Image resampling and discretization effect on the estimate of myocardial radiomic features from T1 and T2 mapping in hypertrophic cardiomyopathy

Radiomics is emerging as a promising and useful tool in cardiac magnetic resonance (CMR) imaging applications. Accordingly, the purpose of this study was to investigate, for the first time, the effect of image resampling/discretization and filtering on radiomic features estimation from quantitative CMR T1 and T2 mapping. Specifically, T1 and T2 maps of 26 patients with hypertrophic cardiomyopathy (HCM) were used to estimate 98 radiomic features for 7 different resampling voxel sizes (at fixed bin width), 9 different bin widths (at fixed resampling voxel size), and 7 different spatial filters (at fixed resampling voxel size/bin width). While we found a remarkable dependence of myocardial radiomic features from T1 and T2 mapping on image filters, many radiomic features showed a limited sensitivity to resampling voxel size/bin width, in terms of intraclass correlation coefficient (> 0.75) and coefficient of variation (< 30%). The estimate of most textural radiomic features showed a linear significant (p < 0.05) correlation with resampling voxel size/bin width. Overall, radiomic features from T2 maps have proven to be less sensitive to image preprocessing than those from T1 maps, especially when varying bin width. Our results might corroborate the potential of radiomics from T1/T2 mapping in HCM and hopefully in other myocardial diseases

Clinical behavior and outcomes of breast cancer in young women with germline BRCA pathogenic variants

Young breast cancer (BC) patients carrying a germline BRCA pathogenic variant (mBRCA) have similar outcomes as non-carriers. However, the impact of the type of gene (BRCA1 vs. BRCA2) and hormone receptor status (positive [HR+] vs. negative [HR 12]) on clinical behavior and outcomes of mBRCA BC remains largely unknown. This is an international, multicenter, hospital-based, retrospective cohort study that included mBRCA patients diagnosed, between January 2000 and December 2012, with stage I\u2013III invasive early BC at age 6440 years. From 30 centers worldwide, 1236 young mBRCA BC patients were included. Among 808 and 428 patients with mBRCA1 or mBRCA2, 191 (23.6%) and 356 (83.2%) had HR+tumors, respectively (P < 0.001). Median follow-up was 7.9 years. Second primary BC (P = 0.009) and non-BC malignancies (P = 0.02) were more frequent among mBRCA1 patients while distant recurrences were less frequent (P = 0.02). Irrespective of hormone receptor status, mBRCA1 patients had worse disease-free survival (DFS; adjusted HR = 0.76, 95% CI = 0.60\u20130.96), with no difference in distant recurrence-free interval (DRFI) and overall survival (OS). Patients with HR+ disease had more frequent distant recurrences (P < 0.001) and less frequent second primary malignancies (BC: P = 0.005; non-BC: P = 0.18). No differences in DFS and OS were observed according to hormone receptor status, with a tendency for worse DRFI (adjusted HR = 1.39, 95% CI = 0.94\u20132.05) in patients with HR+ BC. Type of mBRCA gene and hormone receptor status strongly impact BC clinical behavior and outcomes in mBRCA young patients. These results provide important information for patients\u2019 counseling on treatment, prevention, and surveillance strategies

Ascesso cerebrale otogeno: descrizione di tre casi, considerazioni cliniche e terapeutiche

The authors use the 3 cases of otogenous cerebral abscess which came under observation as starting point for a discussion of the main etiopathogenetic, microbiological, clinical-diagnostic and therapeutic aspects of this disorder. After a brief presentation of the data regarding incidence, preferential localization and age of onset, they discuss the means for intracranial spread of infection and the related symptoms. As regards diagnosis, the authors assert that clinical examination and imaging techniques--CT and especially MRI--enable one to determine the dimension and site of the abscess cavity, differentiating it from other intracranial lesions and to monitor clinical evolution and response to therapy. After mentioning the principle bacteria involved in infection, they deal with the various means of treatment. The authors favor surgical removal of the auricular phlogistic focus and medical treatment of the intracranial abscess. They resort to neurosurgery only in those cases which do not respond to drug treatment or when the size and particular location of the abscess threaten the patient's life. In conclusion, the authors underline the problems seen today in diagnosis and therapy, comparing the quoad vitam and quoad valetudinem prognosis for the affected patient

Ascesso cerebrale otogeno: descrizione di tre casi, considerazioni cliniche e terapeutiche

The authors use the 3 cases of otogenous cerebral abscess which came under observation as starting point for a discussion of the main etiopathogenetic, microbiological, clinical-diagnostic and therapeutic aspects of this disorder. After a brief presentation of the data regarding incidence, preferential localization and age of onset, they discuss the means for intracranial spread of infection and the related symptoms. As regards diagnosis, the authors assert that clinical examination and imaging techniques--CT and especially MRI--enable one to determine the dimension and site of the abscess cavity, differentiating it from other intracranial lesions and to monitor clinical evolution and response to therapy. After mentioning the principle bacteria involved in infection, they deal with the various means of treatment. The authors favor surgical removal of the auricular phlogistic focus and medical treatment of the intracranial abscess. They resort to neurosurgery only in those cases which do not respond to drug treatment or when the size and particular location of the abscess threaten the patient's life. In conclusion, the authors underline the problems seen today in diagnosis and therapy, comparing the quoad vitam and quoad valetudinem prognosis for the affected patient

Evaluation of Brugada syndrome by cardiac magnetic resonance

Brugada syndrome (BrS) has been originally considered to occur in structural normal hearts. However recent pathological and imaging data suggest that structural and functional changes may be present in this syndrome. This study was designed to elucidate whether any macroscopic heart abnormality is detectable in patients with BrS. For this purpose we used cardiac magnetic resonance (CMR). Twenty-nine patients displaying the BrS type-1 ECG pattern and 29 healthy controls underwent CMR (1.5 Tesla). Left (LV) and right ventricular (RV) dimensions, function and regional contractility were evaluated. Late-gadolinium-enhancement (LGE) imaging was obtained in 24 patients. We found no difference between BrS patients and controls regarding LV and RV dimensions and ejection fraction. RV wall motion abnormalities (WMA) were detected in 19 patients (65.5%) and in 22 control subjects (75.9%). The majority of these WMA were attributable to areas of hypokinesia and found in the RV inferior wall. None of the patients showed LGE. No differences were detected between controls and the different subgroups of BrS patients according to symptoms, family history and spontaneous type-1 ECG pattern. BrS patients do not differ from normal subjects with regard to dimensions and global function of both LV and RV. BrS patients may show RV-WMA, however similar changes are also present in healthy subjects and may therefore represent a physiological behaviour of RV. The lack of LGE further confirms the absence of myocardial structural damage. Our results indicate that BrS seems to occur in individuals with structurally and functionally normal heart

Myocardial T1 and T2 mapping in diastolic and systolic phase

The aim of this study was to evaluate the regional (i.e. myocardial segments) variability as well as the overall image quality of cardiac T1 and T2 maps obtained in diastole and in systole. In 22 healthy subjects (group-1), diastolic T1 and T2 maps were obtained at 1.5T in short-axis view at basal, mid-ventricular and apical level, as well as in 4-chamber (4ch) and in 2-chamber (2ch) views. In another group of 25 patients (group-2), the maps were obtained in both diastole and systole. In the group-1, 15.4&nbsp;% of myocardial segments in T1 maps and 0.8&nbsp;% of myocardial segments in T2 maps, mainly located at apical level, showed relevant artifacts and/or partial-volume effect and had to be discarded. We found no significant difference in T1 values among basal, mid-ventricular and apical segments. T2 values at apical level were significantly higher than at basal and mid-ventricular level (short-axis, p&nbsp;&lt;&nbsp;0.0001; 4ch, p&nbsp;&lt;&nbsp;0.009; 2ch, p&nbsp;=&nbsp;0.0002 at ANOVA tests). In the group-2, 21.1&nbsp;%/5.3&nbsp;% and 4.0&nbsp;%/0.8&nbsp;% of segments showed relevant artifacts in diastolic/systolic T1 and T2 maps, respectively. Apical T2 values were significantly lower in systole than in diastole. In systole, there were no significant differences in T1/T2 among basal, mid-ventricular and apical segments. The overall quality of T1 and T2 maps drops in apical segments. This could be problematic when evaluating focal myocardial changes. The acquisition in systole increases the number of evaluable segments