The objective of this study was to demonstrate the feasibility of dual-energy CT (DECT) for locoregional staging of breast cancer and differentiation of tumor histotypes.
From January 2016 to July ...2017, a total of 31 patients (mean ± SD age, 55.8 ± 14.8 years) with breast cancer diagnosed by needle biopsy who underwent preoperative contrast-enhanced DECT for staging purposes were selected from a retrospective review of institutional databases. Monochromatic images obtained at 40 and 70 keV were evaluated by two readers who determining the number of hypervascularized tumors present and the largest tumor diameter for each breast. The attenuation values and iodine concentration of tumors and normal breast tissue and the ratios of these findings in each tissue type were recorded. Cancers were classified as ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma. The reference standard was the final pathologic finding after surgery.
A total of 64 tumor lesions were found at histopathologic analysis versus 67 on DECT for 34 breasts (three bilateral cancers were included). Nonparametric statistics were used. The largest lesion diameter observed DECT was 33.2 ± 20.5 mm versus 31.8 ± 20.5 mm on pathologic analysis, and cancer distribution was correctly classified for 31 of 34 (91%) cases. ROC curves derived from lesion iodine concentration showed that the optimal thresholds for distinguishing infiltrating carcinomas (invasive lobular and ductal carcinomas) and from other lesions were 1.70 mg/mL (sensitivity, 94.9%; specificity, 93.0%; AUC value, 0.968). ROC curves derived from the ratio of the iodine concentration in lesions to that in normal breast parenchyma showed that 6.13 was the optimal threshold to distinguish invasive ductal carcinoma from other lesions (sensitivity, 87.0%; specificity, 81.1%; AUC value, 0.914).
DECT is feasible and seems to be a reliable tool for locoregional staging of breast cancer.
Severe acute respiratory syndrome coronavirus 2–induced direct cytopathic effects against type I and II pneumocytes mediate lung damage. Krebs von den Lungen‐6 (KL‐6) is mainly produced by damaged or ...regenerating alveolar type II pneumocytes. This preliminary study analyzed serum concentrations of KL‐6 in patients with coronavirus disease (COVID‐19) to verify its potential as a prognostic biomarker of severity. Twenty‐two patients (median age interquartile range 63 59‐68 years, 16 males) with COVID‐19 were enrolled prospectively. Patients were divided into mild‐moderate and severe groups, according to respiratory impairment and clinical management. KL‐6 serum concentrations and lymphocyte subset were obtained. Peripheral natural killer (NK) cells/µL were significantly higher in nonsevere patients than in the severe group (P = .0449) and the best cut‐off value was 119 cells/µL. KL‐6 serum concentrations were significantly higher in severe patients than the nonsevere group (P = .0118). Receiver operating characteristic analysis distinguished severe and nonsevere patients according to KL‐6 serum levels and the best cut‐off value was 406.5 U/mL. NK cell analysis and assay of KL‐6 in serum can help identify severe COVID‐19 patients. Increased KL‐6 serum concentrations were observed in patients with severe pulmonary involvement, revealing a prognostic value and supporting the potential usefulness of KL‐6 measurement to evaluate COVID‐19 patients' prognosis.
The aim of this letter is to report some deeper explanations regarding the role of imaging in acute mesenteric ischemia. The correlation between some computed tomography findings and the cause of ...ischemia as well as other main factors that could condition the computed tomography appearance of this critical issue is also discussed.
Objective:
To evaluate the consistency of the quantitative imaging decision support (QIDSTM) tool and radiomic analysis using 594 metrics in lung carcinoma on chest CT scan.
Materials and Methods:
We ...included, retrospectively, 150 patients with histologically confirmed lung cancer who underwent chemotherapy and baseline and follow-ups CT scans. Using the QIDSTM platform, 3 radiologists segmented each lesion and automatically collected the longest diameter and the density mean value. Inter-observer variability, Bland Altman analysis and Spearman’s correlation coefficient were performed. QIDSTM tool consistency was assessed in terms of agreement rate in the treatment response classification. Kruskal Wallis test and the least absolute shrinkage and selection operator (LASSO) method with 10-fold cross validation were used to identify radiomic metrics correlated with lesion size change.
Results:
Good and significant correlation was obtained between the measurements of largest diameter and of density among the QIDSTM tool and the radiologists measurements. Inter-observer variability values were over 0.85. HealthMyne QIDSTM tool quantitative volumetric delineation was consistent and matched with each radiologist measurement considering the RECIST classification (80-84%) while a lower concordance among QIDSTM and the radiologists CHOI classification was observed (58-63%). Among 594 extracted metrics, significant and robust predictors of RECIST response were energy, histogram entropy and uniformity, Kurtosis, coronal long axis, longest planar diameter, surface, Neighborhood Grey-Level Different Matrix (NGLDM) dependence nonuniformity and low dependence emphasis as Volume, entropy of Log(2.5 mm), wavelet energy, deviation and root man squared.
Conclusion:
In conclusion, we demonstrated that HealthMyne quantitative volumetric delineation was consistent and that several radiomic metrics extracted by QIDSTM were significant and robust predictors of RECIST response.
Recently, loss-of-function variants in TLR7 were identified in two families in which COVID-19 segregates like an X-linked recessive disorder environmentally conditioned by SARS-CoV-2. We investigated ...whether the two families represent the tip of the iceberg of a subset of COVID-19 male patients.
This is a nested case-control study in which we compared male participants with extreme phenotype selected from the Italian GEN-COVID cohort of SARS-CoV-2-infected participants (<60 y, 79 severe cases versus 77 control cases). We applied the LASSO Logistic Regression analysis, considering only rare variants on young male subsets with extreme phenotype, picking up TLR7 as the most important susceptibility gene.
Overall, we found TLR7 deleterious variants in 2.1% of severely affected males and in none of the asymptomatic participants. The functional gene expression profile analysis demonstrated a reduction in TLR7-related gene expression in patients compared with controls demonstrating an impairment in type I and II IFN responses.
Young males with TLR7 loss-of-function variants and severe COVID-19 represent a subset of male patients contributing to disease susceptibility in up to 2% of severe COVID-19.
Funded by private donors for the Host Genetics Research Project, the Intesa San Paolo for 2020 charity fund, and the Host Genetics Initiative.
NCT04549831.
Lymphedema is an important medical issue around the world, caused by an anomalous collection of fluid in soft tissue due to congenital malformations or stenosis or obstruction of lymphatic vessels. ...Magnetic resonance lymphangiography (MRL) is an emerging technique focused on noninvasive or minimally invasive imaging of lymphatics with the goal to diagnose and treat lymphedema. This review will briefly discuss lymphatic imaging starting with lymphography and radionuclide lymphoscintigraphy up to the newest methods, focusing on MRL, a rising technique, and highlighting the technical aspects fundamental for achieving high-resolution MRL.
Serum chitotriosidase is a promising biomarker that has shown high specificity and sensitivity in patients with sarcoidosis. The aim of this study was to investigate correlations between serum ...chitotriosidase, clinical phenotypes, disease localizations and different radiological lung involvement and to identify clinical features associated with over-expression of chitotriosidase in a large cohort of sarcoidosis patients.
Chitotriosidase activity was evaluated in a population of 694 consecutive patients (males 39%, age 55.8 ± 12.8 years). Clinical and respiratory functional characteristics, Clinical Outcome Scale (COS) classification, clinical phenotypes proposed by the GenPhenResA project, and radiological assessment, including CT scan, were collected. Serum sampling and clinical and functional assessments at follow-up were also included.
Significantly higher chitotriosidase activity was observed in sarcoidosis patients than in healthy controls (p < 0.0001). Evidence of lung fibrosis with reticular abnormalities and traction bronchiectasis at High resolution CT, presence of multiple extrapulmonary sarcoid localizations and increased 24-h urinary excretion of calcium were associated with significantly higher chitotriosidase activity (p < 0.005). Patients with remitted or minimal disease had lower values of chitotriosidase than patients with persistent disease. At follow-up, patients who required an increase in steroid dose showed an increase in its activity.
Chitotriosidase is a reliable biomarker of sarcoidosis. It is increased in patients with sarcoidosis correlating with disease activity, severity and multiorgan dissemination. Steroid therapy tended to reduce chitotriosidase expression, however it responded in cases of disease relapse.
Non-occlusive mesenteric ischemia (NOMI) is the result of the reduction of mesenteric blood supply, due to mesenteric arterial vasoconstriction secondary to hypotension in cases of shock, septicemia, ...dehydration, heart surgery, or major abdominal surgery. NOMI represents a complex and often misdiagnosed syndrome. Imaging, and in particular CT, has a remarkable importance in NOMI, and despite its complexity, it could allow an early diagnosis and an improved management resulting in life-threatening therapeutic approaches, much better than in the past, provided it is correctly performed and interpreted by experienced radiologists.
Objective
To calculate by means of a computer-aided tool the volumes of healthy residual lung parenchyma, of emphysema, of ground glass opacity (GGO) and of consolidation on chest computed tomography ...(CT) in patients with suspected viral pneumonia by COVID-19.
Materials and methods
This study included 116 patients that for suspected COVID-19 infection were subjected to the reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test. A computer-aided tool was used to calculate on chest CT images healthy residual lung parenchyma, emphysema, GGO and consolidation volumes for both right and left lung. Expert radiologists, in consensus, assessed the CT images using a structured report and attributed a radiological severity score at the disease pulmonary involvement using a scale of five levels. Nonparametric test was performed to assess differences statistically significant among groups.
Results
GGO was the most represented feature in suspected CT by COVID-19 infection; it is present in 102/109 (93.6%) patients with a volume percentage value of 19.50% and a median value of 0.64 L, while the emphysema and consolidation volumes were low (0.01 L and 0.03 L, respectively). Among quantified volume, only GGO volume had a difference statistically significant between the group of patients with suspected versus non-suspected CT for COVID-19 (
p
< < 0.01). There were differences statistically significant among the groups based on radiological severity score in terms of healthy residual parenchyma volume, of GGO volume and of consolidations volume (
p
< < 0.001).
Conclusion
We demonstrated that, using a computer-aided tool, the COVID-19 pneumonia was mirrored with a percentage median value of GGO of 19.50% and that only GGO volume had a difference significant between the patients with suspected or non-suspected CT for COVID-19 infection.
Background
Serum Krebs von den Lungen‐6 (sKL‐6) is an high‐molecular‐weight (200 kDa) glycoprotein predominantly expressed by damaged alveolar type II cells, and it has been proposed as a potential ...biomarker of different ILD. This is a prognostic biomarker for chronic hypersensitivity pneumonitis (cHP) and idiopathic pulmonary fibrosis (IPF), two diseases that share several clinical and radiological features. Little data are available on the potential role of KL‐6 in granulomatous and cystic interstitial lung diseases, including the orphan disease known as pulmonary Langerhans cell histiocytosis (PLCH).
Methods
For the first time, sKL‐6 concentrations were assayed and compared in 96 patients (17 PLCH, 22 IPF, 34 cHP) and 22 healthy controls.
Results
Serum KL‐6 concentrations were significantly higher in PLCH (599 ± 594 U/mL), IPF (1645 ± 846 U/mL) and cHP patients (1691 ± 1643 U/mL) than in healthy controls (268 U/mL) (P = .037). Area‐under‐the‐curve values of sKL‐6 were 73.4% between PLCH and healthy controls, 84.5% between IPF and PLCH and 78% between cHP and PLCH. An indirect correlation between sKL‐6 concentrations and peripheral CD1a‐positive cells was demonstrated (r = −0.82; P = .034).
Conclusion
Serum KL‐6 concentrations were higher in PLCH patients than in controls, reflecting the alveolar damage typical of this rare interstitial lung disease.
PDF
