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Acoustic radiation forced impulse (ARFI) is an integrated ultrasound method, measuring stiffness by point shear wave elastography. To evaluate the diagnostic performance of the ARFI of the liver and the spleen, combined with spleen dimension and platelet count, in predicting high-risk esophageal varices (HRVs) in cirrhotic patients, a prospective and cross-sectional study was conducted between February 2017 and February 2021. The following ratio scores were calculated based on ARFI measurements: ALSDP (ARFI Liver–Spleen Diameter-to-Platelet Ratio Score), ASSDP (ARFI Spleen–Spleen Diameter-to-Platelet Ratio Score), ASSAP (ARFI Spleen–Spleen Area-to-Platelet Ratio Score), and ALSAP (ARFI Liver–Spleen Area-to-Platelet Ratio Score). In 100 enrolled subjects, spleen ARFI, ASSDP, and ASSAP were significantly associated with HRVs in the prospective short- and long-term follow-ups and in the cross-sectional study (p < 0.05), while ALSDP and ALSAP were associated with HRVs only in the prospective long-term follow-up and cross-sectional study (p< 0.05). ASSAP was the best ARFI ratio score for HRVs at the long-term follow-up [value of area under curve (AUC) = 0.88], although all the ARFI ratio scores performed better than individual liver and spleen ARFI (AUC > 0.7). In our study, ARFI ratio scores can predict, in well-compensated cirrhotic patients, the risk of developing HVRs in short- and long-term periods.

Background: Leiomyosarcoma (LMS) originating from the adrenal gland is exceedingly rare, constituting a minute fraction of soft tissue sarcomas. Due to its rarity, with less than 50 documented cases in English medical literature, the diagnosis and management of adrenal LMS remain challenging. The aim of this study was to perform a review of the literature, in order to evaluate the prognosis of these rare cancers and report our specific case. Methods: A systematic review of the literature was conducted using PubMed, Web of Science, Google Scholar, and Scopus databases, up to December 2020. The search utilized MeSH terms such as "Adrenal Gland Neoplasms," "Leiomyosarcoma," "Adrenalectomy," and "Smooth Muscle Tumor." The inclusion criteria focused on studies reporting patients with a histopathological diagnosis of adrenal leiomyosarcoma. The PRISMA guidelines were followed to ensure a comprehensive analysis. Results: Out of 63 identified studies, 43 met the inclusion criteria and were reviewed. These studies highlighted the rarity and aggressive behavior of adrenal leiomyosarcoma. Surgical excision remains the cornerstone of treatment, often complemented by adjuvant therapies. The reviewed case involved a 52-year-old woman who underwent a right laparoscopic adrenalectomy for a 9 × 7 × 6 cm grade 3 leiomyosarcoma. Despite subsequent adjuvant chemotherapy, hepatic metastases were detected, illustrating the aggressive nature of the disease. The literature underscores the importance of histopathological analysis and long-term surveillance for managing disease progression. Conclusions: Optimal management of adrenal leiomyosarcoma requires a multidisciplinary approach and meticulous follow-up. The rarity of the disease poses challenges for standardizing treatment, but surgical excision and tailored adjuvant therapies show promise. Further research is essential to refine treatment strategies and improve prognosis for this rare malignancy. [ABSTRACT FROM AUTHOR]

Background: Pancreatic neuroendocrine tumors (pNETs) represent a rare subset of pancreatic cancer. Functional tumors cause hormonal changes and clinical syndromes, while non-functional ones are often diagnosed late. Surgical management needs multidisciplinary planning, involving enucleation, distal pancreatectomy with or without spleen preservation, central pancreatectomy, pancreaticoduodenectomy or total pancreatectomy. Minimally invasive approaches have increased in the last decade compared to the open technique. The aim of this study was to analyze the current diagnostic and surgical trends for pNETs, to identify better interventions and their outcomes. Methods: The study adhered to the PRISMA guidelines, conducting a systematic review of the literature from May 2008 to March 2022 across multiple databases. Several combinations of keywords were used ("NET", "pancreatic", "surgery", "laparoscopic", "minimally invasive", "robotic", "enucleation", "parenchyma sparing") and relevant article references were manually checked. The manuscript quality was evaluated. Results: The study screened 3867 manuscripts and twelve studies were selected, primarily from Italy, the United States, and China. A total of 7767 surgically treated patients were collected from 160 included centers. The mean age was 56.3 y.o. Enucleation (EN) and distal pancreatectomy (DP) were the most commonly performed surgeries and represented 43.4% and 38.6% of the total interventions, respectively. Pancreatic fistulae, postoperative bleeding, re-operation, and follow-up were recorded and analyzed. Conclusions: Enucleation shows better postoperative outcomes and lower mortality rates compared to pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), despite the similar risks of postoperative pancreatic fistulae (POPF). DP is preferred over enucleation for the pancreas body–tail, while laparoscopic enucleation is better for head pNETs. [ABSTRACT FROM AUTHOR]

Aims: Given the increasing number of individuals developing metabolic dysfunction‐associated steatotic liver disease (MASLD) and the low rate of those with progressive liver disease, there is a pressing need to conceive affordable biomarkers to assess MASLD in general population settings. Herein, we aimed to investigate the performance of the ultrasound‐derived fat fraction (UDFF) for hepatic steatosis in high‐risk individuals. Methods: A total of 302 Europeans with obesity, type 2 diabetes, or a clinical history of hepatic steatosis were included in the analyses. Clinical, laboratory, and imaging data were collected using standardized procedures during a single screening visit in Rome, Italy. Hepatic steatosis was defined by controlled attenuation parameter (CAP) or ultrasound‐based Hamaguchi's score. UDFF performance for hepatic steatosis was estimated by the area under the receiver operating characteristic curve (AUC). Results: Overall, median (IQR) UDFF was 12% (7–20). UDFF was positively correlated with CAP (ρ = 0.73, p < 0.0001) and Hamaguchi's score (ρ = 0.79, p < 0.0001). Independent predictors of UDFF were circulating triglycerides, alanine aminotransferase (ALT), and ultrasound‐measured visceral adipose tissue (VAT). UDFF AUC was 0.89 (0.85–0.93) and 0.92 (0.88–0.95) for CAP‐ and ultrasound‐diagnosed hepatic steatosis, respectively. UDFF AUC for hepatic steatosis was higher than those of fatty liver index (FLI), hepatic steatosis index (HSI), CAP‐score (CAPS), and ALT (p < 0.0001). Lower age, ALT, and VAT were associated with discordance between UDFF and ultrasound. Conclusions: UDFF may be a simple and accurate imaging biomarker to assess hepatic steatosis and monitor changes in hepatic fat content over time or in response to therapeutic interventions beyond clinical trials. [ABSTRACT FROM AUTHOR]

Sarcopenia is a common complication in patients with liver cirrhosis. In this context, its diagnosis is typically based on operational definitions, including the estimation of low muscle mass. Recently, muscle ultrasound-based measurements have drawn attention due to their improved feasibility and accessibility. However, only a limited number of studies evaluating this approach have been reported. Finally, the role of muscle strength respect to mass in identifying patients with the worst clinical outcomes has not been clearly elucidated. In a cohort of cirrhotic patients, our primary aim was to investigate the correlation and agreement between ultrasound-derived measures of muscle mass and bioimpedance analysis (BIA) as the gold standard, as well as their discriminative power. In addition, as a secondary aim, we investigated the correlation of these techniques and muscle strength with clinical outcomes. The study included consecutive adult outpatients attending the Hepatology Unit of the Fondazione Policlinico Campus Bio-Medico of Rome. Muscle mass was defined as appendicular skeletal mass (ASMM) according to the Sergi equation (EWGSOP 2019). Ultrasound was performed to measure muscle mass according to previously described standardized indices (quadriceps and iliopsoas muscles). Hand grip measurement was used to define muscle strength. Pearson's correlation coefficient and Bland-Altman plots were used to assess the correlation and agreement between ASMM and ultrasound indices. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve (AUROC). Finally, crude and adjusted Cox regression analyses were performed to test the possible association between the different proxies of sarcopenia and liver decompensation or mortality within 24 months. 88 patients were included [(mean age 73 years (7.07), 78% male, mean BMI 27 kg/m2 (10)]. The most common aetiology of cirrhosis was viral (40%) and the majority of patients (80%) had well preserved liver function. Average compression index (ACI) and average feather index (AFI) showed a good correlation with ASMM, while among the psoas indices, only psoas to height ratio (PHR)- but not ileopsoas index (IPI) - showed a correlation (Figure 1). Linear regression analysis confirmed that AFI [beta 0.64 (CI95% 0.37-0.92), p<0.001], ACI [0.5 (CI95% 0.21-0.78), p<0.001] and PHR [0.38 (CI95% 0.08-0.69), p=0.01] were significantly associated with ASMM, also independently of gender. In addition, Bland-Altman analyses showed good agreement for US with ASMM. Furthermore, these indices showed adequate discriminatory power, with AUROCs of 0.71 (0.57-0.854), 0.81 (0.69-0.931) and 0.75 (0.63-0.862) for ACI, AFI and PHR, respectively. Finally, in Cox regression analyses, only low muscle strength was associated with higher rates of mortality and liver decompensation [HR 1.62(1.06-2.47), p 0.026; HR 1.29(0.99-1.69), p 0.064]. Ultrasound measurements of quadriceps and psoas diameters showed good correlation and agreement with muscle mass defined by BIA in cirrhotic patients, displaying also an adequate discriminatory ability. At the same time, only low muscle strength exhibited a valuable predictive role for outcomes in our population. If these results are confirmed in larger external series, ultrasound can be proposed as a feasible and cost-effective tool for the assessment of muscle mass in patients with CLD, while dynopenia should be used to better identify patients with the worst outcomes. [ABSTRACT FROM AUTHOR]