US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy

Objectives To compare the outcome of US-guided percutaneous irrigation of calcific tendinopathy (US-PICT) of the rotator cuff in patients with or without previous external shockwave therapy (ESWT). Methods We analyzed all patients treated with US-PICT from March 1, 2016, to October 1, 2019, with shoulder pain refractory to conservative management for rotator cuff calcific tendinopathy, diagnosed with ultrasound. Each patient was examined using the Constant-Murley Score (CMS) questionnaire (score 0-100) before and after treatment. We tested CMS differences using the Mann-Whitney U (Wilcoxon rank-sum) test in the two groups. US-PICT was performed placing two or multiple 14G needles, according to the calcification size, inserted under US guidance to create a circuit of irrigation in the calcified tendon. NaCl solution at 38 degrees C was then injected from the entry needle in a variable amount to hydrate and fragment the calcification, finally allowing for its expulsion through the exit needle. All patients also received an intrabursal steroid injection. Results From 2016 to 2019, 72 US-PICT treatments were performed on 70 patients (females = 46; males = 26) with a mean age of 49.7 years (SD = 8.7. Thirty-three (47%) underwent previous ESWT, while thirty-seven (53%) had no previous treatments. No treatment-related complications were observed. Follow-up was averagely 14.4 months (median = 11.6, SD = 11.9, range 1-45); 37 patients had a follow-up shorter than 12 months (1-11.6); 35 patients were visited after more than 1 year (12.2-45.6, Table W). Before treatment, the mean CMS was 35 (SD = 21); after treatment, it reached 75.4, with an average CMS improvement of 40.3 points (SD = 23.7, p < 0.001). The comparison of improvement between the ESWT and non-ESWT group yielded no significant difference (p = 0.3). Conclusions US-PICT of the rotator cuff is an effective procedure to reduce shoulder pain and increase mobility in patients with calcific tendinopathy, both in short- and long-term time intervals. Previous unsuccessful ESWT does not affect the outcome of US-PICT

A reappraisal of the diagnostic and therapeutic management of uncommon histologies of primary ocular adnexal lymphoma

Lymphoma is the most common malignancy arising in the ocular adnexa, which includes conjunctiva, lachrymal gland, lachrymal sac, eyelids, orbit soft tissue, and extraocular muscles. Ocular adnexal lymphoma (OAL) accounts for 1%-2% of non-Hodgkin lymphoma and 5%-15% of extranodal lymphoma. Histology, stage, and primary localizations are the most important variables influencing the natural history and therapeutic outcome of these malignancies. Among the various lymphoma variants that could arise in the ocular adnexa, marginal zone B-cell lymphoma (OA-MZL) is the most common one. Other types of lymphoma arise much more rarely in these anatomical sites; follicular lymphoma is the second most frequent histology, followed by diffuse large B-cell lymphoma and mantle cell lymphoma. Additional lymphoma entities, like T-cell/natural killer cell lymphomas and Burkitt lymphoma, only occasionally involve orbital structures. Because they are so rare, related literature mostly consists of anecdotal cases included within series focused on OA-MZL and sporadic case reports. This bias hampers a global approach to clinical and molecular properties of these types of lymphoma, with a low level of evidence supporting therapeutic options. This review covers the prevalence, clinical presentation, behavior, and histological and molecular features of uncommon forms of primary OAL and provides practical recommendations for therapeutic management

Dataset related to article "A reference framework for standardization and harmonization of CT Radiomics features: the "CadAIver" analysis"

<p><strong>Abstract</strong></p><p> </p><p><strong>Background</strong></p><p> </p><p>In recent years, Radiomics features (RFs) have been developed to provide quantitative, standardized information about shape, density/intensity and texture patterns on radiological images. Several studies showed limitations in the reproducibility of RFs in different acquisition settings. To date, reproducibility studies using CT images mainly rely on phantoms, due to the harness of patient exposure to X-rays.  In this study we analyze the effects of CT acquisition parameters on RFs of lumbar vertebrae in a cadaveric donor.</p><p> </p><p><strong>Methods</strong></p><p> </p><p>112 unique CT acquisitions from cadaveric truck were performed on 3 different CT scanners varying KV, mA, field of view and reconstruction kernel settings. Lumbar vertebrae were segmented through a deep learning convolutional neural network and RFs were computed. The effects of each protocol on each RFs were assessed by univariate and multivariate Generalized Linear Model. Further, we compared the GLM model to the ComBat algorithm in the efficiency in harmonizing CT images.</p><p> </p><p><strong>Findings</strong></p><p> </p><p>From GLM, mA variation was not associated with alteration of RFs , whereas kV modification was associated with exponential variation of several RFs, including First Order (94.4%), GLCM (87.5%) and NGTDM (100%).</p><p>Upon cross-validation, ComBat algorithm obtained a mean R2 higher than 0.90 in 1 RFs (0.90%), whereas GLM model obtained high R2 in 21 RFs (19.6%), showing that the proposed GLM could effectively harmonize acquisitions better than ComBat.</p><p> </p><p> </p><p><strong>Interpretation</strong></p><p> </p><p>This study represents the first attempt in describing the effects of CT acquisition parameters in bone RFs in a cadaveric donor. Our analyses showed that RFs could be substantially different according to the variation of each acquisition parameter and in dataset obtained from different CT scanners. These differences can be minimized using the proposed GLM model. Publicly available dataset and GLM could foster the research of Radiomics-based studies by increasing harmonization across CT protocols and vendors.</p&gt

PET and MRI studies applied on characterization of Fisher/F98 rat glioma model

Introduction: Preclinical brain tumor models have provided a wealth of information on the biology, imaging and experimental therapeuticsof brain tumors. The aim of our study is characterized Fisher/F98 rat glioma model using Positron Emission Tomography (PET) and Magnetic Resonance (MR) analysis to set up an experimental model useful to study the efficacy of new colloidal vectors for chemotherapy. Methods: Syngenic rat brain-glioma models (Fisher/F98) was obtained by stereotactic (x=2; y=5; z=3) implantation of different cell concentrations (102, 103, 104 and 105). To monitor tumor growth progression, rats underwent once a week Gadolinium enhanced T1-MRI studies followed by [18F]FDG PET studies, starting from 7 days after surgery. A group of animals performed also [18F]FAZA PET studies to evaluate regional tissue hypoxia. To improve quantification, PET and MRI images were fused using PMOD 2.7 software. Max radiotracers uptake was calculated for tumor,frontal cortex, cerebellum and background using region of interest (ROI) analysis. Radioactivity concentration values expressed in MBq/g were then transformed into percentage of injected dose per gram of tissue (%ID/g). Moreover, histological analysis of proliferation, apoptosis, differentiation, neoangiogenesis and hypoxia markers were performed. Results: Mean survival time of rats injected with 104 and 105 cells was nine days. One week after surgery, MRI revealed a rapid growth that reached 0.11 cm3 mean tumour volume. Animals injected with 103 and 102 cells showed a mean survival time of 18 and 24 days respectively. In rats injected with 103 cells, tumor was revealed 14 days after surgery at MRI and [18F]FDG PET and successively tumors rapidly increased. Disease course in 102 cells injected rats was slower. Tumors were characterized by high [18F]FDG uptake and hypoxic subareas which only partially overlapped. Hypoxic areas were mainly localized in correspondence to Gd-enhanced regions whereas hyper glucose metabolic areas were localized in the outer part of the tumors. At histological analysis tumoral masses showed an infiltrative pattern of growth and moderate neoangiogenesis. Tumors obtained at animals death showed diffused necrotic areas. HIF1 was clearly expressed by glial and neuronal cells in oedematous and hypoxic areas. Conclusions: Our study indicates that Fisher/ F98 rat glioma model reproduces the characteristic of aggressiveness of human glioblastoma. Tumor was characterized by high glucose metabolism and by hypoxic sub-areas. The concentration of 102 cells permits to better monitor disease onset and progression and to plan experiments to test new anti-neoplastic therapies efficacy

Identification of imaging biomarkers for the assessment of tumour response to different treatments in a preclinical glioma model

PURPOSE: Hypoxia-inducible factor 1\u3b1 (HIF-1\u3b1) activity is one of the major players in hypoxia-mediated glioma progression and resistance to therapies, and therefore the focus of this study was the evaluation of HIF-1\u3b1 modulation in relation to tumour response with the purpose of identifying imaging biomarkers able to document tumour response to treatment in a murine glioma model. METHODS: U251-HRE-mCherry cells expressing Luciferase under the control of a hypoxia responsive element (HRE) and mCherry under the control of a constitutive promoter were used to assess HIF-1\u3b1 activity and cell survival after treatment, both in vitro and in vivo, by optical, MRI and positron emission tomography imaging. RESULTS: This cell model can be used to monitor HIF-1\u3b1 activity after treatment with different drugs modulating transduction pathways involved in its regulation. After temozolomide (TMZ) treatment, HIF-1\u3b1 activity is early reduced, preceding cell cytotoxicity. Optical imaging allowed monitoring of this process in vivo, and carbonic anhydrase IX (CAIX) expression was identified as a translatable non-invasive biomarker with potential clinical significance. A preliminary in vitro evaluation showed that reduction of HIF-1\u3b1 activity after TMZ treatment was comparable to the effect of an Hsp90 inhibitor, opening the way for further elucidation of its mechanism of action. CONCLUSION: The results of this study suggest that the U251-HRE-mCherry cell model can be used for the monitoring of HIF-1\u3b1 activity through luciferase and CAIX expression. These cells can become a useful tool for the assessment and improvement of new targeted tracers for potential theranostic procedures

Validation and performance assessment of a preclinical SiPM-based SPECT/MRI insert

A preclinical insert for small animal simultaneous SPECT and MR imaging, in particular for imaging mouse brains, is presented. It consists of ten static magnetic resonance imaging (MRI)-compatible gamma cameras based on tiles of silicon photomultipliers readout by a multichannel ASIC and coupled to 5 cm × 5 cm CsI(Tl) scintillators and to an MRI-compatible multipinhole collimator. Calibration and image reconstruction algorithm are illustrated. Mutual compatibility is demonstrated along with imaging performance that is comparable with other non-MR micro-SPECT systems: 0.9 mm tomographic spatial resolution across a transverse field of view of 15.6 mm, 12% energy resolution (at 140 keV), and 1105 cps/MBq sensitivity. Experimental results with phantoms (glass capillaries of 290 μm diameter and a mini Derenzo) are presented