Radiofrequency Ablation of Pancreatic Cancer

Radiofrequency ablation (RFA) is emerging as a safe and feasible technique to treat various pancreatic lesions. In particular, pancreatic ductal adenocarcinoma (PDAC) is the most frequent treated lesion. Nowadays, PDAC treatment by means of RFA is limited to locally advanced, non-resectable, but non-metastatic lesions. The aim of this article is to describe the RFA technique, its results and possible complications

An Overview of Artificial Intelligence Applications in Liver and Pancreatic Imaging

Artificial intelligence (AI) is one of the most promising fields of research in medical imaging so far. By means of specific algorithms, it can be used to help radiologists in their routine workflow. There are several papers that describe AI approaches to solve different problems in liver and pancreatic imaging. These problems may be summarized in four different categories: segmentation, quantification, characterization and image quality improvement. Segmentation is usually the first step of successive elaborations. If done manually, it is a time-consuming process. Therefore, the semi-automatic and automatic creation of a liver or a pancreatic mask may save time for other evaluations, such as quantification of various parameters, from organs volume to their textural features. The alterations of normal liver and pancreas structure may give a clue to the presence of a diffuse or focal pathology. AI can be trained to recognize these alterations and propose a diagnosis, which may then be confirmed or not by radiologists. Finally, AI may be applied in medical image reconstruction in order to increase image quality, decrease dose administration (referring to computed tomography) and reduce scan times. In this article, we report the state of the art of AI applications in these four main categories

Left ventricular adverse remodeling after myocardial infarction and its association with vitamin D levels

Background: Vitamin D, a potential cardiovascular risk biomarker, has an unclear role in the adverse left ventricle remodelling (LVAR) after acute myocardial infarction (AMI). Methods: To evaluate the impact of Vitamin D levels on LVAR in a prospective cohort study of patients with AMI. Results: 253 patients with AMI were studied, 81 of which (32%) developed, in median 4.1 months after AMI, LVAR. Age, sex, risk factors, type and location of the infarction, clinical presentation, timing and mode of revascularization did not differ between patients with and without LVAR. However, patients with LVAR had lower Vitamin D levels (12.6 vs. 18.7 ng/mL, p<0.001), while higher Vitamin D at baseline protected against LVAR (for increase of 10 ng/mL HR 0.74, CI 0.61\u20130.90, p < 0.001). Plasma levels of C Reactive Protein (CRP), peak Troponin I, indexed left ventricular end systolic volume (LVESVI) and NYHA class at discharge predicted, in multivariate analysis, LVAR occurrence at follow-up. Moreover, the inclusion of Vitamin D improved the multivariate model, as shown by the area under the ROC curve (HR 0.82; CI 0.76\u20130.88, p < 0.001). During the follow-up of 25.5 (7\u201377) months, patients with LVAR had a worse event-free survival rate (HF, p = 0.012; combined event HF/mortality, p = 0.006), even when the analysis was restricted to patients with ST-elevation MI (p = 0.006). Conclusions: Low Vitamin D levels are associated with post-infarct LVAR

US-Guided Percutaneous Radiofrequency Ablation of Locally Advanced Pancreatic Adenocarcinoma: A 5-Year High-Volume Center\ua0Experience

The aim of this study was to investigate the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in locally advanced pancreatic cancer (LAPC) of the pancreatic body by assessing the overall survival of patients and evaluating the effects of the procedure in the clinical and radiological follow-up.Zusammenfassung Ziel\u2002Ziel dieser Studie war es, die Sicherheit und Wirksamkeit der perkutanen Radiofrequenzablation (RFA) bei lokal fortgeschrittenem Pankreaskarzinom (LAPC) zu untersuchen, indem das Gesamt\ufcberleben der Patienten beurteilt wurde und die Auswirkungen des Verfahrens in der klinischen und radiologischen Nachsorge bewertet wurden. Material und Methoden\u2002Patienten mit inoperablem LAPC nach fehlgeschlagener Radiochemotherapie \ufcber mindestens 6 Monate wurden retrospektiv eingeschlossen. Die perkutane RFA wurde nach einer vorl\ue4ufigen Ultraschall (US)-Machbarkeitsbewertung durchgef\ufchrt. Eine kontrastverst\ue4rkte Computertomografie (CT) und eine Probenentnahme f\ufcr CA 19-9 wurden vor dem Verfahren und 24 Stunden sowie 30 Tage danach durchgef\ufchrt, um die Auswirkungen der Ablation zu beurteilen. Die Patienten wurden nach Entlassung unter Ber\ufccksichtigung der beiden wichtigsten Endpunkte nachbeobachtet: verfahrensbedingte Komplikationen und Tod. Ergebnisse\u2002Es wurden 35 Patienten eingeschlossen und 5 ausgeschlossen. Alle Patienten wurden der RFA unterzogen, wobei keine verfahrensbezogenen Komplikationen gemeldet wurden. Die durchschnittliche Tumorgr\uf6 fe betrug vor der Behandlung 49\u200amm. Das mittlere Ausma f der abgetragenen nekrotischen Zone betrug 32\u200amm, mit einer mittleren Ausdehnung von 65\u200a% im Vergleich zur gesamten Tumorgr\uf6 fe. Die Tumordichte war einen Tag nach dem Eingriff statistisch signifikant reduziert (p\u200a&lt;\u200a0,001). Die mittleren CA-19-9-Werte vor dem Eingriff und 24 Stunden bzw. 30 Tage danach betrugen 285,8\u200aU/ml, 635,2\u200aU/ml bzw. 336,0\u200aU/ml, mit einer Abnahme oder Stabilit\ue4t der Werte in der 30-Tage-Auswertung bei 80\u200a% der F\ue4lle. Die mittlere cberlebenszeit betrug 310 (65\u2013718) Tage. Schlussfolgerung\u2002Die perkutane RFA der LAPC ist eine durchf\ufchrbare Technik bei Patienten, die nicht operiert werden k\uf6nnen, mit gro fen Debulking-Effekten und einer sehr niedrigen Komplikationsrate

Liver Tumor Burden in Pancreatic Neuroendocrine Tumors: CT Features and Texture Analysis in the Prediction of Tumor Grade and 18F-FDG Uptake

Pancreatic neuroendocrine tumors (p-NETs) are a rare group of neoplasms that often present with liver metastases. Histological characteristics, metabolic behavior, and liver tumor burden (LTB) are important prognostic factors. In this study, the usefulness of texture analysis of liver metastases in evaluating the biological aggressiveness of p-NETs was assessed. Fifty-six patients with liver metastases from p-NET were retrospectively enrolled. Qualitative and quantitative CT features of LTB were evaluated. Histogram-derived parameters of liver metastases were calculated and correlated with the tumor grade (G) and 18F-fluorodeoxyglucose (18F-FDG) standardized uptake value (SUV). Arterial relative enhancement was inversely related with G (-0.37, p = 0.006). Different metastatic spread patterns of LTB were not associated with histological grade. Arterialentropy was significantly correlated to G (-0.368, p = 0.038) and to Ki67 percentage (-0.421, p = 0.018). The ROC curve for the Arterialentropy reported an area under the curve (AUC) of 0.736 (95% confidence interval 0.545-0.928, p = 0.035) in the identification of G1-2 tumors. Arterialuniformity values were correlated to G (0.346, p = 0.005) and Ki67 levels (0.383, p = 0.033). Arterialentropy values were directly correlated with the SUV (0.449, p = 0.047) which was inversely correlated with Arterialuniformity (-0.499, p = 0.025). Skewness and kurtosis reported no significant correlations. In conclusion, histogram-derived parameters may predict adverse histological features and metabolic behavior of p-NET liver metastases

CT Simplified Radiomic Approach to Assess the Metastatic Ductal Adenocarcinoma of the Pancreas

The aim of this study was to perform a simplified radiomic analysis of pancreatic ductal adenocarcinoma based on qualitative and quantitative tumor features and to compare the results between metastatic and non-metastatic patients. A search of our radiological, surgical, and pathological databases identified 1218 patients with a newly diagnosed pancreatic ductal adenocarcinoma who were referred to our Institution between January 2014 and December 2018. Computed Tomography (CT) examinations were reviewed analyzing qualitative and quantitative features. Two hundred eighty-eight patients fulfilled the inclusion criteria and were included in this study. Overall, metastases were present at diagnosis in 86/288 patients, while no metastases were identified in 202/288 patients. Ill-defined margins and a hypodense appearance on portal-phase images were significantly more common among patients with metastases compared to non-metastatic patients (p &lt; 0.05). Metastatic tumors showed a significantly larger size and significantly lower arterial index, perfusion index, and permeability index compared to non-metastatic tumors (p &lt; 0.05). In the management of pancreatic ductal adenocarcinoma, early detection and correct staging are key elements. The study of computerized tomography characteristics of pancreatic ductal adenocarcinoma showed substantial differences, both qualitative and quantitative, between metastatic and non-metastatic disease

Correlation of MR features and histogram-derived parameters with aggressiveness and outcomes after resection in pancreatic ductal adenocarcinoma

To evaluate MR-derived histogram parameters in predicting aggressiveness and surgical outcomes in patients with PDAC, by correlating them to pathological features, recurrence-free survival (RFS), and overall survival (OS)

Magnetic resonance (MR) for mural nodule detection studying Intraductal papillary mucinous neoplasms (IPMN) of pancreas: Imaging-pathologic correlation

Magnetic Resonance (MR) is recommended to diagnose Intraductal Papillary Mucinous Neoplasms (IPMN) and in the follow-up of borderline lesions. The purpose of this work is to evaluate the diagnostic accuracy of dynamic MR with Diffusion Weighted Imaging (DWI) in the identification of mural nodules of pancreatic IPMN by using pathological analysis as gold standard