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The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Magnetic resonance elastography (MRE) is an imaging technique that combines low-frequency mechanical vibrations with magnetic resonance imaging to create visual maps and quantify liver parenchyma stiffness. As in recent years, diffuse liver diseases have become highly prevalent worldwide and could lead to a chronic condition with different stages of fibrosis. There is a strong necessity for a non-invasive, highly accurate, and standardised quantitative assessment to evaluate and manage patients with different stages of fibrosis from diagnosis to follow-up, as the actual reference standard for the diagnosis and staging of liver fibrosis is biopsy, an invasive method with possible peri-procedural complications and sampling errors. MRE could quantitatively evaluate liver stiffness, as it is a rapid and repeatable method with high specificity and sensitivity. MRE is based on the propagation of mechanical shear waves through the liver tissue that are directly proportional to the organ's stiffness, expressed in kilopascals (kPa). To obtain a valid assessment of the real hepatic stiffness values, it is mandatory to obtain a high-quality examination. To understand the pearls and pitfalls of MRE, in this review, we describe our experience after one year of performing MRE from indications and patient preparation to acquisition, quality control, and image analysis.

The aim of this study was to compare CT radiomics and morphological features when assessing benign lymph nodes (LNs) in colon cancer (CC). This retrospective study included 100 CC patients (test cohort) who underwent a preoperative CT examination and were diagnosed as pN0 after surgery. Regional LNs were scored with a morphological Likert scale (NODE-SCORE) and divided into two groups: low likelihood (LLM: 0-2 points) and high likelihood (HLM: 3-7 points) of malignancy. The T -test and the Mann-Whitney test were used to compare 107 radiomic features extracted from the two groups. Radiomic features were also extracted from primary lesions (PLs), and the receiver operating characteristic (ROC) was used to test a LN/PL ratio when assessing the LN's status identified with radiomics and with the NODE-SCORE. An amount of 337 LNs were divided into 167 with LLM and 170 with HLM. Radiomics showed 15/107 features, with a significant difference ( p < 0.02) between the two groups. The comparison of selected features between 81 PLs and the corresponding LNs showed all significant differences ( p < 0.0001). According to the LN/PL ratio, the selected features recognized a higher number of LNs than the NODE-SCORE ( p < 0.001). On validation of the cohort of 20 patients (10 pN0, 10 pN2), significant ROC curves were obtained for LN/PL busyness (AUC = 0.91; 0.69-0.99; 95% C.I.; and p < 0.001) and for LN/PL dependence entropy (AUC = 0.76; 0.52-0.92; 95% C.I.; and p = 0.03). The radiomics ratio between CC and LNs is more accurate for noninvasively discriminating benign LNs compared to CT morphological features.

Objective: The objective of this study is to prospectively compare quantitative and subjective image quality, scanning time, and diagnostic confidence between a new deep learning-based reconstruction(DLR) algorithm and standard MRI protocol of lumbar spine., Materials and Methods: Eighty healthy volunteers underwent 1.5T MRI examination of lumbar spine from September 2021 to May 2023. Protocol acquisition comprised sagittal T1- and T2-weighted fast spin echo and short-tau inversion recovery images and axial multislices T2-weighted fast spin echo images. All sequences were acquired with both DLR algorithm and standard protocols. Two radiologists, blinded to the reconstruction technique, performed quantitative and qualitative image quality analysis in consensus reading; diagnostic confidence was also assessed. Quantitative image quality analysis was assessed by calculating signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Qualitative image quality analysis and diagnostic confidence were assessed with a five-point Likert scale. Scanning times were also compared., Results: DLR SNR was higher in all sequences (all p<0.001). CNR of the DLR was superior to conventional dataset only for axial and sagittal T2-weighted fast spin echo images (p<0.001). Qualitative analysis showed DLR had higher overall quality in all sequences (all p<0.001), with an inter-rater agreement of 0.83 (0.78-0.86). DLR total protocol scanning time was lower compared to standard protocol (6:26 vs 12:59 min, p<0.001). Diagnostic confidence for DLR algorithm was not inferior to standard protocol., Conclusion: DLR applied to 1.5T MRI is a feasible method for lumbar spine imaging providing morphologic sequences with higher image quality and similar diagnostic confidence compared with standard protocol, enabling a remarkable time saving (up to 50%)., (© 2023. The Author(s).)