New advances in radiomics of gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are uncommon neoplasms of the gastrointestinal tract with peculiar clinical, genetic, and imaging characteristics. Preoperative knowledge of risk stratification and mutational status is crucial to guide the appropriate patients’ treatment. Predicting the clinical behavior and biological aggressiveness of GISTs based on conventional computed tomography (CT) and magnetic resonance imaging (MRI) evaluation is challenging, unless the lesions have already metastasized at the time of diagnosis. Radiomics is emerging as a promising tool for the quantification of lesion heterogeneity on radiological images, extracting additional data that cannot be assessed by visual analysis. Radiomics applications have been explored for the differential diagnosis of GISTs from other gastrointestinal neoplasms, risk stratification and prediction of prognosis after surgical resection, and evaluation of mutational status in GISTs. The published researches on GISTs radiomics have obtained excellent performance of derived radiomics models on CT and MRI. However, lack of standardization and differences in study methodology challenge the application of radiomics in clinical practice. The purpose of this review is to describe the new advances of radiomics applied to CT and MRI for the evaluation of gastrointestinal stromal tumors, discuss the potential clinical applications that may impact patients’ management, report limitations of current radiomics studies, and future directions

Hepatocellular carcinoma with macrovascular invasion: Multimodality imaging features for the diagnosis

Hepatocellular carcinoma (HCC) is frequently associated with macrovascular invasion of the portal vein or hepatic veins in advanced stages. The accurate diagnosis of macrovascular invasion and the differentiation from bland non-tumoral thrombus has significant clinical and management implications, since it narrows the therapeutic options and it represents a mandatory con-traindication for liver resection or transplantation. The imaging diagnosis remains particularly challenging since the imaging features of HCC with macrovascular invasion may be subtle, espe-cially in lesions showing infiltrative appearance. However, each radiologic imaging modality may provide findings suggesting the presence of tumor thrombus rather than bland thrombus. The purpose of this paper is to review the current guidelines and imaging appearance of HCC with macrovascular invasion. Knowledge of the most common imaging features of HCC with macro-vascular invasion may improve the diagnostic confidence of tumor thrombus in clinical practice and help to guide patients’ management

Type and gene location of kit mutations predict progression-free survival to first-line imatinib in gastrointestinal stromal tumors: A look into the exon

In previous studies on localized GISTs, KIT exon 11 deletions and mutations involving codons 557/558 showed an adverse prognostic influence on recurrence-free survival. In the metastatic setting, there are limited data on how mutation type and codon location might contribute to progression-free survival (PFS) variability to first-line imatinib treatment. We analyzed the type and gene location of KIT and PDGFRA mutations for 206 patients from a GIST System database prospectively collected at an Italian reference center between January 2005 and September 2020. By describing the mutational landscape, we focused on clinicopathological characteristics according to the critical mutations and investigated the predictive role of type and gene location of the KIT exon 11 mutations in metastatic patients treated with first-line imatinib. Our data showed a predictive impact of KIT exon 11 pathogenic variant on PFS to imatinib treatment: patients with deletion or insertion/deletion (delins) in 557/558 codons had a shorter PFS (median PFS: 24 months) compared to the patients with a deletion in other codons, or duplication/insertion/SNV (median PFS: 43 and 49 months, respectively) (p < 0.001). These results reached an independent value in the multivariate model, which showed that the absence of exon 11 deletions or delins 557/558, the female gender, primitive tumor diameter (≤5 cm) and polymorphonuclear leucocytosis (>7.5 109/L) were significant prognostic factors for longer PFS. Analysis of the predictive role of PDGFRA PVs showed no significant results. Our results also confirm the aggressive biology of 557/558 deletions/delins in the metastatic setting and allow for prediction at the baseline which GIST patients would develop resistance to first-line imatinib treatment earlier

Preoperative imaging findings in patients undergoing transcranial magnetic resonance imaging-guided focused ultrasound thalamotomy

The prevalence and impact of imaging findings detected during screening procedures in patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy for functional neurological disorders has not been assessed yet. This study included 90 patients who fully completed clinical and neuroradiological screenings for tcMRgFUS in a single-center. The presence and location of preoperative imaging findings that could impact the treatment were recorded and classified in three different groups according to their relevance for the eligibility and treatment planning. Furthermore, tcMRgFUS treatments were reviewed to evaluate the number of transducer elements turned off after marking as no pass regions the depicted imaging finding. A total of 146 preoperative imaging findings in 79 (87.8%) patients were detected in the screening population, with a significant correlation with patients’ age (rho = 483, p < 0.001). With regard of the group classification, 119 (81.5%), 26 (17.8%) were classified as group 1 or 2, respectively. One patient had group 3 finding and was considered ineligible. No complications related to the preoperative imaging findings occurred in treated patients. Preoperative neuroradiological findings are frequent in candidates to tcMRgFUS and their identification may require the placement of additional no-pass regions to prevent harmful non-targeted heating

Giant hepatocellular adenoma as cause of severe abdominal pain: a case report

The authors describe the case of a large hepatocellular adenoma diagnosed in a 30-year old woman who came to us complaining of acute pain in the upper abdominal quadrants. The patient had been taking an oral contraceptive pill for the last ten years. We present the clinical features, the diagnostic work-up and the treatment prescribed

Contrast-enhanced ultrasound of hepatocellular carcinoma: Where do we stand?

Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasive assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy

The combined assessment of hepatocellular nodule vascularity at 64-row multidetector CT and contrast-enhanced US. Analysis of diagnostic performance

none4noneQuaia, E; Alaimo, V; Bartolotta, V; Cova, Ma

The “spoke wheel” sign in hepatic focal nodular hyperplasia

CLASSICS IN ABDOMINAL RADIOLOG

Voxel-Based Morphomerty study in patients with amnestic Mild Cognitive Impairment and Alzheimer's Disease: population-based data from the Zabùt Aging Project

Aims and objectives Compare the preliminary results of a voxel-based morphometry (VBM) analysis performed in patients with amnestic Mild Cognitive Impairment (aMCI) and Alzheimer’s disease (AD) in comparison to a control group with normal aging brain (NAB). Methods and materials 83 brain MRI scans were obtained a using 1.5T unit (Sag 3D T1w-FSPGR IR preped ASSET sequence was used for the VBM analysis that was performed with FSL’s sienax tool) during the Zabùt Aging Project (ZAP), a population-based, cohort study regarding aging and dementia conducted in Southern Italy. After the exclusion of subjects with severe leucoaraiosis, silent cerebral infarcts or any other findings that could affect the results, 58 suitale subjects (27 males and 31 females, mean age 72.95/SD6.66 (range 61-85); naMCI=21, nAD=19, nNAB=18) were included. The results were compared using t-test (p = 0.05).VBM result example. Top left: axial Multiple Planar Reconstruction (MPR). VBM extracted tissues: csf in blue (top center), gray matter in red (top right), white matter in yellow (bottom center) and all three components (bottom right). Bottom left (in pink) the result of the brain extraction process (FSL’s BET). Results Statistically significant differences were found between total gray matter volumes (TGMv) (p = 0.002) and total brain volume (TBv) (p = 0.004) in AD vs NAB; between TGMv (p = 0.005) and TBv (p = 0.004) in aMCI vs AD. No statistically significant differences were observed in VBM data between aMCI and NAB or between the white matter volumes within groups. Conclusion Our results, reflect what already reported the scientific literature and confirm the importance of VBM for the quantitative assessment of brain atrophy in subjects with cognitive impairment. The VBM prospective evaluation of aMCI subjects will help to clarify specific areas involved in AD-type neurodegenerative progression