Recent advancement on PD-L1 expression quantification: the radiologist perspective on CT-guided FNAC

PURPOSE: We aimed to evaluate the feasibility, accuracy, and safety of Programmed Death-1/ Programmed Death-Ligand 1 (PD-1/ PD-L1) expression quantification in cytology cell-block samples obtained through transthoracic CT-guided fine-needle aspiration cytology (FNAC) from the interventional radiologist's perspective.METHODS: We performed a consecutive unselected series of 361 CT-guided biopsies of pulmonary nodules and masses which came to our observation from June 2017 to October 2018. For each case, exhaustive clinical, morphologic, molecular and tomographic data were available. All the material obtained was fixed in formalin to obtain a cell-block for the pathologist, who performed immunohistochemical analysis to detect PD-L1 expression levels on each sample.RESULTS: Of all the analyzed samples, 93.6% (338/361) were defined to be diagnostic, including neoplastic (72%, 260/361) and non-neoplastic lesions (21.6%, 78/361); only 6.4% (23/361) of them resulted in nondiagnostic specimens. Non-small cell lung cancer (NSCLC) accounted for 73.8% of neoplastic lesions (192/260): most of them were adenocarcinoma (83%, 160/192), followed by squamous carcinoma (14%, 27/192) and poorly differentiated carcinoma (3%, 5/192). In 96% of NSCLC (184/192), the diagnosis was reached either in the absence of complications or with early minor complications. PD-L1 expression was evaluated in all 192 NSCLC cytology specimens: 180 immunostainings were found to be adequate for PD-L1 testing. In 76% of cases, PD-L1 expression level was lower than 50%.CONCLUSION: The findings of our study indicate that PD-L1 quantification using a cell-block approach on CT-guided FNAC is a feasible and safe technique and should be taken into account alongside with core biopsy approach, especially in case of advanced disease and/or fragile and older patients

ANN-based energy reconstruction procedure for TACTIC gamma-ray telescope and its comparison with other conventional methods

The energy estimation procedures employed by different groups, for determining the energy of the primary $\gamma$-ray using a single atmospheric Cherenkov imaging telescope, include methods like polynomial fitting in SIZE and DISTANCE, general least square fitting and look-up table based interpolation. A novel energy reconstruction procedure, based on the utilization of Artificial Neural Network (ANN), has been developed for the TACTIC atmospheric Cherenkov imaging telescope. The procedure uses a 3:30:1 ANN configuration with resilient backpropagation algorithm to estimate the energy of a $\gamma$-ray like event on the basis of its image SIZE, DISTANCE and zenith angle. The new ANN-based energy reconstruction method, apart from yielding an energy resolution of $\sim$ 26%, which is comparable to that of other single imaging telescopes, has the added advantage that it considers zenith angle dependence as well. Details of the ANN-based energy estimation procedure along with its comparative performance with other conventional energy reconstruction methods are presented in the paper and the results indicate that amongst all the methods considered in this work, ANN method yields the best results. The performance of the ANN-based energy reconstruction has also been validated by determining the energy spectrum of the Crab Nebula in the energy range 1-16 TeV, as measured by the TACTIC telescope.Comment: 23pages, 9 figures Accepted for publication in NIM

Computed Tomography Structured Reporting in the Staging of Lymphoma: A Delphi Consensus Proposal

Abstract Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports for lymphoma patients during the staging phase to improve communication between radiologists, members of multidisciplinary teams, and patients. A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology (SIRM), was established. A modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. The Cronbach's alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. The final SR version was divided into four sections: (a) Patient Clinical Data, (b) Clinical Evaluation, (c) Imaging Protocol, and (d) Report, including n = 13 items in the "Patient Clinical Data" section, n = 8 items in the "Clinical Evaluation" section, n = 9 items in the "Imaging Protocol" section, and n = 32 items in the "Report" section. Overall, 62 items were included in the final version of the SR. A dedicated section of significant images was added as part of the report. In the first Delphi round, all sections received more than a good rating (≥3). The overall mean score of the experts and the sum of score for structured report were 4.4 (range 1-5) and 1524 (mean value of 101.6 and standard deviation of 11.8). The Cα correlation coefficient was 0.89 in the first round. In the second Delphi round, all sections received more than an excellent rating (≥4). The overall mean score of the experts and the sum of scores for structured report were 4.9 (range 3-5) and 1694 (mean value of 112.9 and standard deviation of 4.0). The Cα correlation coefficient was 0.87 in this round. The highest overall means value, highest sum of scores of the panelists, and smallest standard deviation values of the evaluations in this round reflect the increase of the internal consistency and agreement among experts in the second round compared to first round. The accurate statement of imaging data given to referring physicians is critical for patient care; the information contained affects both the decision-making process and the subsequent treatment. The radiology report is the most important source of clinical imaging information. It conveys critical information about the patient's health and the radiologist's interpretation of medical findings. It also communicates information to the referring physicians and records this information for future clinical and research use. The present SR was generated based on a multi-round consensus-building Delphi exercise and uses standardized terminology and structures, in order to adhere to diagnostic/therapeutic recommendations and facilitate enrolment in clinical trials, to reduce any ambiguity that may arise from non-conventional language, and to enable better communication between radiologists and clinicians

AIforCOVID: predicting the clinical outcomes in patients with COVID-19 applying AI to chest-X-rays. An Italian multicentre study

Recent epidemiological data report that worldwide more than 53 million people have been infected by SARS-CoV-2, resulting in 1.3 million deaths. The disease has been spreading very rapidly and few months after the identification of the first infected, shortage of hospital resources quickly became a problem. In this work we investigate whether chest X-ray (CXR) can be used as a possible tool for the early identification of patients at risk of severe outcome, like intensive care or death. CXR is a radiological technique that compared to computed tomography (CT) it is simpler, faster, more widespread and it induces lower radiation dose. We present a dataset including data collected from 820 patients by six Italian hospitals in spring 2020 during the first COVID-19 emergency. The dataset includes CXR images, several clinical attributes and clinical outcomes. We investigate the potential of artificial intelligence to predict the prognosis of such patients, distinguishing between severe and mild cases, thus offering a baseline reference for other researchers and practitioners. To this goal, we present three approaches that use features extracted from CXR images, either handcrafted or automatically by convolutional neuronal networks, which are then integrated with the clinical data. Exhaustive evaluation shows promising performance both in 10-fold and leave-one-centre-out cross-validation, implying that clinical data and images have the potential to provide useful information for the management of patients and hospital resources

Managing Malignant Pleural Mesothelioma in the Age of Personalized Medicine: Where Are We and What Is Still Missing?

Malignant Mesothelioma (MM) is an aggressive neoplasm of the pleural mesothelium, less frequently peritoneal and exceptionally of the vaginal tunic of the testicle and pericardium [...

Ultrasonography of the ulnar nerve in the elbow: video article

Disorders affecting the ulnar nerve in the elbow are common in clinical practice. The diagnosis is based on clinical evaluation and electrodiagnostic tests, but imaging examinations are frequently necessary, particularly for the identification of the structures associated with nerve compression. The purpose of this video article is to review the anatomy, the pathology, scanning techniques, and sonographic appearance of the ulnar nerve in the elbow

Quantitative elastosonography of the myotendinous junction normal behavior and correlation with a standard measurement system during functional tests

Abstract OBJECTIVES: In recent years, an increasing need to use imaging to assess normal and adaptive muscle function, in addition to its anatomy and structure, has emerged. We evaluated the myotendinous junction's elastosonographic behavior in light of the most recent literature on its physiologic behavior. The elastosonographic studies were compared with the results obtained from a standard measurement system to ensure a correlation with maximal muscle contraction. METHODS: Nineteen male professional soccer players were assessed during functional tests. The participants performed 5 repetitions at 60°/s to assess muscle strength and 3 repetitions at 30°/s to assess the maximum force peak of thigh muscles. The participants were monitored by a strength-power measurement system and an ultrasound machine equipped with multifrequency (18-6-MHz) linear array transducers. RESULTS: The 19 soccer players were aged between 19 and 34 years (mean age, 28 years). For the right rectus femoris, the results of the elastosonographic studies showed a mean elasticity value ± SD of 30.75% ± 10.05% with the muscle relaxed and a value of 13.75% ± 8.44% during contraction (mean decrease, 17.00% ± 11.71%). Elasticity values were 36.48% ± 8.39% before contraction and 8.77% ± 6.55% during contraction of the left rectus femoris muscle (mean decrease, 27.71% ± 11.95%). For 30° eccentric contraction of the left leg, correlation with the standard measurement system showed Pearson r values of -0.53 and -0.51 when comparing force peak and mean work, respectively, with elasticity values. CONCLUSIONS: Our study shows that strain elastosonographic quantification of muscle elasticity seems to match the expected physiologic and biomechanical behavior of the myotendinous junction

Sonography before and after carpal tunnel release: video article

Carpal tunnel release for compression of the median nerve at the wrist is a common procedure, often resulting in good clinical outcomes. There are, however, many anatomical variations in and around the carpal tunnel and it is important to be aware of these during carpal tunnel release. After surgery, recurrent carpal tunnel syndrome is uncommon, but difficult to diagnose and treat. Ultrasonography is often necessary for the evaluation of the anatomical variations before carpal tunnel release and to evaluate the most common complications after carpal tunnel release

Influence of subjects characteristics and technical variables on muscle stiffness measured by shear wave elastosonography

PURPOSE: The aim of this study is to quantitatively assess lower limbs muscle elasticity in a court of healthy subjects and to evaluate the influence of technical variables (e.g., diameter of the ROI-region of interest) and examined subjects' characteristics (e.g., sex, levels of physical activity, side evaluated) on muscle stiffness. MATERIALS AND METHODS: 54 healthy subjects (48 men, 6 women) were evaluated for a total of 108 lower limbs. Shear wave elastography was performed with a multifrequency linear probe (15-4 MHz). Two radiologists performed the evaluation of lower limbs from left to right side (first calf and then thigh). The measures were taken on gastrocnemius and on femoral biceps muscle belly. We chose to place for this study two ROIs of 4 and 2 mm of diameter. RESULTS: The mean muscle stiffness was 1.98 ± 0.48 (range between 1.89 ± 0.36 and 2.15 ± 0.57 m/s). The difference in muscle stiffness between left and right side of the body and between different levels of physical activity never became statistically significant (p value between 0.314 and 0.915). Only in one test out of eight the difference of muscle stiffness between male and female resulted statistically significant (p value 0.020). When comparing the measurement obtained with a 2 and 4 mm diameter ROIs the values were statistically different only for the left thigh (p value 0.028). CONCLUSION: Our study, despite its limitations (low sample and low female population), seems to give some clear advice: physiological or technical factors do not determine statistically significant differences on passive muscle stiffness