Imaging of the Kidney and Urinary Tract: Current and Future Trends

The role of imaging in healthcare has become more and more significant in the last decades [...]

Imaging characteristics of pleural tumours

Malignant mesothelioma is doubtless the more known pleural tumour. However, according to the morphology code of the International Classification of Diseases for Oncology (ICDO), there are several histological types of pleural neoplasms, divided into mesothelial, mesenchymal and lymphoproliferative tumours, that may be misdiagnosed. In this paper we summarise and illustrate the incidence aspects and the clinical, pathological and radiological features of these neoplasms

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

Activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) related to the diagnostic impact in focal liver lesion characterisation

Purpose This study was done to assess the clinicaldiagnostic impact and cost of contrast-enhanced ultrasound (CEUS) versus computed tomography (CT) and magnetic resonance (MR) imaging in the characterisation of focal liver lesions. Materials and methods CEUS with sulphur hexafluoridefilled microbubbles (SonoVue bolus 2.4 ml) was performed in 157 patients with 160 focal liver lesions identified by other diagnostic techniques. CEUS images were obtained during the arterial (15 to 35 s from contrast injection), portal venous (40 to 70 s) and late phase (up to 300 s from microbubble injection). Contrast-enhanced CT was performed with a 64- row multidetector CT. MRI was performed before and after administration of the liver-specific contrast agent gadobenate dimeglumine (Gd-BOPTA). A patient-by-patient activitybased cost analysis was performed. Results CEUS led to a change in the diagnostic workup in 131/157 patients (83.4 %) and in the therapeutic workup in 93/157 patients (59.2 %). CEUS allowed for the final diagnosis to be established in 133/157 patients (84.7 %). The full cost of CEUS was lower than that of contrast-enhanced CT and MR imaging. Conclusions CEUS determined a change in the diagnostic and therapeutic workup in the characterisation of focal liver lesions and reduced the full costs of the diagnostic process

Digital Tomosynthesis as a Problem-Solving Technique to Confirm or Exclude Pulmonary Lesions in Hidden Areas of the Chest

Objectives: To evaluate the capability of digital tomosynthesis (DTS) to characterize suspected pulmonary lesions in the so-called hidden areas at chest X-ray (CXR). Materials and Methods: Among 726 patients with suspected pulmonary lesions at CXR who underwent DTS, 353 patients (201 males, 152 females; age 71.5   10.4 years) revealed suspected pulmonary lesions in the apical, hilar, retrocardiac, or paradiaphragmatic lung zones and were retrospectively included. Two readers analyzed CXR and DTS images and provided a confidence score: 1 or 2 = definitely or probably benign pulmonary or extra-pulmonary lesion, or pulmonary pseudo-lesion deserving no further diagnostic work-up; 3 = indeterminate lesion; 4 or 5 = probably or definitely pulmonary lesion deserving further diagnostic work-up by CT. The nature of DTS findings was proven by CT (n = 108) or CXR during follow-up (n = 245). Results: In 62/353 patients the suspected lung lesions were located in the lung apex, in 92/353 in the hilar region, in 59/353 in the retrocardiac region, and in 140/353 in the paradiaphragmatic region. DTS correctly characterized the CXR findings as benign pulmonary or extrapulmonary lesion (score 1 or 2) in 43/62 patients (69%) in the lung apex region, in 56/92 (61%) in the pulmonary hilar region, in 40/59 (67%) in the retrocardiac region, and in 106/140 (76%) in the paradiaphragmatic region, while correctly recommending CT in the remaining cases due to the presence of true solid pulmonary lesion, with the exception of 22 false negative findings (60 false positive findings). DTS showed a significantly (p < 0.05) increased sensitivity, specificity, and overall diagnostic accuracy and area under ROC curve compared to CXR alone. Conclusions: DTS allowed confirmation or exclusion of the presence of true pulmonary lesions in the hidden areas of the chest

Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center

Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence-free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43-89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02-99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%-98.8%) at 3 years, and 88.6% (95% CI: 71.8%-95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature

Accuracy of CT-Guided Core-Needle Biopsy in Diagnosis of Thoracic Lesions Suspicious for Primitive Malignancy of the Lung: A Five-Year Retrospective Analysis

Background: Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest methods to obtain tissue specimens, even though there are relatively high rates of pneumothorax (0–60% incidence) and pulmonary hemorrhage (4–27% occurrence rates). The aim of this retrospective study is to assess the diagnostic accuracy of CT-guided core-needle biopsy in the diagnosis of primary lung malignancies and to compare our results with evidence from the literature. Materials and Methods: Our analysis included 350 thoracic biopsies, performed from 2017 to 2022 with a 64-row CT guidance and 16/18 G needles mounted on a biopsy gun. We included in the final cohort all samples with evidence of primary lung malignancies, precursor lesions, and atypia, as well as inconclusive and negative diagnoses. Results: There was sensitivity of 90.07% (95% CI 86.05–93.25%), accuracy of 98.87% (95% CI 98.12–99.69%), positive predictive value of 100%, and negative value of 98.74% (95% CI 98.23–99.10%). Specificity settled at 100% (93.84–100%). The AUC was 0.952 (95% CI 0.924–0.972). Only three patients experienced major complications after the procedure. Among minor complications, longer distances from the pleura, the presence of emphysema, and the lower dimensions of the lesions were correlated with the development of pneumothorax after the procedure, while longer distances from the pleura and the lower dimensions of the lesions were correlated with intra-alveolar hemorrhage. Immunohistochemistry analysis was performed in 51% of true positive cases, showing TTF-1, CK7, and p40 expression, respectively, in 26%, 24%, and 10% of analyzed samples. Conclusions: The CT-guided thoracic core-needle biopsy is an extremely accurate and safe diagnostic procedure for the histological diagnosis of lung cancer, a first-level interventional radiology exam for peripheral and subpleural lesions of the lung, which is also able to provide adequate samples for advanced pathologic assays (e.g., FISH, PCR) to assess molecular activity and genetic sequencing

Clinical study in phase- contrast mammography: image-quality analysis

The first clinical study of phase-contrast mammography (PCM) with synchrotron radiation was carried out at the Synchrotron Radiation for Medical Physics beamline of the Elettra synchrotron radiation facility in Trieste (Italy) in 2006–2009. The study involved 71 patients with unresolved breast abnormalities after conventional digital mammography and ultrasonography exams carried out at the Radiology Department of Trieste University Hospital. These cases were referred for mammography at the synchrotron radiation facility, with images acquired using a propagation-based phase-contrast imaging technique. To investigate the contribution of phase-contrast effects to the image quality, two experienced radiologists specialized in mammography assessed the visibility of breast abnormalities and of breast glandular structures. The images acquired at the hospital and at the synchrotron radiation facility were compared and graded according to a relative seven-grade visual scoring system. The statistical analysis highlighted that PCM with synchrotron radiation depicts normal structures and abnormal findings with higher image quality with respect to conventional digital mammography