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Although the life expectancy of patients with type 1 diabetes mellitus (T1DM) has improved since the introduction of insulin therapy, the acute life-threatening and long-term complications from diabetes mellitus are significant causes of both mortality and morbidity. Percutaneous intra-portal pancreatic islet transplantation (PIPIT) is a minimally invasive, repeatable procedure which allows a β-cell replacement therapy through a liver islet engraftment, leading to insulin release and glycaemic control restoration in patients with diabetes. Allo-PIPIT, in which isolated and purified islets from cadaveric donor are used, does not require major surgery, and is potentially less expensive for the recipient. In case of long-term T1DM, islet-after-kidney (IAK) transplantation can simultaneously cure diabetes and chronic renal failure, while islet-transplant-alone (ITA) is performed in brittle, short-term T1DM, based on the infusion of an adequate islet mass and on a steroid-free immunosuppressive regimen according to the Edmonton protocol. Results of the Collaborative Islet Transplant Registry (CITR) demonstrate that allo-PIPIT reduces episodes of hypoglycemia and diabetic complications, and improves quality of life of diabetic patients. Auto-PIPIT, in which the own patient’s islets are used, has been investigated as a preventive treatment for pancreatogenic diabetes in patients who undergo extensive pancreatectomy for malignant and non-malignant disease. This Review outlines the role of imaging and interventional radiology in allo- and auto-PIPIT.

Objectives This study sought to compare myocardial scars depicted by computed tomography (CT) with electrical features from electro-anatomic mapping (EAM), assessing the potential role of CT integration in ventricular tachycardia (VT) and radiofrequency catheter ablation (RFCA) procedures. Background Imaging-based characterization of VT myocardial substrate is required to plan EAM and, potentially, to guide RFCA. Methods Forty-two consecutive patients, 35 of whom had implantable cardioverter-defibrillator, all referred for VT RFCA, underwent pre-procedural CT including an angiographic and a 10-min delayed-enhancement scan. Segmental comparison between scars segmented from CT and low voltages (bipolar voltages

The factors that determine whether disseminated transformed cells in vivo yield neoplastic lesions have only been partially identified. We established an ad hoc model of peritoneal carcinomatosis by injecting colon carcinoma cells in mice. Tumor cells recruit inflammatory leukocytes, mostly macrophages, and generate neoplastic peritoneal lesions. Phagocyte depletion via clodronate treatment reduces neoplastic growth. Colon carcinoma cells release a prototypic damage-associated molecular pattern (DAMP)/alarmin, High Mobility Group Box1 (HMGB1), which attracts leukocytes. Exogenous HMGB1 accelerates leukocyte recruitment, macrophage infiltration, tumor growth and vascularization. Lentiviral-based HMGB1 knockdown or pharmacological interference with its extracellular impair macrophage recruitment and tumor growth. Our findings provide a preclinical proof of principle that strategies based on preventing HMGB1-driven recruitment of leukocytes could be used for treating peritoneal carcinomatosis.

Purpose: To prospectively compare the diagnostic performance of diffusion - weighted magnetic resonance (DW -MR), multidetector computed tomography (MDCT) and endoscopic ultrasound (EUS) in the preoperative loco -regional staging of oesophageal cancer. Methods and Materials: Eighteen patients with biopsy -proved oesophageal tumour (9 directly treated with surgery and 9 addressed t o chemo/radiotherapy before) underwent 1.5 T DW -MRI, 64 -channels MDCT and EUS before and after neoadjuvant treatment. All images were analysed blindly by dedicated operators and two radiologists calculated independently the ADC from the first scan. Results were then compared with surgical findings. Spearman and intraclass correlation coefficients, Mann- Whitney and ROC curves analysis were performed. The population was divided into T1 -2 vs T3 -4 and N0 vs N+. Sensitivity, specificity, accuracy, positive and negative predictive value were calculated and compared for each technique. Results: For T staging, EUS showed the best sensitivity (100%) while MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%) but none of the three techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage. Mean ADC was different between surgery - only and chemo/radiotherapy groups (1.90 vs 1.30 x 10-3 mm2/s, respective ly; p= 0.005), with an optimal cut off for local invasion of 1.33 x 10-3 mm2/s (p=0.05). Conclusion: DW -MR could improve the current preoperative staging workup for oesophageal cancer, showing characteristic advantages for both staging and initial treatment decision -making. Purpose: To prospectively compare the diagnostic performance of diffusion - weighted magnetic resonance (DW -MR), multidetector computed tomography (MDCT) and endoscopic ultrasound (EUS) in the preoperative loco -regional staging of oesophageal cancer. Methods and Materials: Eighteen patients with biopsy -proved oesophageal tumour (9 directly treated with surgery and 9 addressed t o chemo/radiotherapy before) underwent 1.5 T DW -MRI, 64 -channels MDCT and EUS before and after neoadjuvant treatment. All images were analysed blindly by dedicated operators and two radiologists calculated independently the ADC from the first scan. Results were then compared with surgical findings. Spearman and intraclass correlation coefficients, Mann- Whitney and ROC curves analysis were performed. The population was divided into T1 -2 vs T3 -4 and N0 vs N+. Sensitivity, specificity, accuracy, positive and negative predictive value were calculated and compared for each technique. Results: For T staging, EUS showed the best sensitivity (100%) while MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%) but none of the three techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage. Mean ADC was different between surgery - only and chemo/radiotherapy groups (1.90 vs 1.30 x 10-3 mm2/s, respective ly; p= 0.005), with an optimal cut off for local invasion of 1.33 x 10-3 mm2/s (p=0.05). Conclusion: DW -MR could improve the current preoperative staging workup for oesophageal cancer, showing characteristic advantages for both staging and initial treatment decision -making.

Purpose: To investigate the influence of ADC in the diagnostic performance of MRI in the preoperative staging of gastric cancer. Methods a nd Materials: Between October 2009 and October 2014 a total of 88 patients with biopsy -proved gastric cancer underwent 1.5 T MRI with T1, T2 and DWI sequences and then treated with radical surgery. Two radiologists independently measured minimum ADC from tumour and assessed T and N staging by MRI. All findings were then compared with final histology, considering T1- 3 vs T4a -b and N0 vs N+ (according to 7th TNM staging). Results: Minimum pathological ADC was significantly different both for T and N staging ( p < 0.01). An optimal cut -off of 1.28 x 10 -3 mm2/s could distinguish between patients with local invasion (area under the curve: 0.91; p < 0.001). For T staging, MR showed a sensitivity of 70% and a specificity of 68%, which increased to 87% and 88% respectively, when adding our ADC cut -off. For N staging, the sensitivity increased from 68% to 77% with similar results in terms of accuracy (69% and 70%, respectively), when adding our ADC cut -off. Conclusion: ADC is different according to local invasion and nodal involvement in gastric cancer. Adding ADC to morphological T and N staging by MRI helps in the prediction of postoperative staging. Purpose: To investigate the influence of ADC in the diagnostic performance of MRI in the preoperative staging of gastric cancer. Methods a nd Materials: Between October 2009 and October 2014 a total of 88 patients with biopsy -proved gastric cancer underwent 1.5 T MRI with T1, T2 and DWI sequences and then treated with radical surgery. Two radiologists independently measured minimum ADC from tumour and assessed T and N staging by MRI. All findings were then compared with final histology, considering T1- 3 vs T4a -b and N0 vs N+ (according to 7th TNM staging). Results: Minimum pathological ADC was significantly different both for T and N staging ( p < 0.01). An optimal cut -off of 1.28 x 10 -3 mm2/s could distinguish between patients with local invasion (area under the curve: 0.91; p < 0.001). For T staging, MR showed a sensitivity of 70% and a specificity of 68%, which increased to 87% and 88% respectively, when adding our ADC cut -off. For N staging, the sensitivity increased from 68% to 77% with similar results in terms of accuracy (69% and 70%, respectively), when adding our ADC cut -off. Conclusion: ADC is different according to local invasion and nodal involvement in gastric cancer. Adding ADC to morphological T and N staging by MRI helps in the prediction of postoperative staging.

Islet transplantation is one of the most promising and effective therapies for restoring normoglycemia in type 1 diabetes (T1D) patients, but islet engraftment is one of the main obstacles hampering long-term success. Monitoring graft loss, caused either by immunological or nonimmunological events, occurring in the first phase after transplantation and at later stages of a patient's life is a very important issue. Among the imaging approaches previously applied, magnetic resonance imaging (MRI) monitoring of islet fate following labeling with superparamagnetic iron oxide agents yielded promising results. The aim of this study was to translate into patients the method of islet labeling and MRI monitoring developed in our preclinical setting and to compare imaging results with graft clinical outcome. Three T1D patients and one nondiabetic patient undergoing autotransplantation following subtotal pancreatectomy received Endorem®-labeled islets. Patients were monitored by MRI and metabolically (HbA1c, exogenous insulin requirement, and C-peptide, TEF) at 1, 3, and 7 days following transplantation and once a month up to 10 months. Labeled transplanted islets appeared as hypointense areas scattered within the liver parenchyma, whose absolute number at 24 h after transplantation reflected the labeling efficiency. In patients #1 and #3 with good midterm graft function, MRI follow-up showed an important early loss of hypointense spots followed by a slow and progressive disappearance at later timepoints. Graft loss of function in patient #2 4 weeks after transplantation was associated with the complete disappearance of all hypointense signals. The autotransplanted patient, stably insulin free, showed no significant signal reduction during the first 3 days, followed by loss of spots similar to a patient with good midterm graft function. These results suggest that MRI monitoring of islet transplantation at early time points could represent a meaningful readout for helping in predicting transplant failure or success, but its relevance for mid/long-term islet function assessment appears evanescent.

Purpose: Our aim was to prospectively analyze the use of contrast-enhanced ultrasound (CEUS) in the quantitative assessment of the response of uveal melanoma (UM) to gamma-knife radiosurgery (GKR), investigating whether changes in tumor vascularization precede thickness reduction, which on average occurs at 12 months after GKR. Methods: Ten patients with UM treated with GKR underwent sonography (US) and CEUS at baseline and at 3, 6, and 12 months after GKR. The transverse diameter, thickness, and quantitative parameters of the UM (ie, area under the curve in the wash-in phase, wash-in perfusion index, peak enhancement, and wash-in rate) were calculated by using dedicated software and compared by using Wilcoxon's signed-rank test. Results: The mean tumor thickness on US was significantly less at both 6 (6.6 mm) and 12 months after GKR (5.8 mm) than it was at baseline (8.3 mm; p