Imaging characterization of non-hypersecreting adrenal masses. Comparison between MR and radionuclide techniques.

AIM: In patients with non-hypersecreting adrenal masses, tumor characterization is clinically relevant to establish the appropriate treatment planning. The aim of this study was to comparatively characterize such adrenal lesions using MR and radionuclide techniques. METHODS: Thirty patients with non-hypersecreting unilateral adrenal tumors underwent both MR and adrenal scintigraphy. MR was performed using SE T1- (pre- and post-gadolinium DTPA) and T2-weighted images as well as in- and out-phase chemical-shift imaging (CSI). MR qualitative and quantitative (signal intensity ratios) evaluation was performed. Radionuclide studies consisted of iodine-131 nor-cholesterol (n=20), iodine-131 MIBG (n=15) and fluorine-18 FDG PET (n=11) scans. Histology (n=16), biopsy (n=3) or clinical-imaging follow-up (n=11) demomstrated 13 adenomas, 3 cysts, 2 myelolipomas, 4 pheochromocytomas (pheos), 4 carcinomas, 1 sarcoma and 3 metastases. Comparative imaging analysis was focused on adenomas, pheos and malignant tumors. RESULTS: Qualitative MR evaluation showed: signal T2-hyperintensity in 46% of adenomas and in 100% of pheos and malignant tumors, no gadolinium enhancement in 92% of adenomas and definite signal intensity loss on CSI in 100% of such tumor lesions, gadolinium enhancement in 100% of pheos and in 63% of malignancies and no absolute change of signal intensity on CSI in 100% of both pheos and malignancies. Quantitative MR analysis demonstrated: significantly higher signal T2-hyperintensity of pheos compared to adenomas and malignancies as well as significantly higher enhancement after gadolinium in pheos compared to adenomas and malignancies (p<0.03). Radionuclide studies showed significantly increased nor-cholesterol uptake only in adenomas (n=13), significant MIBG accumulation only in pheos (n=4) and FDG activity only in malignant adrenal lesions (n=8). CONCLUSION: MR techniques may provide some presumptive criteria to characterize non-hypersecreting adrenal masses, such as no gadolinium enhancement and definite signal intensity loss on CSI in adenomas or quantitatively measured T2-hyperintensity and gadolinium enhancement in pheos. On the other hand, radionuclide modalities offer more specific findings in this setting since nor-cholesterol and MIBG scans are respectively able to reveal benign tumors such as adenoma and pheochromocytoma, while FDG imaging allows identification of malignant adrenal lesions. Adrenal scintigraphy is recommended in those patients, when MR images are uncertain or inconclusive

Telehealth in oncofertility and breast cancer patients during COVID-19: preliminary results of insenoallasalute.it project

Abstract. – OBJECTIVE: Breast cancer (BC) is the leading diagnosis in premenopausal patients. Lockdown measures during COVID-19 pandemic reduced facilities for premenopausal patients, impairing oncological and reproductive health. To reduce its effect, a telehealth program called insenoallasalute.it was designed in Italy. PATIENTS AND METHODS: A national-based multicentric observational study was undertaken by insenoallasalute.it study group (Italian Ministry of Health, Modena Hospital and Tor Vergata University Hospital) to raise awareness among women on a) BC and its negative role on reproductive health; b) increase adherence to screening programs and self-examination; c) present oncofertility strategies. A webbased platform with two sections was designed: an informative section and a telehealth application activated with a mobile one-time password. After a self-evaluation test to select premenopausal women with maternal desire and family or personal history for BC or ovarian cancer, and premenopausal women with maternity desires with prior medically assisted procreation, a dedicated agenda for telehealth evaluation was displayed and planned. In case the patients fulfilled the criteria for further evaluation, they were invited to perform an outpatient evaluation in one of the pilot centers. RESULTS: From July 2021 to December 2021, 2,830 single accounts were activated, and 2,450 (86.57%) completed the tests. 53 patients were selected to undergo telehealth consultation and 40 (80.0%) scheduled the telehealth visit. 6 patients underwent surgery in the study centers. CONCLUSIONS: In our experience insenoallasalute.it embodied an innovative solution to spread BC awareness, BC screening program, and oncofertility opportunities in the oncological population

Frequency encoding for simultaneous display of multimodality images.

An original method for simultaneous display of functional and anatomic images, based on frequency encoding (FE), merges color PET with T1-weighted MR brain images, and grayscale PET with multispectral color MR images. A comparison with two other methods reported in the literature for image fusion (averaging and intensity modulation techniques) was performed. Methods: For FE, the Fourier transform of the merged image was obtained summing the low frequencies of the PET image and the high frequencies of the MR image. For image averaging, the merged image was obtained as a weighted average of the intensities of the two images to be merged. For intensity modulation, the red, green and blue components of the color image were multiplied on a pixel- by-pixel basis by the grayscale image. A comparison of the performances of the three techniques was made by three independent observers assessing the conspicuity of specific MRI and PET information in the merged images. For evaluation purposes, images from seven patients and a computer-simulated MRI/PET phantom were used. Data were compared with a chi-square test applied to ranks. Results: For the depiction of MRI and PET information when merging color PET and T1-weighted MR images, FE was rated superior to intensity modulation and averaging techniques in a significant number of comparisons. For merging grayscale PET with multispectral color MR images, FE and intensity modulation were rated superior to image averaging in terms of both MRI and PET information. Conclusion: The data suggest that improved simultaneous evaluation of MRI and PET information can be achieved with a method based on FE

2-deoxy-2[F-18] fluoro-D-glucose positron emission tomography Deauville scale and core-needle biopsy to determine successful management after six doxorubicin, bleomycin, vinblastine and dacarbazine cycles in advanced-stage Hodgkin lymphoma.

Abstract Background The clinical impact of the positivity of the Deauville scale (DS) of positron emission tomography (PET) performed at the end of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) in patients with advanced Hodgkin lymphoma (HL), in terms of providing rationale to shift poor responders onto a more intensive regimen, remain to be validated by histopathology. Patients and methods This prospective trial involved patients with stage IIB/IV HL who after six ABVD cycles underwent PET (PET6) and core-needle cutting biopsy (CNCB) of 2-deoxy-2[F-18] fluoro- d -glucose (FDG)-avid lymph nodes. Patients received high-dose chemotherapy/autologous haematopoietic stem cell rescue (HDCT/AHSCR) if CNCB was positive for HL, alternatively, if CNCB or PET was negative, received observation or consolidation radiotherapy (cRT) on residual nodal masses, as initially planned. The end-point was 5-year progression-free survival (PFS). Results In all, 43 of the 169 (25%) evaluable patients were PET6 positive (DS 4, 32; DS 5, 11). Among them, histology showed malignancy (HL) in 100% of DS 5 scores and in 12.5% of DS 4 scores. Fifteen patients with positive biopsy received HDCT/AHSCR, whereas 28 patients with negative biopsy, as well as 126 patients with negative PET6, continued the original plan (cRT, 78 patients; observation, 76 patients). The 5-year PFS in the negative PET6 group, negative biopsy group and positive biopsy group was 95.4%, 100% and 52.5%, respectively. Conclusion DS positivity of end-of-ABVD PET in advanced HL carried a certain number of CNCB-proven non-malignant FDG-uptakes. The DS 4 scores which were found to have negative histology appeared to benefit from continuing the original non-intensive therapeutic plane as indicated by the successful outcome in more than 95% of them by obtaining similar 5-year PFS to the PET6-negative group. By contrast, the DS 5 score had consistently positive histology and was associated with unsuccessful conventional therapy, promptly requiring treatment intensification or innovative therapeutic approaches

Research perspectives on corporate reputation and company’s performance measurement: an interpretive framework

In the knowledge economy, corporate reputation is relevant in increasing financial and extra-financial performance of contemporary companies. Although corporate reputation represents a significant dimension of relational capital, included in the intellectual capital, its characteristics are not easy to measure in assessing company performance over the time. In this direction, the paper aims to analyze the corporate reputation as influential intangible asset of contemporary company to define its evaluation by completing the company performance measurement system. This paper uses an updated conceptualization of corporate reputation literature which focuses on the need to integrate and complete the value of company performance. Performing a literature review on corporate reputation allows us to build an adequate framework for a new, integrated and innovative way to evaluate this intangible asset in the future scientific contribution. So, the research aims to create an integrated literature framework on corporate reputation, including studies on the evaluation of corporate reputation as strategic asset, its relevance in the definition of company performance, its impact on stakeholders’ behavio