evaluation of the N-parameter demonstrated low value of sensitivity with both US (15.8%) and CT (42.9%). Considering the results of our series, we feel that it is necessary to use both imaging techniques because results obtained are complementary referring to the T-parameter, although N-parameter were a little significant.
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Affiliation(s)
- L Garretti
- Istituto di Radiologia, Università degli Studi, Torino
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