Arms down cone beam CT hepatic angiography: are we focusing on the wrong target?

We read with great interest the recent article by Dr. Gonzalez-Aguirre and colleagues entitled ‘‘Arms Down Cone Beam CT Hepatic Angiography Performance Assessment: Vascular Imaging Quality and Imaging Artefacts’’ [1]. One of the most important advantages of cone beam CT (CBCT) is the possibility to evaluate the lesion’s feeders assisting their identification and catheterization [2]. In this set, the patient’s arms positioning is crucial in order not to impair CBCT imaging. Dr. Gonzalez-Aguirre et al. had elegantly demonstrated that vessels’ visualization is independent from the patient’s arms position, allowing to perform the entire procedure without patient’s movements. This minimizes the risk of contamination and reduces procedural time. However, literature shows that the major pivotal strength of CBCT, either mono-phasic or possibly bi-phasic, is the ability to depict in intra-procedurally ‘‘occult lesions’’, not visible at pre-procedural second-line non-invasive imaging (MRI, MDCT) [3]. This ability is not just for show, but yield to some major clinical implications: the visualization of an occult nodule identifies a subset of population experiencing fast tumour growth, having consequences on the number of adjunctive treatments controlling tumour growth (adjunctive RFA, or TACE procedures) and prioritization for transplantation [4]. Moreover, bi-phasic CBCT, with its unique ability to intra-procedural permit nodule characterization, could help in patients’ reclassification and real-time TACE strategy modification [5]. In this light would be a crucial interest for the audience to know whether the CBCT acquisition with arms down does not alter the diagnostic performance of the modality and ability of lesion’s characterization, especially for those lesion localized peripherally, where the beam hardening artefacts have been shown to be significant. Finally, patient’s positioning is fundamental for CBCT imaging. By acquiring the scan with patient’s arm down, liver volume would not be located within the rotation isocentre. This could be a substantial limitation for lesion located within the left liver lobe, eventually hypertrophied, and for high BMI patients

Polyethylene Glycol Epirubicin-Loaded Transcatheter Arterial Chemoembolization Procedures Utilizing a Combined Approach with 100 and 200 μm Microspheres: A Promising Alternative to Current Standards

PURPOSE:To report clinical effectiveness, toxicity profile, and prognostic factors of combined 100 μm ± 25 and 200 μm ± 50 epirubicin-loaded polyethylene glycol (PEG) microsphere drug-eluting embolic transcatheter arterial chemoembolization protocol in patients with hepatocellular carcinoma. MATERIALS AND METHODS: In this prospective, single-center, single-arm study with 18 months of follow-up, 36 consecutive patients (mean age 69.9 y ± 10.8; 26 men, 10 women; 54 naïve lesions) were treated. Embolization was initiated with 100 μm ± 25 microspheres, and if stasis (10 heart beats) was not achieved, 200 μm ± 50 microspheres were administered. Each syringe (2 mL) of PEG microsphere was loaded with 50 mg of epirubicin. Results were evaluated using Modified Response Evaluation Criteria In Solid Tumors with multidetector computed tomography/magnetic resonance imaging at 1, 3-6, 9-12, and 15-18 months. Toxicity profile was assessed by laboratory testing before and after the procedure. Complications were recorded. Postembolization syndrome (PES) was defined as onset of fever/nausea/pain after the procedure. Patient/lesion characteristics and treatment results were correlated with predicted outcome using regression analysis. Child-Pugh score was A in 86.1% of patients (31/36) and B in 13.9% (5/36). RESULTS: In 10 of 21 lesions, < 2 cm in diameter (47.5%) stasis was achieved with 100 μm ± 25 microspheres only, whereas all other lesions required adjunctive treatment with 200 μm ± 50 microspheres. Reported adverse events were grade 1 acute liver bile duct injury (3/39 cases, 7.7%) and PES (grade 2; 3/39 cases, 7.7%). Complete response (CR) at 1, 3-6, 9-12, and 15-18 months was 61.1%, 65.5%, 63.63%, and 62.5%. Objective response (CR + partial response) at 1, 3-6, 9-12, and 15-18 months was 83.3%, 65.85%, 63.63%, and 62.5%. No single factor (laboratory testing, etiology, patient status, hepatic status, tumor characteristics, administration protocol) predicted outcomes except for albumin level at baseline for CR (P < .05, odds ratio = 1.09). CONCLUSIONS: The combined microsphere sizing strategy was technically feasible and yielded promising results in terms of effectiveness and toxicity

Plaque imaging volume analysis: technique and application

The prevention and management of atherosclerosis poses a tough challenge to public health organizations worldwide. Together with myocardial infarction, stroke represents its main manifestation, with up to 25% of all ischemic strokes being caused by thromboembolism arising from the carotid arteries. Therefore, a vast number of publications have focused on the characterization of the culprit lesion, the atherosclerotic plaque. A paradigm shift appears to be taking place at the current state of research, as the attention is gradually moving from the classically defined degree of stenosis to the identification of features of plaque vulnerability, which appear to be more reliable predictors of recurrent cerebrovascular events. The present review will offer a perspective on the present state of research in the field of carotid atherosclerotic disease, focusing on the imaging modalities currently used in the study of the carotid plaque and the impact that such diagnostic means are having in the clinical setting

Multimodality Quantitative Assessments of Myocardial Perfusion Using Dynamic Contrast Enhanced Magnetic Resonance and 15O-Labeled Water Positron Emission Tomography Imaging

Kinetic modeling of myocardial perfusion imaging data allows the absolute quantification of myocardial blood flow (MBF) and can improve the diagnosis and clinical assessment of coronary artery disease (CAD). Positron emission tomography (PET) imaging is considered the reference standard technique for absolute quantification, whilst oxygen-15 (15O)-water has been extensively implemented for MBF quantification. Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has also been used for MBF quantification and showed comparable diagnostic performance against (¹⁵ O)-water PET studies. We investigated for the first time the diagnostic performance of two different PET MBF analysis softwares PMOD and Carimas, for obstructive CAD detection against invasive clinical standard methods in 20 patients with known or suspected CAD. Fermi and distributed parameter modeling-derived MBF quantification from DCE-MRI was also compared against (15O)-water PET, in a subgroup of six patients. The sensitivity and specificity for PMOD was significantly superior for obstructive CAD detection in both per vessel (0.83, 0.90) and per patient (0.86, 0.75) analysis, against Carimas (0.75, 0.65) and (0.81, 0.70), respectively. We showed strong, significant correlations between MR and PET MBF quantifications (r = 0.83 - 0.92). However, DP and PMOD analysis demonstrated comparable and higher hemodynamic differences between obstructive versus (no, minor, or non)-obstructive CAD, against Fermi and Carimas analysis. Our MR method assessments against the optimum PET reference standard technique for perfusion analysis showed promising results in per segment level and can support further multimodality assessments in larger patient cohorts. Further MR against PET assessments may help to determine their comparative diagnostic performance for obstructive CAD detection

EPOCHS VI: The Size and Shape Evolution of Galaxies since z ~ 8 with JWST Observations

We present the results of a size and structural analysis of 1395 galaxies at $0.5 \leq z \lesssim 8$ with stellar masses $\log \left(M_* / M_{\odot}\right)$ $>$ 9.5 within the JWST Public CEERS field that overlaps with the HST CANDELS EGS observations. We use GALFIT to fit single S\'ersic models to the rest-frame optical profile of our galaxies, which is a mass-selected sample complete to our redshift and mass limit. Our primary result is that at fixed rest-frame wavelength and stellar mass, galaxies get progressively smaller, evolving as $\sim (1+z)^{-0.71\pm0.19}$ up to $z \sim 8$. We discover that the vast majority of massive galaxies at high redshifts have low S\'ersic indices, thus do not contain steep, concentrated light profiles. Additionally, we explore the evolution of the size-stellar mass relationship, finding a correlation such that more massive systems are larger up to $z \sim 3$. This relationship breaks down at $z > 3$, where we find that galaxies are of similar sizes, regardless of their star formation rates and S\'ersic index, varying little with mass. We show that galaxies are more compact at redder wavelengths, independent of sSFR or stellar mass up to $z \sim 3$. We demonstrate the size evolution of galaxies continues up to $z \sim 8$, showing that the process or causes for this evolution is active at early times. We discuss these results in terms of ideas behind galaxy formation and evolution at early epochs, such as their importance in tracing processes driving size evolution, including minor mergers and AGN activity.Comment: Submitted to MNRA

Modelling [18F]LW223 PET data using simplified imaging protocols for quantification of TSPO expression in the rat heart and brain

PURPOSE: To provide a comprehensive assessment of the novel 18 kDa translocator protein (TSPO) radiotracer, [(18)F]LW223, kinetics in the heart and brain when using a simplified imaging approach. METHODS: Naive adult rats and rats with surgically induced permanent coronary artery ligation received a bolus intravenous injection of [(18)F]LW223 followed by 120 min PET scanning with arterial blood sampling throughout. Kinetic modelling of PET data was applied to estimated rate constants, total volume of distribution (V(T)) and binding potential transfer corrected (BP(TC)) using arterial or image-derived input function (IDIF). Quantitative bias of simplified protocols using IDIF versus arterial input function (AIF) and stability of kinetic parameters for PET imaging data of different length (40–120 min) were estimated. RESULTS: PET outcome measures estimated using IDIF significantly correlated with those derived with invasive AIF, albeit with an inherent systematic bias. Truncation of the dynamic PET scan duration to less than 100 min reduced the stability of the kinetic modelling outputs. Quantification of [(18)F]LW223 uptake kinetics in the brain and heart required the use of different outcome measures, with BP(TC) more stable in the heart and V(T) more stable in the brain. CONCLUSION: Modelling of [(18)F]LW223 PET showed the use of simplified IDIF is acceptable in the rat and the minimum scan duration for quantification of TSPO expression in rats using kinetic modelling with this radiotracer is 100 min. Carefully assessing kinetic outcome measures when conducting a systems level as oppose to single-organ centric analyses is crucial. This should be taken into account when assessing the emerging role of the TSPO heart-brain axis in the field of PET imaging. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00259-021-05482-1

Spontaneous Abdominal Wall Hematoma Treated with Percutaneous Transarterial Embolization: Diagnostic Findings, Procedural Outcome, and Efficacy—A Multicenter Study

Endovascular management of abdominal wall hematomas (AWHs) is now the primary treatment option in hemodynamically stable patients, and it is often preferred to surgical interventions. The purpose of this multicentric study was to assess the safety, technical, and clinical success of percutaneous transarterial embolization (PTAE) of spontaneous AWHs to evaluate the efficacy of blind or empiric embolization compared to targeted embolization and to compare the outcome of the endovascular treatment approach in patients affected by COVID-19 and non-COVID-19 patients. We retrospectively enrolled 112 patients with spontaneous AWHs who underwent PTAE, focusing on signs of bleeding at pre-procedural CTA and DSA. Patients were separated into two groups depending on whether a blind or targeted embolization approach was used. We also divided patients into COVID-19 and non-COVID-19 groups. The mean age of the study population was 68.6 ± 15.8 years. CTA and DSA revealed signs of active bleeding in 99 and 88 patients, respectively. In 21 patients, blind embolization was performed. The overall technical success rate was 99%. Clinical success was obtained in 96 patients (86%), while 16 (14%) re-bled within 96 h. One patient reported a major peri-procedural complication. The comparison between blind and targeted embolization approaches showed no statistically significant differences in the characteristics of groups and technical and clinical success rates. No significant differences were found in the procedural outcome between COVID-19 and non-COVID-19 groups. Our study confirmed that PTAE is effective for treating spontaneous AWHs, even in COVID-19 patients. It suggests that the efficacy and safety of blind embolization are comparable to targeted embolization

Surgical resection is superior to TACE in the treatment of HCC in a well selected cohort of BCLC-B elderly patients—A retrospective observational study

Simple Summary Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Liver transplantation (LT) and surgical resection (SR) are currently the primary treatments with curative intent. Nevertheless, more than two-thirds of patients are elderly and, therefore, excluded from LT; while, according to the Barcelona Clinic Liver Cancer (BCLC) system, SR should only be offered to a small group of patients with early stage HCC. The identification in stage B of an intermediate subgroup of patients that fulfill the criteria for surgery may play an important role in the implementation of potentially curative treatments. Hepatocellular carcinoma (HCC) usually develops in cirrhotic liver, with high recurrence rates. However, considering its increasing detection in non-cirrhotic liver, the choice of treatment assumes particular relevance. This study aimed to investigate outcomes of patients among BCLC stages and enrolled for surgical resection (SR) according to a more complex evaluation, to establish its safety and efficacy. A total of 186 selected HCC patients (median age 73.2 yrs), submitted to SR between January 2005 and January 2021, were retrospectively analyzed. Of which, 166 were staged 0, A, B according to the BCLC system, while 20 with a single large tumor (>5 cm) were classified as stage AB. No perioperative mortality was recorded; complications occurred in 48 (25.80%) patients, and all but two were Clavien-Dindo grade I-II. Median follow-up was 9.2 years. Subsequently, 162 recurrent patients (87,1%) were selected for new treatments. Comparable overall survival rates (OS) were observed at 1, 3, 5, and 10 years in 0, A, B and AB stages (p = 0.2). Eventually, the BCLC-B group was matched to 40 BCLC-B patients treated (2015-2021) with TACE. Significant differences in baseline characteristics (p <0.0001) and in OS were observed at 1 and 3 years (p <0.0001); a significant difference was also observed in oncological outcomes, in terms of the absence, residual, or relapse of disease (p <0.05). Surgery might be a valid treatment in HCC for patients affected by chronic liver disease in a condition of compensation, up to BCLC-B stage. Surgical indication for liver resection in case of HCC should be extensively revised

Deep Learning assessment of galaxy morphology in S-PLUS Data Release 1

The morphological diversity of galaxies is a relevant probe of galaxy evolution and cosmological structure formation, but the classification of galaxies in large sky surveys is becoming a significant challenge. We use data from the Stripe-82 area observed by the Southern Photometric Local Universe Survey (S-PLUS) in 12 optical bands, and present a catalogue of the morphologies of galaxies brighter than r = 17 mag determined both using a novel multiband morphometric fitting technique and Convolutional Neural Networks (CNNs) for computer vision. Using the CNNs, we find that, compared to our baseline results with three bands, the performance increases when using 5 broad and 3 narrow bands, but is poorer when using the full 12 band S-PLUS image set. However, the best result is still achieved with just three optical bands when using pre-trained network weights from an ImageNet data set. These results demonstrate the importance of using prior knowledge about neural network weights based on training in unrelated, extensive data sets, when available. Our catalogue contains 3274 galaxies in Stripe-82 that are not present in Galaxy Zoo 1 (GZ1), and we also provide our classifications for 4686 galaxies that were considered ambiguous in GZ1. Finally, we present a prospect of a novel way to take advantage of 12 band information for morphological classification using morphometric features, and we release a model that has been pre-trained on several bands that could be adapted for classifications using data from other surveys. The morphological catalogues are publicly available.Fil: Bom, C. R.. Centro Brasileiro de Pesquisa Fisicas; BrasilFil: Cortesi, A.. Valongo Observatory; BrasilFil: Lucatelli, G.. Universidade do Sao Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas; BrasilFil: Dias, L. O.. Centro Brasileiro de Pesquisa Fisicas; BrasilFil: Schubert, P.. Centro Brasileiro de Pesquisa Fisicas; BrasilFil: Oliveira Schwarz, G. B.. Universidade Presbiteriana Mackenzie; BrasilFil: Cardoso, N. M.. Universidade de Sao Paulo; BrasilFil: Lima, E. V. R.. Universidade do Sao Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas; BrasilFil: Mendes de Oliveira, C.. Universidade do Sao Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas; BrasilFil: Sodre, L.. Universidade do Sao Paulo. Instituto de Astronomia, Geofísica e Ciências Atmosféricas; BrasilFil: Smith Castelli, Analia Viviana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Astrofísica La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Astronómicas y Geofísicas. Instituto de Astrofísica La Plata; ArgentinaFil: Ferrari, F.. Universidade Federal Do Rio Grande.; BrasilFil: Damke, G.. Universidad de La Serena; ChileFil: Overzier, R.. Ministério de Ciencia, Tecnologia e Innovacao. Observatorio Nacional; BrasilFil: Kanaan, A.. Universidade Federal Da Santa Catarina. Cent.de Cs Físicas E Matemáticas. Departamento de Física; BrasilFil: Ribeiro, T.. Universidade Federal do Rio Grande do Sul; BrasilFil: Schoenell, W.. Noao; Estados Unido

[18F]LW223 has low non-displaceable binding in murine brain, enabling high sensitivity TSPO PET imaging

Neuroinflammation is associated with a number of brain diseases, making it a common feature of cerebral pathology. Among the best-known biomarkers for neuroinflammation in Positron Emission Tomography (PET) research is the 18 kDa translocator protein (TSPO). This study aims to investigate the binding kinetics of a novel TSPO PET radiotracer, [18F]LW223, in mice and specifically assess its volume of non-displaceable binding (VND) in brain as well as investigate the use of simplified analysis approaches for quantification of [18F]LW223 PET data. Adult male mice were injected with [18F]LW223 and varying concentrations of LW223 (0.003–0.55 mg/kg) to estimate VND of [18F]LW223. Dynamic PET imaging with arterial input function studies and radiometabolite studies were conducted. Simplified quantification methods, standard uptake values (SUV) and apparent volume of distribution (VTapp), were investigated. [18F]LW223 had low VND in the brain (<10% of total binding) and low radiometabolism (∼15–20%). The 2-tissue compartment model provided the best fit for [18F]LW223 PET data, although its correlation with SUV90–120min or VTapp allowed for [18F]LW223 brain PET data quantification in healthy animals while using simpler experimental and analytical approaches. [18F]LW223 has the required properties to become a successful TSPO PET radiotracer