1
|
Panebianco V, Briganti A, Boellaard TN, Catto J, Comperat E, Efstathiou J, van der Heijden AG, Giannarini G, Girometti R, Mertens L, Takeuchi M, Muglia VF, Narumi Y, Novara G, Pecoraro M, Roupret M, Sanguedolce F, Santini D, Shariat SF, Simone G, Vargas HA, Woo S, Barentsz J, Witjes JA. Clinical application of bladder MRI and the Vesical Imaging-Reporting and Data System. Nat Rev Urol 2024; 21:243-251. [PMID: 38036666 DOI: 10.1038/s41585-023-00830-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic work-up and risk stratification in patients with bladder cancer before and after treatment must be refined to optimize management and improve outcomes. MRI has been suggested as a non-invasive technique for bladder cancer staging and assessment of response to systemic therapy. The Vesical Imaging-Reporting And Data System (VI-RADS) was developed to standardize bladder MRI image acquisition, interpretation and reporting and enables accurate prediction of muscle-wall invasion of bladder cancer. MRI is available in many centres but is not yet recommended as a first-line test for bladder cancer owing to a lack of high-quality evidence. Consensus-based evidence on the use of MRI-VI-RADS for bladder cancer care is needed to serve as a benchmark for formulating guidelines and research agendas until further evidence from randomized trials becomes available.
Collapse
Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Eva Comperat
- Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hopital Tenon, Paris, France
| | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Laura Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Morgan Roupret
- Department of Urology, Sorbonne University, AP-HP, Pitié Salpétrière Hospital, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Daniele Santini
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Giuseppe Simone
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jelle Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Monterubbiano L, Cereser L, D'Alì L, Girometti R, Zuiani C. I saw the Torricelli-Bernoulli sign: When physics provides imaging insights. Clin Imaging 2024; 107:110095. [PMID: 38280338 DOI: 10.1016/j.clinimag.2024.110095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/30/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
The Torricelli-Bernoulli sign is a rare radiologic sign seen on computed tomography (CT) or magnetic resonance imaging (MRI), which helps direct the diagnosis of a gastrointestinal tumor. It indicates the presence of non-dependent air trapped within a necrotic ulcer located in a gastrointestinal tumor; sometimes, a vertical stream of bubbles emanating from the opening of the ulcer is present. The term Torricelli-Bernoulli sign first appeared in the literature in 1999, referring to the homonymous physical theorems.
Collapse
Affiliation(s)
- Leonardo Monterubbiano
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Lorenzo D'Alì
- Institute of Pathological Anatomy, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| |
Collapse
|
3
|
Maggioni E, Pigoni A, Fontana E, Delvecchio G, Bonivento C, Bianchi V, Mauri M, Bellina M, Girometti R, Agarwal N, Nobile M, Brambilla P. Right frontal cingulate cortex mediates the effect of prenatal complications on youth internalizing behaviors. Mol Psychiatry 2024:10.1038/s41380-024-02475-y. [PMID: 38378927 DOI: 10.1038/s41380-024-02475-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
Prenatal and perinatal complications represent well-known risk factors for the future development of psychiatric disorders. Such influence might become manifested during childhood and adolescence, as key periods for brain and behavioral changes. Internalizing and externalizing behaviors in adolescence have been associated with the risk of psychiatric onset later in life. Both brain morphology and behavior seem to be affected by obstetric complications, but a clear link among these three aspects is missing. Here, we aimed at analyzing the association between prenatal and perinatal complications, behavioral issues, and brain volumes in a group of children and adolescents. Eighty-two children and adolescents with emotional-behavioral problems underwent clinical and 3 T brain magnetic resonance imaging (MRI) assessments. The former included information on behavior, through the Child Behavior Checklist/6-18 (CBCL/6-18), and on the occurrence of obstetric complications. The relationships between clinical and gray matter volume (GMV) measures were investigated through multiple generalized linear models and mediation models. We found a mutual link between prenatal complications, GMV alterations in the frontal gyrus, and withdrawn problems. Specifically, complications during pregnancy were associated with higher CBCL/6-18 withdrawn scores and GMV reductions in the right superior frontal gyrus and anterior cingulate cortex. Finally, a mediation effect of these GMV measures on the association between prenatal complications and the withdrawn dimension was identified. Our findings suggest a key role of obstetric complications in affecting brain structure and behavior. For the first time, a mediator role of frontal GMV in the relationship between prenatal complications and internalizing symptoms was suggested. Once replicated on independent cohorts, this evidence will have relevant implications for planning preventive interventions.
Collapse
Affiliation(s)
- Eleonora Maggioni
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Elisa Fontana
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Valentina Bianchi
- Child and Adolescent Psychiatry Unit, Scientific Institute IRCCS "Eugenio Medea", Bosisio Parini (Lc), Italy
| | - Maddalena Mauri
- Child and Adolescent Psychiatry Unit, Scientific Institute IRCCS "Eugenio Medea", Bosisio Parini (Lc), Italy
| | - Monica Bellina
- Child and Adolescent Psychiatry Unit, Scientific Institute IRCCS "Eugenio Medea", Bosisio Parini (Lc), Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine (DMED), University of Udine, Udine, Italy
- University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Nivedita Agarwal
- Neuroimaging Unit, Scientific Institute IRCCS "Eugenio Medea", Bosisio Parini (Lc), Italy
| | - Maria Nobile
- Child and Adolescent Psychiatry Unit, Scientific Institute IRCCS "Eugenio Medea", Bosisio Parini (Lc), Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| |
Collapse
|
4
|
Cereser L, Cortiula F, Simiele C, Peruzzi V, Bortolot M, Tullio A, Como G, Zuiani C, Girometti R. Assessing the impact of structured reporting on learning how to report lung cancer staging CT: A triple cohort study on inexperienced readers. Eur J Radiol 2024; 171:111291. [PMID: 38218064 DOI: 10.1016/j.ejrad.2024.111291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE To assess the clinical utility of chest computed tomography (CT) reports for non-small-cell lung cancer (NSCLC) staging generated by inexperienced readers using structured reporting (SR) templates from the Royal College of Radiologists (RCR-SR) and the Italian Society of Medical and Interventional Radiology (SIRM-SR), compared to traditional non-systematic reports (NSR). METHODS In a cohort of 30 NSCLC patients, six third-year radiology residents reported CT examinations in two 2-month-apart separate sessions using NSR in the first and NSR, RCR-SR, or SIRM-SR in the second. Couples of expert radiologists and thoracic oncologists in consensus evaluated completeness, accuracy, and clarity. All the quality indicators were expressed on a 100-point scale. The Wilcoxon signed ranks, and Wilcoxon-Mann Whitney tests were used for statistical analyses. RESULTS Results showed significantly higher completeness for RCR-SR (90 %) and SIRM-SR (100 %) compared to NSR (70 %) in the second session (all p < 0.001). SIRM-SR demonstrated superior accuracy (70 % vs. 55 %, p < 0.001) over NSR, while RCR-SR and NSR accuracy did not significantly differ (60 % vs. 62.5 %, p = 0.06). In the second session, RCR-SR and SIRM-SR surpassed NSR in completeness, accuracy, and clarity (all p < 0.001, except p = 0.04 for accuracy between RCR-SR and NSR). SIRM-SR outperformed RCR-SR in completeness (100 % vs. 90 %, p < 0.001) and accuracy (70 % vs. 62.5 %, p = 0.002), with equivalent clarity (90 % for both, p = 0.27). CONCLUSIONS Inexperienced readers using RCR-SR and SIRM-SR demonstrated high-quality reporting, indicating their potential in radiology residency programs to enhance reporting skills for NSCLC staging and effective interaction with all the physicians involved in managing NSCLC patients.
Collapse
Affiliation(s)
- L Cereser
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - F Cortiula
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy; Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, The Netherlands.
| | - C Simiele
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - V Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - M Bortolot
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy.
| | - A Tullio
- Institute of Hygiene and Evaluative Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy.
| | - G Como
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - C Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - R Girometti
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| |
Collapse
|
5
|
Kocak B, Akinci D'Antonoli T, Mercaldo N, Alberich-Bayarri A, Baessler B, Ambrosini I, Andreychenko AE, Bakas S, Beets-Tan RGH, Bressem K, Buvat I, Cannella R, Cappellini LA, Cavallo AU, Chepelev LL, Chu LCH, Demircioglu A, deSouza NM, Dietzel M, Fanni SC, Fedorov A, Fournier LS, Giannini V, Girometti R, Groot Lipman KBW, Kalarakis G, Kelly BS, Klontzas ME, Koh DM, Kotter E, Lee HY, Maas M, Marti-Bonmati L, Müller H, Obuchowski N, Orlhac F, Papanikolaou N, Petrash E, Pfaehler E, Pinto Dos Santos D, Ponsiglione A, Sabater S, Sardanelli F, Seeböck P, Sijtsema NM, Stanzione A, Traverso A, Ugga L, Vallières M, van Dijk LV, van Griethuysen JJM, van Hamersvelt RW, van Ooijen P, Vernuccio F, Wang A, Williams S, Witowski J, Zhang Z, Zwanenburg A, Cuocolo R. METhodological RadiomICs Score (METRICS): a quality scoring tool for radiomics research endorsed by EuSoMII. Insights Imaging 2024; 15:8. [PMID: 38228979 DOI: 10.1186/s13244-023-01572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/01/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024] Open
Abstract
PURPOSE To propose a new quality scoring tool, METhodological RadiomICs Score (METRICS), to assess and improve research quality of radiomics studies. METHODS We conducted an online modified Delphi study with a group of international experts. It was performed in three consecutive stages: Stage#1, item preparation; Stage#2, panel discussion among EuSoMII Auditing Group members to identify the items to be voted; and Stage#3, four rounds of the modified Delphi exercise by panelists to determine the items eligible for the METRICS and their weights. The consensus threshold was 75%. Based on the median ranks derived from expert panel opinion and their rank-sum based conversion to importance scores, the category and item weights were calculated. RESULT In total, 59 panelists from 19 countries participated in selection and ranking of the items and categories. Final METRICS tool included 30 items within 9 categories. According to their weights, the categories were in descending order of importance: study design, imaging data, image processing and feature extraction, metrics and comparison, testing, feature processing, preparation for modeling, segmentation, and open science. A web application and a repository were developed to streamline the calculation of the METRICS score and to collect feedback from the radiomics community. CONCLUSION In this work, we developed a scoring tool for assessing the methodological quality of the radiomics research, with a large international panel and a modified Delphi protocol. With its conditional format to cover methodological variations, it provides a well-constructed framework for the key methodological concepts to assess the quality of radiomic research papers. CRITICAL RELEVANCE STATEMENT A quality assessment tool, METhodological RadiomICs Score (METRICS), is made available by a large group of international domain experts, with transparent methodology, aiming at evaluating and improving research quality in radiomics and machine learning. KEY POINTS • A methodological scoring tool, METRICS, was developed for assessing the quality of radiomics research, with a large international expert panel and a modified Delphi protocol. • The proposed scoring tool presents expert opinion-based importance weights of categories and items with a transparent methodology for the first time. • METRICS accounts for varying use cases, from handcrafted radiomics to entirely deep learning-based pipelines. • A web application has been developed to help with the calculation of the METRICS score ( https://metricsscore.github.io/metrics/METRICS.html ) and a repository created to collect feedback from the radiomics community ( https://github.com/metricsscore/metrics ).
Collapse
Affiliation(s)
- Burak Kocak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Tugba Akinci D'Antonoli
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.
| | - Nathaniel Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bettina Baessler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ilaria Ambrosini
- Department of Translational Research, Academic Radiology, University of Pisa, Pisa, Italy
| | - Anna E Andreychenko
- Laboratory for Digital Public Health Technologies, ITMO University, St. Petersburg, Russian Federation
| | - Spyridon Bakas
- Division of Computational Pathology, Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
- Center for Federated Learning in Precision Medicine, Indiana University, Indianapolis, IN, USA
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Keno Bressem
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Irene Buvat
- Institut Curie, Inserm, PSL University, Laboratory of Translational Imaging in Oncology, Orsay, France
| | - Roberto Cannella
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | | | - Armando Ugo Cavallo
- Division of Radiology, Istituto Dermopatico dell'Immacolata (IDI) IRCCS, Rome, Italy
| | - Leonid L Chepelev
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Linda Chi Hang Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Aydin Demircioglu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital , Essen, Germany
| | - Nandita M deSouza
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Department of Imaging, The Royal Marsden National Health Service (NHS) Foundation Trust, London, UK
| | - Matthias Dietzel
- Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | | | - Andrey Fedorov
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laure S Fournier
- Department of Radiology, Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris, France
| | | | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Kevin B W Groot Lipman
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Georgios Kalarakis
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Division of Radiology, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Medical School, University of Crete, Heraklion, Greece
| | - Brendan S Kelly
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
- Insight Centre for Data Analytics, UCD, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, FORTH, Heraklion, Crete, Greece
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Elmar Kotter
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Mario Maas
- Department of Radiology & Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Luis Marti-Bonmati
- Medical Imaging Department and Biomedical Imaging Research Group, Hospital Universitario y Politécnico La Fe and Health Research Institute, Valencia, Spain
| | - Henning Müller
- University of Applied Sciences of Western Switzerland (HES-SO Valais), Sierra, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UniGe), Geneva, Switzerland
| | - Nancy Obuchowski
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fanny Orlhac
- Institut Curie, Inserm, PSL University, Laboratory of Translational Imaging in Oncology, Orsay, France
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
- Department of Radiology, Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Ekaterina Petrash
- Radiology department, Research Institute of Pediatric Oncology and Hematology n. a. L.A. Durnov, National Medical Research Center of Oncology n. a. N.N. Blokhin Ministry of Health of Russian Federation, Moscow, Russia
- Medical Department IRA-Labs, Moscow, Russia
| | - Elisabeth Pfaehler
- Institute for advanced simulation (IAS-8): Machine learning and data analytics, Forschungszentrum Jülich, Jülich, Germany
| | - Daniel Pinto Dos Santos
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
- Institute for Diagnostic and Interventional Radiology, Goethe-University Frankfurt Am Main, Frankfurt, Germany
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sebastià Sabater
- Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Philipp Seeböck
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alberto Traverso
- Department of Radiotherapy, Maastro Clinic, Maastricht, the Netherlands
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter van Ooijen
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, Palermo, 90127, Italy
| | - Alan Wang
- Centre for Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Stuart Williams
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK
| | - Jan Witowski
- Department of Radiology, New York University Grossman School of Medicine, New York, USA
| | - Zhongyi Zhang
- School of Information and Communication Technology, Griffith University, Nathan, Brisbane, Australia
| | - Alex Zwanenburg
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| |
Collapse
|
6
|
Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Aksoy Ozcan U, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus SÖ, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Preoperative breast MRI positively impacts surgical outcomes of needle biopsy-diagnosed pure DCIS: a patient-matched analysis from the MIPA study. Eur Radiol 2023:10.1007/s00330-023-10409-5. [PMID: 37999727 DOI: 10.1007/s00330-023-10409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/06/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). METHODS The MIPA observational study database (7245 patients) was searched for patients aged 18-80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). RESULTS Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). CONCLUSIONS Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. CLINICAL RELEVANCE STATEMENT When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. KEY POINTS • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.
Collapse
Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Division of Molecular and Structural Preclinical Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Julia Camps Herrero
- Department of Radiology, Hospital Universitario de La Ribera, Alzira, Spain
- Ribera Salud Hospitals, Valencia, Spain
| | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
- Department of Radiology, Duna Medical Center, GE-RAD Kft, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit Aksoy Ozcan
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.R.L., La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Levaldigi, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Sila Ö Ulus
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| |
Collapse
|
7
|
Zuiani C, Mansutti I, Caronia G, Linda A, Londero V, Girometti R. Added value of the EUSOBI diffusion levels in breast MRI. Eur Radiol 2023:10.1007/s00330-023-10418-4. [PMID: 37932389 DOI: 10.1007/s00330-023-10418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate whether using the diffusion levels (DLs) proposed by the European Society of Breast Imaging (EUSOBI) improves the diagnostic accuracy of breast MRI. MATERIALS AND METHODS This retrospective study included 145 women who, between September 2019 and June 2020, underwent breast 1.5-T MRI with DWI. Reader 1 and reader 2 (R1-R2) independently assessed breast lesions using the BI-RADS on dynamic contrast-enhanced imaging and T2-weighted imaging. DWI was subsequently disclosed, allowing readers able to measure lesions ADC and subjectively express the overall risk of malignancy on a 1-5 Likert scale. ADCs were interpreted as a range of values corresponding to the EUSOBI DLs. The analysis evaluated the inter-reader agreement in measuring ADC and DLs, the per-DL malignancy rate, and accuracy for malignancy using ROC analysis against histological examination or a 3-year follow-up. RESULTS Lesions were malignant and showed non-mass enhancement in 67.7% and 76.1% of cases, respectively. ADC was measurable in 63.2%/66.7% of lesions (R1/R2), with a minimal discrepancy on Bland-Altman analysis and 0.948 (95%CI 0.925-0.965)/0.989 (95%CI 0.988-0.991) intraclass correlation coefficient in measuring ADC/DLs. The malignancy rate (R1/R2) increased from 0.5/0.5% ("very high" DL) to 96.0/96.8% ("very low" DL), as expected. Likert categorization showed larger areas under the curve than the BI-RADS for both R1 (0.91 versus 0.87; p = 0.0208) and R2 (0.91 versus 0.89; p = 0.1171), with improved specificity (81.5% versus 78.5% for R1 and 84.4% versus 81.2% for R2). CONCLUSION Though ADC was not measurable in about one-third of lesions, DLs were categorized with excellent inter-reader agreement, improving the specificity for malignancy. CLINICAL RELEVANCE STATEMENT DLs proposed by the EUSOBI are a reproducible tool to interpret the ADC of breast lesions and, in turn, to improve the specificity of breast MRI and reduce unnecessary breast biopsies. KEY POINTS • The European Society of Breast Imaging proposed diffusion levels for the interpretation of the apparent diffusion coefficient in diffusion-weighted imaging of the breast. • Adding diffusion levels to the interpretation of magnetic resonance imaging improved the diagnostic accuracy for breast cancer, especially in terms of specificity. • Diffusion levels can favor a more widespread and standardized use of diffusion-weighted imaging of the breast.
Collapse
Affiliation(s)
- Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Iris Mansutti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Guido Caronia
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Anna Linda
- Institute of Radiology, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Viviana Londero
- Institute of Radiology, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
| |
Collapse
|
8
|
Peruzzi V, Torresan S, Cortiula F, Fanelli M, Ermacora P, Girometti R, Cereser L. Unveiling the Potential of Venn Diagrams as a Helpful Tool for Clinical Reasoning: An Illustrative Case-based Discussion. Curr Probl Diagn Radiol 2023; 52:478-481. [PMID: 37438231 DOI: 10.1067/j.cpradiol.2023.06.002] [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] [Received: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
Venn diagrams graphically represent a cognitive approach that can assist in highlighting information shared by different data sets while eliminating nonoverlapping conditions. When applied to clinical reasoning, such an approach helps physicians visually focus on data pertaining to differential diagnoses. We present and discuss a 3-step reasoning pathway derived from a real-life case in which we used Venn diagrams to diagnose drug-related pneumonitis in a 67-year-old man with advanced bladder cancer and nodular lung findings at chest CT. This education paper supports using Venn diagrams in Radiology.
Collapse
Affiliation(s)
- Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Sara Torresan
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Francesco Cortiula
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy; Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martina Fanelli
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Paola Ermacora
- Department of Oncology, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy.
| |
Collapse
|
9
|
Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. Eur Radiol 2023; 33:6213-6225. [PMID: 37138190 PMCID: PMC10415233 DOI: 10.1007/s00330-023-09600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/19/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. METHODS The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. RESULTS A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. CONCLUSIONS Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. KEY POINTS • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.
Collapse
Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- BioMaps (UMR1281), INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone, Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.r.l, La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy
- CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| |
Collapse
|
10
|
Girometti R, Bertolotto M. Editorial for "Noninvasive Assessment of the Renal Function, Oxford Classification and Prognostic Risk Stratification of IgAN by Using Intravoxel Incoherent Motion Diffusion-Weighted Imaging and Blood Oxygenation Level-Dependent MRI". J Magn Reson Imaging 2023; 58:892-893. [PMID: 36651295 DOI: 10.1002/jmri.28598] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia-Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Michele Bertolotto
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, University Hospital Cattinara-Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Trieste, Italy
| |
Collapse
|
11
|
Cereser L, Evangelista L, Giannarini G, Girometti R. Prostate MRI and PSMA-PET in the Primary Diagnosis of Prostate Cancer. Diagnostics (Basel) 2023; 13:2697. [PMID: 37627956 PMCID: PMC10453091 DOI: 10.3390/diagnostics13162697] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/15/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Over the last years, prostate magnetic resonance imaging (MRI) has gained a key role in the primary diagnosis of clinically significant prostate cancer (csPCa). While a negative MRI can avoid unnecessary prostate biopsies and the overdiagnosis of indolent cancers, a positive examination triggers biopsy samples targeted to suspicious imaging findings, thus increasing the diagnosis of csPCa with a sensitivity and negative predictive value of around 90%. The limitations of MRI, including suboptimal positive predictive values, are fueling debate on how to stratify biopsy decisions and management based on patient risk and how to correctly estimate it with clinical and/or imaging findings. In this setting, "next-generation imaging" imaging based on radiolabeled Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is expanding its indications both in the setting of primary staging (intermediate-to-high risk patients) and primary diagnosis (e.g., increasing the sensitivity of MRI or acting as a problem-solving tool for indeterminate MRI cases). This review summarizes the current main evidence on the role of prostate MRI and PSMA-PET as tools for the primary diagnosis of csPCa, and the different possible interaction pathways in this setting.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, 20072 Milan, Italy;
- University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Gianluca Giannarini
- Urology Unit, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, 20072 Milan, Italy;
- University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| |
Collapse
|
12
|
Messina E, Pecoraro M, Laschena L, Bicchetti M, Proietti F, Ciardi A, Leonardo C, Sciarra A, Girometti R, Catalano C, Panebianco V. Low cancer yield in PI-RADS 3 upgraded to 4 by dynamic contrast-enhanced MRI: is it time to reconsider scoring categorization? Eur Radiol 2023; 33:5828-5839. [PMID: 37045981 PMCID: PMC10326099 DOI: 10.1007/s00330-023-09605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To evaluate MRI diagnostic performance in detecting clinically significant prostate cancer (csPCa) in peripheral-zone PI-RADS 4 lesions, comparing those with clearly restricted diffusion (DWI-score 4), and those with equivocal diffusion pattern (DWI-score 3) and positive dynamic contrast-enhanced (DCE) MRI. METHODS This observational prospective study enrolled 389 men referred to MRI and, if positive (PI-RADS 3 with PSA-density [PSAD] ≥ 0.15 ng/mL/mL, 4 and 5), to MRI-directed biopsy. Lesions with DWI-score 3 and positive DCE were classified as "PI-RADS 3up," instead of PI-RADS 4. Univariable and multivariable analyses were implemented to determine features correlated to csPCa detection. RESULTS Prevalence of csPCa was 14.5% and 53.3% in PI-RADS categories 3up and 4, respectively (p < 0.001). MRI showed a sensitivity of 100.0%, specificity 40.9%, PPV 46.5%, NPV 100.0%, and accuracy 60.9% for csPCa detection. Modifying the threshold to consider MRI positive and to indicate biopsy (same as previously described, but PI-RADS 3up only when associated with elevated PSAD), the sensitivity changed to 93.9%, specificity 57.2%, PPV 53.0%, NPV 94.8%, and accuracy 69.7%. Age (p < 0.001), PSAD (p < 0.001), positive DWI (p < 0.001), and PI-RADS score (p = 0.04) resulted in independent predictors of csPCa. CONCLUSIONS Most cases of PI-RADS 3up were false-positives, suggesting that upgrading peripheral lesions with DWI-score 3 to PI-RADS 4 because of positive DCE has a detrimental effect on MRI accuracy, decreasing the true prevalence of csPCa in the PI-RADS 4 category. PI-RADS 3up should not be upgraded and directed to biopsy only if associated with increased PSAD. KEY POINTS • As per PI-RADS v2.1 recommendations, in case of a peripheral zone lesion with equivocal diffusion-weighted imaging (DWI score 3), but positive dynamic contrast-enhanced (DCE) MRI, the overall PI-RADS score should be upgraded to 4. • The current PI-RADS recommendation of upgrading PI-RADS 3 lesions of the peripheral zone to PI-RADS 4 because of positive DCE decreased clinically significant prostate cancer detection rate in our series. • According to our results, the most accurate threshold for setting indication to prostate biopsy is PI-RADS 3 or PI-RADS 3 with positive DCE both associated with increased PSA density.
Collapse
Affiliation(s)
- Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Ludovica Laschena
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Marco Bicchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Flavia Proietti
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S, Maria Della Misericordia; P.Le S. Maria Della Misericordia 15, 33100, Udine, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, 00185, Rome, Italy.
| |
Collapse
|
13
|
Girometti R, Giannarini G, De Martino M, Caregnato E, Cereser L, Soligo M, Rozze D, Pizzolitto S, Isola M, Zuiani C. Multivariable stratification of PI-RADS version 2.1 categories for the risk of false-positive target biopsy: Impact on prostate biopsy decisions. Eur J Radiol 2023; 165:110897. [PMID: 37300933 DOI: 10.1016/j.ejrad.2023.110897] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/27/2023] [Revised: 04/30/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To identify clinical and multiparametric magnetic resonance imaging (mpMRI) factors predicting false positive target biopsy (FP-TB) of prostate imaging reporting and data system version 2.1 (PI-RADSv2.1) ≥ 3 findings. METHOD We retrospectively included 221 men with and without previous negative prostate biopsy who underwent 3.0 T/1.5 T mpMRI for suspicious clinically significant prostate cancer (csPCa) between April 2019-July 2021. A study coordinator revised mpMRI reports provided by one of two radiologists (experience of > 1500/>500 mpMRI examinations, respectively) and matched them with the results of transperineal systematic biopsy plus fusion target biopsy (TB) of PI-RADSv2.1 ≥ 3 lesions or PI-RADSv2.1 ≤ 2 men with higher clinical risk. A multivariable model was built to identify features predicting FP-TB of index lesions, defined as the absence of csPCa (International Society of Urogenital Pathology [ISUP] ≥ 2). The model was internally validated with the bootstrap technique, receiving operating characteristics (ROC) analysis, and decision analysis. RESULTS Features significantly associated with FP-TB were age < 65 years (odds ratio [OR] 2.77), prostate-specific antigen density (PSAD) < 0.15 ng/mL/mL (OR 2.45), PI-RADS 4/5 category vs. category 3 (OR 0.15/0.07), and multifocality (OR 0.46), with a 0.815 area under the curve (AUC) in assessing FP-TB. When adjusting PI-RADSv2.1 categorization for the model, mpMRI showed 87.5% sensitivity and 79.9% specificity for csPCa, with a greater net benefit in triggering biopsy compared to unadjusted categorization or adjustment for PSAD only at decision analysis, from threshold probability ≥ 15%. CONCLUSION Adjusting PI-RADSv2.1 categories for a multivariable risk of FP-TB is potentially more effective in triggering TB of index lesions than unadjusted PI-RADS categorization or adjustment for PSAD alone.
Collapse
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Maria De Martino
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine, Udine, Italy, pl.le Kolbe, 4, 33100 Udine, Italy
| | - Elena Caregnato
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| | - Matteo Soligo
- Urology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Davide Rozze
- Pathology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Miriam Isola
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine, Udine, Italy, pl.le Kolbe, 4, 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine (DAME), University of Udine, University Hospital S. Maria della Misericordia - Azienda Sanitaria-Universitaria Friuli Centrale (ASU FC), p.le S. Maria ella Misericordia, 15, 33100 Udine, Italy
| |
Collapse
|
14
|
Girometti R, Giannarini G, Peruzzi V, Amparore D, Pizzolitto S, Zuiani C. MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition. Eur J Radiol 2023; 164:110852. [PMID: 37167683 DOI: 10.1016/j.ejrad.2023.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Quality is currently recognized as the pre-requisite for delivering the clinical benefits expected by magnetic resonance imaging (MRI)-informed prostate biopsy (MRI-i-PB) in patients with a suspicion for clinically significant prostate cancer (csPCa). The "quality chain" underlying MRI-i-PB is multidisciplinary in nature, and depends on several factors related to the patient, imaging technique, image interpretation and biopsy procedure. This review aims at making the radiologist aware of biopsy-related factors impacting on MRI-i-PB quality, both in terms of biopsy planning (threshold for biopsy decisions, association with systematic biopsy and number of targeted cores) and biopsy acquisition (biopsy route, targeting technique, and operator's experience). While there is still space for improvement and better standardization of several biopsy-related procedures, current evidence suggests that high-quality MRI-i-PB can be delivered by acquiring and increased the number of biopsy cores targeted to suspicious imaging findings and perilesional area ("focal saturation biopsy"). On the other hand, uncertainty still exists as to whether software-assisted fusion of MRI and transrectal ultrasound images can outperform cognitive fusion strategy. The role for operator's experience and quality assurance/quality control procedures are also discussed.
Collapse
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Torino, Italy.
| | - Stefano Pizzolitto
- Unit of Pathology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| |
Collapse
|
15
|
Casagrande A, Fabris F, Girometti R. An information-oriented paradigm in evaluating accuracy and agreement in radiology. Eur Radiol Exp 2023; 7:14. [PMID: 36939967 PMCID: PMC10027965 DOI: 10.1186/s41747-023-00327-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/26/2023] [Indexed: 03/21/2023] Open
Abstract
The goal of any radiological diagnostic process is to gain information about the patient's status. However, the mathematical notion of information is usually not adopted to measure the performance of a diagnostic test or the agreement among readers in providing a certain diagnosis. Indeed, commonly used metrics for assessing diagnostic accuracy (e.g., sensitivity and specificity) or inter-reader agreement (Cohen [Formula: see text] statistics) use confusion matrices containing the number of true- and false positives/negatives results of a test, or the number of concordant/discordant categorizations, respectively, thus lacking proper information content. We present a methodological paradigm, based on Shannon's information theory, aiming to measure both accuracy and agreement in diagnostic radiology. This approach models the information flow as a "diagnostic channel" connecting the state of the patient's disease and the radiologist or, in the case of agreement analysis, as an "agreement channel" linking two or more radiologists evaluating the same set of images. For both cases, we proposed some measures, derived from Shannon's mutual information, which can represent an alternative way to express diagnostic accuracy and agreement in radiology.Key points• Diagnostic processes can be modeled with information theory (IT).• IT metrics of diagnostic accuracy are independent from disease prevalence.• IT metrics of inter-reader agreements can overcome Cohen κ pitfalls.
Collapse
Affiliation(s)
- Alberto Casagrande
- Dipartimento di Matematica e Geoscienze, Università degli Studi di Trieste, Trieste, Italy
| | - Francesco Fabris
- Dipartimento di Matematica e Geoscienze, Università degli Studi di Trieste, Trieste, Italy.
| | - Rossano Girometti
- Istituto di Radiologia, Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy
| |
Collapse
|
16
|
Zattoni F, Maresca S, Dal Moro F, Bednarova I, Randazzo G, Basso G, Reitano G, Giannarini G, Zuiani C, Girometti R. Abbreviated Versus Multiparametric Prostate MRI in Active Surveillance for Prostate-Cancer Patients: Comparison of Accuracy and Clinical Utility as a Decisional Tool. Diagnostics (Basel) 2023; 13:diagnostics13040578. [PMID: 36832066 PMCID: PMC9955028 DOI: 10.3390/diagnostics13040578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
(1) Purpose: To compare the diagnostic accuracy between full multiparametric contrast-enhanced prostate MRI (mpMRI) and abbreviated dual-sequence prostate MRI (dsMRI) in men with clinically significant prostate cancer (csPCa) who were candidates for active surveillance. (2) Materials and Methods: Fifty-four patients with a diagnosis of low-risk PCa in the previous 6 months had a mpMRI scan prior to a saturation biopsy and a subsequent MRI cognitive transperineal targeted biopsy (for PI-RADS ≥ 3 lesions). The dsMRI images were obtained from the mpMRI protocol. The images were selected by a study coordinator and assigned to two readers blinded to the biopsy results (R1 and R2). Inter-reader agreement for clinically significant cancer was evaluated with Cohen's kappa. The dsMRI and mpMRI accuracy was calculated for each reader (R1 and R2). The clinical utility of the dsMRI and mpMRI was investigated with a decision-analysis model. (3) Results: The dsMRI sensitivity and specificity were 83.3%, 31.0%, 75.0%, and 23.8%, respectively, for R1 and R2. The mpMRI sensitivity and specificity were 91.7%, 31.0%, 83.3%, and 23.8%, respectively, for R1 and R2. The inter-reader agreement for the detection of csPCa was moderate (k = 0.53) and good (k = 0.63) for dsMRI and mpMRI, respectively. The AUC values for the dsMRI were 0.77 and 0.62 for the R1 and R2, respectively. The AUC values for the mpMRI were 0.79 and 0.66 for R1 and R2, respectively. No AUC differences were found between the two MRI protocols. At any risk threshold, the mpMRI showed a higher net benefit than the dsMRI for both R1 and R2. (4) Conclusions: The dsMRI and mpMRI showed similar diagnostic accuracy for csPCa in male candidates for active surveillance.
Collapse
Affiliation(s)
- Fabio Zattoni
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-0498212931
| | - Silvio Maresca
- Department of Medicine, Institute of Radiology, University of Udine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Fabrizio Dal Moro
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padova, Italy
| | - Iliana Bednarova
- Department of Breast Radiology, Veneto Institute of Oncology, IRCCS, 35128 Padua, Italy
| | - Gianmarco Randazzo
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padova, Italy
| | - Giovanni Basso
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padova, Italy
| | - Giuseppe Reitano
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padova, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Chiara Zuiani
- Department of Medicine, Institute of Radiology, University of Udine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Rossano Girometti
- Department of Medicine, Institute of Radiology, University of Udine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| |
Collapse
|
17
|
Cereser L, Passarotti E, Tullio A, Patruno V, Monterubbiano L, Apa P, Zuiani C, Girometti R. Can a chest HRCT-based crash course on COVID-19 cases make inexperienced thoracic radiologists readily available to face the next pandemic? Clin Imaging 2023; 94:1-8. [PMID: 36434939 PMCID: PMC9678839 DOI: 10.1016/j.clinimag.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/08/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To test the inter-reader agreement in assessing lung disease extent, HRCT signs, and Radiological Society of North America (RSNA) categorization between a chest-devoted radiologist (CR) and two HRCT-naïve radiology residents (RR1 and RR2) after the latter attended a COVID-19-based chest high-resolution computed tomography (HRCT) "crash course". METHODS The course was built by retrospective inclusion of 150 patients who underwent HRCT for COVID-19 pneumonia between November 2020 and January 2021. During a first 10-days-long "training phase", RR1 and RR2 read a pool of 100/150 HRCTs, receiving day-by-day access to CR reports as feedback. In the subsequent 2-days-long "test phase", they were asked to report 50/150 HRCTs with no feedback. Test phase reports of RR1/RR2 were then compared with CR using unweighted or linearly-weighted Cohen's kappa (k) statistic and intraclass correlation coefficient (ICC). RESULTS We observed almost perfect agreement in assessing disease extent between RR1-CR (k = 0.83, p < 0.001) and RR2-CR (k = 0.88, p < 0.001). The agreement between RR1-CR and RR2-CR on consolidation, crazy paving pattern, organizing pneumonia (OP) pattern, and pulmonary artery (PA) diameter was substantial (k = 0.65 and k = 0.68), moderate (k = 0.42 and k = 0.51), slight (k = 0.10 and k = 0.20), and good-to-excellent (ICC = 0.87 and ICC = 0.91), respectively. The agreement in providing RSNA categorization was moderate for R1 versus CR (k = 0.56) and substantial for R2 versus CR (k = 0.67). CONCLUSION HRCT-naïve readers showed an acceptable overall agreement with CR, supporting the hypothesis that a crash course can be a tool to readily make non-subspecialty radiologists available to cooperate in reading high burden of HRCT examinations during a pandemic/epidemic.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital “S. Maria della Misericordia”, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy,Corresponding author
| | - Emanuele Passarotti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital “S. Maria della Misericordia”, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Annarita Tullio
- Institute of Hygiene and Clinical Epidemiology, University Hospital “S. Maria della Misericordia”, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Department, “S. Maria della Misericordia” University Hospital, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Leonardo Monterubbiano
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital “S. Maria della Misericordia”, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Pierpaolo Apa
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital “S. Maria della Misericordia”, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital “S. Maria della Misericordia”, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital “S. Maria della Misericordia”, p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| |
Collapse
|
18
|
Girometti R, Bertolotto M. Editorial for “Exploration of Interstitial Fibrosis in Chronic Kidney Disease by Diffusion‐Relaxation Correlation Spectrum MR Imaging: A Preliminary Study”. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine (DAME) University of Udine, University Hospital S. Maria della Misericordia – Azienda Sanitaria Universitaria Friuli Centrale (ASU FC) Udine Italy
| | - Michele Bertolotto
- Radiology Unit, Department of Medical, Surgical and Health Sciences University of Trieste, University Hospital Cattinara ‐ Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI) Trieste Italy
| |
Collapse
|
19
|
Cereser L, Marchesini F, Di Poi E, Quartuccio L, Zabotti A, Zuiani C, Girometti R. Structured report improves radiology residents' performance in reporting chest high-resolution computed tomography: a study in patients with connective tissue disease. Diagn Interv Radiol 2022; 28:569-575. [PMID: 36550757 PMCID: PMC9885652 DOI: 10.5152/dir.2022.21488] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the performance of radiology residents (RRs) when using a dedicated structured report (SR) template for chest HRCT in patients with suspected connective tissue disease-interstitial lung disease (CTD-ILD), compared to the traditional narrative report (NR). METHODS We retrospectively evaluated 50 HRCT exams in patients with suspected CTD-ILD. A chest-devoted radiologist reported all the HRCT exams as the reference standard, pointing out pulmonary fibrosis findings (i.e., honeycombing, traction bronchiectasis, reticulation, and volume loss), presence and pattern of ILD, and possible other diagnoses. We divided four RRs into two groups according to their expertise level. In each group, RRs reported all HRCT examinations alternatively with NR or SR, noting each report's reporting time. The Cohen's Kappa, Wilcoxon, and McNemar tests were used for statistical analysis. RESULTS Regarding the pulmonary fibrosis findings, we found higher agreement between RRs and the reference standard reader when using SR than NR, regardless of their expertise level, except for volume loss.RRs' accuracy for "other diagnosis" was higher when using SR than NR, moving from 0.48 to 0.66 in the novel group (p = 0.035) and from 0.44 to 0.80 in the expertise group (p < 0.001). No differences in accuracy were found between ILD presence and ILD pattern. The reporting time was significantly lower (p = 0.001) when using SR than NR. CONCLUSION SR is of value in increasing the reporting of critical chest HRCT findings in the complex CTD-ILD scenario and should be used early and systematically during the residency.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Department of Medicine, Institute of Radiology, University of Udine, Udine, Italy
| | - Filippo Marchesini
- Department of Medicine, Institute of Radiology, University of Udine, Udine, Italy
| | - Emma Di Poi
- Department of Medicine, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Luca Quartuccio
- Department of Medicine, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Alen Zabotti
- Department of Medicine, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Chiara Zuiani
- Department of Medicine, Institute of Radiology, University of Udine, Udine, Italy
| | - Rossano Girometti
- Department of Medicine, Institute of Radiology, University of Udine, Udine, Italy
| |
Collapse
|
20
|
Bicchetti M, Simone G, Giannarini G, Girometti R, Briganti A, Brunocilla E, Cardone G, De Cobelli F, Gaudiano C, Del Giudice F, Flammia S, Leonardo C, Pecoraro M, Schiavina R, Catalano C, Panebianco V. A novel pathway to detect muscle-invasive bladder cancer based on integrated clinical features and VI-RADS score on MRI: results of a prospective multicenter study. Radiol Med 2022; 127:881-890. [PMID: 35763251 PMCID: PMC9349064 DOI: 10.1007/s11547-022-01513-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
To determine the clinical, pathological, and radiological features, including the Vesical Imaging-Reporting and Data System (VI-RADS) score, independently correlating with muscle-invasive bladder cancer (BCa), in a multicentric national setting.
Method and Materials
Patients with BCa suspicion were offered magnetic resonance imaging (MRI) before trans-urethral resection of bladder tumor (TURBT). According to VI-RADS, a cutoff of ≥ 3 or ≥ 4 was assumed to define muscle-invasive bladder cancer (MIBC). Trans-urethral resection of the tumor (TURBT) and/or cystectomy reports were compared with preoperative VI-RADS scores to assess accuracy of MRI for discriminating between non-muscle-invasive versus MIBC. Performance was assessed by ROC curve analysis. Two univariable and multivariable logistic regression models were implemented including clinical, pathological, radiological data, and VI-RADS categories to determine the variables with an independent effect on MIBC.
Results
A final cohort of 139 patients was enrolled (median age 70 [IQR: 64, 76.5]). MRI showed sensitivity, specificity, PPV, NPV, and accuracy for MIBC diagnosis ranging from 83–93%, 80–92%, 67–81%, 93–96%, and 84–89% for the more experienced readers. The area under the curve (AUC) was 0.95 (0.91–0.99). In the multivariable logistic regression model, the VI-RADS score, using both a cutoff of 3 and 4 (P < .0001), hematuria (P = .007), tumor size (P = .013), and concomitant hydronephrosis (P = .027) were the variables correlating with a bladder cancer staged as ≥ T2. The inter-reader agreement was substantial (k = 0.814).
Conclusions
VI-RADS assessment scoring proved to be an independent predictor of muscle-invasiveness, which might implicate a shift toward a more aggressive selection approach of patients’ at high risk of MIBC, according to a novel proposed predictive pathway.
Collapse
Affiliation(s)
- Marco Bicchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, 'Regina Elena' National Cancer Institute, IRCCS, Rome, Italy
| | - Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS Vita-Salute San Raffaele University, Milan, Italy
| | | | - Gianpiero Cardone
- Department of Radiology, IRCCS Ospedale San Raffaele Di Turro, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCSS Vita-Salute San Raffaele University, Milan, Italy
| | | | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Simone Flammia
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | | | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy.
| |
Collapse
|
21
|
Cereser L, Giovannini I, Caronia G, Zabotti A, De Vita S, Zuiani C, Quartuccio L, Girometti R. Chest high-resolution computed tomography in primary Sjögren's syndrome: an up-to-date primer for rheumatologists. Clin Exp Rheumatol 2022; 40:2450-2462. [DOI: 10.55563/clinexprheumatol/9t3ul2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University Hospital S. Maria della Misericordia, University of Udine, Italy.
| | - Ivan Giovannini
- Rheumatology Clinic, University Hospital S. Maria della Misericordia, University of Udine, Italy
| | - Guido Caronia
- Institute of Radiology, Department of Medicine, University Hospital S. Maria della Misericordia, University of Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, University Hospital S. Maria della Misericordia, University of Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, University Hospital S. Maria della Misericordia, University of Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University Hospital S. Maria della Misericordia, University of Udine, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, University Hospital S. Maria della Misericordia, University of Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University Hospital S. Maria della Misericordia, University of Udine, Italy
| |
Collapse
|
22
|
Kalor A, Girometti R, Maheshwari E, Kierans AS, Pugliesi RA, Buros C, Furlan A. Update on MR Contrast Agents for Liver Imaging. Radiol Clin North Am 2022; 60:679-694. [DOI: 10.1016/j.rcl.2022.04.005] [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: 11/17/2022]
|
23
|
Pecoraro M, Turkbey BI, Purysko AS, Girometti R, Giannarini G, Villeirs G, Roberto M, Catalano C, Padhani AR, Barentsz JO, Panebianco V. Diagnostic Accuracy and Observer Agreement of the MRI Prostate Imaging for Recurrence Reporting Assessment Score. Radiology 2022; 304:342-350. [PMID: 35536130 DOI: 10.1148/radiol.212252] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Prostate cancer local recurrence location and extent must be determined in an accurate and timely manner. Because of the lack of a standardized MRI approach after whole-gland treatment, a panel of international experts recently proposed the Prostate Imaging for Recurrence Reporting (PI-RR) assessment score. Purpose To determine the diagnostic accuracy of PI-RR for detecting local recurrence in patients with biochemical recurrence (BCR) after radiation therapy (RT) or radical prostatectomy (RP) and to evaluate the interreader variability of PI-RR scoring. Materials and Methods This retrospective observational study included patients who underwent multiparametric MRI between September 2016 and May 2021 for BCR after RT or RP. MRI scans were analyzed, and a PI-RR score was assigned independently by four radiologists. The reference standard was defined using histopathologic findings, follow-up imaging, or clinical response to treatment. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to assess PI-RR performance for each reader. The intraclass correlation coefficient was used to determine interreader agreement. Results A total of 100 men were included: 48 patients after RT (median age, 76 years [IQR, 70-82 years]) and 52 patients after RP (median age, 70 years [IQR, 66-74 years]). After RT, with PI-RR of 3 or greater as a cutoff (assigned when recurrence is uncertain), diagnostic performance ranges were 71%-81% sensitivity, 74%-93% specificity, 71%-89% PPV, 79%-86% NPV, and 77%-88% accuracy across the four readers. After RP, with PI-RR of 3 or greater as a cutoff, performance ranges were 59%-83% sensitivity, 87%-100% specificity, 88%-100% PPV, 66%-80% NPV, and 75%-85% accuracy. The intraclass correlation coefficient was 0.87 across the four readers for both the RT and RP groups. Conclusion MRI scoring with the Prostate Imaging for Recurrence Reporting assessment provides structured, reproducible, and accurate evaluation of local recurrence after definitive therapy for prostate cancer. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Haider in this issue.
Collapse
Affiliation(s)
- Martina Pecoraro
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Baris I Turkbey
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Andrei S Purysko
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Rossano Girometti
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Gianluca Giannarini
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Geert Villeirs
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Michela Roberto
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Carlo Catalano
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Anwar R Padhani
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Jelle O Barentsz
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| | - Valeria Panebianco
- From the Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy (M.P., M.R., C.C., V.P.); National Cancer Institute, Center for Cancer Research, Bethesda, Md (B.I.T.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (A.S.P.); Institute of Radiology (R.G.) and Unit of Urology (G.G.), Santa Maria della Misericordia Academic Medical Center, Udine, Italy; Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium (G.V.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, England (A.R.P.); and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.O.B.)
| |
Collapse
|
24
|
Cereser L, Zancan G, Giovannini I, Cicciò C, Tinazzi I, Variola A, Bramuzzo M, Murru FM, Marino M, Tullio A, De Vita S, Girometti R, Zabotti A. Asymptomatic sacroiliitis detected by magnetic resonance enterography in patients with Crohn's disease: prevalence, association with clinical data, and reliability among radiologists in a multicenter study of adult and pediatric population. Clin Rheumatol 2022; 41:2499-2511. [PMID: 35389115 DOI: 10.1007/s10067-022-06143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/10/2022] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with Crohn's disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most frequent extraintestinal manifestation in inflammatory bowel diseases, especially in CD, with sacroiliitis at imaging occurring in about 6-46% of patients and possibly correlating with axial spondyloarthritis. The primary study aim was to assess the prevalence of sacroiliitis in adult and pediatric patients with CD performing an MRE. We also evaluated the inter-rater agreement for MRE sacroiliitis and the association between sacroiliitis and patients' clinical data. METHOD We retrospectively identified 100 adult and 30 pediatric patients diagnosed with CD who performed an MRE between December 2012 and May 2020 in three inflammatory bowel disease centers. Two radiologists assessed the prevalence of sacroiliitis at MRE. We evaluated the inter-rater agreement for sacroiliitis with Cohen's kappa and intraclass correlation coefficient statistics and assessed the correlation between sacroiliitis and demographic, clinical, and endoscopic data (Chi-square and Fisher's tests). RESULTS The prevalence of sacroiliitis at MRE was 20% in adults and 6.7% in pediatric patients. The inter-rater agreement for sacroiliitis was substantial (k = 0.62, p < 0.001) in the adults and moderate (k = 0.46, p = 0.011) in the pediatric cohort. Age ≥ 50 years and the time between CD diagnosis and MRE (≥ 86.5 months) were significantly associated with sacroiliitis in adult patients (p = 0.049 and p = 0.038, respectively). CONCLUSIONS Sacroiliitis is a frequent and reliable abnormality at MRE in adult patients with CD, associated with the age of the patients ≥ 50 years and CD duration.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy.
| | - Giovanni Zancan
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Carmelo Cicciò
- Department of Diagnostic Imaging and Interventional Radiology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Ilaria Tinazzi
- Department of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Angela Variola
- Department of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5-37024, Negrar di Valpolicella, Verona, Italy
| | - Matteo Bramuzzo
- Gastroenterology, Digestive Endoscopy, and Nutrition Unit Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Via dell Istria 65/1-34137, Trieste, Italy
| | - Flora Maria Murru
- Pediatric Radiology, IRCSS Burlo Garofolo, Via dell'Istria 65/1-34137, Trieste, Italy
| | - Marco Marino
- Department of Gastroenterology, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Annarita Tullio
- Institute of Hygiene and Clinical Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| | - Alen Zabotti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, ple S. Maria della Misericordia, 15-33100, Udine, Italy
| |
Collapse
|
25
|
Girometti R, Blandino A, Zichichi C, Cicero G, Cereser L, De Martino M, Isola M, Zuiani C, Ficarra V, Valotto C, Bertolotto M, Giannarini G. Inter-reader agreement of the Prostate Imaging Quality (PI-QUAL) score: A bicentric study. Eur J Radiol 2022; 150:110267. [PMID: 35325773 DOI: 10.1016/j.ejrad.2022.110267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/26/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the inter-reader agreement of the Prostate imaging quality (PI-QUAL) for multiparametric magnetic resonance imaging (mpMRI). METHODS We included 66 men who underwent 1.5 T mpMRI in June 2020-July 2020 in center 1, with no exclusion criteria. mpMRI included multiplanar T2-weighted imaging (T2WI), Diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCE). Two readers from center 2 (experience <1000 to >1500 examinations), blinded to clinical history but not to acquisition parameters, independently assessed PI-QUAL qualitative/anatomical items of each mpMRI sequence, final PI-QUAL score (1-5), and the Prostate imaging reporting and data system version 2.1 (PI-RADSv2.1) category of the index lesion. Cohen's kappa statistics (k) or prevalence-adjusted-bias-adjusted kappa (PABAK) were used to calculate the inter-reader agreement in assessing the PI-QUAL (1-to-5 scale and 1-2 versus 3 versus 4-5), the diagnostic quality of each mpMRI sequence, qualitative/anatomical items, and PI-RADSv2.1 category. RESULTS The inter-reader agreement for PI-QUAL category was moderate upon 1-5 scale (k = 0.55; 95%CI 0.39-0.71) or 1-3 scale (k = 0.51; 95%CI 0.29-0.72), with 90.9% examinations categorized PI-QUAL ≥ 3 by readers. The agreement in assessing a sequence as diagnostic was higher for T2WI (k = 0.76) than DCE (PABAK = 0.61) and DWI (k = 0.46), ranging moderate-to-substantial for most of the items. Readers provided comparable PI-RADSv2.1 categorization (k = 0.88 [excellent agreement]; 95%CI 0.81-0.96), with most PI-RADSv2.1 ≥ 3 assignments found in PI-QUAL ≥ 3 examinations (43/46 by reader 1, and 47/47 by reader 2). CONCLUSIONS The reproducibility of PI-QUAL was moderate. Higher PI-QUAL scores were associated with excellent inter-reader agreement for PI-RADSv2.1 categorization.
Collapse
Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria n. 1, 98100, Messina, Italy.
| | - Clara Zichichi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria n. 1, 98100, Messina, Italy.
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Maria De Martino
- Division of Medical Statistic, Department of Medicine, University of Udine, p.le Kolbe n. 4, 33100 Udine, Italy.
| | - Miriam Isola
- Division of Medical Statistic, Department of Medicine, University of Udine, p.le Kolbe n. 4, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Via Consolare Valeria n. 1 - 98100, Messina, Italy.
| | - Claudio Valotto
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, University Hospital Cattinara, Strada di Fiume n. 447, 34149 Trieste, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| |
Collapse
|
26
|
Casagrande A, Fabris F, Girometti R. Fifty years of Shannon information theory in assessing the accuracy and agreement of diagnostic tests. Med Biol Eng Comput 2022; 60:941-955. [PMID: 35195818 PMCID: PMC8863911 DOI: 10.1007/s11517-021-02494-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/10/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Abstract
Since 1948, Shannon theoretic methods for modeling information have found a wide range of applications in several areas where information plays a key role, which goes well beyond the original scopes for which they have been conceived, namely data compression and error correction over a noisy channel. Among other uses, these methods have been applied in the broad field of medical diagnostics since the 1970s, to quantify diagnostic information, to evaluate diagnostic test performance, but also to be used as technical tools in image processing and registration. This review illustrates the main contributions in assessing the accuracy of diagnostic tests and the agreement between raters, focusing on diagnostic test performance measurements and paired agreement evaluation. This work also presents a recent unified, coherent, and hopefully, final information-theoretical approach to deal with the flows of information involved among the patient, the diagnostic test performed to appraise the state of disease, and the raters who are checking the test results. The approach is assessed by considering two case studies: the first one is related to evaluating extra-prostatic cancers; the second concerns the quality of rapid tests for COVID-19 detection.
Collapse
Affiliation(s)
- Alberto Casagrande
- Dipartimento di Matematica e Geoscienze, Università degli Studi di Trieste, Trieste, Italy
| | - Francesco Fabris
- Dipartimento di Matematica e Geoscienze, Università degli Studi di Trieste, Trieste, Italy.
| | - Rossano Girometti
- Istituto di Radiologia, Dipartimento di Area Medica, Università degli Studi di Udine, Ospedale S. Maria della Misericordia, Udine, Italy
| |
Collapse
|
27
|
Giovannini I, Lorenzon M, Manfrè V, Zandonella Callegher S, Pegolo E, Zuiani C, Girometti R, Hocevar A, Dejaco C, Luca Q, De Vita S, Zabotti A. Safety, patient acceptance and diagnostic accuracy of ultrasound core needle biopsy of parotid or submandibular glands in primary Sjögren's syndrome with suspected salivary gland lymphoma. RMD Open 2022; 8:rmdopen-2021-001901. [PMID: 35131750 PMCID: PMC8823241 DOI: 10.1136/rmdopen-2021-001901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/27/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022] Open
Abstract
Background Enlargement of the major salivary glands (SGs) is a major risk factor for B-cell lymphoma among patients with primary Sjögren’s syndrome (pSS). Ultrasound-guided core needle biopsy (US-guided CNB) could be a novel technique to manage SG enlargement among patients with pSS. Objective Accordingly, this study’s main aim was to evaluate the safety, patient tolerance and diagnostic accuracy of US-guided CNB procedure for patients with pSS with major SG enlargement. Methods Patients with clinical diagnosis of pSS and a clinical indication for SG biopsy consecutively underwent US-guided CNB between September 2019 and June 2021. These patients were evaluated clinically 1, 2 and 12 weeks after US-guided CNB. Patients were asked to complete a questionnaire about postprocedural complications as well as periprocedural pain, using the Visual Analogue Scale. Complications were categorised as transient (<12 weeks) or persistent (≥12 weeks). Results US-guided CNB was performed on 30 major salivary glands (22 parotid glands and 8 submandibular glands). The procedure was well tolerated. Transient complications—such as haematoma, swelling—were observed among 43% of patients, and mean periprocedural pain was low. However, no persistent complications were reported during the study’s follow-up period. Conclusion US-guided CNB represents a novel approach for the management of patients with pSS with SG enlargement. The procedure showed remarkable patient safety and tolerance, allowing adequate glandular sampling and a definite diagnosis for almost all participating patients without long-term complications.
Collapse
Affiliation(s)
- Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Michele Lorenzon
- Institute of Radiology, Department of Medicine, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy.,Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Enrico Pegolo
- Institute of Anatomic Pathology, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Alojzija Hocevar
- Department of Rheumatology, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Christian Dejaco
- Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy.,Department of Rheumatology, Medical University Graz, Graz, Austria
| | - Quartuccio Luca
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia' c/o University of Udine, Udine, Italy
| |
Collapse
|
28
|
Vetrugno L, Sala A, Orso D, Meroi F, Fabbro S, Boero E, Valent F, Cammarota G, Restaino S, Vizzielli G, Girometti R, Merelli M, Tascini C, Bove T, Driul L. Lung Ultrasound Signs and Their Correlation With Clinical Symptoms in COVID-19 Pregnant Women: The "PINK-CO" Observational Study. Front Med (Lausanne) 2022; 8:768261. [PMID: 35127744 PMCID: PMC8814327 DOI: 10.3389/fmed.2021.768261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/31/2021] [Accepted: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To analyze the application of lung ultrasound (LUS) diagnostic approach in obstetric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and compare LUS score and symptoms of the patients. Design A single-center observational retrospective study from October 31, 2020 to March 31, 2021. Setting Department of Ob/Gyn at the University-Hospital of Udine, Italy. Participants Pregnant women with SARS-CoV-2 diagnosed with reverse transcription-PCR (RT-PCR) swab test were subdivided as symptomatic and asymptomatic patients with COVID-19. Exposure Lung ultrasound evaluation both through initial evaluation upon admission and through serial evaluations. Main Outcome Reporting LUS findings and LUS score characteristics. Results Symptomatic patients with COVID-19 showed a higher LUS (median 3.5 vs. 0, p < 0.001). LUS was significantly correlated with COVID-19 biomarkers as C-reactive protein (CPR; p = 0.011), interleukin-6 (p = 0.013), and pro-adrenomedullin (p = 0.02), and inversely related to arterial oxygen saturation (p = 0.004). The most frequent ultrasound findings were focal B lines (14 vs. 2) and the light beam (9 vs. 0). Conclusion Lung ultrasound can help to manage pregnant women with SARS-CoV-2 infection during a pandemic surge. Study Registration ClinicalTrials.gov, NCT04823234. Registered on March 29, 2021.
Collapse
Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Alessia Sala
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Francesco Meroi
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | | | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Francesca Valent
- Department of Epidemiology and Public Health, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, University of Perugia, Perugia, Italy
| | - Stefano Restaino
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Giuseppe Vizzielli
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Rossano Girometti
- Department of Medicine, University of Udine, Udine, Italy.,Department of Radiology, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Maria Merelli
- Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy.,Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | | |
Collapse
|
29
|
Girometti R, Giannarini G, Panebianco V, Maresca S, Cereser L, De Martino M, Pizzolitto S, Pecoraro M, Ficarra V, Zuiani C, Valotto C. Comparison of different thresholds of PSA density for risk stratification of PI-RADSv2.1 categories on prostate MRI. Br J Radiol 2021; 95:20210886. [PMID: 34762506 PMCID: PMC8978227 DOI: 10.1259/bjr.20210886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the effect of different PSA density (PSAD) thresholds on the accuracy for clinically significant prostate cancer (csPCa) of the Prostate Imaging Reporting And Data System v.2.1 (PI-RADSv2.1). METHODS We retrospectively included 123 biopsy-naïve men who underwent multiparametric magnetic resonance imaging (mpMRI) and transperineal mpMRI-targeted and systematic prostate biopsy between April 2019 and October 2020. mpMRI, obtained on a 3.0T magnet with a PI-RADSv2.1-compliant protocol, was read by two radiologists (>1500/>500 mpMRI examinations). csPCa was defined as International Society of Urogenital Pathology grading group ≥2. Receiver operating characteristic analysis was used to calculate per-index lesion sensitivity, specificity, and area under the curve (AUC) of PI-RADSv.2.1 categories after adjusting for PSAD ≥0.10,≥0.15, and ≥0.20 ng/mL ml-1. Per-adjusted category cancer detection rate (CDR) was calculated, and decision analysis performed to compare PSAD-adjusted PI-RADSv.2.1 categories as a biopsy trigger. RESULTS csPCa prevalence was 43.9%. PSAD-adjustment increased the CDR of PI-RADSv2.1 category 4. Sensitivity/specificity/AUC were 92.6%/53.6%/0.82 for unadjusted PI-RADS, and 85.2%/72.4%/0.84, 62.9%/85.5%/0.83, and 92.4%/53.6%/0.82 when adjusting PI-RADS categories for a 0.10, 0.15, and 0.20 ng/ml ml-1 PSAD threshold, respectively. Triggering biopsy for PI-RADS four lesions and PSAD ≥0.10 ng/mL ml-1 was the strategy with greatest net benefit at 30 and 40% risk probability (0.307 and 0.271, respectively). CONCLUSIONS PI-RADSv2.1 category four with PSAD ≥0.10 ng/mL ml-1 was the biopsy-triggering cut-off with the highest net benefit in the range of expected prevalence for csPCa. ADVANCES IN KNOWLEDGE 0.10 ng/mL ml-1 is the PSAD threshold with higher clinical utility in stratifying the risk for prostate cancer of PI-RADSv.2.1 categories.
Collapse
Affiliation(s)
- Rossano Girometti
- Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital, Udine, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Silvio Maresca
- Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital, Udine, Italy
| | - Lorenzo Cereser
- Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital, Udine, Italy
| | - Maria De Martino
- Division of Medical Statistic, Department of Medicine, University of Udine, Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section,University of Messina, Messina, Italy
| | - Chiara Zuiani
- Department of Medicine, Institute of Radiology, University of Udine, Santa Maria dellaMisericordia University Hospital, Udine, Italy
| | - Claudio Valotto
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| |
Collapse
|
30
|
Como G, Valotto C, Tulipano Di Franco F, Giannarini G, Cereser L, Girometti R, Zuiani C. Role of contrast-enhanced ultrasound in assessing indeterminate renal lesions and Bosniak ≥2F complex renal cysts found incidentally on CT or MRI. Br J Radiol 2021; 94:20210707. [PMID: 34432542 PMCID: PMC8553198 DOI: 10.1259/bjr.20210707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the impact of contrast-enhanced ultrasound (CEUS) in reclassifying incidental renal findings categorized as indeterminate lesions (IL) or Bosniak ≥ 2F complex renal cysts (CRC) on CT or MRI. Methods: We retrospectively included 44 subjects who underwent CEUS between 2016 and 2019 to assess 48 IL (n = 12) and CRC (n = 36) incidentally found on CT or MRI. CEUS was performed by one radiologist with 10 year of experience with a sulfur hexafluoride-filled microbubble contrast agent. The same radiologist, blinded to clinical information and previous CT/MRIs, retrospectively reviewed CEUS images/videos, categorizing renal findings with Bosniak-derived imaging categories ranging from 0 (indeterminate) to 5 (solid lesion). CEUS-related reclassification rate was calculated (proportion of IL reclassified with an imaging category >0, or CRC reclassified below or above imaging category >2F). Using histological examination or a ≥ 24 months follow-up as the standard of reference, we also estimated per-lesion sensitivity/specificity for malignancy. Results: CEUS reclassified 24/48 findings (50.0%; 95% C.I. 35.2–64.7), including 12/12 IL (100%; 95% CI 73.5–100) and 12/36 CRC (33.3%; 95% C.I. 18.5–50.9), mostly above category >2F (66.7%). CEUS and CT/MRI showed 96.0% (95%CI 79.7–99.9) vs 44.0% (95%CI 24.4–65.1) sensitivity, and 82.6% (95%CI 61.2–95.1) vs 60.9% (95%CI 38.5–80.3%) specificity. Conclusion: CEUS provided substantial and accurate reclassification of CT/MRI incidental findings. Advances in knowledge: Previous studies included Bosniak 2 incidental findings, thus possibly underestimating CEUS-induced reclassification rates. Using a more meaningful cut-off (Bosniak ≥2F), problem-solving CEUS was effective as well, with higher reclassification rates for CRC than in literature.
Collapse
Affiliation(s)
- Giuseppe Como
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Claudio Valotto
- Urology Unit, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Francesco Tulipano Di Franco
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | | | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| |
Collapse
|
31
|
Lorenzon M, Tulipano Di Franco F, Zabotti A, Pegolo E, Giovannini I, Manfrè V, Mansutti E, De Vita S, Zuiani C, Girometti R. Sonographic features of lymphoma of the major salivary glands diagnosed with ultrasound-guided core needle biopsy in Sjögren's syndrome. Clin Exp Rheumatol 2021; 39 Suppl 133:175-183. [PMID: 34665707 DOI: 10.55563/clinexprheumatol/4c36nr] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To identify ultrasound (US) features of lymphomas (L) of major salivary glands (SGs) in primary Sjögren's syndrome (pSS) patients and to differentiate US pattern of L and non-L. METHODS Prospectively, from September 2019 to March 2021, 27 pSS-patients with clinical findings suspicious for L of the SGs underwent US evaluation followed by US-guided core-needle biopsy (CNB). For each patient, we assessed the OMERACT score, dichotomised (0/1 "lower", 2/3 "higher"), and we compared it between L-pSS and nonL-pSS groups. For focal lesions, echogenicity, inner appearance, shape, margins, presence of septa, vascularisation and posterior acoustic features were also assessed and compared between the two groups; we planned to consider as "suspicious" features more frequently associated with L. We expected to compare frequencies at which two or more "suspicious" features were simultaneously present between L-pSS and nonL-pSS. P<0.05 were considered statistically significant. RESULTS L-pSS showed more inhomogeneous glandular pattern (100% vs. 69.2% higher OMERACT; p=0.0407). For focal lesions, the "suspicious" features identified were: OMERACT grade 3, very hypoechoic, homogenous, oval shape, well-defined margins, presence of septa, colour-Doppler vascularization, posterior acoustic enhancement. 6/8 and 7/8 simultaneous suspicious features were significantly higher among L-pSS patients, compared to nonL-pSS (88.9% vs. 28.6%, p=0.034 for 6/8 features; 77.8% vs. 14.3%, p=0.040 for 7/8 features). CONCLUSIONS L of the major SGs in pSS was always associated with OMERACT scores 2 or 3 and presented with diffuse or focal patterns. For focal lesions, the association of more "suspicious" features made the diagnosis of L increasingly more likely. This information can help to improve planning of US-guided CNB.
Collapse
Affiliation(s)
- Michele Lorenzon
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | | | - Alen Zabotti
- Clinic of Rheumatology, Department of Medicine, University of Udine, Italy
| | - Enrico Pegolo
- Institute of Pathology, Department of Experimental and Clinical Medical Sciences, University of Udine, Italy
| | - Ivan Giovannini
- Clinic of Rheumatology, Department of Medicine, University of Udine, Italy
| | - Valeria Manfrè
- Clinic of Rheumatology, Department of Medicine, University of Udine, Italy
| | - Elisa Mansutti
- Department of General Medicine, Hospital of Latisana, ASUFC, Udine, Italy
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medicine, University of Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, Italy
| |
Collapse
|
32
|
Cereser L, Zabotti A, Zancan G, Quartuccio L, Cicciò C, Giovannini I, De Vita S, Zuiani C, Girometti R. Magnetic resonance imaging assessment of ASAS-defined active sacroiliitis in patients with inflammatory back pain and suspected axial spondyloarthritis: a study of reliability. Clin Exp Rheumatol 2021; 39:1331-1337. [PMID: 33635212 DOI: 10.55563/clinexprheumatol/8d6y80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The main purpose was to investigate the intra- and inter-rater reliability of the Assessment of SpondyloArthritis international Society (ASAS) definition of positive MRI for active sacroiliitis (ASAS-positive MRI), in a sample of patients with inflammatory back pain (IBP) and suspected axial spondyloarthritis (axSpA), who underwent sacroiliac joints (SIJ) MRI. We also evaluated the intra- and inter-rater reliability for the detection of the recently ASAS-refined findings indicating inflammatory activity. METHODS We retrospectively identified 105 consecutive patients with IBP and suspected axSpA who underwent SIJ MRI. Two radiologists in two distinct reading sessions assessed the prevalence of ASAS-positive MRI and of ASAS-defined signs of inflammatory activity. We determined the intra-rater and inter-rater reliability of the above-mentioned variables by means of prevalence-adjusted bias-adjusted kappa (PABAK) statistic, and verified whether there was any significant difference in providing the diagnosis of ASAS-positive MRI on an inter-rater basis (McNemar test). RESULTS We observed substantial reliability in assessing a SIJ MRI as ASAS-positive both on intra-rater basis (PABAK ranging 0.70-0.77) and inter-rater basis (PABAK 0.71 for the first reading, and 0.64 for the second reading). No significant difference in the rate of diagnosis between raters was found (p>0.99 for both reading sets). Intra-rater and inter-rater reliability for inflammatory activity signs ranged from moderate to almost perfect. CONCLUSIONS The substantial intra- and inter-rater reliability in assessing the ASAS-positive MRI supports its use for classification purposes. The variable reliability of inflammatory activity signs suggests they are suboptimal as a complement to the current definition of ASAS-positive MRI.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy.
| | - Giovanni Zancan
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Carmelo Cicciò
- Department of Diagnostic Imaging and Interventional Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| |
Collapse
|
33
|
Sardanelli F, Trimboli RM, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, Cozzi A, de Andrade DA, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Sacchetto D, Scaperrotta GP, Schiaffino S, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Di Leo G. Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA). Eur Radiol 2021; 32:1611-1623. [PMID: 34643778 PMCID: PMC8831264 DOI: 10.1007/s00330-021-08240-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 06/05/2021] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. METHODS This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. RESULTS Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). CONCLUSIONS Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. KEY POINTS • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.
Collapse
Affiliation(s)
- Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy. .,Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
| | - Rubina M Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | | | | | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Università degli Studi di Palermo, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit A Ozcan
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Research Group: Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | - Daniela Sacchetto
- Kiwifarm S.R.L, La Morra, Italy.,Disaster Medicine Service 118, ASL CN1, Saluzzo, Italy.,CRIMEDIM, Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.,Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Özden S Ulus
- Unit of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Università degli Studi di Udine, Udine, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
34
|
Girometti R, Sardanelli F, Marconi V, Bondini F, De Serio I, Bracciani A, Londero V, Zuiani C. Diagnostic Performance of Digital Breast Tomosynthesis, Unenhanced MRI, and Their Combination in the Preoperative Assessment of Breast Cancer: A Multi-reader Study. Acad Radiol 2021; 28:1339-1351. [PMID: 32307272 DOI: 10.1016/j.acra.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 01/31/2023]
Abstract
RATIONALE AND OBJECTIVES To compare the diagnostic performance of digital breast tomosynthesis (DBT) and unenhanced magnetic resonance imaging (UMRI) in the preoperative assessment of breast cancer. MATERIALS AND METHODS We retrospectively included 59 patients with 74 pathology-proven cancers who underwent DBT and preoperative 1.5 T magnetic resonance imaging between January 2016 and February 2017. Four residents with 2-3 years of experience, blinded to pathology, independently reviewed DBT and UMRI (diffusion-weighted and unenhanced T1-weighted sequences), using the breast imaging reporting and data system (BI-RADS) and a 0-5 Likert score, respectively. We calculated per-lesion sensitivity and positive predictive value of DBT, UMRI, and combined DBT+UMRI, as well as the agreement between DBT and UMRI vs. pathology in assessing cancer size (Bland-Altman analysis). Logistic regression was performed to assess clinical features predictive of missing cancer. RESULTS Of 74 lesions, 84% were invasive ductal carcinoma, 27% of which with an in situ component; 31% of cancers were ≤10 mm large. Sensitivity of UMRI (74-85%) was equal or higher than that of DBT (68-82%), with similar positive predictive value (93-97% vs. 98-100%, respectively). DBT+UMRI increased the sensitivity up to 88%. UMRI showed closer limits of agreement with pathological size than DBT. Missing cancer was independently predicted by size ≤10 mm on DBT, UMRI, and DBT+UMRI (odds ratio 18.7, 5.1, and 13.3, respectively), and by increased breast density on DBT alone (odds ratio 3.50). CONCLUSION UMRI was equal or better than DBT in the preoperative assessment of breast cancer. Combined imaging achieved up to 88% per-lesion sensitivity, suggesting potential use in clinical practice.
Collapse
|
35
|
Cereser L, Passarotti E, De Pellegrin A, Patruno V, Poi ED, Marchesini F, Zuiani C, Girometti R. Chest high-resolution computed tomography in patients with connective tissue disease: pulmonary conditions beyond "the usual suspects". Curr Probl Diagn Radiol 2021; 51:759-767. [PMID: 34579993 DOI: 10.1067/j.cpradiol.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/18/2021] [Indexed: 11/22/2022]
Abstract
The term "connective tissue diseases" (CTDs) refers to a heterogeneous group of autoimmune disorders, including systemic sclerosis, rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, polymyositis, dermatomyositis, antisynthetase syndrome, and mixed connective tissue disease. Chest high-resolution computed tomography (HRCT) is the imaging method of choice for evaluating patients with known or suspected CTD-related interstitial lung disease (CTD-ILD), a complication accounting for substantial morbidity and mortality. While specific HRCT patterns and signs of CTD-ILD have been extensively described (hence the designation "the usual suspects"), the knowledge of various, less frequent conditions involving the lungs in patients with CTD would help the radiologist produce a clinically valuable report, thus potentially influencing patient management. This paper aims to provide an up-to-date review of various unusual pulmonary CTD-related conditions the radiologist should be aware of; namely, acute exacerbation of CTD-ILD, CTD-related interstitial lung abnormalities, lung amyloidosis, MALT lymphoma, antisynthetase syndrome, pleuroparenchymal fibroelastosis-like lesion, drug-induced ILD, combined pulmonary fibrosis and emphysema, and pulmonary hypertension. For each condition, the chest HRCT appearance and the key histopathological and clinical features are resumed, helping the radiologist participate actively in the multidisciplinary discussion of complex clinical cases.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy.
| | - Emanuele Passarotti
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Alessandro De Pellegrin
- Department of Pathology, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Department, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Emma Di Poi
- Rheumatology Clinic, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Filippo Marchesini
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, "S. Maria della Misericordia" University Hospital, p.le S. Maria della Misericordia, 15 - 33100 Udine, Italy
| |
Collapse
|
36
|
Evangelista L, De Pellegrin A, Girometti R, Cassarino G, Giacomuzzi F, Rensi M. An Incidental Pancreatic Finding at 18F-Choline PET/CT: Chronic Mass-Forming Pancreatitis. Diagnostics (Basel) 2021; 11:diagnostics11081490. [PMID: 34441424 PMCID: PMC8393948 DOI: 10.3390/diagnostics11081490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/15/2021] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
We present a case of a chronic mass-forming pancreatitis (CMFP) detected by 18F-choline (FCH) PET/CT in a male affected by prostate cancer. FCH PET/CT scan showed a focal uptake in the uncinate process of the pancreas, later diagnosed as a CMFP at biopsy. Although the physiological distribution of FCH in the pancreas, a careful interpretation of the images in this area is warranted.
Collapse
Affiliation(s)
- Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, 35128 Padova, Italy;
- Correspondence:
| | - Alessandro De Pellegrin
- Department of Pathology, University Hospital S. Maria della Misericordia, 33100 Udine, Italy;
| | - Rossano Girometti
- Institute of Radiology, Santa Maria della Misericordia Academic Medical Centre, 33100 Udine, Italy;
- Department of Medicine, University of Udine, Santa Maria della Misericordia Academic Medical Centre, 33100 Udine, Italy
| | - Gianluca Cassarino
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, 35128 Padova, Italy;
| | - Francesco Giacomuzzi
- Nuclear Medicine Unit, University Hospital S. Maria della Misericordia, 33100 Udine, Italy; (F.G.); (M.R.)
| | - Marco Rensi
- Nuclear Medicine Unit, University Hospital S. Maria della Misericordia, 33100 Udine, Italy; (F.G.); (M.R.)
| |
Collapse
|
37
|
Nobile M, Maggioni E, Mauri M, Garzitto M, Piccin S, Bonivento C, Giorda R, Girometti R, Tomasino B, Molteni M, Fabbro F, Brambilla P. Brain Anatomical Mediators of GRIN2B Gene Association with Attention/Hyperactivity Problems: An Integrated Genetic-Neuroimaging Study. Genes (Basel) 2021; 12:genes12081193. [PMID: 34440367 PMCID: PMC8394308 DOI: 10.3390/genes12081193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 12/02/2022] Open
Abstract
This study aims to investigate the genetic and neural determinants of attention and hyperactivity problems. Using a proof-of-concept imaging genetics mediation design, we explore the relationship between the glutamatergic GRIN2B gene variants and inattention/hyperactivity with neuroanatomical measures as intermediates. Fifty-eight children and adolescents were evaluated for behavioral problems at three time points over approximately 7 years. The final assessment included blood drawing for genetic analyses and 3T magnetic resonance imaging. Attention/hyperactivity problems based on the Child Behavior Checklist/6-18, six GRIN2B polymorphisms and regional cortical thickness, and surface area and volume were estimated. Using general linear model (GLM) and mediation analyses, we tested whether GRIN2B exerted an influence on stable inattention/hyperactivity over development, and to what extent this effect was mediated by brain morphology. GLM results enlightened the relation between GRIN2B rs5796555-/A, volume in the left cingulate isthmus and inferior parietal cortices and inattention/hyperactivity. The mediation results showed that rs5796555-/A effect on inattention/hyperactivity was partially mediated by volume in the left isthmus of the cingulate cortex, suggesting a key role of this region in translating glutamatergic GRIN2B variations to attention/hyperactivity problems. This evidence can have important implications in the management of neurodevelopmental and psychiatric disorders.
Collapse
Affiliation(s)
- Maria Nobile
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 22040 Bosisio Parini, Italy; (M.N.); (M.M.); (M.M.)
| | - Eleonora Maggioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Maddalena Mauri
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 22040 Bosisio Parini, Italy; (M.N.); (M.M.); (M.M.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Marco Garzitto
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, 33170 Pordenone, Italy; (M.G.); (C.B.); (B.T.); (F.F.)
| | - Sara Piccin
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
| | - Carolina Bonivento
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, 33170 Pordenone, Italy; (M.G.); (C.B.); (B.T.); (F.F.)
| | - Roberto Giorda
- Molecular Biology Laboratory, Scientific Institute, IRCCS Eugenio Medea, 22040 Bosisio Parini, Italy;
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, 33100 Udine, Italy;
| | - Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, 33170 Pordenone, Italy; (M.G.); (C.B.); (B.T.); (F.F.)
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 22040 Bosisio Parini, Italy; (M.N.); (M.M.); (M.M.)
| | - Franco Fabbro
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, 33170 Pordenone, Italy; (M.G.); (C.B.); (B.T.); (F.F.)
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Correspondence: ; Tel.: +39-02-5503-2717
| |
Collapse
|
38
|
Girometti R, Linda A, Conte P, Lorenzon M, De Serio I, Jerman K, Londero V, Zuiani C. Multireader comparison of contrast-enhanced mammography versus the combination of digital mammography and digital breast tomosynthesis in the preoperative assessment of breast cancer. Radiol Med 2021; 126:1407-1414. [PMID: 34302599 DOI: 10.1007/s11547-021-01400-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/01/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare preoperative contrast-enhanced spectral mammography (CEM) versus digital mammography plus digital breast tomosynthesis (DM + DBT) in detecting breast cancer (BC) and assessing its size. MATERIAL AND METHODS We retrospectively included 78 patients with histological diagnosis of BC who underwent preoperative DM, DBT, and CEM over one year. Four readers, blinded to pathology and clinical information, independently evaluated DM + DBT versus CEM to detect BC and measure its size. Readers' experience ranged 3-10 years. We calculated the per-lesion cancer detection rate (CDR) and the complement of positive predictive value (1-PPV) of both methods, stratifying analysis on the total of lesions, index lesions, and additional lesions. The agreement in assessing cancer size versus pathology was assessed with Bland-Altman analysis. RESULTS 100 invasive BCs (78 index lesions and 22 additional lesions) were analyzed. Compared to DM + DBT, CEM showed higher overall CDR in less experienced readers (range 0.85-0.90 vs. 0.95-0.96), and higher CDR for additional lesions, regardless of the reader (range 0.54-0.68 vs. 0.77-0.86). CEM increased the detection of additional disease in dense breasts in all readers and non-dense breasts in less experienced readers only. The 1-PPV of CEM (range 0.10-0.18) was comparable to that of DM + DBT (range 0.09-0.19). At Bland-Altman analysis, DM + DBT and CEM showed comparable mean differences and limits of agreement in respect of pathologic cancer size. CONCLUSION Preoperative CEM improved the detection of additional cancer lesions compared to DM + DBT, particularly in dense breasts. CEM and DM + DBT achieved comparable performance in cancer size assessment.
Collapse
Affiliation(s)
- Rossano Girometti
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Anna Linda
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Paola Conte
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Michele Lorenzon
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Isabella De Serio
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Katerina Jerman
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Viviana Londero
- Institute of Radiology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy
| | - Chiara Zuiani
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria Della Misericordia, p.le S. Maria della Misericordia n. 15, 33100, Udine, Italy.
| |
Collapse
|
39
|
Giannarini G, Cereser L, Como G, Bonato F, Pizzolitto S, Valotto C, Ficarra V, Dal Moro F, Zuiani C, Girometti R. Accuracy of abbreviated multiparametric MRI-derived protocols in predicting local staging of prostate cancer in men undergoing radical prostatectomy. Acta Radiol 2021; 62:949-958. [PMID: 32718179 DOI: 10.1177/0284185120943047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Abbreviated magnetic resonance imaging (aMRI) protocols have emerged as an alternative to multiparametric MRI (mpMRI) to reduce examination time and costs. PURPOSE To compare multiple aMRI protocols for predicting pathological stage ≥T3 (≥pT3) prostate cancer (PCa). MATERIAL AND METHODS One hundred and eight men undergoing staging mpMRI before radical prostatectomy (RP) were retrospectively evaluated. 3.0-T imaging was performed with a 32-channel surface coil and a protocol including diffusion-weighted imaging (DWI), transverse T2-weighted (tT2W) imaging, coronal T2W (cT2W) imaging, sagittal T2W (sT2) imaging, and dynamic contrast-enhanced (DCE) imaging. Two readers independently assessed whether any MRI observation showed stage ≥T3 on each sequence (reading order: DWI, cT2W, tT2W, sT2W, DCE). Final stage was assessed by matching readers' assignments to pathology, and combining them into eight protocols: DWI + tT2W, DWI + cT2W + tT2W, DWI + tT2W + sT2W, DWI + cT2W + tT2W + sT2W, DWI + tT2W + DCE, DWI + cT2W + tT2W + DCE, DWI + tT2W + sT2W + DCE, and mpMRI. Diagnostic accuracy and inter-reader agreement for aMRI protocols were calculated. RESULTS Prevalence of ≥pT3 PCa was 31.5%. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of aMRI protocols were comparable to mpMRI for R1. Sensitivity was 74.3% (95% confidence interval [CI] 64.8-72.0) to 77.1% (95% CI 67.9-84.4), and NPV 86.8% (95% CI 78.6-92.3) to 88.1% (95% CI 80.1-93.3). All accuracy measures of the various aMRI protocols were similar to mpMRI also for R2, albeit all slightly lower compared to R1. On a per-protocol basis, there was substantial inter-reader agreement in predicting stage ≥pT3 (k 0.63-0.67). CONCLUSION When comparing the diagnostic accuracy of multiple aMRI protocols against mpMRI for predicting stage ≥pT3 PCa, the protocol with the fewest sequences (DWI + tT2W) is apparently equivalent to standard mpMRI.
Collapse
Affiliation(s)
- Gianluca Giannarini
- Urology Unit, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Giuseppe Como
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Filippo Bonato
- Department of Medicine, University of Udine, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Claudio Valotto
- Urology Unit, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi,” Urologic Section, University of Messina, Messina, Italy
| | - Fabrizio Dal Moro
- Urologic Clinic, University of Udine, Udine, Italy
- Department of Surgery, Oncology and Gastroenterology, Urology Unit, University of Padua, Padua, Italy
| | - Chiara Zuiani
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
- Department of Medicine, University of Udine, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
- Department of Medicine, University of Udine, Academic Medical Centre “Santa Maria della Misericordia,” Udine, Italy
| |
Collapse
|
40
|
Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging 2021; 70:61-66. [PMID: 33125986 PMCID: PMC7585631 DOI: 10.1016/j.clinimag.2020.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/24/2020] [Accepted: 10/17/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In patients with mild COVID-19 pneumonia, chest high-resolution computed tomography (HRCT) is advised when risk factors for severe disease (i.e., age > 65 years and/or comorbidities) are present, and can influence management strategy. The objective was to assess whether HRCT is associated to short-time development of severe disease in patients with COVID-19 pneumonia. METHODS Seventy-seven consecutive patients (mean age, 64 ± 15 years) with mild COVID-19 pneumonia (no or mild respiratory failure) that underwent HRCT were retrospectively identified. Fifty-two on 77 patients had reported risk factors for severe disease. A chest-imaging devoted radiologist recorded, on a per-examination basis, the following HRCT features: ground-glass opacity, crazy-paving pattern, consolidation, organizing pneumonia (OP) pattern, mosaic attenuation, and nodules. The extent of each feature (total feature score, TFS) was semi-quantitatively assessed. Total lung involvement (TLI) was defined as the sum of all TFSs. The study outcome was defined as the occurrence of severe disease (moderate-to-severe respiratory failure) within 15 days from HRCT. Logistic regression analysis was performed to assess if age, comorbidities, and HRCT features were associated to severe disease. RESULTS On univariable analysis, severe disease was significantly associated with age > 59 years (29/47 patients, 61.7%) (p = 0.013), and not significantly associated with having comorbidities (22/44 patients, 50.0%). On multivariable analysis, TLI >15 and OP pattern >5 were independently associated to severe disease, with odds ratio of 8.380 (p = 0.003), and of 4.685 (p = 0.035), respectively. CONCLUSION Short-time onset of severe COVID-19 was associated to TLI >15 and OP pattern score > 5. Severe disease was not associated to comorbidities.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Jacopo Da Re
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100 Udine, Italy.
| |
Collapse
|
41
|
Cereser L, Girometti R, Da Re J, Marchesini F, Como G, Zuiani C. Inter-reader agreement of high-resolution computed tomography findings in patients with COVID-19 pneumonia: A multi-reader study. Radiol Med 2021; 126:577-584. [PMID: 33389557 PMCID: PMC7778575 DOI: 10.1007/s11547-020-01320-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/23/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023]
Abstract
Purpose To investigate the inter-reader agreement in assessing high-resolution computed tomography (HRCT) features of coronavirus disease 2019 (COVID-19) pneumonia. Method Seventy-seven consecutive patients (mean age, 64 ± 15 years) with mild COVID-19 pneumonia that underwent HRCT were retrospectively included. Three radiologists [two devoted to thoracic imaging (R1, R2), and one generalist (R3)] on a per-examination basis independently assessed ground-glass opacity (GGO), consolidation, and crazy-paving pattern. The extent of each feature (total feature score, TFS) was semi-quantitatively assessed, and each TFS summed up to obtain total lung score (TLS). Presence of organizing pneumonia (OP) pattern was also recorded. The inter-reader agreement was calculated with Cohen’s Kappa (k) and Free-Marginal Multirater k. Multivariable analysis was run to determine whether imaging features were predictive of short-term evolution to severe disease (need for ventilation). Results Most features showed substantial inter-reader agreement, including TLS > 6 (k = 0.69), which was an independent predictor of short-term occurrence of severe disease, regardless of the reader (OR 9–53.19). Consolidation TFS > 2 and OP pattern showed substantial and moderate agreement, respectively, only when comparing R1 and R2. Consolidation TFS > 2 and OP pattern were independent predictors of severe disease for R2 (OR 4.87) and R1 (OR 6), respectively. Conclusions The inter-reader agreement for most HRCT features of COVID-19 pneumonia ranges moderate-to-substantial, though it depends on readers’ experience in the case of consolidation and OP pattern.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100, Udine, Italy.
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Jacopo Da Re
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Filippo Marchesini
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Giuseppe Como
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| |
Collapse
|
42
|
Como G, Montaldo L, Baccarani U, Lorenzin D, Zuiani C, Girometti R. Contrast-enhanced ultrasound applications in liver transplant imaging. Abdom Radiol (NY) 2021; 46:84-95. [PMID: 31925494 DOI: 10.1007/s00261-020-02402-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is gaining ever-increasing acceptance in the preoperative and postoperative evaluation of liver-transplanted patients. While indications are still a matter of research, CEUS is used in tertiary centers to supplement ultrasound (US) and Color Doppler US examination, with the potential of providing a comprehensive first-line ultrasound-based diagnosis. Alternatively, CEUS is used as a problem-solving tool when previous cross-sectional or US imaging was inconclusive, especially in assessing hepatocellular carcinoma, parenchymal perfusion abnormalities, the vascular status, and even the biliary tree. This review describes the potential use for CEUS in the setting of orthotopic liver transplantation (OLT).
Collapse
|
43
|
Bacchetti S, Pegolo E, Adani G, Macrì A, Andreetta C, Ermacora P, Girometti R, Trovò M, Driul L, Di Loreto C, Pasqual E. Extraskeletal myxoid chondrosarcoma: a case report with adjuvant intraoperative treatment. J Surg Case Rep 2020; 2020:rjaa503. [PMID: 33391642 PMCID: PMC7769219 DOI: 10.1093/jscr/rjaa503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
Extraskeletal myxoid chondrosarcoma is a rare form of malignant mesenchymal neoplasm mainly localized into the limbs, particularly in the thigh and popliteal fossa. It has been classified as a low-grade sarcoma so far, but it shows a tendency to relapse and metastasize. In the early stage of disease, surgery represents the only chance of cure. In case of diffuse metastatic disease, systemic chemotherapy with anthracyclines is the standard of care. In this paper, we present a case of a patient affected by this rare disease and the analysis of radiological, surgical and histopathological aspects.
Collapse
Affiliation(s)
- Stefano Bacchetti
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | | | | | - Antonio Macrì
- Messina University, Medical School Hospital, Messina, Italy
| | | | | | - Rossano Girometti
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | | | - Lorenza Driul
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Carla Di Loreto
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | | |
Collapse
|
44
|
Casagrande A, Fabris F, Girometti R. Beyond kappa: an informational index for diagnostic agreement in dichotomous and multivalue ordered-categorical ratings. Med Biol Eng Comput 2020; 58:3089-3099. [PMID: 33145661 PMCID: PMC7679268 DOI: 10.1007/s11517-020-02261-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/29/2020] [Indexed: 10/28/2022]
Abstract
Agreement measures are useful tools to both compare different evaluations of the same diagnostic outcomes and validate new rating systems or devices. Cohen's kappa (κ) certainly is the most popular agreement method between two raters, and proved its effectiveness in the last sixty years. In spite of that, this method suffers from some alleged issues, which have been highlighted since the 1970s; moreover, its value is strongly dependent on the prevalence of the disease in the considered sample. This work introduces a new agreement index, the informational agreement (IA), which seems to avoid some of Cohen's kappa's flaws, and separates the contribution of the prevalence from the nucleus of agreement. These goals are achieved by modelling the agreement-in both dichotomous and multivalue ordered-categorical cases-as the information shared between two raters through the virtual diagnostic channel connecting them: the more information exchanged between the raters, the higher their agreement. In order to test its fair behaviour and the effectiveness of the method, IA has been tested on some cases known to be problematic for κ, in the machine learning context and in a clinical scenario to compare ultrasound (US) and automated breast volume scanner (ABVS) in the setting of breast cancer imaging. Graphical Abstract To evaluate the agreement between the two raters [Formula: see text] and [Formula: see text] we create an agreement channel, based on Shannon Information Theory, that directly connects the random variables X and Y, that express the raters outcomes. They are the terminals of the chain X⇔ diagnostic test performed by [Formula: see text] ⇔ patient condition[Formula: see text] ⇔ diagnostic test performed by [Formula: see text] ⇔ Y.
Collapse
Affiliation(s)
- Alberto Casagrande
- Dipartimento di Matematica e Geoscienze, Università degli Studi di Trieste, Trieste, Italy
| | - Francesco Fabris
- Dipartimento di Matematica e Geoscienze, Università degli Studi di Trieste, Trieste, Italy
| | - Rossano Girometti
- Dipartimento di Area Medica, Istituto di Radiologia, Ospedale S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| |
Collapse
|
45
|
Bonfiglio R, Disma N, Stagnaro N, Girometti R, Gentile A, Torre M, Bove T, Vetrugno L. The use of lung ultrasound compared to chest X-ray to diagnose pneumothorax following the Nuss procedure for pectus excavatum repair in children. Paediatr Anaesth 2020; 30:1224-1232. [PMID: 32865297 DOI: 10.1111/pan.14007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pectus Excavatum is the most common deformation of the skeletal chest wall, and the Nuss procedure is used to correct this deformation. Residual pneumothorax is a frequent postoperative complication after thoracoscopy. Primary aim of this prospective observational study was to compare the level of agreement among readers using lung ultrasound and chest X-ray. METHODS This was an inter-reader single-center prospective observational agreement study for lung ultrasound and chest X-ray. Three lung ultrasound evaluations were performed at the end of surgery in the operating room by two Consultant Anesthesiologist (A1 and A2) and by a medical student (A3). Chest X-ray was interpreted by a consultant Radiologist (R1) and a pool of 11 radiologists (collectively named R2). Cohen's kappa was used to evaluate the level of agreement between the two imaging techniques. RESULTS Sixty-eight pediatric patients were included in the study. The overall agreement among (A = Anesthesiologist) A1, A2, A3, (R = Radiologist) R1, and R2 in assessing pneumothorax was fair (k = 0.32; 95% CI 0.21-0.40). The stratified analysis showed moderate inter-reader agreement among lung ultrasound readers A1, A2, and A3 (k 0.58; 95% CI 0.44-0.71), as opposed to the fair agreement found among chest X-ray readers R1 and R2 (k = 0.39; 95% CI 0.18-0.60). CONCLUSIONS Our results support the use of lung ultrasound to diagnose pneumothorax after Nuss procedure. We found that the inter-reader accuracy was better with ultrasound compared to X-ray at our institution.
Collapse
Affiliation(s)
- Rachele Bonfiglio
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Disma
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Stagnaro
- Department of Radiology, Istituto Giannina Gaslini, Genoa, Italy
| | - Rossano Girometti
- Department of Medicine, Institute of Radiology, University of Udine, Udine, Italy.,University Hospital S. Maria della Misericordia of Udine, Udine, Italy
| | | | - Michele Torre
- Pediatric Airway Team Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Tiziana Bove
- University Hospital S. Maria della Misericordia of Udine, Udine, Italy.,Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- University Hospital S. Maria della Misericordia of Udine, Udine, Italy.,Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| |
Collapse
|
46
|
Cereser L, Giannarini G, Bonato F, Pizzolitto S, Como G, Valotto C, Ficarra V, Dal Moro F, Zuiani C, Girometti R. Comparison of multiple abbreviated multiparametric MRI-derived protocols for the detection of clinically significant prostate cancer. Minerva Urol Nephrol 2020; 74:29-37. [PMID: 33016030 DOI: 10.23736/s2724-6051.20.03952-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this paper was to compare the accuracy of multiple abbreviated multiparametric magnetic resonance imaging (mpMRI)-derived protocols in detecting clinically significant prostate cancer (csPCa). METHODS One hundred and eight men undergoing staging 3.0T mpMRI with a Prostate Imaging - Reporting and Data System version 2 (PI-RADSv2)-compliant protocol before radical prostatectomy (RP) were retrospectively evaluated. Two readers (R1, R2) independently analyzed mpMRI, assigning a PI-RADSv2 category to each observation as appearing on each examination sequence. A study coordinator assessed final PI-RADSv2 category by combining readers' assignments according to four protocols: short MRI (sMRI) (diffusion-weighted imaging + axial T2-weighted imaging), contrast-enhanced short MRI (cesMRI) (sMRI + dynamic contrast-enhanced [DCE] imaging), biparametric MRI (diffusion-weighted imaging + multiplanar T2-weigthed imaging), and mpMRI. Using RP pathology as the reference standard for csPCa, we calculated the per-lesion cancer detection rate (CDR) and false discovery rate (FDR) for each MRI protocol (cut-off PI-RADSv2 category ≥3), and the per-PI-RADSv2 category prevalence of csPCa and false positives. RESULTS Pathology after RP found 142 csPCas with median International Society of Urogenital Pathology grade group 2, and stage ≤pT2c in 68.6% of cases. CDR was comparable across the four MRI protocols (74.6% to 75.3% for R1, and 68.3% for R2). FDR was comparable as well (14.4%-14.5% for R1 and 11.1% for R2). sMRI was the minimum protocol equaling mpMRI in terms of CDR, although cesMRI, similarly to mpMRI, was associated with fewer PI-RADSv2 category 3 assignments and higher prevalence of csPCa within PI-RADSv2 category 3 observations (66.7% versus 76.9% for R1, and 100% versus 91.7% for R2, respectively). CONCLUSIONS Among multiple abbreviated mpMRI-derived protocols, cesMRI was the one equaling mpMRI in terms of csPCa detection and minimizing PI-RADSv2 category 3 assignments.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy -
| | - Filippo Bonato
- Department of Medicine, Santa Maria della Misericordia Academic Medical Center, University of Udine, Udine, Italy
| | - Stefano Pizzolitto
- Unit of Pathology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Giuseppe Como
- Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Claudio Valotto
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Vincenzo Ficarra
- Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Fabrizio Dal Moro
- Clinic of Urology, University of Udine, Udine, Italy.,Unit of Urology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Chiara Zuiani
- Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy.,Department of Medicine, Santa Maria della Misericordia Academic Medical Center, University of Udine, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy.,Department of Medicine, Santa Maria della Misericordia Academic Medical Center, University of Udine, Udine, Italy
| |
Collapse
|
47
|
Cereser L, Giannarini G, Bonato F, Pizzolitto S, Como G, Valotto C, Ficarra V, Dal Moro F, Zuiani C, Girometti R. Comparison of multiple abbreviated multiparametric MRI-derived protocols for the detection of clinically significant prostate cancer. Minerva Urol Nefrol 2020. [PMID: 33016030 DOI: 10.23736/s0393-2249.20.03952-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To compare the accuracy of multiple abbreviated multiparametric magnetic resonance imaging (mpMRI)-derived protocols in detecting clinically significant prostate cancer (csPCa). METHODS 108 men undergoing staging 3.0T mpMRI with a Prostate Imaging - Reporting and Data System version 2 (PI-RADSv2)-compliant protocol before radical prostatectomy (RP) were retrospectively evaluated. Two readers (R1, R2) independently analyzed mpMRI, assigning a PI-RADSv2 category to each observation as appearing on each examination sequence. A study coordinator assessed final PI-RADSv2 category by combining readers' assignments according to four protocols: short MRI (sMRI) (diffusion-weighted imaging + axial T2-weighted imaging), contrast-enhanced short MRI (cesMRI) (sMRI + dynamic contrast-enhanced [DCE] imaging), biparametric MRI (diffusion-weighted imaging + multiplanar T2-weigthed imaging), and mpMRI. Using RP pathology as the reference standard for csPCa, we calculated the per-lesion cancer detection rate (CDR) and false discovery rate (FDR) for each MRI protocol (cutoff PI-RADSv2 category ≥3), and the per-PI-RADSv2 category prevalence of csPCa and false positives. RESULTS Pathology after RP found 142 csPCas with median International Society of Urogenital Pathology grade group 2, and stage ≤pT2c in 68.6% of cases. CDR was comparable across the four MRI protocols (74.6% to 75.3% for R1, and 68.3% for R2). FDR was comparable as well (14.4%-14.5% for R1 and 11.1% for R2). sMRI was the minimum protocol equaling mpMRI in terms of CDR, although cesMRI, similarly to mpMRI, was associated with fewer PI-RADSv2 category 3 assignments and higher prevalence of csPCa within PI-RADSv2 category 3 observations (66.7% versus 76.9% for R1, and 100% versus 91.7% for R2, respectively). CONCLUSIONS Among multiple abbreviated mpMRI-derived protocols, cesMRI was the one equaling mpMRI in terms of csPCa detection and minimizing PI-RADSv2 category 3 assignments.
Collapse
Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy -
| | - Filippo Bonato
- Department of Medicine, University of Udine, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Stefano Pizzolitto
- Pathology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Giuseppe Como
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Claudio Valotto
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Vincenzo Ficarra
- Urologic Section, Department of Human and Pediatric Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Fabrizio Dal Moro
- Urologic Clinic, University of Udine, Udine, Italy.,Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Chiara Zuiani
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy.,Department of Medicine, University of Udine, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy.,Department of Medicine, University of Udine, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| |
Collapse
|
48
|
Giannarini G, Girometti R, Bonato F, Pizzolitto S, Zattoni F, Valotto C, Zuiani C, Dal Moro F. Multiparametric MRI before robot-assisted radical prostatectomy allows for a greater utilization of nerve sparing with no detrimental impact on surgical margins status. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35351-9] [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: 10/23/2022] Open
|
49
|
Valotto C, Giannarini G, Cereser L, Como G, Bonato F, Pizzolitto S, Zuiani C, Ficarra V, Dal Moro F, Girometti R. Abbreviated multiparametric MRI-derived protocols for local staging of prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35374-x] [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
|
50
|
Cereser L, Marchesini F, Di Poi E, Sacco S, De Marchi G, Linda A, Como G, Zuiani C, Girometti R. Structured report for chest high-resolution computed tomography in patients with connective tissue disease: Impact on the report quality as perceived by referring clinicians. Eur J Radiol 2020; 131:109269. [PMID: 32949860 DOI: 10.1016/j.ejrad.2020.109269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/04/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the impact on perceived report quality of referring rheumatologists for a chest high-resolution computed tomography (HRCT) structured report (SR) template for patients with connective tissue disease (CTD), compared to the traditional narrative report (NR). MATERIALS AND METHODS We retrospectively considered 123 HRCTs in patients with CTD. Three radiologists, blinded to the original NRs they wrote during clinical routine, re-reported each HRCT using an SR dedicated template. We then divided all NR-SR couples into three groups (41 HRCT each). Each group was evaluated by one of three rheumatologists (R1, R2, R3), who expressed their perceived report quality for the respective pools of NRs and SRs in terms of completeness, clarity (both on a 10-points scale), and clinical relevance (on a 5-points scale). The Wilcoxon test and the McNemar test were used for statistical analysis. RESULTS For each rheumatologist, SR received higher ratings compared to NR for completeness (median ratings: R1, 10 vs. 7; R2, 10 vs. 8; R3, 10 vs. 6, all p < 0.0001), clarity (median ratings: R1, 10 vs. 7; R2, 10 vs. 8; R3, 10 vs. 7, all p < 0.0001), and clinical relevance (median ratings: R1, 5 vs. 4; R2, 5 vs. 4; R3, 5 vs. 1, all p < 0.0001). After rating dichotomization, the use of SR led to a significant increase (p < 0.01) in completeness, clarity, and clinical relevance as compared to NR, except for clarity as perceived by R2 (p = 1). CONCLUSION Referring rheumatologists' perceived report quality for structured reporting of HRCT in patients with CTD was superior to narrative reporting.
Collapse
Affiliation(s)
- L Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - F Marchesini
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - E Di Poi
- Rheumatology Clinic, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - S Sacco
- Rheumatology Clinic, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - G De Marchi
- Rheumatology Clinic, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - A Linda
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - G Como
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - C Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| | - R Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital "S. Maria della Misericordia", p.le S. Maria della Misericordia, 15 - 33100, Udine, Italy.
| |
Collapse
|