Benign and malignant mimickers of infiltrative hepatocellular carcinoma: tips and tricks for differential diagnosis on CT and MRI

Hepatocellular carcinoma (HCC) may have an infiltrative appearance in about 8–20% of cases. Infiltrative HCC can be a challenging diagnosis and it is associated with the worst overall survival among HCC patients. Infiltrative HCC is characterized by the spread of multiple minute nodules throughout the liver, without a dominant one, ultimately resulting into macrovascular invasion. On CT and MRI, infiltrative HCC appears as an ill-defined, large mass, with variable degree of enhancement, and satellite neoplastic nodules in up to 52% of patients. On MRI, it may show restriction on diffusion weighted imaging, hyperintensity on T2- and hypointensity on T1-weighted images, and, if hepatobiliary agent is used, hypointensity on hepatobiliary phase. Infiltrative HCC must be differentiated from other liver diseases, such as focal confluent fibrosis, steatosis, amyloidosis, vascular disorders of the liver, cholangiocarcinoma, and diffuse metastatic disease. In cirrhotic patients, the identification of vascular tumor invasion of the portal vein and its differentiation from bland thrombosis is of utmost importance for patient management. On contrast enhanced CT and MRI, portal vein tumor thrombosis appears as an enhancing thrombus within the portal vein, close to the main tumor and results into vein enlargement. The aim of this pictorial review is to show CT and MRI features that allow the diagnosis of infiltrative HCC and portal vein tumor thrombosis. A particular point of interest includes the tips and tricks for differential diagnosis with potential mimickers of infiltrative HCC

ETHICS AND AGING: FOCUS ON LIVING WILL FOR PATIENTS WITH DEMENTIA

Today dementia certainly represents a public health priority with a huge global impact on wordwide population. However, clinical and social issues related to demen-tia have long been marginalized. The actual high prevalence of dementias requires also to face issues from a bioethical perspective, regarding how to deal with demented patient\u2019s disposition. There are currently no specific guide-lines on the national territory regarding whether to draw up a living will by a patient with dementia, neither about the informa-tive role of physicians during the progres-sive story of the disease

Nutrition, physical activity, and other lifestyle factors in the prevention of cognitive decline and dementia

Multiple factors combined are currently recognized as contributors to cognitive decline. The main independent risk factor for cognitive impairment and dementia is advanced age followed by other determinants such as genetic, socioeconomic, and environmental factors, including nutrition and physical activity. In the next decades, a rise in dementia cases is expected due largely to the aging of the world population. There are no hitherto effective pharmaceutical therapies to treat age-associated cognitive impairment and dementia, which underscores the crucial role of prevention. A relationship among diet, physical activity, and other lifestyle factors with cognitive function has been intensively studied with mounting evidence supporting the role of these determinants in the development of cognitive decline and dementia, which is a chief cause of disability globally. Several dietary patterns, foods, and nutrients have been investigated in this regard, with some encouraging and other disappointing results. This review presents the current evidence for the effects of dietary patterns, dietary components, some supplements, physical activity, sleep patterns, and social engagement on the prevention or delay of the onset of age-related cognitive decline and dementia. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Sarcopenia using muscle mass prediction model and cognitive impairment: A longitudinal analysis from the English longitudinal study on ageing

Background: Literature on the association between sarcopenia and cognitive impairment is largely unclear and mainly limited to non-European populations. Therefore, the aim of this study is to explore if the presence of sarcopenia at the baseline could increase the risk of cognitive impairment in a large cohort of older people participating to the English Longitudinal Study of Ageing (ELSA), over ten years of follow-up. Methods: Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index at the baseline, using a muscle mass prediction model; cognitive function was evaluated in the ELSA through several tests. The results are reported in the whole sample adjusted for potential baseline confounders and after matching sarcopenic and non-sarcopenic participants with a propensity score. Results: 2738 people (mean age: 68.7 years, 54.4% males) were included. During the ten years of follow-up, sarcopenia was associated with significantly lower scores in memory (p < 0.001), verbal fluency (p < 0.001), immediate word recall (p <0.001), delayed word recall (p = 0.018), and in recall summary score (p < 0.001). After adjusting for eight potential confounders, the presence of sarcopenia was significantly associated with poor verbal fluency (odds ratio, OR= 1.417, 95% confidence intervals, CI= 1.181–1.700) and in propensity-score matched analyses (OR=1.272, 95%CI= 1.071- 1.511). Conclusions and implications: Sarcopenia was found to be associated with a significantly higher incidence of poor cognitive status in a large population of elderly people followed up for 10 years, suggesting it may be an important potential risk factor for dementia

Surgical complications after pancreatic transplantation: A computed tomography imaging pictorial review

pancreatic transplantation should start with the evaluation of the arterial Y-graft, the venous anastomosis and the duodenojejunostomy. With regard to complications, CT allows for the identification of vascular complications, such as thrombosis or stenosis of blood vessels supplying the graft, the detection of pancreatic fluid collections, including pseudocysts, abscesses, or leaks, the assessment of bowel complications (anastomotic leaks, ileus or obstruction), and the identification of bleeding. The aim of this pictorial review is to illustrate CT findings of surgical-related complications after pancreatic transplantation. The knowledge of surgical techniques is of key importance to understand postoperative anatomic changes and imaging evaluation. Therefore, we first provide a short summary of the main techniques of pancreatic transplantation. Then, we provide a practical imaging approach to pancreatic transplantation and its complications providing tips and tricks for the prompt imaging diagnosis on CT.Pancreatic transplantation is considered by the American Diabetes Association and the European Association for the Study of Diabetes an acceptable surgical procedure in patients with type 1 diabetes also undergoing kidney transplantation in pre-final or end-stage renal disease if no contraindications are present. Pancreatic transplantation, however, is a complex surgical procedure and may lead to a range of postoperative complications that can significantly impact graft function and patient outcomes. Postoperative computed tomography (CT) is often adopted to evaluate perfusion of the transplanted pancreas, identify complications and as a guide for interventional radiology procedures. CT assessment afte

Swallowing evaluation with videofluoroscopy in the paediatric population

Paediatric swallowing disorders can have several causes, from prematurity and congenital anomalies to gastro-oesophageal reflux and infective or inflammatory pathologies of the upper digestive tract. In neonates, the swallowing process is reflexive and involuntary. Later in infancy, the oral phase comes under voluntary control, while the pharyngeal phase and oesophageal phases remain involuntary. Swallowing difficulties can severely compromise pulmonary health and nutritional intake of paediatric patients. Videofluoroscopic Swallow Study (VFSS) is a radiographic procedure that provides a dynamic view of the swallowing process and is frequently considered to be definitive evaluation for objective assessment of dysphagia in paediatric patients. This review focuses on the different possible aetiologies of paediatric swallowing disorders and related videofluoroscopic swallowing study procedures and appearances

Systematic review with radiomics quality score of cholangiocarcinoma: an EuSoMII Radiomics Auditing Group Initiative

Objectives To systematically review current research applications of radiomics in patients with cholangiocarcinoma and to assess the quality of CT and MRI radiomics studies. Methods A systematic search was conducted on PubMed/Medline, Web of Science, and Scopus databases to identify original studies assessing radiomics of cholangiocarcinoma on CT and/or MRI. Three readers with different experience levels independently assessed quality of the studies using the radiomics quality score (RQS). Subgroup analyses were performed according to journal type, year of publication, quartile and impact factor (from the Journal Citation Report database), type of cholangiocarcinoma, imaging modality, and number of patients. Results A total of 38 original studies including 6242 patients (median 134 patients) were selected. The median RQS was 9 (corresponding to 25.0% of the total RQS; IQR 1-13) for reader 1, 8 (22.2%, IQR 3-12) for reader 2, and 10 (27.8%; IQR 5-14) for reader 3. The inter-reader agreement was good with an ICC of 0.75 (95% CI 0.62-0.85) for the total RQS. All studies were retrospective and none of them had phantom assessment, imaging at multiple time points, nor performed cost-effectiveness analysis. The RQS was significantly higher in studies published in journals with impact factor > 4 (median 11 vs. 4, p = 0.048 for reader 1) and including more than 100 patients (median 11.5 vs. 0.5, p < 0.001 for reader 1). Conclusions Quality of radiomics studies on cholangiocarcinoma is insufficient based on the radiomics quality score. Future research should consider prospective studies with a standardized methodology, validation in multi-institutional external cohorts, and open science data

Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI

Rim arterial phase hyperenhancement is an imaging feature commonly encountered on contrast-enhanced CT and MRI in focal liver lesions. Rim arterial phase hyperenhancement is a subtype of arterial phase hyperenhancement mainly present at the periphery of lesions on the arterial phase. It is caused by a relative arterialization of the periphery compared with the center of the lesion and needs to be differentiated from other patterns of peripheral enhancement, including the peripheral discontinuous nodular enhancement and the corona enhancement. Rim arterial phase hyperenhancement may be a typical or an atypical imaging presentation of many benign and malignant focal liver lesions, challenging the radiologists during imaging interpretation. Benign focal liver lesions that may show rim arterial phase hyperenhancement may have a vascular, infectious, or inflammatory origin. Malignant focal liver lesions displaying rim arterial phase hyperenhancement may have a vascular, hepatocellular, biliary, lymphoid, or secondary origin. The differences in imaging characteristics on contrast-enhanced CT may be subtle, and a multiparametric approach on MRI may be helpful to narrow the list of differentials. This article aims to review the broad spectrum of focal liver lesions that may show rim arterial phase hyperenhancement, using an approach based on the benign and malignant nature of lesions and their histologic origin.Critical relevance statement Rim arterial phase hyperenhancement may be an imaging feature encountered in benign and malignant focal liver lesions and the diagnostic algorithm approach provided in this educational review may guide toward the final diagnosis

Multidisciplinary Approach to the Diagnosis and In-Hospital Management of COVID-19 Infection: A Narrative Review

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-19 disease) was declared a pandemic on 11th March 2020 by the World Health Organization. This unprecedented circumstance has challenged hospitals’ response capacity, requiring significant structural and organizational changes to cope with the surge in healthcare demand and to minimize in-hospital risk of transmission. As our knowledge advances, we now understand that COVID-19 is a multi-systemic disease rather than a mere respiratory tract infection, therefore requiring holistic care and expertise from various medical specialties. In fact, the clinical spectrum of presentation ranges from respiratory complaints to gastrointestinal, cardiac or neurological symptoms. In addition, COVID-19 pandemic has created a global burden of mental illness that affects the general population as well as healthcare practitioners. The aim of this manuscript is to provide a comprehensive and multidisciplinary insight into the complexity of this disease, reviewing current scientific evidence on COVID-19 management and treatment across several medical specialties involved in the in-hospital care of these patients

DIAGNOSTIC ACCURACY OF IXIP INDEX AND PROSTATE MRI IN THE DIAGNOSIS OF PROSTATE CANCER: PRELIMINARY RESULTS ON A COMBINED APPROACH

The purpose of this study was to assess whether Immune CompleX Predictive Index (iXip) improves diagnostic accuracy of multiparametric prostate MRI (mpMRI) for clinically significant prostate cancer. This study included 72 patients (mean age: 68±8 years) with suspicion of prostate cancer and available iXip score. mpMRI images were evaluated by two radiologists according to the PI-RADS v2.1. Reference standard was based on fusion biopsy and standard transperineal 12-point biopsy. Diagnostic accuracy of iXip, mpMRI and their combination were calculated. Optimal cutoff of iXip with sensitivity and specificity was identified using the Youden index. Patients with clinically significant prostate cancers had significantly higher iXip values compared to patients without clinically significant prostate cancers (median 0.411 vs 0.273; p=0.026). The AUROC for iXip was 0.795 (95% CI 0.579-1.000, p=0.026). Sensitivity and specificity were 75% and 100% respectively for mpMRI alone, and 100% and 80% respectively for mpMRI combined with iXip > 0.375. The combination of mpMRI with a cutoff value of iXip > 0.375 has a very high sensitivity for the diagnosis of prostate cancer and a moderately high specificity