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Radiomics represents the science of extracting and analyzing a multitude of quantitative features from medical imaging, revealing the quantitative potential of radiologic images. This scientific review aims to provide radiologists with a comprehensive understanding of radiomics, emphasizing its principles, applications, challenges, limits, and prospects. The limitations of standardization in current scientific production are analyzed, along with possible solutions proposed by some of the referenced papers. As the continuous evolution of medical imaging is ongoing, radiologists must be aware of new perspectives to play a central role in patient management. [ABSTRACT FROM AUTHOR]

Pleural mesothelioma (PM) is an aggressive disease that has a strong causal relationship with asbestos exposure and represents a major challenge from both a diagnostic and therapeutic viewpoint. Despite recent improvements in patient care, PM typically carries a poor outcome, especially in advanced stages. Therefore, a timely and effective diagnosis taking advantage of currently available imaging techniques is essential to perform an accurate staging and dictate the most appropriate treatment strategy. Our aim is to provide a brief, but exhaustive and up-to-date overview of the role of multimodal medical imaging in the management of PM. [ABSTRACT FROM AUTHOR]

Objectives: The prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. We sought to evaluate the prognosis role of LV papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease. Methods: A total of 391 patients with > 500/24 h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF, and no cardiac disease were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). Dark-Paps was defined as end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images. Mitral valve prolapse, mitral annular disjunction (MAD), and myocardial LGE were considered. Results: Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve analysis, patients with Dark-Paps were at higher risk of events than those without (p < 0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p = 0.03), to LGE (NRI 0.25, p = 0.04), and to NSVT + LGE (NRI 0.32, p = 0.02). Conclusions: In LV papillary muscles, Dark-Paps is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. Key Points: • Papillary muscle abnormalities are seen in patients with ventricular arrhythmias and preserved left ventricular ejection fraction. • Early post-contrast hypointensity of papillary muscles in end-systolic cine images (Dark-Paps) is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. • Dark-Paps had an additive prognostic role over late gadolinium enhancement and non-sustained ventricular tachycardia. [ABSTRACT FROM AUTHOR]

Digital Breast Tomosynthesis (DBT) is a cutting-edge technology introduced in recent years as an in-depth analysis of breast cancer diagnostics. Compared with 2D Full-Field Digital Mammography, DBT has demonstrated greater sensitivity and specificity in detecting breast tumors. This work aims to quantitatively evaluate the impact of the systematic introduction of DBT in terms of Biopsy Rate and Positive Predictive Values for the number of biopsies performed (PPV-3). For this purpose, we collected 69,384 mammograms and 7894 biopsies, of which 6484 were Core Biopsies and 1410 were stereotactic Vacuum-assisted Breast Biopsies (VABBs), performed on female patients afferent to the Breast Unit of the Istituto Tumori "Giovanni Paolo II" of Bari from 2012 to 2021, thus, in the period before, during and after the systematic introduction of DBT. Linear regression analysis was then implemented to investigate how the Biopsy Rate had changed over the 10 year screening. The next step was to focus on VABBs, which were generally performed during in-depth examinations of mammogram detected lesions. Finally, three radiologists from the institute's Breast Unit underwent a comparative study to ascertain their performances in terms of breast cancer detection rates before and after the introduction of DBT. As a result, it was demonstrated that both the overall Biopsy Rate and the VABBs Biopsy Rate significantly decreased following the introduction of DBT, with the diagnosis of an equal number of tumors. Besides, no statistically significant differences were observed among the three operators evaluated. In conclusion, this work highlights how the systematic introduction of DBT has significantly impacted the breast cancer diagnostic procedure, by improving the diagnostic quality and thereby reducing needless biopsies, resulting in a consequent reduction in costs. [ABSTRACT FROM AUTHOR]

Objectives: The recently proposed standardized reporting and data system for somatostatin receptor (SSTR)–targeted PET/CT SSTR-RADS 1.0 showed promising first results in the assessment of diagnosis and treatment planning with peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors (NET). This study aimed to determine the intra- and interreader agreement of SSTR-RADS 1.0. Methods: SSTR-PET/CT scans of 100 patients were independently evaluated by 4 readers with different levels of expertise according to the SSTR-RADS 1.0 criteria at 2 time points within 6 weeks. For each scan, a maximum of five target lesions were freely chosen by each reader (not more than three lesions per organ) and stratified according to the SSTR-RADS 1.0 criteria. Overall scan score and binary decision on PRRT were assessed. Intra- and interreader agreement was determined using the intraclass correlation coefficient (ICC). Results: Interreader agreement using SSTR-RADS 1.0 for identical target lesions (ICC ≥ 0.91) and overall scan score (ICC ≥ 0.93) was excellent. The decision to state "functional imaging fulfills requirements for PRRT and qualifies patient as potential candidate for PRRT" also demonstrated excellent agreement among all readers (ICC ≥ 0.86). Intrareader agreement was excellent even among different experience levels when comparing target lesion–based scores (ICC ≥ 0.98), overall scan score (ICC ≥ 0.93), and decision for PRRT (ICC ≥ 0.88). Conclusion: SSTR-RADS 1.0 represents a highly reproducible and accurate system for stratifying SSTR-targeted PET/CT scans with high intra- and interreader agreement. The system is a promising approach to standardize the diagnosis and treatment planning in NET patients. Key Points: • SSTR-RADS 1.0 offers high reproducibility and accuracy. • SSTR-RADS 1.0 is a promising method to standardize diagnosis and treatment planning for patients with NET. [ABSTRACT FROM AUTHOR]

Background and Objective: In the USA, cabozantinib was approved for the treatment of patients aged ≥ 12 years with radioiodine-refractory differentiated thyroid cancer (DTC) who progressed on prior vascular endothelial growth factor (VEGFR)-targeted therapy based on the Phase 3 COSMIC-311 trial, which evaluated cabozantinib 60 mg/day versus placebo. Approved dosing is 60 mg/day for adults and for pediatric patients aged ≥ 12 years with body surface area (BSA) ≥ 1.2 m2, and 40 mg/day for pediatric patients aged ≥ 12 years with BSA < 1.2 m2. This report describes a population pharmacokinetic (PopPK) and exposure–response analysis of COSMIC-311. Methods: A PopPK model was developed using concentration-time data from COSMIC-311 and 6 other cabozantinib studies. The final (full) PopPK model was used to simulate the effect of sex, body weight, race, and patient population. For exposure–response analysis, derived datasets from COSMIC-311 were constructed for time-to-event analyses of progression-free survival (PFS) and safety endpoints. Results: The PopPK analysis included 4746 cabozantinib PK samples from 1745 patients and healthy volunteers. Body weight had minimal impact on cabozantinib exposure but increasing body weight was associated with increased apparent volume of distribution. Based on model-based simulation, adolescents < 40 kg had higher maximum plasma concentration at steady state of cabozantinib 60 mg/day compared to adults. Allometric scaling simulation in adolescents < 40 kg demonstrated higher exposure with 60 mg/day relative to adults receiving the same dose, while exposure with 40 mg/day in adolescents < 40 kg was similar to 60 mg/day in adults. The exposure–response analysis included 115 patients. There was no clear relationship between PFS or dose modification and cabozantinib exposure. A statistically significant relationship was demonstrated for cabozantinib exposure and hypertension (Grade ≥ 3) and fatigue/asthenia (Grade ≥ 3). Conclusions: These results support the dosing strategy implemented in COSMIC-311 and the BSA-based label recommendations for adolescents. The cabozantinib dose should be reduced to manage adverse events as indicated. [ABSTRACT FROM AUTHOR]

Purpose: In the phase 3 CheckMate 9ER trial, intravenous nivolumab (240 mg every 2 weeks) plus oral cabozantinib (40 mg/day) improved progression-free survival (PFS) versus sunitinib as first-line therapy for advanced renal cell carcinoma (RCC). To support cabozantinib dosing with the combination, this exposure–response analysis characterized the relationship of cabozantinib exposure with clinical endpoints. Methods: Dose modification was allowed with cabozantinib (holds and reductions) to manage adverse events (AEs). The population pharmacokinetics analysis was updated and used to generate individual predicted cabozantinib exposure measures. Kaplan–Meier plots and time-to-event Cox proportional hazard (CPH) exposure–response models characterized the relationship of cabozantinib exposure with PFS, dose modifications, and selected AEs. Results: Kaplan–Meier plots showed no clear difference in PFS across cabozantinib exposure quartiles. Cabozantinib exposure did not significantly affect the hazard of PFS in the CPH base model nor in the final model. In contrast, baseline albumin and nivolumab clearance had a significant effect on PFS. There was no significant relationship between cabozantinib clearance and risk of dose modification, but a significant relationship was identified between cabozantinib exposure and Grade ≥ 1 palmar-plantar-erythrodysesthesia and Grade ≥ 3 diarrhea in the exposure–response analysis. Conclusion: To optimize individual cabozantinib exposure, these data support the dose modification strategies in CheckMate 9ER for cabozantinib in patients with advanced RCC when combined with nivolumab. [ABSTRACT FROM AUTHOR]

Objectives: To develop a structured reporting (SR) template for whole-body CT examinations of polytrauma patients, based on the consensus of a panel of emergency radiology experts from the Italian Society of Medical and Interventional Radiology. Methods: A multi-round Delphi method was used to quantify inter-panelist agreement for all SR sections. Internal consistency for each section and quality analysis in terms of average inter-item correlation were evaluated by means of the Cronbach's alpha (Cα) correlation coefficient. Results: The final SR form included 118 items (6 in the "Patient Clinical Data" section, 4 in the "Clinical Evaluation" section, 9 in the "Imaging Protocol" section, and 99 in the "Report" section). The experts' overall mean score and sum of scores were 4.77 (range 1–5) and 257.56 (range 206–270) in the first Delphi round, and 4.96 (range 4–5) and 208.44 (range 200–210) in the second round, respectively. In the second Delphi round, the experts' overall mean score was higher than in the first round, and standard deviation was lower (3.11 in the second round vs 19.71 in the first round), reflecting a higher expert agreement in the second round. Moreover, Cα was higher in the second round than in the first round (0.97 vs 0.87). Conclusions: Our SR template for whole-body CT examinations of polytrauma patients is based on a strong agreement among panel experts in emergency radiology and could improve communication between radiologists and the trauma team. [ABSTRACT FROM AUTHOR]

NAVIGATOR is an Italian regional project boosting precision medicine in oncology with the aim of making it more predictive, preventive, and personalised by advancing translational research based on quantitative imaging and integrative omics analyses. The project's goal is to develop an open imaging biobank for the collection and preservation of a large amount of standardised imaging multimodal datasets, including computed tomography, magnetic resonance imaging, and positron emission tomography data, together with the corresponding patient-related and omics-related relevant information extracted from regional healthcare services using an adapted privacy-preserving model. The project is based on an open-source imaging biobank and an open-science oriented virtual research environment (VRE). Available integrative omics and multi-imaging data of three use cases (prostate cancer, rectal cancer, and gastric cancer) will be collected. All data confined in NAVIGATOR (i.e., standard and novel imaging biomarkers, non-imaging data, health agency data) will be used to create a digital patient model, to support the reliable prediction of the disease phenotype and risk stratification. The VRE that relies on a well-established infrastructure, called D4Science.org, will further provide a multiset infrastructure for processing the integrative omics data, extracting specific radiomic signatures, and for identification and testing of novel imaging biomarkers through big data analytics and artificial intelligence. [ABSTRACT FROM AUTHOR]

Background: There is an unmet need for new biomarkers able to predict both the outcomes of up–front therapy and the compliance of elderly patients diagnosed with glioblastoma. For this purpose, temporal muscle thickness is a promising tool to be investigated. Methods: Data from 52 glioblastoma patients older than 65 years, treated with post-operative radio or radio-chemotherapy and referred to Pisa University Hospital, were retrieved. The thickness of temporal muscle (TMT) was divided into quartiles and correlated with overall survival (Our primary endpoint). Survival curves were calculated using Kaplan–Meier method, and log-rank test was used to evaluate the differences between curves. Results: Patients in the lower quartile of TMT, with TMT thinner than 7 mm, have survived longer; both univariate and multivariate analyses showed a statistically significant correlation between TMT and overall survival (P = 0.012 and P = 0.003, respectively). Conclusion: Future prospective and more extensive studies focused on elderly glioblastoma patients are needed to confirm the role of TMT as prognostic value on OS and to help explaining this association. [ABSTRACT FROM AUTHOR]

The use of artificial intelligence (AI) and radiomics in the healthcare setting to advance disease diagnosis and management and facilitate the creation of new therapeutics is gaining popularity. Given the vast amount of data collected during cancer therapy, there is significant concern in leveraging the algorithms and technologies available with the underlying goal of improving oncologic care. Radiologists will attain better precision and effectiveness with the advent of AI technology, making machine-assisted medical services a valuable and important option for future oncologic medical care. As a result, it is critical to figure out which specific radiology activities are best positioned to gain from AI and radiomics models and methods of oncologic imaging, while also considering the algorithms' capabilities and constraints. Our purpose is to overview the current evidence and future prospects of AI and radiomics algorithms used in oncologic imaging efforts with an emphasis on the three most frequent cancers worldwide, i.e., lung cancer, breast cancer and colorectal cancer. We discuss how AI and radiomics could be used to detect and characterize cancers and assess therapy response. [ABSTRACT FROM AUTHOR]

Background and objective: The systematic collection of medical images combined with imaging biomarkers and patient non-imaging data is the core concept of imaging biobanks, a key element for fuelling the development of modern precision medicine. Our purpose is to review the existing image repositories fulfilling the criteria for imaging biobanks. Methods: Pubmed, Scopus and Web of Science were searched for articles published in English from January 2010 to July 2021 using a combination of the terms: "imaging" AND "biobanks" and "imaging" AND "repository". Moreover, the Community Research and Development Information Service (CORDIS) database (https://cordis.europa.eu/projects) was searched using the terms: "imaging" AND "biobanks", also including collections, projects, project deliverables, project publications and programmes. Results: Of 9272 articles retrieved, only 54 related to biobanks containing imaging data were finally selected, of which 33 were disease-oriented (61.1%) and 21 population-based (38.9%). Most imaging biobanks were European (26/54, 48.1%), followed by American biobanks (20/54, 37.0%). Among disease-oriented biobanks, the majority were focused on neurodegenerative (9/33, 27.3%) and oncological diseases (9/33, 27.3%). The number of patients enrolled ranged from 240 to 3,370,929, and the imaging modality most frequently involved was MRI (40/54, 74.1%), followed by CT (20/54, 37.0%), PET (13/54, 24.1%), and ultrasound (12/54, 22.2%). Most biobanks (38/54, 70.4%) were accessible under request. Conclusions: Imaging biobanks can serve as a platform for collecting, sharing and analysing medical images integrated with imaging biomarkers, biological and clinical data. A relatively small proportion of current biobanks also contain images and can thus be classified as imaging biobanks. Key Points: • Imaging biobanks are a powerful tool for large-scale collection and processing of medical images integrated with imaging biomarkers and patient non-imaging data. • Most imaging biobanks retrieved were European, disease-oriented and accessible under user request. • While many biobanks have been developed so far, only a relatively small proportion of them are imaging biobanks. [ABSTRACT FROM AUTHOR]

Background: Radiology is an essential tool in the management of a patient. The aim of this manuscript was to build structured report (SR) Mammography based in Breast Cancer. Methods: A working team of 16 experts (group A) was composed to create a SR for Mammography Breast Cancer. A further working group of 4 experts (group B), blinded to the activities of the group A, was composed to assess the quality and clinical usefulness of the SR final draft. Modified Delphi process was used to assess level of agreement for all report sections. Cronbach's alpha (Cα) correlation coefficient was used to assess internal consistency and to measure quality analysis according to the average inter-item correlation. Results: The final SR version was built by including n = 2 items in Personal Data, n = 4 items in Setting, n = 2 items in Comparison with previous breast examination, n = 19 items in Anamnesis and clinical context; n = 10 items in Technique; n = 1 item in Radiation dose; n = 5 items Parenchymal pattern; n = 28 items in Description of the finding; n = 12 items in Diagnostic categories and Report and n = 1 item in Conclusions. The overall mean score of the experts and the sum of score for structured report were 4.9 and 807 in the second round. The Cronbach's alpha (Cα) correlation coefficient was 0.82 in the second round. About the quality evaluation, the overall mean score of the experts was 3.3. The Cronbach's alpha (Cα) correlation coefficient was 0.90. Conclusions: Structured reporting improves the quality, clarity and reproducibility of reports across departments, cities, countries and internationally and will assist patient management and improve breast health care and facilitate research. [ABSTRACT FROM AUTHOR]

Objectives: The relationship between glucose metabolism and tumor cellularity before chemo-radiotherapy in patients with head and neck squamous cell carcinoma (SCC) has never been compared with that of patients evaluated after treatment. This retrospective study analyzed the correlation between glucose metabolism parameters expressed by standardized uptake value (SUV) derived from 18F-fluorodeoxyglucose (18F-FDG) PET/CT and cellularity tumor parameters expressed by apparent diffusion coefficients (ADC) derived from diffusion-weighted (DW) MRI in untreated and treated patients with head and neck SCC. Methods: In 19 patients with no previous exposure to any treatment and 17 different chemo-radiotreated patients with head and neck SCC, we correlated the semi-quantitative uptake values (SUVmax, SUVpeak, and SUVmean) with the ADC functional parameters (ADCmin, ADCmean) including the standard deviation of ADC values (ADCsd). Results: No significant correlation was found between glucose metabolism parameters and ADCmin or ADCmean in untreated and treated patient groups. However, in untreated patients, significant inverse correlations were found between ADCsd and SUVmax (P = 0.039, r = −0.476), SUVpeak (P = 0.003, r = −0.652) and SUVmean (P = 0.039, r = −0.477). Analyses after chemo-radiotherapy in 17 patients showed no significant correlation between glucose metabolism parameters and DW MRI values, excluding a persistent significant (but lower intensity) inverse correlation between SUVpeak and ADCsd (P = 0.033, r = −0.519). Conclusions: The demonstrated relationships suggest complex interactions especially between metabolic activity and heterogeneity of tumoral tissue, which might play a complementary role in the assessment of head and neck SCC. Trial date of registration and registration number: Our retrospective study was registered on April 9th, 2020 by the Ethics Committee of the Coordinating Center "Area Vasta Nord Ovest" (CEAVNO) with Registration Number CEAVNO09042020. [ABSTRACT FROM AUTHOR]

During the coronavirus disease 19 (COVID-19) pandemic, extracorporeal membrane oxygenation (ECMO) has been proposed as a possible therapy for COVID-19 patients with acute respiratory distress syndrome. This pictorial review is intended to provide radiologists with up-to-date information regarding different types of ECMO devices, correct placement of ECMO cannulae, and imaging features of potential complications and disease evolution in COVID-19 patients treated with ECMO, which is essential for a correct interpretation of diagnostic imaging, so as to guide proper patient management. [ABSTRACT FROM AUTHOR]

Blockchain usage in healthcare, in radiology, in particular, is at its very early infancy. Only a few research applications have been tested, however, blockchain technology is widely known outside healthcare and widely adopted, especially in Finance, since 2009 at least. Learning by history, radiology is a potential ideal scenario to apply this technology. Blockchain could have the potential to increase radiological data value in both clinical and research settings for the patient digital record, radiological reports, privacy control, quantitative image analysis, cybersecurity, radiomics and artificial intelligence. Up-to-date experiences using blockchain in radiology are still limited, but radiologists should be aware of the emergence of this technology and follow its next developments. We present here the potentials of some applications of blockchain in radiology. [ABSTRACT FROM AUTHOR]

Background: 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 in colon cancer during the staging phase in order to improve communication between the radiologist, members of multidisciplinary teams and patients. Materials and methods: A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. 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. Results: The final SR version was built by including n = 18 items in the "Patient Clinical Data" section, n = 7 items in the "Clinical Evaluation" section, n = 9 items in the "Imaging Protocol" section and n = 29 items in the "Report" section. Overall, 63 items were included in the final version of the SR. Both in the first and second round, all sections received a higher than good rating: a mean value of 4.6 and range 3.6–4.9 in the first round; a mean value of 5.0 and range 4.9–5 in the second round. In the first round, Cronbach's alpha (Cα) correlation coefficient was a questionable 0.61. In the first round, the overall mean score of the experts and the sum of scores for the structured report were 4.6 (range 1–5) and 1111 (mean value 74.07, STD 4.85), respectively. In the second round, Cronbach's alpha (Cα) correlation coefficient was an acceptable 0.70. In the second round, the overall mean score of the experts and the sum of score for structured report were 4.9 (range 4–5) and 1108 (mean value 79.14, STD 1.83), respectively. The overall mean score obtained by the experts in the second round was higher than the overall mean score of the first round, with a lower standard deviation value to underline greater agreement among the experts for the structured report reached in this round. Conclusions: A wide implementation of SR is of critical importance in order to offer referring physicians and patients optimum quality of service and to provide researchers with the best quality data in the context of big data exploitation of available clinical data. Implementation is a complex procedure, requiring mature technology to successfully address the multiple challenges of user-friendliness, organization and interoperability. [ABSTRACT FROM AUTHOR]

Anthropogenic factors have significantly influenced the frequency, duration, and intensity of meteorological drought in many regions of the globe, and the increased frequency of wildfires is among the most visible consequences of human-induced climate change. Despite the fire role in determining biodiversity outcomes in different ecosystems, wildfires can cause negative impacts on wildlife. We conducted ground surveys along line transects to estimate the first-order impact of the 2020 wildfires on vertebrates in the Pantanal wetland, Brazil. We adopted the distance sampling technique to estimate the densities and the number of dead vertebrates in the 39,030 square kilometers affected by fire. Our estimates indicate that at least 16.952 million vertebrates were killed immediately by the fires in the Pantanal, demonstrating the impact of such an event in wet savanna ecosystems. The Pantanal case also reminds us that the cumulative impact of widespread burning would be catastrophic, as fire recurrence may lead to the impoverishment of ecosystems and the disruption of their functioning. To overcome this unsustainable scenario, it is necessary to establish proper biomass fuel management to avoid cumulative impacts caused by fire over biodiversity and ecosystem services. [ABSTRACT FROM AUTHOR]

PRIMAGE is a European Commission-financed project dealing with medical imaging and artificial intelligence aiming to create an imaging biobank in oncology. The project includes a task dedicated to the interoperability between imaging and standard biobanks. We aim at linking Digital imaging and Communications in Medicine (DICOM) metadata to the Minimum Information About BIobank data Sharing (MIABIS) standard of biobanking. A very first integration model based on the fusion of the two existing standards, MIABIS and DICOM, has been developed. The fundamental method was that of expanding the MIABIS core to the imaging field, adding DICOM metadata derived from CT scans of 18 paediatric patients with neuroblastoma. The model was developed with the relational database management system Structured Query Language. The integration data model has been built as an Entity Relationship Diagram, commonly used to organise data within databases. Five additional entities have been linked to the "Image Collection" subcategory in order to include the imaging metadata more specific to the particular type of data: Body Part Examined, Modality Information, Dataset Type, Image Analysis, and Registration Parameters. The model is a starting point for the expansion of MIABIS with further DICOM metadata, enabling the inclusion of imaging data in biorepositories. [ABSTRACT FROM AUTHOR]

Background: Cardiac computed tomography (CT) is commonly used to study left atrial (LA) and pulmonary veins (PVs) anatomy before atrial fibrillation (AF) ablation. The aim of the study was to determine the impact of pre-procedural cardiac CT with 3D reconstruction on procedural outcomes and radiological exposure in patients who underwent radiofrequency catheter ablation (RFA) of AF.Methods: In this registry, 493 consecutive patients (age 62 ± 8 years, 70% male) with paroxysmal (316) or persistent (177) AF who underwent first procedure of RFA were included. A pre-procedural CT scan was obtained in 324 patients (CT group). Antral pulmonary vein isolation was performed in all patients using an open-irrigation-tip catheter with a 3D electroanatomical navigation system. Procedural outcome, including radiological exposure, and clinical outcomes were compared among patients who underwent RFA with (CT group) and without (no CT group) pre-procedural cardiac CT.Results: Acute PV isolation was obtained in all patients, with a comparable overall complication rate between CT and no CT group (4.3% vs 3%, p = 0.7). No differences were observed about mean duration of the procedure (231 ± 60 vs 233 ± 58 min, p = 0.7) and fluoroscopy time (13 ± 10 vs 13 ± 8 min, p = 0.6) among groups. Cumulative radiation dose resulted significantly higher in the CT group compared with no CT group (8.9 ± 24 vs 4.8 ± 15 mSv, P = 0.02). At 1 year, freedom from AF/atrial tachycardia were comparable among groups (CT group, 227/324 (70%), vs no CT group,119/169 (70%), p = ns).Conclusions: Pre-procedural CT does not improve safety and efficacy of AF ablation, increasing significantly the cumulative radiological exposure. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak has played havoc within healthcare systems, with radiology sharing a substantial burden. Our purpose is to report findings from a survey on the crisis impact among members of the Italian Society of Medical and Interventional Radiology (SIRM). Methods: All members were invited to a 42-question online survey about the impact of the COVID-19 outbreak on personal and family life, professional activity, socioeconomic and psychological condition. Participants were classified based on working in the most severely affected Italian regions ("hot regions") or elsewhere. Results: A total of 2150 radiologists joined the survey. More than 60% of respondents estimated a workload reduction greater than 50%, with a higher prevalence among private workers in hot regions (72.7% vs 66.5% elsewhere, p = 0.1010). Most respondents were concerned that the COVID-19 outbreak could impact the management of non-COVID-19 patients and expected a work overload after the crisis. More than 40% were moderately or severely worried that their professional activity could be damaged, and most residents believed that their training had been affected. More than 50% of respondents had increased emotional stress at work, including moderate or severe symptoms due to sleep disturbances, feeling like living in slow motion and having negative thoughts, those latter being more likely in single-living respondents from hot regions [log OR 0.7108 (CI95% 0.3445 ÷ 1.0770), p = 0.0001]. Conclusions: The COVID-19 outbreak has had a sensible impact on the working and personal life of SIRM members, with more specific criticalities in hot regions. Our findings could aid preserving the radiologists' wellbeing after the crisis. [ABSTRACT FROM AUTHOR]

Purpose: To report the results of a nationwide online survey on artificial intelligence (AI) among radiologist members of the Italian Society of Medical and Interventional Radiology (SIRM). Methods and materials: All members were invited to the survey as an initiative by the Imaging Informatics Chapter of SIRM. The survey consisted of 13 questions about the participants' demographic information, perceived advantages and issues related to AI implementation in radiological practice, and their overall opinion about AI. Results: In total, 1032 radiologists (equaling 9.5% of active SIRM members for the year 2019) joined the survey. Perceived AI advantages included a lower diagnostic error rate (750/1027, 73.0%) and optimization of radiologists' work (697/1027, 67.9%). The risk of a poorer professional reputation of radiologists compared with non-radiologists (617/1024, 60.3%), and increased costs and workload due to AI system maintenance and data analysis (399/1024, 39.0%) were seen as potential issues. Most radiologists stated that specific policies should regulate the use of AI (933/1032, 90.4%) and were not afraid of losing their job due to it (917/1032, 88.9%). Overall, 77.0% of respondents (794/1032) were favorable to the adoption of AI, whereas 18.0% (186/1032) were uncertain and 5.0% (52/1032) were unfavorable. Conclusions: Radiologists had a mostly positive attitude toward the implementation of AI in their working practice. They were not concerned that AI will replace them, but rather that it might diminish their professional reputation. [ABSTRACT FROM AUTHOR]

Background: Kaposi's Sarcoma Herpesvirus (KSHV) is a gammaherpesvirus strongly linked to human cancer. The virus is also able to induce immune suppression, effect that contributes to onset/progression of the viral-associated malignancies. As KSHV may infect macrophages and these cells abundantly infiltrate Kaposi's sarcoma lesions, in this study we investigated whether KSHV-infection could affect macrophage polarisation to promote tumorigenesis.Methods: FACS analysis was used to detect macrophage markers and PD-L1 expression. KSHV infection and the molecular pathways activated were investigated by western blot analysis and by qRT-PCR while cytokine release was assessed by Multi-analyte Kit.Results: We found that KSHV infection reduced macrophage survival and skewed their polarisation towards M2 like/TAM cells, based on the expression of CD163, on the activation of STAT3 and STAT6 pathways and the release of pro-tumorigenic cytokines such as IL-10, VEGF, IL-6 and IL-8. We also found that KSHV triggered Ire1 α-XBP1 axis activation in infected macrophages to increase the release of pro-tumorigenic cytokines and to up-regulate PD-L1 surface expression.Conclusions: The findings that KSHV infection of macrophages skews their polarisation towards M2/TAM and that activate Ire1 α-XBP1 to increase the release of pro-tumorigenic cytokines and the expression of PD-L1, suggest that manipulation of UPR could be exploited to prevent or improve the treatment of KSHV-associated malignancies. [ABSTRACT FROM AUTHOR]

Background: Our purpose was to assess the performance of ESR iGuide for assisting the selection of the most appropriate imaging tests based on clinical signs and symptoms in patients with hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC). Methods: We retrospectively reviewed the medical records of 113 patients with a final diagnosis of HCC or CC. Data from a cohort of 40 patients with a reported clinical history suggestive for either disease, who had undergone at least their first imaging test related to their condition at the same Institution, were entered into ESR iGuide. The appropriateness level of the diagnostic tests suggested by ESR iGuide was compared with that of the tests actually performed. Results: All patients underwent several imaging examinations, ranging from a minimum of 1 to a maximum of 4, for a total of 98 diagnostic procedures. Of these, 79.6% (78/98) were considered "usually appropriate" by ESR iGuide, 11.2% (11/98) were designated as "may be appropriate", and 9.2% (9/98) were not even suggested. Given a total estimated cost of €14,016 for the 98 examinations performed within the regional (BLINDED) healthcare system, the usage of ESR iGuide would have allowed saving €3033 (21.6%) due to inappropriate testing. Conclusions: In patients with HCC or CC, ESR iGuide can be effective in guiding the selection of the appropriate imaging examinations and cutting costs due to inappropriate testing. [ABSTRACT FROM AUTHOR]

Purpose: To assess the current status of patient's informed consent (PIC) management at radiological centres and the overall opinion of radiologist active members of the Italian Society of Medical Radiology (SIRM) about PIC dematerialisation through an online survey. Methods and materials: All members were invited to join the survey as an initiative by the Imaging Informatics Chapter of SIRM. The survey consisted of 11 multiple-choice questions about participants' demographics, current local modalities of PIC acquisition and storage, perceived advantages and disadvantages of PIC dematerialisation over conventional paper-based PIC, and overall opinion about PIC dematerialisation. Results: A total of 1791 radiologists (amounting to 17.4% of active SIRM members for the year 2016) joined the survey. Perceived advantages of PIC dematerialisation were easier and faster PIC recovery (96.5%), safer storage and conservation (94.5%), and reduced costs (90.7%). Conversely, the need to create dedicated areas for PIC acquisition inside each radiological unit (64.0%) and to gain preliminary approval for the use of advanced digital signature tools from patients (51.8%) were seen as potential disadvantages. Overall, 94.5% of respondents had a positive opinion about PIC dematerialisation. Conclusion: Radiologists were mostly favourable to PIC dematerialisation. However, concerns were raised that its practical implementation might face hurdles due to its complexity in current real life working conditions. [ABSTRACT FROM AUTHOR]

The Asian citrus psyllid (ACP) Diaphorina citri is the main vector of the bacteria associated with Huanglongbing, and can exploit more than 50 species of the family Rutaceae as hosts. The number of possible hosts is even higher if plant varieties are included. This study evaluated the influence of different combinations of scion and rootstock citrus varieties on the development and feeding of ACP. Survival rates for the egg stage were highest on the Valencia and Sicilian varieties, both grafted on Sunki mandarin, with means of 87.99 and 87.98%, respectively; and lowest (67.63%) on Hamlin × Rangpur lime. The lowest levels of both nymphal and total viability (egg-adult) were obtained on Hamlin, regardless of the rootstock used. The total development time (egg-adult) ranged from 17.92 to 19.33 days for the Pêra × Sunki and Hamlin × Swingle combinations, respectively. Cluster analysis separated the hosts into two groups, the first consisting of the combinations of the Hamlin variety, and the second group formed by the other varieties. The highest food value (assessed by the area of honeydew produced) was observed for the orange scion varieties, and among these, the highest value was observed on Valencia (0.902 cm); the smallest honeydew area was obtained on Ponkan (0.269 cm). The rootstocks did not affect the feeding behavior of D. citri. The results of this study could aid in the development of management techniques, mainly in providing information for the installation of new citrus groves and assistance in crop-improvement research. [ABSTRACT FROM AUTHOR]

Objectives: The early detection of oral soft tissue lesions is an important prognostic factor, and the possibility of using ultrasonography (US) as a diagnostic tool may improve the diagnosis and characterization of tissue alterations at an early stage. This study aims to evaluate the feasibility of intraoral US by performing a preclinical assessment of an ex vivo specimen in which focal lesions were simulated. Materials and methods: Fourteen lesions were simulated on a freshly extracted calf tongue, by introducing in the tongue different materials mimicking the appearance of various focal lesions. The specimen was scanned with a 8 MHz US probe and computed tomography (CT) was performed to compare the two imaging techniques. Later, the specimen was dissected to set a benchmark for size assessment. Results: US was able to identify all the simulated lesions within the tongue, resulting in one case more accurate than CT. Statistical analysis demonstrated high correlation between the measurements of the simulated lesions performed on the US images and the real size of the materials introduced in the tongue ( p < 0.05). Conclusions: This preclinical study proves that US performs well in the detection and characterization of simulated lesions of the tongue. These findings suggest that US could be effectively used in clinical applications. However, further research is mandatory to assess the reliability of in vivo US in the detection and characterization of tongue lesions as well as of other oral soft tissue alterations. [ABSTRACT FROM AUTHOR]

Objectives: To assess the opinion on structured reporting (SR) and its usage by radiologist members of the Italian Society of Medical Radiology (SIRM) via an online survey.Methods: All members received an email invitation to join the survey as an initiative by the SIRM Imaging Informatics Chapter. The survey included 10 questions about demographic information, definition of radiological SR, its usage in everyday practice, perceived advantages and disadvantages over conventional reporting and overall opinion about SR.Results: 1159 SIRM members participated in the survey. 40.3 % of respondents gave a correct definition of radiological SR, but as many as 56 % of them never used it at work. Compared with conventional reporting, the most appreciated advantages of SR were higher reproducibility (70.5 %), better interaction with referring clinicians (58.3 %) and the option to link metadata (36.7 %). Risk of excessive simplification (59.8 %), template rigidity (56.1 %) and poor user compliance (42.1 %) were the most significant disadvantages. Overall, most respondents (87.0 %) were in favour of the adoption of radiological SR.Conclusions: Most radiologists were interested in radiological SR and in favour of its adoption. However, concerns about semantic, technical and professional issues limited its diffusion in real working life, encouraging efforts towards improved SR standardisation and engineering.Key Points: • Despite radiologists' awareness, radiological SR is little used in working practice. • Perceived SR advantages are reproducibility, better clinico-radiological interaction and link to metadata. • Perceived SR disadvantages are excessive simplification, template rigidity and poor user compliance. • Improved standardisation and engineering may be helpful to boost SR diffusion. [ABSTRACT FROM AUTHOR]

Purpose: Histone deacetylase inhibitors (HDACi) are anti-neoplastic agents that are known to affect the growth of different cancer types, but their underlying mechanisms are still incompletely understood. Here, we compared the effects of two HDACi, i.e., Trichostatin A (TSA) and Valproic Acid (VPA), on the induction of cell death and autophagy in pancreatic cancer-derived cells that exhibit a high metastatic capacity and carry KRAS/p53 double mutations. Methods: Cell viability and proliferation tests were carried out using Trypan blue dye exclusion, MTT and BrdU assays. FACS analyses were carried out to assess cell cycle progression, apoptosis, reactive oxygen species (ROS) production and mitochondrial depolarization, while Western blot and immunoprecipitation analyses were employed to detect proteins involved in apoptosis and autophagy. Results: We found that both VPA and TSA can induce apoptosis in Panc1 and PaCa44 pancreatic cancer-derived cells by triggering mitochondrial membrane depolarization, Cytochrome c release and Caspase 3 activation, although VPA was more effective than TSA, especially in Panc1 cells. As underlying molecular events, we found that ERK1/2 was de-phosphorylated and that the c-Myc and mutant p53 protein levels were reduced after VPA and, to a lesser extent, after TSA treatment. Up-regulation of p21 and Puma was also observed, concomitantly with mutant p53 degradation. In addition, we found that in both cell lines VPA increased the pro-apoptotic Bim level, reduced the anti-apoptotic Mcl-1 level and increased ROS production and autophagy, while TSA was able to induce these effects only in PaCA44 cells. Conclusions: From our results we conclude that both VPA and TSA can induce pancreatic cancer cell apoptosis and autophagy. VPA appears have a stronger and broader cytotoxic effect than TSA and, thus, may represent a better choice for anti-pancreatic cancer therapy. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the technical feasibility of 64-row computed tomography (CT) quantitative perfusion imaging of head and neck squamous cell carcinoma (SCC).Methods: Twenty-nine patients with a total of 29 pathologically proven SCC underwent a cine-mode CT perfusion acquisition covering the lesion site. The acquisition started 10 s after intravenous injection of iodinated contrast material and lasted 50 s. On a dedicated workstation, regions of interest (ROI) were traced within the SCC, on a healthy portion of tissue (H), and on the ipsilateral sternocleidomastoid muscle (M). Blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability-surface product (PS) were calculated.Results: In SCC, BF, BV and PS were higher compared with H (p<0.0001, p=0.002 and p=0.004, respectively) and M (p<0.0001). Conversely, MTT was lower in SCC than in H (p=0.0009) and M (p=0.0003). All datasets were free from substantial motion artefacts and ROI misregistration phenomena. No substantial discomfort or adverse events were experienced by any of the patients.Conclusion: 64-row CT quantitative perfusion imaging allows head and neck SCC to be distinguished from normal tissues. [ABSTRACT FROM AUTHOR]