Gunshot wound without entrance hole: where is the trick? - a case report and review of the literature

The presence at CT scan of more retained bullets than expected could be a very difficult interpretation challenge in the early management of gunshot wounds. The modern non operative management of haemodinamically stable patients without peritonitis requires that the trajectory of the bullet is clearly recognized. This clinical case reporting of a gunshot wound without evident entry hole, allows to discuss the diagnostic and therapeutic implications in the management of gunshot wounds cases with atypical entry and/or exit holes

A pragmatic approach improves the clinical management of stage IV gastric cancer: Comparison between the Meta-Gastro results and the GIRCG's retrospective series

Introduction: The Italian Research Group for Gastric Cancer developed a prospective database about stage IV gastric cancer, to evaluate how a pragmatic attitude impacts the management of these patients. Materials and methods: We prospectively collected data about metastatic gastric cancer patients thanks to cooperation between radiologists, oncologists and surgeons and we analyzed survival and prognostic factors, comparing the results to those obtained in our retrospective study. Results: Three-hundred and eighty-three patients were enrolled from 2018 to September 2022. We observed a higher percentage of laparoscopic exploration with peritoneal lavage in the prospective cohort. In the registry only 3.6 % of patients was submitted to surgery without associated chemotherapy, while in the retrospective population 44.3 % of patients were operated on without any chemotherapy. At univariate and multivariate analyses, the different metastatic sites did not show any survival differences among each other (OS 20.0 vs 16.10 vs 16.7 months for lymphnodal, peritoneal and hepatic metastases, respectively), while the number of metastatic sites and the type of treatment showed a statistical significance (OS 16,7 vs 13,0 vs 4,5 months for 1, 2 and 3 different metastatic sites respectively, p < 0.001; 24,2 vs 12,0 vs 2,5 months for surgery with/without chemotherapy, chemotherapy alone and best supportive treatment respectively, p < 0.001). Conclusions: Our data highlight that the different metastatic sites did not show different survivals, but survival is worse in case of multiple localization. In patients where a curative resection can be achieved, acceptable survival rates are possible. A better diagnostic workup and a more accurate staging impact favorably upon survival

Magnetic resonance myelography. Preliminary experience

Three-dimensional (3D) MR Myelography is a new technique using constructive interference steady-state (CISS) sequences, which are characterized by a symmetric flow compensation enhancing CSF signal intensity compared with neural and extradural structures. 3D myelographic projections with different rotation angles are obtained from the 3D dataset with a mathematical algorithm called maximum intensity projection (MIP). Myelographic projections yield a global view of subarachnoid spaces and of root sleeves with no intrathecal contrast agent injection. This study was aimed at assessing the feasibility, the clinical value and the diagnostic accuracy of 3D MR Myelography in comparison with conventional myelography. From September 1992 to January 1994, thirty-five myelograms were performed. The study population consisted of 10 volunteers, 8 patients with traumatic brachial plexus lesions, 7 with herniated disks (4 lumbar and 3 cervical disks), 4 with sacral radicular cysts, 2 with spinal vascular malformations, 3 with extramedullary intradural neoplasms (2 cervical neuromas and 1 cervical meningioma) and 1 with an intramedullary tumor (a conus medullaris ependymoma). All patients underwent SE MRI and conventional myelography (22 lumbar injections, 3 cervical injections of nonionic iodinated contrast agent) followed by CT (CT myelography). This trial demonstrates the feasibility of 3D MR myelography in the study of the cervical and lumbar spine: its results are comparable to those obtained with conventional myelography also in some specific indications like traumatic brachial plexus injuries, where invasive conventional myelography is usually thought to be essential

Diagnostic value of hepatocellular nodule vascularity after microbubble injection for characterizing malignancy in patients with cirrhosis

none8mixedQuaia, E; D'Onofrio, M; Cabassa, P; Vecchiato, F; Caffarri, S; Pittiani, F; WITTKOWSKI K., M; Cova, M. A

Delta-radiomics and response to neoadjuvant treatment in locally advanced gastric cancer—a multicenter study of GIRCG (Italian Research Group for Gastric Cancer)

Background: To predict response to neoadjuvant chemotherapy (NAC) of gastric cancer (GC), prior to surgery, would be pivotal to customize patient treatment. The aim of this study is to investigate the reliability of computed tomography (CT) texture analysis (TA) in predicting the histo-pathological response to NAC in patients with resectable locally advanced gastric cancer (AGC). Methods: Seventy (40 male, mean age 63.3 years) patients with resectable locally AGC, treated with NAC and radical surgery, were included in this retrospective study from 5 centers of the Italian Research Group for Gastric Cancer (GIRCG). Population was divided into two groups: 29 patients from one center (internal cohort for model development and internal validation) and 41 from other four centers (external cohort for independent external validation). Gross tumor volume (GTV) was segmented on each pre- and post-NAC multidetector CT (MDCT) image by using a dedicated software (RayStation), and 14 TA parameters were then extrapolated. Correlation between TA parameters and complete pathological response (tumor regression grade, TRG1), was initially investigated for the internal cohort. The univariate significant variables were tested on the external cohort and multivariate logistic analysis was performed. Results: In multivariate logistic regression the only significant TA variable was delta gray-level co-occurrence matrix (GLCM) contrast (P=0.001, Nagelkerke R2: 0.546 for the internal cohort and P=0.014, Nagelkerke R2: 0.435 for the external cohort). Receiver operating characteristic (ROC) curves, generated from the logistic regression of all the patients, showed an area under the curve (AUC) of 0.763. Conclusions: Post-NAC GLCM contrast and dissimilarity and delta GLCM contrast TA parameters seem to be reliable for identifying patients with locally AGC responder to NAC