Conventional MRI-Derived Biomarkers of Adult-Type Diffuse Glioma Molecular Subtypes: A Comprehensive Review

The introduction of molecular criteria into the classification of diffuse gliomas has added interesting practical implications to glioma management. This has created a new clinical need for correlating imaging characteristics with glioma genotypes, also known as radiogenomics or imaging genomics. Although many studies have primarily focused on the use of advanced magnetic resonance imaging (MRI) techniques for radiogenomics purposes, conventional MRI sequences remain the reference point in the study and characterization of brain tumors. A summary of the conventional imaging features of glioma molecular subtypes should be useful as a tool for daily diagnostic brain tumor management. Hence, this article aims to summarize the conventional MRI features of glioma molecular subtypes in light of the recent literature

IMPIEGO DELL'ARTROSCOPIA NEL TRATTAMENTO DEI POSTUMI FRATTURATIVI DELLA CAVIGLIA

Valutazione clinica mediante" scheda Faos" in pazienti sottoposti ad artroscopia di caviglia in esiti fratturativi della tibio-tarsica: dati pre e post trattamento a confronto

La chirurgia addominale d’urgenza nel paziente geriatrico. Nostra esperienza

L’invecchiamento della popolazione pone nuovi problemi sociosanitari. Si sono tra l’altro modificate e ampliate le indicazioni all’intervento chirurgico. I risultati nei soggetti anziani sono soddisfacenti quando si tratti di chirurgia di elezione, meno in quelli sottoposti ad intervento chirurgico d’urgenza, ove la morbilità e la mortalità si rivelano ancora oggi elevate. Gli Autori riportano la propria esperienza in tema di chirurgia d’urgenza nel paziente geriatrico. Dal 1982 al 2002, 718 pazienti (361 maschi, 50,3%; 357 femmine, 49,7%; età media 50 anni, range 5-92) sono stati sottoposti ad interventi chirurgici d’urgenza per lesioni addominali. I pazienti sono stati suddivisi in due gruppi: gruppo A (> 65 anni; 190 pazienti, 87 maschi e 103 femmine; età media 72 anni, range 66-92); gruppo B di controllo (<65 anni; 528 pazienti, 274 maschi e 254 femmine; età media 43 anni, range 5-65). I risultati sono stati valutati in funzione della morbilità e della mortalità operatoria e postoperatoria. La morbilità postoperatoria è risultata pari al 25,7% (36,3% nel gruppo A, 21,9% nel gruppo B). La mortalità intraoperatoria è risultata pari allo 0,27%. La mortalità postoperatoria è risultata pari al 12,1% (significativamente più elevata nei pazienti del gruppo A -16,8% vs 10,4%). La mortalità nei 190 pazienti del gruppo A è risultata più elevata nei pazienti che presentavano rispettivamente 1, 2, 3 o più malattie concomitanti. Il progressivo aumento percentuale del numero di interventi eseguiti nei pazienti anziani è ascrivibile oltre che all’incremento demografico dei soggetti di età avanzata anche al cambiamento dell’atteggiamento del chirurgo. Mentre la chirurgia geriatrica condotta in elezione comporta oggi indici di mortalità accettabili (5-8%), per la chirurgia geriatrica in urgenza la prognosi non si è modificata negli ultimi decenni in misura sostanziale e la mortalità rimane elevata (20-30%). Riteniamo che in chirurgia geriatrica si potranno ottenere risultati globalmente migliori solo riducendo per quanto possibile la necessità dell’urgenza, insistendo sulla opportunità di intervenire prima che la malattia nella sua evoluzione naturale esiga provvedimenti non più procrastinabili. Ciò consentirebbe risultati positivi non solo in termini di mortalità e di morbilità, che rimangono obiettivi primari, ma anche di durata della degenza e del costo

Comparison between dynamic [18F]Fluoroethyltyrosine PET/CT and advanced MRI in cerebral high and low grade gliomas.\ua0 ;\ua0

Comparison between dynamic [18F]Fluoroethyltyrosine PET/CT and advanced MRI in cerebral high and low grade gliomas L. Picori, U. Rozzanigo, D. Donner, M. Erini, P. Feraco, M. Recla, F. Chierichetti; Santa Chiara Hospital, Trento, ITALY. Aim/Introduction: To investigate if dynamic [18F]fluoroethyl- L-tyrosine [18F]FET PET/CT improves the diagnosis in patients with suspected new or recurrent cerebral gliomas, respect to advanced MRI techniques. Materials and Methods: We retrospectively evaluated 20 patients who performed [18F] FET by a PET/CT tomograph: 15 had an indeterminate brain lesion, 5 a suspect glioma recurrence. All patients underwent a 40 minutes dynamic [18F]FET PET/CT acquisition and two different sequences, between 5-15 minutes and 20-30 minutes. For dynamic studies time-activity and time to peak curves were extracted using different region-of-interest (ROIs) and volume of interest (VOIs) definitions. MRI was performed with a 1.5T scanner just before [18F]FET-PET/CT using perfusion (PWI) and diffusion (DWI) weighted imaging: afterwards rCBV and ADC values were calculated placing the VOIs on the solid components of the lesion. In case of doubt (13 cases) single-voxel MR spectroscopy was performed. Multimodality imaging by fusion of PET/CT and different MRI sequences was performed for a joint assessment (radiologist and nuclear physician). Results: Final diagnosis was based on histology in 8 patients who underwent neurosurgery (5 HGG, 3 LGG) and on follow-up imaging in 12 patients (8 tumor progression, 4 stable benign lesion). On the basis of [18F]FET- PET, 7 cases were classified as high uptake (2 glioma recurrence and 5 new diagnosis of HGG tumor), 8 as low uptake (4 glioma recurrence, 2 new diagnosis of LGG tumor, 1 tumor progression, 1 tumefactive demielinating lesion) and 5 as no uptake (1 new diagnosis of LGG tumor, 4 stable benign lesion). Sensibility for dynamic [18F]FET-PET was 93% and specificity was 80%. Multiparametric MRI was in agreement with [18F]FET-PET in all 7 cases of high uptake and in 5 cases of low uptake. [18F]FET- PET helped to classify 6 MRI indeterminate lesions (2 suspect radionecrosis with pathologic uptake, 4 benign lesions without uptake). In 2 cases there was a discrepancy between MRI and PET: 1 tumefactive demielinating lesion was classified by [18F] FET as low uptake lesion, 1 LGG confirmed at histology showed no uptake. Conclusion: In our experience, adding quantitative data, such as dynamic acquisition in PET/CT by aminoacid tracer like [18F]FET, to rCBV and ADC maps in advanced MRI is crucial for a better comprehension of tumor lesions and to assess grading. Dynamic [18F]FET-PET/CT and multiparametric MR imaging have a very high sensibility to detect new tumoral lesions or suspect glioma recurrence. Agreement between PET and MRI is essential to improve diagnostic specificity. References: None

Abdominal emergency surgery in the geriatric patients. Our experience

The ageing process of general population implies new socio-sanitary problems. Indications for surgical intervention have been modified and enhanced. As far as elective surgery is concerned, the results in elderly subjects do not seem alarming, whereas less satisfactory results have been registered in the patients who underwent an emergency surgical intervention, where nowadays morbidity and mortality still turn out to be high. The Authors have reported their experience of emergency surgery in the geriatric patient. From 1982 to 2002, 718 pts (361 males, 50.3% and 357 females, 49.7%; average age 50 yrs, range 5-92) underwent emergency surgical interventions for abdominal lesions. The pts were subdivided in two groups: group A (> 65 years; 190 pts, 87 males and 103 females; average age 72 yrs, range 66-92); control group B (<65 years; 528 pts, 274 males and 254 females; average age 43 yrs, range 5-65). The results were assessed in terms of morbidity and of the operative and post-operative mortality. Postoperative morbidity proved to be equal to 25.7% (36.3% in the group A, 21.9% in the group B), while intraoperative mortality equal to 0.27%. Postoperative mortality resulted equal to 12.1% (significantly higher in group A pts -- 16.8%- than in group B pts --10.4%). The mortality of the 190 pts belonging to group A was higher in the pts which were presenting respectively 1, 2, 3 or more concomitant diseases. The progressive percentage increase in the number of interventions on elderly pts not only can be due to the demographic increase of old people, but it can also be linked to a change in the surgeon's attitude. At the present time, while elective geriatric surgery implies an acceptable mortality rate (5-8 %), emergency geriatric surgery has not notably modified the prognosis in the last decades and mortality has turned out to be still high (20-30%). We think that it will be possible to obtain better results through geriatric surgery only by reducing emergency interventions as much as possible. In order to do so, it will be important to insist on intervening before the illness, during its natural evolution, requires actions which cannot be postponed. This would lead to positive results not only in terms of mortality and morbidity, which are still considered as the main targets, but also as far as the period of the stay in hospital and costs are concerned