Relationship between white matter hyperintensities volume and the circle of Willis configurations in patients with carotid artery pathology

Purpose We aimed to assess if there is a difference of distribution and volume of white matter hyperintensities (WMH) in the brain according to the Circle of Willis (CoW) configuration in patients with carotid artery pathology. Material and methods One-hundred consecutive patients (79 males, 21 females; mean age 70 years; age range 46–84 years) that underwent brain MRI before carotid endarterectomy (CEA) were included. FLAIR-WMH lesion volume was performed using a semi-automated segmentation technique and the status of the circle of Willis was assessed by two neuroradiologists in consensus. Results We found a prevalence of 55% of variants in the CoW configuration; 22 cases had one variants (40%); 25 cases had two variants (45.45%) and 8 cases showed 3 variants (14.55%). The configuration that was associated with the biggest WMH volume and number of lesions was the A1 + PcoA + PcoA. The PcoA variants were the most prevalent and there was no statistically significant difference in number of lesions and WMH for each vascular territory assessed and the same results were found for AcoA and A1 variants. Conclusion Results of our study suggest that the more common CoW variants are not associated with the presence of an increased WMH or number of lesions whereas uncommon configurations, in particular when 2 or more segment are missing increase the WMH volume and number of lesions. The WHM volume of the MCA territory seems to be more affected by the CoW configuration

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

Optimization and Reproducibility of Aortic Valve 18F-Fluoride Positron Emission Tomography in Patients With Aortic Stenosis

$\textbf{BACKGROUND}$: 18F-Fluoride positron emission tomography (PET) and computed tomography (CT) can measure disease activity and progression in aortic stenosis. Our objectives were to optimize the methodology, analysis, and scan-rescan reproducibility of aortic valve 18F-fluoride PET-CT imaging. $\textbf{METHODS AND RESULTS}$: Fifteen patients with aortic stenosis underwent repeated 18F-fluoride PET-CT. We compared nongated PET and noncontrast CT, with a modified approach that incorporated contrast CT and ECG-gated PET. We explored a range of image analysis techniques, including estimation of blood-pool activity at differing vascular sites and a most diseased segment approach. Contrast-enhanced ECG-gated PET-CT permitted localization of 18F-fluoride uptake to individual valve leaflets. Uptake was most commonly observed at sites of maximal mechanical stress: the leaflet tips and the commissures. Scan-rescan reproducibility was markedly improved using enhanced analysis techniques leading to a reduction in percentage error from ±63% to ±10% (tissue to background ratio MDS mean of 1.55, bias -0.05, limits of agreement -0·20 to +0·11). $\textbf{CONCLUSIONS}$: Optimized 18F-fluoride PET-CT allows reproducible localization of calcification activity to different regions of the aortic valve leaflet and commonly to areas of increased mechanical stress. This technique holds major promise in improving our understanding of the pathophysiology of aortic stenosis and as a biomarker end point in clinical trials of novel therapies. $\textbf{CLINICAL TRIAL REGISTRATION}$ - URL: http://www.clinicaltrials.gov. Unique identifier: NCT02132026.The study was funded by the British Heart Foundation (FS/14/78/31020). Drs Pawade, Cartlidge, Jenkins, Dweck, and Newby are supported by the British Heart Foundation (SS/CH/09/002/26360, FS/13/77/30488, SS/CH/09/002/2636, FS/14/78/31020, and CH/09/002). Dr Newby is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr Dweck is the recipient of the Sir Jules Thorn Award for Biomedical Research 2015. Dr Adamson is supported by New Zealand Overseas Training and Research Fellowship (1607) and Edinburgh and Lothians Health Foundation (50–534). The Wellcome Trust Clinical Research Facility and the Clinical Research Imaging Centre are supported by NHS Research Scotland (NRS) through NHS Lothian. Dr Rudd is partly supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, and the Wellcome Trust

Possible use of Digital Variance Angiography in Liver Transarterial Chemoembolization: A Retrospective Observational Study

Purpose Digital variance angiography (DVA), a recently developed image processing technology, provided higher contrast-to-noise ratio (CNR) and better image quality (IQ) during lower limb interventions than digital subtraction angiography (DSA). Our aim was to investigate whether this quality improvement can be observed also during liver transarterial chemoembolization (TACE).Materials and MethodsWe retrospectively compared the CNR and IQ parameters of DSA and DVA images from 25 patients (65% male, mean +/- SD age: 67.5 +/- 11.2 years) underwent TACE intervention at our institute. CNR was calculated on 50 images. IQ of every image set was evaluated by 5 experts using 4-grade Likert scales. Both single image evaluation and paired image comparison were performed in a blinded and randomized manner. The diagnostic value was evaluated based on the possibility to identify lesions and feeding arteries.ResultsDVA provided significantly higher CNR (mean CNRDVA/CNRDSA was 1.33). DVA images received significantly higher individual Likert score (mean +/- SEM 3.34 +/- 0,08 vs. 2.89 +/- 0.11, Wilcoxon signed-rank p < 0.001) and proved to be superior also in paired comparisons (median comparison score 1.60 [IQR:2.40], one sample Wilcoxon p < 0.001 compared to equal quality level). DSA could not detect lesion and feeding artery in 28 and 36% of cases, and allowed clear detection only in 22% and 16%, respectively. In contrast, DVA failed only in 8 and 18% and clearly revealed lesions and feeding arteries in 32 and 26%, respectively.ConclusionIn our study, DVA provided higher quality images and better diagnostic insight than DSA; therefore, DVA could represent a useful tool in liver TACE interventions

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

Carotid artery intra-plaque attenuation variability using computed tomography

Background: In the CT assessment of the carotid plaque, the analysis of the attenuation value is a fundamental parameter in order to classify the type of the tissue that composes the plaque. The purpose of this paper is to assess the intra-plaque attenuation variability in order to verify the potential reproducibility of HU measurements. Methods: In this retrospective study, 68 consecutive patients (males 42; average age 64 ± 11 years) that underwent CT of carotid arteries were included. Exams were performed before and after administration of contrast medium and in each slice 4 different circular or elliptical ROIs (≥1 and ≤ 2 mm2) were traced and attenuation values were recorded. Wilcoxon and Mann-Whitney test were used to test the differences between the ROI. Results: A total of 192 slices were analysed. The average value of attenuation before contrast medium was 41.591(SD 8.1) HU and 54.159 (SD 15.7) in post-contrast scan. Mann-Whitney test did not find statistically significant difference among the ROI in the pre-contrast scan whereas a statistically significant differences was found in post-contrast scan. Wilcoxon analysis showed a statistically significant difference (p value = 0.001) between pre and post-contrast attenuation. Conclusion: In conclusion, results of our study suggest that ROI sampling performed in the CT dataset acquired after administration of contrast medium show significant degree of heterogeneity and a statistically significant differences compared to the baseline measurement. This effect may be driven by a different amount of contrast acquisition in some areas of the carotid artery plaque