Valutazione della perfusione tissutale nelle neoplasie del distretto testa-collo: risultati preliminari con TC a 64 canali

L'avvento della TC multistrato facilita la valutazione dei parametri funzionali nei pazienti oncologici, come la perfusione tissutale, che può integrare l'informazione morfologica derivata dalle tecniche di TC convenzionale. Lo studio TC di perfusione è una tecnica dinamica "contrast-enhanced" per la valutazione quantitativa del microcircolo tissutale, che fu primariamente sviluppata quasi 30 anni fa per la quantificazione della perfusione ematica cerebrale nei pazienti con ictus acuto, ed è stata recentemente riscoperta come un promettente strumento non invasivo per la valutazione dei cambiamenti microcircolatori di numerose neoplasie, come i tumori del distretto testa-collo. Il rinnovato interesse nelle applicazioni oncologiche dello studio TC di perfusione è stato alimentato ancora di più dalla recente disponibilità di scanner di tomografia computerizzata multistrato con un elevato numero di file di detettori, tenendo conto di una maggiore copertura anatomica senza il movimento del tavolo e di una più alta risoluzione temporale rispetto alla precedente tecnologia TC. Lo scopo della tesi è quello di valutare la fattibilità dell'esame TC di perfusione per la valutazione funzionale dei tumori del distretto testa-collo attraverso lo studio quantitativo dei parametri di perfusione (flusso ematico, volume ematico, tempo medio di transito e prodotto permeabilità-superficie)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Quantitative CT evaluation of pulmonary emphysema in ITALUNG trial assessed by commercial and CALIPER software: two-year progression

Objectives. To evaluate pulmonary smoking-related parenchymal changes with two different software application in asymptomatic subjects enrolled in the ITALUNG randomized screening trial for early diagnosis of lung cancer using low-dose computed tomography (LDCT). The aim of the study was to determine if a novel texture and local volumetric histogram feature-based analysis software (CALIPER) that can also quantify fibrosis and other visual features is comparable with a commercially available software designed to exclusively evaluate low attenuation based on threshold values and global histogram analysis (InSpace, Siemens). Specifically, the potential to demonstrate parenchymal features and changes in relation with smoking habits over time was evaluated. Methods and Materials. 284 subjects randomized into the active arm of the ITALUNG trial underwent 2 lung LDCT examinations 2 years apart; at enrolment (T1, baseline) and the third (T3) round. LDCT parameters analysed with two different software were: total lung volume (ml); % of Relative Areas (RA) -950 HU and 15th percentile (HU). Subjects were divided in four subgroups on the basis of smoking habits: persistent smokers, former smokers, restarters and quitters. Results: In the whole population CALIPER demonstrated an increase of the RA -950 from T1 to T3 (%RA-950 = 21.3 at T1 and 22.4 at T3, p<.0001) and a decrease of 15th percentile HU (-966.6 at T1 and -969.4 at T3, p<.0001). In the four smoking-habits subgroups CALIPER showed a significant progression of %RA-950 in particular an increase of RA -950 in persistent smokers (19.4 T1 to 20.1 T3, p=0.004), in former smokers (24.9 T1 to 25.9 T3, p=0.005) and in quitters (20.0 T1 to 23.8 T3, p<.0001). In 7 restarters was observed a non-significant decrease of %RA-950 (19.3 T1 to 16.0 T3, p=0.13). The commercial software longitudinally demonstrated a similar increase of the %RA -950 from T1 to T3 (%RA-950 = 21.4 at T1 and 22.6 at T3, p<.0001) and decrease of the 15th percentile HU (-966,6 at T1 and -970.1 at T3, p<.0001) and same trends in the four subgroups. Conclusion: During this short-term follow up CALIPER quantified parenchymal density changes nearly equivalent to the commercial software in asymptomatic subjects and in the four subgroup of smokers. However, in addiction, CALIPER allowed the characterization of severity of low attenuation areas (mild, moderate or severe) and quantification of other lung abnormalities such as honeycombing, reticulation and ground-glass opacity that are not available in the other software analysis

CT colonography with rectal iodine tagging: Feasibility and comparison with oral tagging in a colorectal cancer screening population

PURPOSE: To evaluate feasibility, diagnostic performance, patient acceptance, and overall examination time of CT colonography (CTC) performed through rectal administration of iodinated contrast material. MATERIALS AND METHODS: Six-hundred asymptomatic subjects (male:female=270:330; mean 63 years) undergoing CTC for colorectal cancer screening on an individual basis were consecutively enrolled in the study. Out of them, 503 patients (group 1) underwent CTC with rectal tagging, of which 55 had a total of 77 colonic lesions. The remaining 97 patients (group 2) were randomly selected to receive CTC with oral tagging of which 15 had a total of 20 colonic lesions. CTC findings were compared with optical colonoscopy, and per-segment image quality was visually assessed using a semi-quantitative score (1=poor, 2=adequate, 3=excellent). In 70/600 patients (11.7%), CTC was performed twice with both types of tagging over a 5-year follow-up cancer screening program. In this subgroup, patient acceptance was rated via phone interview two weeks after CTC using a semi-quantitative scale (1=poor, 2=fair, 3=average, 4=good, 5=excellent). RESULTS: Mean per-polyp sensitivity, specificity, positive and negative predictive values of CTC with rectal vs oral tagging were 96.1% (CI95% 85.4÷99.3%) vs 89.4% (CI95% 65.4÷98.1%), 95.3% (CI95% 90.7÷97.8%) vs 95.8% (CI95% 87.6÷98.9%), 86.0% (CI95% 73.6÷93.3) vs 85.0% (CI95% 61.1÷96.0%), and 98.8% (CI95% 95.3÷99.8%) vs 97.2% (CI95% 89.4÷99.5%), respectively (p>0.05). Polyp detection rates were not statistically different between groups 1 and 2 (p>0.05). Overall examination time was significantly shorter with rectal than with oral tagging (18.3±3.5 vs 215.6±10.3 minutes, respectively; p<0.0001). CONCLUSIONS: Rectal iodine tagging can be an effective alternative to oral tagging for CTC with the advantages of greater patient acceptance and lower overall examination time

Quantitative texture-based analysis of pulmonary parenchymal features on chest CT: comparison with densitometric indices and short-term effect of changes in smoking habit

To investigate the correlations between densitometric and CALIPER-derived indices of pulmonary emphysema and their change in the short-term period for groups of patients with different smoking habits

CT colonography with rectal iodine tagging: Feasibility and comparison with oral tagging in a colorectal cancer screening population

PURPOSE: To evaluate feasibility, diagnostic performance, patient acceptance, and overall examination time of CT colonography (CTC) performed through rectal administration of iodinated contrast material. MATERIALS AND METHODS: Six-hundred asymptomatic subjects (male:female=270:330; mean 63 years) undergoing CTC for colorectal cancer screening on an individual basis were consecutively enrolled in the study. Out of them, 503 patients (group 1) underwent CTC with rectal tagging, of which 55 had a total of 77 colonic lesions. The remaining 97 patients (group 2) were randomly selected to receive CTC with oral tagging of which 15 had a total of 20 colonic lesions. CTC findings were compared with optical colonoscopy, and per-segment image quality was visually assessed using a semi-quantitative score (1=poor, 2=adequate, 3=excellent). In 70/600 patients (11.7%), CTC was performed twice with both types of tagging over a 5-year follow-up cancer screening program. In this subgroup, patient acceptance was rated via phone interview two weeks after CTC using a semi-quantitative scale (1=poor, 2=fair, 3=average, 4=good, 5=excellent). RESULTS: Mean per-polyp sensitivity, specificity, positive and negative predictive values of CTC with rectal vs oral tagging were 96.1% (CI95% 85.4÷99.3%) vs 89.4% (CI95% 65.4÷98.1%), 95.3% (CI95% 90.7÷97.8%) vs 95.8% (CI95% 87.6÷98.9%), 86.0% (CI95% 73.6÷93.3) vs 85.0% (CI95% 61.1÷96.0%), and 98.8% (CI95% 95.3÷99.8%) vs 97.2% (CI95% 89.4÷99.5%), respectively (p>0.05). Polyp detection rates were not statistically different between groups 1 and 2 (p>0.05). Overall examination time was significantly shorter with rectal than with oral tagging (18.3±3.5 vs 215.6±10.3 minutes, respectively; p<0.0001). CONCLUSIONS: Rectal iodine tagging can be an effective alternative to oral tagging for CTC with the advantages of greater patient acceptance and lower overall examination time