Showing papers by "Andrea Laghi published in 2018"

Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting

Abstract: The article Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting, written by [§§§ AuthorNames §§§].

Haralick's texture features for the prediction of response to therapy in colorectal cancer: a preliminary study

Abstract: Haralick features Texture analysis is a recent oncologic imaging biomarker used to assess quantitatively the heterogeneity within a tumor. The aim of this study is to evaluate which Haralick’s features are the most feasible in predicting tumor response to neoadjuvant chemoradiotherapy (CRT) in colorectal cancer. After MRI and histological assessment, eight patients were enrolled and divided into two groups based on response to neoadjuvant CRT in complete responders (CR) and non-responders (NR). Oblique Axial T2-weighted MRI sequences before CRT were analyzed by two radiologists in consensus drawing a ROI around the tumor. 14 over 192 Haralick’s features were extrapolated from normalized gray-level co-occurrence matrix in four different directions. A dedicated statistical analysis was performed to evaluate distribution of the extracted Haralick’s features computing mean and standard deviation. Pretreatment MRI examination showed significant value (p < 0.05) of 5 over 14 computed Haralick texture. In particular, the significant features are the following: concerning energy, contrast, correlation, entropy and inverse difference moment. Five Haralick’s features showed significant relevance in the prediction of response to therapy in colorectal cancer and might be used as additional imaging biomarker in the oncologic management of colorectal patients.

Lean Body Weight-Tailored Iodinated Contrast Injection in Obese Patient: Boer versus James Formula.

Abstract: Purpose. To prospectively compare the performance of James and Boer formula in contrast media (CM) administration, in terms of image quality and parenchymal enhancement in obese patients undergoing CT of the abdomen. Materials and Methods. Fifty-five patients with a body mass index (BMI) greater than 35 kg/m2 were prospectively included in the study. All patients underwent 64-row CT examination and were randomly divided in two groups: 26 patients in Group A and 29 patients in Group B. The amount of injected CM was computed according to the patient’s lean body weight (LBW), estimated using either Boer formula (Group A) or James formula (Group B). Patient’s characteristics, CM volume, contrast-to-noise ratio (CNR) of liver, aorta and portal vein, and liver contrast enhancement index (CEI) were compared between the two groups. For subjective image analysis readers were asked to rate the enhancement of liver, kidneys, and pancreas based on a 5-point Likert scale. Results. Liver CNR, aortic CNR, and portal vein CNR showed no significant difference between Group A and Group B (all ). Group A provided significantly higher CEI compared to Group B ( ). Group A and Group B returned comparable overall subjective enhancement values (3.54 and vs 3.20, all ). Conclusions. Boer formula should be the method of choice for LBW estimation in obese patients, leading to an accurate CM amount calculation and an optimal liver contrast enhancement in CT.

ECCO-ESGAR Guideline for Diagnostic Assessment in Inflammatory Bowel Disease

Abstract: Christian Maaser , Andreas Sturm , Stephan R. Vavricka , Torsten Kucharzik , Gionata Fiorino , Vito Annese , Emma Calabrese , Daniel C. Baumgart , Dominik Bettenworth , Paula Borralho Nunes , Johan Burisch , Fabiana Castiglione , Rami Eliakim , Pierre Ellul , Yago González-Lama , Hannah Gordon , Steve Halligan , Konstantinos Katsanos , Uri Kopylov , Paulo G. Kotze , Eduards Krustiņš , Andrea Laghi , Jimmy K. Limdi , Florian Rieder , Jordi Rimola , Stuart A. Taylor , Damian Tolan , Patrick van Rheenen , Bram Verstockt , Jaap Stoker cc on behalf of the European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR]

Contrast media injection protocol optimization for dual-energy coronary CT angiography: results from a circulation phantom

Abstract: To investigate the minimum iodine delivery rate (IDR) required to achieve diagnostic coronary attenuation (300 HU) with dual-energy coronary CTA. Acquisitions were performed on a circulation phantom with a third- generation dual-source CT scanner. Contrast media was injected for a fixed time whilst IDRs varied from 1.0 to 0.3 gI/s in 0.1-gI/s intervals. Noise-optimized virtual monoenergetic imaging (VMI+) reconstructions from 40 to 90 keV in 5 keV increments were generated. Contrast-to-noise ratio (CNR) and coronary HU were measured for each injection. VMI+ from 40–70 keV reached diagnostic attenuation with at least one IDR. The minimum IDR achieving a diagnostic attenuation ranged from 0.4 gI/s at 40 keV (312.8 HU) to 1.0 gI/s at 70 keV (334.1 HU). Attenuation values reached with IDR of 1.0 gI/s were significantly higher at each keV level (p<0.001). CNR showed a near perfect correlation with the IDR (ρ≥0.962; p<0.001), the IDR of 1.0 gI/s provided the highest CNR at each keV level, achieving the highest overall value at 40 keV (54.0±3.1). IDRs from 0.4–1.0 gI/s associated with VMI+ from 40–70 keV provide diagnostic coronary attenuation with dual-energy coronary CTA. • Iodine delivery rate (IDR) is a major determinant of contrast enhancement. • Low-keV noise-optimized monoenergetic images (VMI+) maximize iodine attenuation. • Low-keV VMI+ allows for lower IDRs while maintaining adequate coronary attenuation. • Lowest IDR to reach 300 HU was 0.4 gI/s, 40 keV VMI+.

Automatic segmentation of colorectal cancer in 3D MRI by combining deep learning and 3D level-set algorithm-a preliminary study

Abstract: In this paper, a novel method to automatically segment colorectal cancer from 3D MR images based on combination of 3D fully convolutional neural networks (3D-FCNNs) and 3D level-set is proposed. The 3D-level set is incorporated in the 3D-FCNNs aiming at: i) a fine-tuning of the training phase; ii) a refinement of the outputs during the testing phase by integrating smoothing function and prior information in a post-processing step. The proposed method is assessed and compared with 3D-FCNNs without 3D-level set (3D-FCNNs alone) in terms of Dice Similarity Coefficient (DSC) as a performance metric. The proposed method showed higher DSC than 3D-FCNNs alone on both training and testing data set as, (0.91813 vs 0.8568) and (0.9378 vs 0.86238), respectively. Our results on 3D colorectal MRI data demonstrated that the proposed method gives better and accurate segmentation results than 3D-FCNNs alone.

Computer-based self-training for CT colonography with and without CAD

Abstract: To determine whether (1) computer-based self-training for CT colonography (CTC) improves interpretation performance of novice readers; (2) computer-aided detection (CAD) use during training affects learning. Institutional review board approval and patients’ informed consent were obtained for all cases included in this study. Twenty readers (17 radiology residents, 3 radiologists) with no experience in CTC interpretation were recruited in three centres. After an introductory course, readers performed a baseline assessment test (37 cases) using CAD as second reader. Then they were randomized (1:1) to perform either a computer-based self-training (150 cases verified at colonoscopy) with CAD as second reader or the same training without CAD. The same assessment test was repeated after completion of the training programs. Main outcome was per lesion sensitivity (≥ 6 mm). A generalized estimating equation model was applied to evaluate readers’ performance and the impact of CAD use during training. After training, there was a significant improvement in average per lesion sensitivity in the unassisted phase, from 74% (356/480) to 83% (396/480) (p < 0.001), and in the CAD-assisted phase, from 83% (399/480) to 87% (417/480) (p = 0.021), but not in average per patient sensitivity, from 93% (390/420) to 94% (395/420) (p = 0.41), and specificity, from 81% (260/320) to 86% (276/320) (p = 0.15). No significant effect of CAD use during training was observed on per patient sensitivity and specificity, nor on per lesion sensitivity. A computer-based self-training program for CTC improves readers’ per lesion sensitivity. CAD as second reader does not have a significant impact on learning if used during training. • Computer-based self-training for CT colonography improves per lesion sensitivity of novice readers. • Self-training program does not increase per patient specificity of novice readers. • CAD used during training does not have significant impact on learning.

Bowel preparation in CT colonography: Is diet restriction necessary? A randomised trial (DIETSAN)

Abstract: To investigate whether diet restriction affects quality of colon cleansing and patient tolerance during reduced bowel preparation for CT colonography (CTC). Asymptomatic and symptomatic patients were enrolled in this pragmatic, single-centre, randomised trial. All patients were randomly assigned (1:1 ratio, blocks of ten) to receive a reduced bowel preparation and faecal tagging with (Diet-Restriction-Group [DR]) or without (No-Diet-Restriction-Group [NDR]) dietary restriction. Five readers performed a blinded subjective image analysis, by means of 4-point Likert-scales from 0 (highest score) to 3 (worst score). Endpoints were the quality of large bowel cleansing and tolerance to the assigned bowel preparation regimen. The trial is registered at ClinicalTrial.gov (URomLSDBAL1). Ninety-five patients were randomly allocated to treatments (48 in NDR-group, 47 in DR-group). Both groups resulted in optimal colon cleansing. The mean residual stool (0.22, 95%CI 0.00-0.44) and fluid burden (0.39, 95%CI 0.25-0.53) scores for patients in DR-group were similar to those in patients in NDR-group (0.25, 95%CI 0.03-0.47 [p = 0.82] and 0.49, 95%CI 0.30-0.67 [p = 0.38], respectively). Tolerance was significantly better in NDR-group. A reduced bowel preparation in association with faecal tagging and without any dietary restriction demonstrated optimal colon cleansing effectiveness for CTC, providing better patient compliance compared with dietary restriction. • Dietary restriction in reduced bowel preparation regimen can be avoided. • The quality of colon cleansing is not affected by dietary restriction. • The quality of faecal tagging is not affected by dietary restriction. • Avoidance of dietary restriction improves patients’ tolerance for CTC.

Methods to Address Computed Tomography-Related Risk Factors in Oncology Patients: An Expert Opinion Based on Current Evidence.

Abstract: Background: The present paper is intended to be a practical guide organized by statements describing methods to reduce risks related to CT examinations in cancer patients. Methods: A panel of radiologists, oncologists and nephrologists were selected based on their publication records in the field and expertise. Ten clinical questions, which were derived from clinical needs and an integration of all the committee members’ suggestions, were stated. The modified Delphi approach was used; it involved a detailed literature review and the collective judgement of experts, including electronic and face-to-face discussions. Results: Ten statements were derived from expert opinions based on the current literature, recently developed guidelines and technological advancements. Each statement is discussed in a short paragraph reporting the current key evidence. Conclusion: This paper addresses the clinical implications of performing numerous CT examinations in patients with cancer, providing clinicians with information regarding methods to reduce risk factors in this patient population.

USPIO-labeling in M1 and M2-polarized macrophages: An in vitro study using a clinical magnetic resonance scanner.

Abstract: Aim of the study was to evaluate USPIO labeling in different macrophage populations using a clinical 3.0T MR unit with optical and electron microscopy as the gold standard. Human monocytic cell line THP-1 cells were differentiated into macrophages. Afterwards, M0 macrophages were incubated with IL-4 and IL-13 in order to obtain M2 polarized macrophages or with IFN-gamma and LPS for classical macrophage activation (M1). These groups were incubated with USPIO-MR contrast agent (P904) for 36 hr; M0, M0 + P904, M1 + P904, and M2 + P904 were analyzed in gel phantoms with a 3.0T MR scanner. m-RNA of M1 and M2 markers confirmed the polarization of THP-1-derived macrophages. M2 + P904 showed a much higher T1 signal (p < 0.0001), a significantly lower (p < 0.0001) T2* signal, and significantly higher R* (p < 0.0001) compared to the other populations. Hystological analysis confirmed higher iron content in the M2-polarized population compared to both M1-polarized (p = 0.04) and M0-P904 (p = 0.003). Ultrastructure analysis demonstrated ubiquitous localization of P904 within the cellular compartments. Our results demonstrate that a selective USPIO-labeling of different macrophage populations can be detected in vitro using the 3.0T clinical scanner.

How new technologies could impact on radiology diagnosis and assessment of pancreatic lesions: Future perspectives.

Abstract: 310 Address for correspondence Prof. Andrea Laghi, Department of Radiological Sciences, Oncology and Pathology, Sant’Andrea Hospital, Sapienza‐University of Rome, Via Di Grottarossa 1035, 00189, Rome, Italy. E‐mail: andrea.laghi@uniroma1.it Received: 2018-06-27; Accepted: 2018-07-06; Published online: 2018-10-15 How new technologies could impact on radiology diagnosis and assessment of pancreatic lesions: Future perspectives

The Role of Imaging Before and After Surgery

Abstract: In the preoperative phase, a multidisciplinary approach is recommended to evaluate obesity-related comorbidities

Peritoneal Surface Malignancy

Abstract: The term peritoneal surface malignancies comprises any cancer originated from the peritoneum itself (primary peritoneal malignancy) or metastasized to the peritoneum from a different primary site (secondary peritoneal malignancy). A major problem in treating peritoneal metastases (PM) originating from the various intra-abdominal tumors (gastric, colorectal, ovarian) is how to identify these malignant implants early so as to stage patients accurately (Cotte et al. 2010). Multidetector computed tomography (MDCT) is considered the imaging modality of choice for the evaluation of these patients. An accurate depiction of peritoneal implants and staging is essential to guide patients’ management.

Small Bowel Disease

Abstract: Diagnostic imaging and in particular cross-sectional modalities (US, CT, and MR) have a critical and complementary role in diagnosis and management of small bowel diseases. Radiologists should be aware of advantages and disadvantages of each imaging test in order to choose the best option, considering the specific small bowel disease and the patient’s characteristics (age, gender, clinical status). US is a powerful tool, especially in combination with oral (SICUS) and intravenous (CEUS) contrast agents. CT is the imaging modality of choice in the emergency setting (i.e., small bowel occlusion, ischemia, and, in some circumstances, bleeding). MR is the preferred imaging test in benign disorders, and in particular inflammatory bowel diseases (IBDs), because of multiparametric approach, evaluation of bowel motility, and lack of radiation exposure. A brief review of main findings in different pathological entities involving the small bowel is provided, in order to offer to radiologists the instruments for a correct diagnosis and for providing the clinicians with the necessary information for patient management.