Time-intensity curves obtained after microbubble injection can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment

Purpose: To assess whether contrast material-enhanced ultrasonography (US) can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after\ub1weeks of pharmacologic treatment. Materials and Methods: This prospective study was approved by our ethics committee, and written informed consent was obtained from all patients. Fifty consecutive patients (26 men and 24 women; mean age, 34.76 years\ub19) with a proved diagnosis of active Crohn disease who were scheduled to begin therapy with biologics (infliximab or adalimumab) were included, with enrollment from June 1, 2013, to June 1, 2015. In each patient, the terminal ileal loop was imaged with contrast-enhanced US before the beginning and at the end of week\ub1of pharmacologic treatment. Time-intensity curves obtained in responders (those with a decrease in the Crohn disease endoscopic index of severity score of 25-44 before treatment to 10-15 after treatment, an inflammatory score ,7, and/or a decrease 6570 in the Crohn disease activity index score compared with baseline) and nonresponders were compared with Mann-Whitney test. Results: Responders (n = 31) and nonresponders (n = 19) differed (P , .05) in the percent change of peak enhancement (240.78\ub162.85 vs 53.21\ub172.5; P = .0001), wash-in (234.8\ub167.72 vs 89.44\ub1145.32; P = .001) and washout (25.64\ub1130.71 vs 166.83\ub1204.44; P = .002) rate, wash-in perfusion index (242.29\ub159.21 vs 50.96\ub171.13; P = .001), area under the time-intensity curve (AUC; 246.17\ub148.42 vs 41.78\ub187.64; P = .001), AUC during wash-in (243.93\ub154.29 vs 39.79\ub170.85; P = .001), and AUC during washout (249.36\ub147.42 vs 42.65\ub197.09; P = .001). Responders and nonresponders did not differ in the percent change of rise time (5.09\ub149.13 vs 6.24\ub148.06; P = .93) and time to peak enhancement (8.82\ub154.5 vs 10.21\ub143.25; P = .3). Conclusion: Analysis of time-intensity curves obtained after injection of microbubble contrast material\ub1weeks after beginning pharmacologic treatment can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease

Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

Purpose: The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. Methods: A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. Results: A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B). Conclusions: A growing number of evidences evidence support the role of maximal safe resection as primary OS predictor in GG4 patients. The ongoing development of intraoperative techniques for a precise real-time identification of peritumoral functional pathways enables surgeons to maximize EOR minimizing the post-operative morbidity

Bolus versus continuous infusion of microbubble contrast agent for liver ultrasound by using an automatic power injector in humans: A pilot study

Purpose. To evaluate the feasibility of using continuous infusion, in comparison with bolus injection, of a sulfur hexafluoride\u2013microbubble contrast agent to prolong the duration of hepatic parenchymal enhancement in humans during sonographic examination. Methods. This pilot study was approved by our institution\u2019s ethics committee. Ten patients (5 men and 5 women; mean age 6 SD, 65 6 10 years) each received two injections: a bolus injection (2 ml/s) and then continuous infusion (0.5 ml/min) of the contrast agent by using an automatic injector. Acquired cine clips were transferred to a personal computer, and the video intensity was quantified by dedicated software. Results. From the time of the first microbubble visualization in the scanning plane, maximal enhancement was reached in 6.3 6 0.94 seconds after bolus injection and in 13.9 6 1.44 seconds during continuous infusion (p 5 0.002, Wilcoxon\u2019s test for paired data). Compared with bolus injection, continuous infusion prolonged the duration of contrast enhancement (4.3 minutes 6 42 seconds versus 7.3 minutes 6 40 seconds; p 5 0.002), although no statistically significant difference in maximal enhancement was observed (45 6 18% for bolus injection and 396 6%for continuous infusion; p50.62). Conclusions. Continuous infusion of sulfur hexafluoride\u2013filled microbubbles via an automatic power injector prolongs hepatic contrast enhancement without significantly modifying the maximal enhancement over that at baseline. These data, coming from a pilot study, can be used to design a larger study with adequate statistical power

Bolus versus continuous infusion of microbubble contrast agent for liver ultrasound by using an automatic power injector in humans: A pilot study

Purpose. To evaluate the feasibility of using continuous infusion, in comparison with bolus injection, of a sulfur hexafluoride\u2013microbubble contrast agent to prolong the duration of hepatic parenchymal enhancement in humans during sonographic examination. Methods. This pilot study was approved by our institution\u2019s ethics committee. Ten patients (5 men and 5 women; mean age 6 SD, 65 6 10 years) each received two injections: a bolus injection (2 ml/s) and then continuous infusion (0.5 ml/min) of the contrast agent by using an automatic injector. Acquired cine clips were transferred to a personal computer, and the video intensity was quantified by dedicated software. Results. From the time of the first microbubble visualization in the scanning plane, maximal enhancement was reached in 6.3 6 0.94 seconds after bolus injection and in 13.9 6 1.44 seconds during continuous infusion (p 5 0.002, Wilcoxon\u2019s test for paired data). Compared with bolus injection, continuous infusion prolonged the duration of contrast enhancement (4.3 minutes 6 42 seconds versus 7.3 minutes 6 40 seconds; p 5 0.002), although no statistically significant difference in maximal enhancement was observed (45 6 18% for bolus injection and 396 6%for continuous infusion; p50.62). Conclusions. Continuous infusion of sulfur hexafluoride\u2013filled microbubbles via an automatic power injector prolongs hepatic contrast enhancement without significantly modifying the maximal enhancement over that at baseline. These data, coming from a pilot study, can be used to design a larger study with adequate statistical power

Indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography: Assessment of the additional diagnostic value of contrast-enhanced ultrasound in the non-cirrhotic liver

Objective: To assess the additional diagnostic value of contrast-enhanced ultrasound (CEUS) in the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography (CT). Methods: Fifty-five solid hepatic lesions (1\u20134 cm in diameter) in 46 non-cirrhotic patients (26 female, 20 male; age \ub1 SD, 55 \ub1 10 years) underwent CEUS after being detected on contrast-enhanced CT which was considered as non-diagnostic after on-site analysis. Two blinded independent readers assessed CT and CEUS scans and were asked to classify retrospectively each lesion as a malignant or benign based on reference diagnostic criteria for the different hepatic lesion histotypes. Diagnostic accuracy and confidence (area \u2013 Az \u2013 under ROC curve) were assessed by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging (n = 30 lesions), histology (n = 7 lesions), or US follow-up (n = 18 lesions) as the reference standards. Results: Final diagnoses included 29 hemangiomas, 3 focal nodular hyperplasias, 1 hepatocellular adenoma, and 22 metastases. The additional review of CEUS after CT images improved significantly (P < .05) the diagnostic accuracy (before vs after CEUS review = 49% [20/55] vs 89% [49/55] \u2013 reader 1 and 43% [24/55] vs 92% [51/55] \u2013 reader 2) and confidence (Az, 95% Confidence Intervals before vs after CEUS review = .773 [.652\u2013.895] vs .997 [.987\u20131] \u2013 reader 1 and .831 [.724\u2013.938] vs .998 [.992\u20131] \u2013 reader 2). Conclusions: CEUS improved the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced CT by identifying some specific contrast enhancement patterns

Predictors of intrahepatic cholangiocarcinoma in cirrhotic patients scanned by gadobenate dimeglumine-enhanced magnetic resonance imaging: Diagnostic accuracy and confidence

Objective: To identify predictors of intrahepatic cholangiocarcinoma in cirrhotic patients scanned by gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging. Methods: Fifty cirrhotic patients with 120 nodules, including 10 mass-forming intrahepatic cholangiocarcinomas and two combined hepatocellular carcinoma-cholangiocarcinomas, were scanned by Gd-BOPTA-enhanced MR imaging. Results: T1 hypointensity [odds ratio (OR), 20.12], peripheral hyperintense rim at hepatic arterial phase (OR, 13.5), and iso-hyperintensity at hepatobiliary phase (OR 21.32) were found to be independent predictors of intrahepatic cholangiocarcinoma. Conclusions: T1 hypointensity, peripheral hyperintense rim at hepatic arterial phase, and iso-hyperintensity at hepatobiliary phase are independent predictors of intrahepatic cholangiocarcinoma diagnosis in patients with liver cirrhosis. \ua9 2015 Elsevier Inc

Arterial enhancing \u2013 only nodules less than 2 cm in diameter in patients with liver cirrhosis: predictors of hepatocellular carcinoma diagnosis on gadobenate dimeglumine - enhanced MR Imaging.

Purpose: To assess whether gadobenate dimeglumine (Gd-BOPTA)-enhanced MR imaging could predict hepatocellular carcinoma (HCC) diagnosis in small arterial enhancing-only nodules detected by contrast-enhanced computed tomography (CT) in patients with liver cirrhosis. Materials and Methods: We prospectively recruited 125 cirrhotic patients (67 males, and 58 females; age: 68 6 12.36 years) with 151 small (<2 cm in diameter) arterial enhancing-only nodules identified by contrast-enhanced CT. All patients were scanned by MR imaging before and after Gd-BOPTA injection during the hepatic arterial phase (HAP), portal venous phase (PVP), equilibrium phase (EP), and hepatobiliary phase (HP). Nodule characterization was based on reference imaging criteria (n \ubc 29 nodules), follow-up (n \ubc 105), or histology (n \ubc 17). Two radiologists (5 and 10 years experience) analyzed the MR images, and logistic regression was conducted to assess how well MR imaging findings could predict HCC diagnosis. Results: Final diagnoses included 115 benign nodules and 36 HCCs. Nodule T2 hyperintensity, T1 hypointensity, PVP-EP hypointensity, and HP hypointensity were the best predictors of HCC on univariate analysis. Nodule T2 hyperintensity, T1 hypointensity, and HP hypointensity, were independent predictors of HCC on multivariate analysis. Conclusion: Gd-BOPTA-enhanced MR imaging provides imaging findings which may predict a diagnosis of HCC in small arterial enhancing-only nodules in cirrhotic patients

Value of percent change in tumoral volume measured at T2-weighted and diffusion-weighted MRI to identify responders after neoadjuvant chemoradiation therapy in patients with locally advanced rectal carcinoma

Purpose: To evaluate the percent change in tumoral volume measured at T2-weighted magnetic resonance imaging (T2WMRI) and diffusion-weighted (DWI) as a method to identify responders after chemo- and radiation therapy (CRT) in patients with locally advanced rectal carcinoma. Materials and Methods: Forty-five consecutive patients (mean age \ub1 SD: 72 years \ub1 9.7; male/female = 24/21) with locally advanced rectal carcinoma underwent CRT followed by surgery. Each patient underwent T2WMRI and DWI at 1.5T before and 6 weeks after the completion of CRT. The percent change in tumoral volume before and 6 weeks after CRT was compared in patients classified as responders and nonresponders according to rectal cancer regression grade. Results: Twenty-five patients were classified as responders with either partial (n = 20) or complete response (n = 5), while 20 patients were classified as nonresponders due to stable disease (n = 18) or disease progression (n = 2). Responders vs. nonresponders differed in the percent change of tumoral volume at T2WMRI ( 1267% \ub1 26% vs. 1229% \ub1 26%; P < 0.05) and DWI images ( 1272% \ub1 24% vs. 1233% \ub1 28%; P < 0.05) with a cutoff 64 1270% for T2WMRI (sensitivity = 69%, 95% confidence interval [CI]: 48 1285%; specificity = 100%, 95% CI 81\u2013100%) and 6466% for DWI (sensitivity = 73%, 95% CI: 52\u201388%; specificity = 100%, 95% CI 81\u2013100%). Conclusion: The percent change in tumoral volume at T2WMRI and DWI images can differentiate responders from nonresponders in patients with locally advanced rectal carcinoma after neoadjuvant CRT

Predictors of mesorectal fascia invasion after gadolinium injection in rectal carcinoma after neoadjuvant therapy

OBJECTIVE: To assess spectral presaturation inversion-recovery MRI sequence with gadolinium to identify predictors of mesorectal fascia (MRF) invasion in patients with locally advanced rectal carcinoma after neoadjuvant therapy. MATERIALS AND METHODS: Sixty-five patients underwent neoadjuvant concomitant radiation and chemotherapy and surgery. Magnetic resonance images were assessed by two radiologists. RESULTS: Linear (odds ratio, 95% confidence intervals: 19.33, 1.98-188.6) and reticular strands (odds ratio, 95% confidence intervals: 9.75, 1.45-67.77) reaching the MRF are predictors of MRF invasion. CONCLUSION: Linear or reticular mesorectal strands reaching the MRF detected at contrast-enhanced MRI represent a predictor of MRF invasion