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Rationale: Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor that is prevalent among children and adolescents. Surgery is the most important therapeutic approach for IMT and complete resection is recommended. Although 50% of IMTs show anaplastic lymphoma kinase (ALK) rearrangements, crizotinib has proven an effective therapeutic approach. However, the genetic landscape of this tumor is still not fully understood and treatment options are limited, especially in the majority of ALK-negative tumors. Patient concerns: We describe the clinical case of a healthy 18-year-old female in whom a pulmonary nodule was incidentally detected Diagnoses: Following a small increase in the size of the nodule, the patient underwent both 18FDG-PET/CT and 68Ga-PET/CT, resulting in a suspicion of bronchial hamartoma. Interventions: The patient underwent surgery and a salivary gland-like lung tumor was diagnosed. Outcomes: After surgery, the patient was referred to our cancer center, where a review of the histology slides gave a final diagnosis of ALK-negative lung IMT. Given the histology, it was decided not to administer adjuvant therapy and the patient was placed in a 3-monthly follow-up program. The patient is still disease-free 2 years post-surgery. Lessons: Although there is no standard of care for the treatment of IMT, identifying genomic alterations could help to redefine the management of patients with negative-ALK disease. Our review of the literature on IMT and other kinase fusions revealed, in addition to ALK rearrangements, the potential association of ROS1, NTRK, RET, or PDGFR beta alterations with the tumor.

PURPOSE: FDG-positive neuroendocrine tumors (NETs) have a poorer prognosis and exhibit shorter response duration to peptide receptor radionuclide therapy (PRRT). The aim of this prospective phase II study was to evaluate the efficacy and toxicity of PRRT with (177)Lu-DOTATATE associated with metronomic capecitabine as a radiosensitizer agent in patients with advanced progressive FDG-positive gastro-entero-pancreatic (GEP) NETs. PATIENTS AND METHODS: Patients with advanced somatostatin receptor- and FDG-positive G1-G3 GEP-NETs (Ki6720%) NETs. Grade 3 (G3) or 4 (G4) hematological toxicity occurred in 16.2% of patients. Other G3-G4 adverse events were diarrhea in 5.4% of cases and asthenia in 5.4%. No renal toxicity was observed for the duration of follow-up. Thirty-three of 37 patients were evaluable for response. Objective responses included partial response (PR) in 10 patients (30%), stable disease (SD) in 18 patients (55%), with a DCR of 85%. Median follow up was 38 months (range 4.6–51.1 months). Median PFS was 31.4 months (17.6–45.4) and mOS was not reached. CONCLUSIONS: This study demonstrated that the combination of PRRT with (177)Lu-DOTATATE and metronomic capecitabine is active and well tolerated in patients with aggressive FDG-positive G1-G3 GEP-NETs. These data constitute the basis for a randomized study of PPRT alone vs. PRRT plus metronomic capecitabine.

Two patients with grade III obesity (body mass index [BMI] ≥ 40), a 31-year-old man (A) and a 26-year-old woman (B), banded gastroplasty. Both patients followed the same nutritional and postsurgical approach. After 12 months, both patients achieved a similar reduction in BMI (patient A: −29.7%

Dual energy X-ray absorptiometry (DXA) is a well-established method for the diagnosis of osteoporosis and monitoring of treatment. Recent advances in DXA technologies have improved accuracy and precision. Nevertheless, errors in bone mineral density measurement and interpretation could occur and negatively affect the diagnosis and management of patients. These errors can result from improper equipment installation and maintenance, inadequate education and training in bone densitometry, and insufficient knowledge of current clinical guidelines. This review describes the current procedures of quality assurance in bone densitometry and emphasizes strict adherence of technicians and clinicians to manufacturers’ recommendations and current clinical guidelines.

Objective: The aim of the present study was to evaluate the reliability of scout CT (sCT) lateral radiograph, in terms of diagnostic accuracy and intra- and interobserver agreement in the detection of vertebral fractures (VFs). Methods: 300 CT examinations of the thoracic and/or lumbar spine were collected and independently analysed by 3 musculoskeletal radiologists in 2 different sessions. A semi-quantitative approach was used for VF assessment on sCT, and morphometric analysis was performed when a VF was suspected. Results of multiplanar sagittal CT reconstructions interpreted by the most expert radiologist were considered as gold standard. Arthrosiswas also scored.Only vertebral bodies assessable by both sCT and gold standard were considered for the analysis. Area under the receiver operating characteristic curve (AUROC), Cohen’s kappa statistic and linear-by-linear association were used for statistical analysis. Results: 1522 vertebrae were considered (130 males and 170 females; ages, 73.062.8 years). 73 of 1522 (4.8%) VFs were identified in 34/300 patients (11.3%). In the detection of VFs, the sensitivity and specificity of sCT were 98.7% and 99.7%, respectively. Accuracy (AUROC50.99260.008), as well as interobserver agreement (k50.96860.008), was excellent. Intra-observer agreement was perfect (k51.000). Performance of this method was independent of arthrosis, vertebral level and type and grade of VFs. Conclusion: sCT is a simple but very accurate method for the detection of VFs. It should be introduced as a spine evaluation tool for the detection of VFs in examinations that are performed for other diagnostic purposes. Advances in knowledge: sCT lateral radiograph is an accurate tool for the detection of VFs. This technique may be used with several advantages in clinical practice.

Background The increasing longevity of the population coupled with the progress of treatments for primary tumors is enhancing the incidence and the burden of distant metastases such as bone metastases. Bone metastases are the most common cause of cancer-related pain. Quality of life may be significantly impaired as a consequence of painful bone metastases. The treatment of secondary bone lesions will become even more important in the near future. The development of strategies to improve quality of life in patients with bone metastases is fundamental and represents a major clinical challenge. This issue is of huge impact on today health care and economy.

To investigate the predictive value for hepatic steatosis of a new software for the quantification of visceral fat by dual-energy X-ray absorptiometry (DXA) and to design new regions of interest (ROIs).Adult volunteers were prospectively screened for hepatic steatosis by ultrasonography to obtain a well-balanced population according to the presence/absence of the disease. 90 adult patients without steatosis and 90 with steatosis (mild, 53.3%; moderate, 37.7%; and severe, 10.0%) were recruited. On the same day, all subjects were submitted to blood testing and to anthropometric and whole-body DXA for body composition evaluation. A new software for android visceral fat assessment was employed, and six new "liver-suited" ROIs as well as two modified android ROIs were designed. Their association with steatosis grade was tested by correlation analysis.Fat mass (FM) of the new ROIs showed the highest correlation coefficients with steatosis grade (ρ = 0.610-0.619; p0.001), which was also confirmed by multivariate analysis. On the whole population, the new ROIs maintained the highest predictive role for liver steatosis, with areas under the receiver operating characteristic curve up to 0.820 ± 0.032. Inter- and intra-operator agreement for the new ROIs was excellent (k = 0.915-1.000 and k = 0.927-1.000).New ROIs could be designed, standardized and implemented in DXA whole-body scan to provide more specific and predictive values of hepatic lipid content.This is the first study to investigate the predictive value for hepatic steatosis of visceral and regional FM assessed on the hepatic site by DXA in comparison with ultrasonography, anthropometry and surrogate markers derived by previously validated algorithms (fatty liver index).

Purpose: Our aim was to investigate the link between adiposity fat indexes obtained using ultrasound (US) examination, total and android fat amount by dual-energy x-ray absorptiometry (DXA), and body weight (BW) in normal-weight, over-weight and obese subjects. Material & Methods: We retrospectively analyzed body composition (BC) parameters of 138 normal-weight (62M, 76F, age 41.2613.6year-old, BMI 22.361.5Kg/m2), 92 over-weight (60M, 32F, age 48.2613.3year-old, BMI 27.061.4Kg/m2) and 42 obese (4M, 38F, age 49.9612.8year-old, BMI 37.066.0Kg/m2) subjects. Data were collected from different studies in our Hospital where US and DXA evaluations were simultaneously performed for BC assessment. The carotid intimal-medial-thickness (CIMT), the ratio between minimum subcutaneous fat-thickness and maximum pre-peritoneal fat-thickness (wall-fat-index – WFI), and that one between maximum subcutaneous fat-thickness and intra-abdominal fat-thickness (MAR) were considered for US evaluations. Simple regression and ANOVA were used for the analysis (only p,0.05 were considered). Results: In all groups, WFI had significant correlations with total fat mass (FM) and FM percentage, while MAR got a relation with only BW; moreover, CIMT was related to android and whole-body FM. FM percentage in android region was linked to MAR and WFI only in normal-weight and over-weight subjects. Android FM was correlated with MAR only in normal-weight subjects. Conclusion: DXA, US and BW look at the human body from different points of view. An integration of these three techniques should be considered when the assessment of BC is needed.

Professor Romeo Canini’s name did not appear in the list of authors of the following abstract that was presented at the Special Scientific session of the ISS held in Athens in September 2010 and published in Skeletal Radiology (2010,10,1051). The title and complete list of authors is as follows; New dual-energy x-ray absorptiometry equipments in the assessment of vertebral fractures: technical limits and software accuracy. Alberto Bazzocchi, Danila Diano, Claudia Sassi, Giuseppe Battista, Giuseppe Guglielmi, Romeo Canini.

BackgroundOsteoid osteoma is a bone-producing lesion frequentlylocalized in long bones. The most common presentingsymptom is pain with nocturnal exacerbation, respon-sive to nonsteroidal anti-i nflammatory drugs [1]. Mini-mally invasive treatment options have become thestandard of care for osteoid osteoma and at presentradiofrequency ablation is the treatment of choice [2].Only one preliminary study has been performed usingmagnetic resonance guided focused ultrasound(MRgFUS) to treat osteoid osteoma showing MRgFUSto be effective for pain relief through thermal cell deathand periosteal denervation induced by cortical heatingrelative to acoustic energy absorption [3]. The purposeof this research was to evaluate the efficacy of MRgFUSin treating osteoid osteoma and to highlight potentialbenefits and limitations provided by this technology.Materials and methodsSeven patients affected by osteoid osteoma were consecu-tively recruited for MRgFUS (ExAblate 2100, InSightec,Israel on 1.5 T Signa Twin Speed MR system, GE, USA).The diagnosis of osteoid ost eoma was based on typicalclinical and imaging findings (CT and MRI) . Pain andfunction were scored before and after MRgFUS (VAS –0-10 scale), and any intra- and post-procedure complica-tion or adverse effect was recorded. Initial follow-upincluded clinical assessment at discharge, and everymonth.ResultsIn one patient the lesion c ould not be approached dueto the high body mass index (33 Kg/m