Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary

With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated

Skeletal anomalies in dusky grouper Epinephelus marginatus (Lowe 1834) juveniles reared with different methodologies and larval densities

The first attempts to reproduce dusky grouper (Epinephelus marginatus, Lowe 1834) under controlled conditions started in 1995, but the egg and larvae quality was very low. Mass production is still encountering many difficulties, mainly concentrated in the larval period when very high mortality rates are observed, confirming what has been observed in the rearing of other grouper species. The main bottlenecks have been identified as the difficulty to properly nourish the larvae, stress shock syndrome, and the high deformation rates. We analysed 633 dusky grouper larvae and juveniles (0.2–7.2 cm total length, TL), sampled during two larval rearing cycles carried out in 2001 and 2002 in Italy. The specimens at different development stages were stained in toto for bone and cartilage and examined for skeletal anomalies during dusky grouper ontogenesis. The incidence of anomalies in groupers hatched from the same egg batch but reared using two different methods (green waters and semi-intensive rearing) and three stocking densities (8, 16 and 28 larvae/l) was compared, with a view to providing tools for identifying the most appropriate larval rearing method in order to at least limit the onset of skeletal anomalies. Our results suggest that during development no particular skeletal anomaly patterns (or fate) can be clearly identified as a high variability was observed in malformation typologies and the regions affected. No significant differences in the morphological quality between groupers reared using semi-intensive (LV02 lot) and green water (GW02-01 lot) methodologies were observed, whilst groupers reared at the highest stocking density (28 larvae/l) showed the highest frequency of deformed individuals (75.8%), the highest malformation charge (average of 5.5 anomalies per deformed individual), the largest range of anomaly typologies (38), and the highest incidence of individuals with at least one severe anomaly (30.9%). Whilst in green waters no evident effects of larvae density were observed on survival rates, the survival rate in large volume reared individuals (17.5%) was considerably higher with respect to those reared in green waters (0.2%) at 7–8 larvae/l. This indicates that the semi-intensive methodology should be considered more effective in enhancing the survival rate of dusky grouper larvae

Therapeutic Radiometals: Global Trends Analysis of Scientific Literature (2008 -2018)

Background-aim: Academic journals have published a large number of papers in the therapeutic NM research field in the last 10 years. Despite this, a literature analysis has never been made before to point out the research interest in therapeutic radionuclides (RNs). For this reason, the present study has the aim to specifically analyze the research output on therapeutic radiometals from 2008 (January) to 2018 (October) with the aim to quantify and identify the global trend of scientific literature and emphasize the interdisciplinary nature of this research field. Methods: The data search has been targeted on conventional (I-131, Y-90, Lu-177, Re-188, Re-186, Sm-153, Sr-89, Er-186) and emergent (Cu-67, Sc-47, Ra-223, Ho-166, Tb-161, Tb-149, Pb-212/Bi-212, Ac225, Bi-213, At-211, Sn-117) RNs. Authors, starting from this time frame data, have been quantitatively first, and qualitatively after, analyzed and interpreted the scientific trend of this topic. Bibliometric data have been exported from Scopus database and elaborated with Excel. The number of article, article in press, note, short survey, review and letter, have been divided per year and RN with the aim to make perceptible the trend of the last decade. Data have been categorized also in terms of Journal Subject Areas in order to bring out the multidisciplinary nature of the research in this field. Finally, for each publication, authors country provenience have been extrapolated and elaborated to map the global researcher interest and involvement of human and financial resources. Results: A total of 12.717 publications have been analyzed. 81.3% of the publications regards conventional RNs while 18.7% regards emergent RNs. The most investigated therapeutic RNs are I-131, Y-90, Lu-177 among conventional, Ra-223, followed by Sn-117, Bi213 and Ac-225 among emergent RNs. From the analysis, it is evident the multidisciplinary contribution to this field but in particular, as expected, in the case of conventional RN most publications comes from preclinical and clinical fields while for the emergents the contribution is unbalanced for Physics, Engineering, Material Science fields mainly focused on emergent RNs production studies. From the geographical point of view we can see how almost half of the total works have been published by European in both conventional and Clin Transl Imaging (2019) 7 (Suppl 1):S1–S138 S127 123 emergent RNs categories. It is also evident the high collaboration grade between countries characteristics in line with the multidisciplinarity of this medical sector. Moreover, we extrapolated a countries top 20 for each category. On the podium for the conventional RNs are USA, Germany and China, while for emergent RNs are USA, Germany, United Kingdom. And much more. Conclusions: From this analysis arise that the success of NM has been intimately linked to the availability of new RNs and the radiopharmaceuticals field is constantly evolving thanks to the contribution of specialists coming from different disciplines and the collaboration between countries. In recent years the focus of the research shifted on the field of emergent therapeutic radioisotope production and application, such as Cu-67, Sc-47, for the interest in new treatment strategies such as the theranostics personalized approach. Alpha emitters, in particular Ra-223 and Ac-225 are also gaining attention in particular in USA and Germany. Instead, among conventional radionuclides the research on Lu-177 is constantly growing

Prostate MRI quality: a critical review of the last 5 years and the role of the PI-QUAL score

There is increasing interest in the use of multiparametric magnetic resonance imaging (mpMRI) in the prostate cancer pathway. The European Association of Urology (EAU) and the British Association of Urological Surgeons (BAUS) now advise mpMRI prior to biopsy, and the Prostate Imaging Reporting and Data System (PI-RADS) recommendations set out the minimal technical requirements for the acquisition of mpMRI of the prostate.The widespread and swift adoption of this technique has led to variability in image quality. Suboptimal image acquisition reduces the sensitivity and specificity of mpMRI for the detection and staging of clinically significant prostate cancer.This critical review outlines the studies aimed at improving prostate MR quality that have been published over the last 5 years. These span from the use of specific MR sequences, magnets and coils to patient preparation. The rates of adherence of prostate mpMRI to technical standards in different cohorts across the world are also discussed.Finally, we discuss the first standardised scoring system (i.e., Prostate Imaging Quality, PI-QUAL) that has been created to evaluate image quality, although further iterations of this score are expected in the future

Sequential prostate MRI reporting in men on active surveillance: initial experience of a dedicated PRECISE software program

BACKGROUND AND OBJECTIVES: There is interest in using sequential multiparametric magnetic resonance imaging (mpMRI) to assess men on active surveillance (AS) for prostate cancer. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations propose standardised reporting mpMRI data for these men. This includes accurate size measurements of lesions over time, but such approach is time consuming for the radiologist and there is a strong need of dedicated tools to report serial scans in a systematic manner. We present the results from an initial validation cohort using dedicated PRECISE reporting software to allow automated comparison between sequential scans on AS. MATERIALS AND METHODS: We retrospectively analysed baseline and follow-up scans of 20 men randomised to 6 months of daily dutasteride (n = 10) or placebo (n = 10) from the MAPPED trial. Men underwent 3T mpMRI at baseline and after 6 months, and a dedicated radiologist reported the scans using both a widespread commercially-available platform (Osirix®) and a semi-automated dedicated PRECISE reporting tool (MIM®). Tumour volume by planimetry in all sequences and conspicuity on diffusion-weighted imaging were assessed. Reporting time was recorded, and we used the Wilcoxon test for statistical analysis. RESULTS: Median tumour volumes and conspicuity were similar using both approaches. The reporting time of the follow-up scan was quicker using the PRECISE reporting workflow both in the whole population (12'33″ vs 10'52″; p = 0.005) and in the dutasteride arm (15'50″ vs 12'59″; p = 0.01). A structured report including clinical and imaging data was generated according to the PRECISE recommendations and a comparison table between lesion characteristics at baseline and follow-up scans was also included. CONCLUSION: We conclude that a dedicated PRECISE reporting tool for sequential scans in men on AS results in a significant reduction in the reporting time and allows the radiologist to easily compare scans over time. This tool will help with our understanding of the natural history of mpMRI changes during AS

Neck paraganglioma and follicular lymphoma: A case report

Background: Paragangliomas and pheochromocytomas are sympathetic or parasympathetic tumors derived from the paraganglia and the adrenal medulla, respectively. Paragangliomas and pheochromocytomas can be sporadic or familial, the latter frequently being multifocal and possibly due to succinate dehydrogenase complex genes mutations. In addition, 12% of sporadic paragangliomas are related to covered succinate dehydrogenase complex mutations. The importance of identifying succinate dehydrogenase complex mutations is related to the risk for these patients of developing multiple tumors, including non-endocrine ones, showing an aggressive clinical presentation. Case presentation: We report the case of a 45-year-old Caucasian man with an indolent mass in his neck. Ultrasound of his neck, magnetic resonance imaging, and 1,4,7,10-tetraazacyclododecane-N(I),N(II),N(III),N(IIII)-tetraacetic acid(D)-Phe(1)-thy(3)-octreotide (68Ga-DOTATOC) positron emission tomography-computed tomography and endocrine work-up were consistent with a carotid body paraganglioma with concomitant nodal enlargement in several body regions, which turned out to be a follicular lymphoma at histology. He was found to carry a germline Succinate dehydrogenase subunit B gene (SDHB) mutation. Conclusion: It is crucial to look for a second malignancy in the case of a paraganglioma demonstrating succinate dehydrogenase complex germline mutations

Contrast enhanced ultrasound (CEUS) in blunt abdominal trauma.

In the assessment of polytrauma patient, an accurate diagnostic study protocol with high sensitivity and specificity is necessary. Computed Tomography (CT) is the standard reference in the emergency for evaluating the patients with abdominal trauma. Ultrasonography (US) has a high sensitivity in detecting free fluid in the peritoneum, but it does not show as much sensitivity for traumatic parenchymal lesions. The use of Contrast-Enhanced Ultrasound (CEUS) improves the accuracy of the method in the diagnosis and assessment of the extent of parenchymal lesions. Although the CEUS is not feasible as a method of first level in the diagnosis and management of the polytrauma patient, it can be used in the follow-up of traumatic injuries of abdominal parenchymal organs (liver, spleen and kidneys), especially in young people or children

Tumour growth rates of prostate cancer during active surveillance: is there a difference between MRI-visible low and intermediate-risk disease?

OBJECTIVES: The aim of this study was to evaluate the changes in lesion volume on serial multiparametric magnetic resonance (mpMRI) during active surveillance for prostate cancer. METHODS: A total of 160 patients with a targeted biopsy-confirmed visible lesion on mpMRI, stratified by low- and intermediate-risk disease (Gleason Grade Group 1 vs Gleason Grade Group 2), were analysed. The % change per year was calculated using the formula: [(final volume/initial volume) exp (1/interval between scans in years)]-1. RESULTS: There was no significant difference in the annual median percentage change between Gleason Grade Group 1 (18%) and Gleason Grade Group 2 (23%) disease (p = 0.16), and between ≤ 10% (23%) and > 10% (22%) of Gleason pattern 4 (p = 0.78).Assuming a spherical lesion, these changes corresponded to annual increases in mean tumour diameter of 6% and 7% for Gleason Grade Group 1 and Gleason Grade Group 2 respectively, which may be less than the interscan variability of serial mpMRI. CONCLUSION: In an active surveillance cohort, we did not see a significant difference in the annual growth rate of Gleason Grade Group 1 and 2 tumours. ADVANCES IN KNOWLEDGE: In patients on active surveillance, the measured growth rates for visible tumours in Gleason Grade Groups 1 and 2 were similar. The annual growth rate was small in most cases and this may have implications for the MRI follow-up interval in active surveillance