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Objective: To define a predictive Artificial Intelligence (AI) algorithm based on the integration of a set of biopsy-based microRNAs expression data and radiomic features to understand their potential impact in predicting clinical response (CR) to neoadjuvant radio-chemotherapy (nRCT). Summary background data: The identification of patients who would truly benefit from nRCT for Locally Advanced Rectal Cancer (LARC) could be crucial for an improvement in a tailored therapy. Methods: Forty patients with LARC were retrospectively analyzed. An MRI of the pelvis before and after nRCT was performed. In the diagnostic biopsy, the expression levels of 7 miRNAs were measured and correlated with the tumor response rate (TRG), assessed on the surgical sample. The accuracy of complete CR (cCR) prediction was compared for i) clinical predictors; ii) radiomic features; iii) miRNAs levels; and iv) combination of radiomics and miRNAs. Results: Clinical predictors showed the lowest accuracy. The best performing model was based on the integration of radiomic features with miR-145 expression level (AUC-ROC = 0.90). AI algorithm, based on radiomics features and the overexpression of miR-145, showed an association with the TRG class and demonstrated a significant impact on the outcome. Conclusion: The pre-treatment identification of responders/NON-responders to nRCT could address patients to a personalized strategy, such as total neoadjuvant therapy (TNT) for responders and upfront surgery for non-responders. The combination of radiomic features and miRNAs expression data from images and biopsy obtained through standard of care has the potential to accelerate the discovery of a noninvasive multimodal approach to predict the cCR after nRCT for LARC.

Objective. Among the clinical manifestations of stroke mimics, isolated aphasia is one of the most challenging due to its aetiopathogenic diagnosis. This short communication describes a specific perfusion and brain oscillatory pattern in a challenging case of prolonged isolated aphasia caused by status epilepticus(SE), jointly investigated by computed tomography (CT) perfusion, single‐photon emission computerized tomography (SPECT)/CT and EEG qualitative and quantitative analysis. Methods. We discuss the different patterns of perfusion neuroimaging and EEG between SE and ischaemic stroke or postictal (Todd's)‐related isolated aphasia, and propose these differences as a basis to support the differential diagnosis. Results. The pattern associated with SE was characterized by focal hyperperfusion on CT perfusion maps (the left mean transit time was shorter with >10% asymmetry, and left cerebral blood volume and cerebral blood flow increased or slightly altered, relative to the contralateral side) and SPECT (focal left temporal hyperperfusion), without any early ischaemic signs on non‐enhanced CT, while the EEG showed a predominant left hemispheric slow delta power. The aforementioned perfusion pattern contrasts with postictal epileptic Todd's phenomenon, which is characterized by hypoperfusion on CT perfusion (the mean transit time is prolonged and cerebral blood volume and cerebral blood flow are reduced, compared to the contralateral hemisphere) and SPECT (focal hypoperfusion), not restricted to the specific vascular territories. Significance. CT perfusion patterns may add valuable information to support the differential diagnosis of status epilepticus, rather than acute ischaemic stroke or postictal Todd's phenomenon, in cases with challenging symptoms of prolonged isolated aphasia.

Acute scrotum is characterized by intense acute scrotal pain, which may be associated with other symptoms and signs such as abdominal pain, inflammation, and fever. Many pathologic conditions can present in this way, most which involve the scrotal contents. Nonscrotal conditions, however, can rarely present clinically only as acute scrotum: among them, renal colic, aneurysm rupture or other causes of retroperitoneal hemorrhage, primary abdominal or pelvic tumors and metastases, pancreatitis, pelvic inflammation, and muscle injuries. The pathophysiologic characteristics of the clinical presentation, clues for diagnosis, and imaging features of a series of nonscrotal lesions presenting clinically with acute scrotal pain are herein reported and illustrated. In patients presenting with acute scrotal symptoms and normal scrotal ultrasound findings, nonscrotal causes of acute scrotal pain should be considered in the differential diagnosis. Therefore, an ultrasound investigation of the abdomen, groin, and thighs is indicated.

The aim of this study was to identify early predictors of the long‐term response to therapy in patients with Crohn disease (CD) from time‐intensity curves obtained after microbubble injection. One hundred fifteen consecutive patients with a proven diagnosis of CD involving the terminal ileal loop who were scheduled to begin pharmacologic therapy with biologics (infliximab or adalimumab) were scanned after sulfur hexafluoride–filled microbubble injection before the beginning and at the end of the sixth week of treatment. The absolute value and percentage change of each semiquantitative kinetic parameter (peak enhancement, time to peak enhancement, rise time, mean transit time, wash‐in and wash‐out rates, area under the curve [AUC] for the whole time‐intensity curve, AUC during wash‐in, AUC during wash‐out, and wash‐in perfusion index) as measured on the terminal ileal tract and adjacent reactive mesenteric fat were calculated from time‐intensity curves. Patients were followed for at least 24 months with redetermination of the Crohn Disease Activity Index and with at least 1 endoscopy within 18 weeks after the beginning of pharmacologic treatment. The absolute values and percentage changes of kinetic parameters were assessed as potential predictors of the therapeutic outcome by a logistic regression analysis. The study group included 66 male and 49 female patients (mean age ± SD, 45.76 ± 11 years). The pretreatment values and percentage changes of the peak enhancement, AUC, AUC during wash‐in, and AUC during wash‐out were found to be predictors (P< .05) of the long‐term therapeutic outcome. The analysis of time‐intensity curves obtained after microbubble contrast agent injection provides early predictors of the long‐term therapeutic outcome in patients with CD.

Contrast-enhanced US represents an alternative imaging modality to CT and MR imaging for monitoring Crohn disease activity during pharmacologic treatment and, compared with the other modalities, offers several advantages, including low cost, portability, availability, lack of restrictions in performing frequent serial examinations at short intervals, and absence of radiation exposure.

Objective: The current surgical trend in the treatment of pleomorphic adenomas of the parotid gland is to limit the extent of resection. This raises the need to correctly identify the mass within the normal parenchyma so as to avoid dissecting the entire superficial lobe of the gland. We describe ultrasound-guided tattooing as a technique to facilitate identification and excision of parotid pleomorphic adenomas.Methods: We reviewed 23 consecutive patients with pleomorphic adenoma of the parotid gland. All patients underwent ultrasound-guided tattooing of the lesions with a charcoal suspension. Baseline tumor and patients’ characteristics, major and minor complications, and subjective tolerance to the procedure were recorded. We assessed the number of intralesionally marked masses and the percentage of intraoperatively detected marked lesions.Results: The injection was well tolerated. No major complications were recorded. In 2 cases (9%), a transient increase in lesion size was observed. No other minor complications were encountered. Charcoal was found inside the tumor in 19 cases (83%). In 4 cases (17%), it was found in the tissues above the lesion. Twenty-three lesions were intraoperatively detected (100%) and dissected.Conclusion: Charcoal suspension tattooing is safe and well tolerated for the detection of small pleomorphic adenomas during parotid surgery.

Inpatient hypoglycemia is associated with increased morbidity and mortality. After a hypoglycemic event, the likelihood of additional episodes increases. The Joint Commission recommends evaluating all episodes of hypoglycemia for root-cause analysis. Studies have shown that pharmacists’ involvement with glycemic control protocols can prevent hypoglycemia.

Detection of liver metastases is one of the most common problems in evaluating patients with primary neoplasms. Gray-scale and color Doppler ultrasonography have limited accuracy with a sensitivity ranging between 53% and 77%. Isoechoic metastases and nodules under 1 cm in size may not be detectable. Occasionally, non-metastatic liver lesions can be identified in neoplastic patients which must be correctly characterized. Microbubble contrast agents overcome many limitations of gray-scale ultrasonography to detect liver metastases and increase the possibility to differentiate them from other focal liver lesions. In this review article we discuss the current role of contrast enhanced ultrasonography in detection of liver metastases using specialized destructive and non-destructive modes. Using air-filled microbubbles and destructive modes the sensitivity of contrast enhanced ultrasonography to detect liver metastases ranges between 80% and 98%. The ease of use of the non-destructive approach makes it much more attractive and is particularly helpful for lesion characterization. An increasing number of studies is being published regarding the diagnostic performance of perfluorocarbon- or sulfur hexafluoride-filled microbubbles with non-destructive modes to detect liver metastases, and the general agreement is that sensitivity and specificity of the non-destructive modes approach those of the destructive approach and of helical CT.

Gray-scale and color Doppler ultrasonography have limited accuracy in characterization of focal liver lesions because a significant overlapping exists between the echo pattern and vascularity of benign and malignant lesions. Several clinical studies have demonstrated that characterization of focal liver lesions that are indeterminate at conventional ultrasonography could be improved using microbubble contrast agents with contrast specific modes. In particular, latest generation ultrasound contrast agents allow evaluation of lesion vascularity in real time using low acoustic power contrast specific modes with the resolution afforded with gray-scale imaging. In this review article the enhancement pattern of different types of benign and malignant focal liver lesions using low acoustic power contrast specific modes is described, and the current role of contrast enhanced ultrasonography in liver lesion characterization is discussed.

We sought to investigate whether thalidomide is able to produce tumor vascular changes in patients with untreatable hepatocellular carcinoma (HCC) that can be detected using microbubble contrast agents.

Tsukamoto H, Kang YS, Jones LC, Cova M, Herold CJ, McVeigh E, Hungerford DS, Zerhouni EA. Evaluation of marrow perfusion in the femoral head by dynamic magnetic resonance imaging: effect of venous occlusion in a dog model. Invest Radiol 1992;27:275–281.