Aim To investigate the correlation between conventional computed tomography (CT) features, quantitative texture analysis (QTA), epidermal growth factor receptor (EGFR) mutations, and survival rates ...in patients with lung adenocarcinoma. Materials and methods Sixty-eight patients were evaluated for conventional CT features and QTA in this retrospective study. A multiple logistic regression analysis and receiver operating characteristics (ROC) curve analysis versus death and EGFR status was performed for CT features and QTA in order to assess correlation between CT features, QTA, EGFR mutations, and survival rates. A p -value <0.05 was regarded to indicate a statistically significant association. Results An EGFR mutation was identified in 26/68 tumours (38.2%). A negative association was found between EGFR mutation and emphysema ( p < 0.0001) whereas a positive correlation was found with necrosis ( p =0.017), air bronchogram ( p =0.0304), and locoregional infiltration ( p =0.0018). Mean, standard deviation, and skewness were found to have significant correlation with EGFR mutation ( p =0.0001; p =0.0001; p =0.0459; Fig 3). The only parameter correlated with the event death was entropy ( r =0.2708; p =0.0329). Conclusion Both qualitative and quantitative analysis disclosed potential associations between CT features and QTA parameters, EGFR mutations and prognosis; these correlations need to be confirmed in larger studies to be used as imaging biomarkers in the management of patients affected by lung adenocarcinoma.
In recent years, there has been tremendous progress in endovascular aneurysm repair (EVAR) techniques and devices. This process has seen a change in incidence, risk factors, and treatment of ...endoleaks as well as in follow-up protocols after EVAR. In particular, recent literature has highlighted new concepts in the evaluation and prevention/treatment of type I and II endoleak after standard EVAR. There is also recent evidence regarding new imaging protocols for follow-up after EVAR, which include magnetic resonance imaging and contrast-enhanced ultrasound. This comprehensive review aims to outline the most recent concepts on imaging follow-up, pathophysiology/risk factors, and management of endoleaks.
Hepatic encephalopathy is a frequent event after transjugular-intrahepatic-portosystemic-shunt (TIPS), especially during the first months. Aim of this study was to compare two different treatments ...(lactitol 60
g/day, rifaximin 1200
mg/day) with no-treatment in the prevention of post-TIPS hepatic encephalopathy.
Seventy-five consecutive cirrhotics submitted to TIPS were randomized to receive either one of the above treatments or no-treatment. The main end-point was the occurrence of an episode of overt hepatic encephalopathy during the first month post-TIPS. Before the procedure and weekly thereafter the patients were evaluated by examining their mental status, asterixis, ammonia and trail-making-test Part-A (TMT-A).
The three groups were comparable for age, sex, etiology, Child-Pugh-score, post-TIPS porto-systemic gradient, previous hepatic encephalopathy, basal values of ammonia and psychometric performance. Twenty-five patients developed hepatic encephalopathy (33%, CI 95%=22–45%). One-month incidence was similar in the three groups (
P=0.97). Previous hepatic encephalopathy (Relative Hazard=3.79;1.27–11.31) and basal-TMT-A
Z-score>1.5 (RH=3.55;1.24–10.2) were predictors of post-TIPS encephalopathy at multivariate analysis. A <5
mmHg porto-systemic gradient was also significantly related to the occurrence of encephalopathy.
Our data show that treatment with lactitol or rifaximin is not effective in the prophylaxis of hepatic encephalopathy during the first month after a TIPS.
Objectives
To identify frequent MRI features of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT) using a fast protocol with a 3 T magnet.
Methods
Thirty-eight patients ...with PHPT underwent a 3 T-MR. All patients had positive US and Tc-99 sestamibi, for a total number of 46 PTAs. T2-weighted IDEAL-FSE and T1 IDEAL-sequences, before and after contrast, were performed. Five features of PTAs were recognised: hyperintensity, homogeneous or "marbled" appearance and elongated morphology on T2-sequences; cleavage plane from thyroid gland on T2-outphase; rapid enhancement in post-contrast T1. Image quality for T2-weighted IDEAL FSE and usefulness for IDEAL post-contrast T1-weighted and T2-outphase sequences were also graded.
Results
PTAs were hyperintense in T2-sequences in 44/46 (95.7 %), "marbled" in 30/46 (65.2 %) and elongated in 38/46 (82.6 %) patients. Cleavage plane was observed in 36/46 (78.3 %), and rapid enhancement in 20/46 (43.5 %) patients. T2-sequences showed both excellent fat suppression and image quality (average scores of 3.2 and 3.1). T2-outphase images demonstrated to be quite useful (score 2.8), whereas, post-contrast T1 images showed a lower degree of utility (score 2.4).
Conclusions
A fast protocol with 3.0-T MRI, recognising most common features of PTAs, may be used as a second-line method in the preoperative detection of PTAs.
Key Points
•
3 T MRI protocol based on T2-weighted IDEAL FSE sequences was used
.
•
T2-hyperintensity and elongated morphology are common features of PTAs
.
•
3 T MRI could be used in the preoperative detection of PTAs
.
Diagnosis of tuberculous pleurisy (TP) may be challenging and it often requires pleural biopsy. A tool able to increase pre-test probability of TP may be helpful to guide diagnostic work-up and ...enlargement of internal mammary lymph node (IMLN) has been suggested to play a potential role.
The aim of the present investigation was to assess role of IMLN involvement in TP in a multi-centric case-control study, by comparing its prevalence and test performance to those observed in patients with infectious, non-tuberculous pleurisy (NTIP), and in controls free from respiratory diseases (CP).
A total of 419 patients, from 14 Pulmonology Units across Italy were enrolled (127 patients affected by TP, 163 affected by NTIP and 129 CP). Prevalence, accuracy and predictive values of ipsilateral IMLN involvement between cases and control groups were assessed, as well as concordance between chest computed tomography (CT scan) and thoracic ultrasound (TUS) measurements.
The prevalence of ipsilateral IMLN involvement in TP was significantly higher than that observed in NTIP and CP groups (respectively 77.2%, 39.3% and 14.7%). Results on test performance, stratified by age, revealed a high positive predictive value in patients aged ≤50 years, while a high negative predictive value in patients aged >50 years. The comparison between CT scan and ultrasound showed moderate agreement (Kappa=0.502).
Evaluation of IMLN involvement plays a relevant role in assessing the pre-test probability of TP. Considering the increasing global prevalence of mycobacterial infections, a tool able to guide diagnostic work-up of suspected TP is crucial, especially where local sources are limited.
Aim To evaluate image quality and diagnostic accuracy of different dual-energy computed tomography (DECT) datasets for identification of hepatocellular carcinoma (HCC), assess the reliability of ...virtual unenhanced (VU) images in replacing standard unenhanced (SU) images, and quantify effective dose (ED) at different tube voltages. Material and methods Thirty cirrhotic patients underwent liver contrast-enhanced DECT. Two blinded observers retrospectively evaluated conventional unenhanced and VU images, 140 kVp/80 kVp/mixed tube potential arterial datasets and conventional portal-venous/late phases in consensus. Final diagnosis was based on pathological proof or imaging criteria. Image quality, ED, sensitivity, and specificity of arterial datasets were calculated. Results Thirty-eight HCC and 18 benign lesions were detected at 80 kVp, 33 HCC and 22 benign lesions were detected at 140 kVp, and 36 HCC and 20 benign lesions were detected at mixed tube potentials. Final diagnosis confirmed 37 HCC and 20 benign lesions. There was no significant difference in diagnostic confidence between 80 kVp, 140 kVp, and mixed tube potential arterial datasets ( p >0.05). Image quality was adequate for all datasets, with increased quality at higher tube potential (80 versus 140 kVp, p =0.001; mixed versus 140 kVp, p =0.001; 80 kVp versus mixed, p =0.0024). Significant ED reduction was observed between 140 and 80 kVp datasets ( p <0.001). Conclusions The 140 kVp dataset provided higher image quality. The 80 kVp images were more sensitive in detecting HCC. VU images are adequate in replacing SU images. The ED of the 80 kVp dataset was significantly lower.
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