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It has been proven in a few early studies that radiomic analysis offers a promising opportunity to detect or differentiate between organ lesions based on their unique texture parameters. Recently, the utilization of CT texture analysis (CTTA) has been receiving significant attention, especially for response evaluation and prognostication of different oncological diagnoses. In this review article, we discuss the unique ability of radiomics and its subfield CTTA to diagnose lesions in the pancreas and kidney. We review studies in which CTTA was used for the classification of histology grades in pancreas and kidney tumors. We also review the role of radiogenomics in the prediction of the molecular and genetic subtypes of pancreatic tumors. Furthermore, we provide a short report on recent advancements of radiomic analysis in predicting prognosis and survival of patients with pancreatic and renal cancers.

Artificial Intelligence and the use of radiomics analysis have been of great interest in the last decade in the field of imaging. CT texture analysis (CTTA) is a new and emerging field in radiomics, which seems promising in the assessment and diagnosis of both focal and diffuse liver lesions. The utilization of CTTA has only been receiving great attention recently, especially for response evaluation and prognostication of different oncological diagnoses. Radiomics, combined with machine learning techniques, offers a promising opportunity to accurately detect or differentiate between focal liver lesions based on their unique texture parameters. In this review article, we discuss the unique ability of radiomics in the diagnostics and prognostication of both focal and diffuse liver lesions. We also provide a brief review of radiogenomics and summarize its potential role of in the non-invasive diagnosis of malignant liver tumors.

Background: Heart rate (HR), mean arterial pressure (MAP) and carotid intima–media thickness (cIMT) are moderately heritable cardiovascular traits, but the environmental effects on the longitudinal change of their heritability have never been investigated. Methods: 368 Italian and Hungarian twins (107 monozygotic, 77 dizygotic) underwent oscillometric measurement and B-mode sonography of bilateral carotid arteries in 2009/2010 and 2014. Within- -individual/cross-study wave, cross-twin/within-study wave and cross-twin/cross-study wave correlations were estimated, and bivariate Cholesky models were fitted to decompose the total variance at each wave and covariance between study waves into additive genetic, shared and unique environmental components. Results: For each trait, a moderate longitudinal stability was observed, with within-individual/crosswave correlations of 0.42 (95% CI: 0.33–0.51) for HR, 0.34 (95% CI: 0.24–0.43) for MAP, and 0.23 (95% CI: 0.12–0.33) for cIMT. Cross-twin/cross-wave correlations in monozygotic pairs were all significant and substantially higher than the corresponding dizygotic correlations. Genetic continuity was the main source of longitudinal stability, with across-time genetic correlations of 0.52 (95% CI: 0.29–0.71) for HR, 0.56 (95% CI: 0.31–0.81) for MAP, and 0.36 (95% CI: 0.07–0.64) for cIMT. Overlapping genetic factors explained respectively 57%, 77%, and 68% of the longitudinal covariance of the HR, MAP and cIMT traits. Conclusions: Genetic factors have a substantial role in the longitudinal change of HR, MAP and cIMT; however, the influence of unique environmental factors remains relevant. Further studies should better elucidate whether epigenetic mechanisms have a role in influencing the stability of the investigated traits over time.

Összefoglaló. Bevezetés: A prosztatarák diagnosztikájában az utóbbi években paradigmaváltás történt. Az MR-vizsgálat fejlődése lehetővé tette a prosztatatumor gyanús elváltozásainak célzott mintavételét. Az mpMR fúziós biopszia pontos és költséghatékony módszer. Célkitűzés: Célkitűzésünk az volt, hogy összegezzük az mpMR fúziós biopsziák terén szerzett tapasztalatainkat. Módszer: A Semmelweis Egyetem Urológiai Klinikáján 2017 és 2019 között 40, mpMR fúziós biopsziát végeztünk a BioJet-program segítségével, transperinealis behatolásból. Az MR-vizsgálatok kiértékelése a PI-RADS v2 ajánlása szerint történt. Megvizsgáltuk, hogy a laesiók PI-RADS-besorolása, elhelyezkedése, mérete, az extraprosztatikus terjedés jeleinek megléte, a páciensek PSA-, illetve PSAD-értékei, valamint a prosztata volumene befolyásolja-e a mintavételek kimenetelét. Eredmények: A célzott mintavételek során pácienseink 80%-ánál igazolódott malignitás. PI-RADS 5. és 4. besorolású laesiók esetén a detektációs ráta 91%, illetve 85%, míg PI-RADS 3. laesióknál 20% volt. A perifériás zóna elváltozásainál szignifikánsan magasabb volt a pozitív eredmény valószínűsége, mint a tranzicionális zóna laesióinál (khi2(1) = 6,555, p = 0,010, Fisher-féle egzakt p = 0,017, V = 0,355). Az extraprosztatikus terjedés jelei és a magasabb PSAD-értékek növelték a pozitív minták valószínűségét (khi2(1) = 7,704, p = 0,006, Fisher-féle egzakt p = 0,004, V = 0,355; illetve 0,47 ± 0,50 ng/ml2 vs. 0,18 ± 0,17 ng/ml2; Z = 3,447, pKövetkeztetések: Az elvégzett fúziós biopsziák detektációs rátája magasabb volt az irodalmi átlagnál. Eredményeink alapján a mintavételek kimenetelét befolyásolhatja az elváltozások PI-RADS-besorolása, elhelyezkedése, az extraprosztatikus terjedés, a PSAD-értékek, valamint a prosztatatérfogat. A fenti szempontok figyelembevételével kiválaszthatók azok a páciensek, akik a legtöbbet profitálhatnak a beavatkozásból. Orv Hetil. 2020; 161(52): 2188–2194. Summary. Introduction: The past decade has seen some major changes in the diagnostics of prostate cancer. Progress in MR imaging has allowed us to better visualise prostate cancer and thus perform targeted biopsies of tumour suspect lesions. mpMRI-ultrasound fusion-guided prostate biopsy is a precise and cost-effective method to diagnose prostate cancer. Objective: The purpose of this study was to summarise our results in mpMRI-ultrasound fusion biopsy between 2017 and 2019 and compare them with the findings in the current literature. Method: Between 2017 and 2019, fully 40, mpMRI-ultrasound fusion biopsies were performed transperineally using the BioJet fusion system at Semmelweis University Urology Clinic. The MRI evaluations were done in line with the PI-RADS v2 guidelines. It was analysed whether the PI-RADS score, the location of the tumour, lesion size, the signs of extraprostatic extension, PSA/PSAD density and prostate volume have an influence on the outcome of mpMRI-ultrasound fusion biopsy. Results: Prostate cancer was diagnosed in 80% of the cases during targeted biopsies. The detection rate was 91%, 85%, and 20% for PI-RADS 5, 4 and 3 lesions, respectively. The detection rate was significantly higher for lesions located at the peripheral zone compared to the ones in the transitional zone (khi2(1) = 6.555, p = 0.010, Fisher-exact p = 0.017, V = 0.355). Signs of extraprostatic extension and higher PSAD correlated with better detection rate (khi2(1) = 7.704, p = 0.006, Fisher-exact p = 0.004, V = 0.355; and 0.47 ± 0.50 ng/ml2 vs. 0.18 ± 0.17 ng/ml2; Z = 3.447, pConclusions: The detection rate of prostate cancer with targeted biopsies was higher than the data found in the international literature. The PI-RADS score, the location of the tumour, MRI signs of extraprostatic extension, PSAD and prostate volume had an influence on the detection rate. Our findings may promote a better selection of the best candidates for targeted biopsies in the future. Orv Hetil. 2020; 161(52): 2188–2194.

We sought to analyze the prognostic value of laboratory and clinical data, and an artificial intelligence (AI)-based algorithm for Coronavirus disease 2019 (COVID-19) severity scoring, on CT-scans of patients hospitalized with COVID-19. Moreover, we aimed to determine personalized probabilities of clinical deterioration. Data of symptomatic patients with COVID-19 who underwent chest-CT-examination at the time of hospital admission between April and November 2020 were analyzed. COVID-19 severity score was automatically quantified for each pulmonary lobe as the percentage of affected lung parenchyma with the AI-based algorithm. Clinical deterioration was defined as a composite of admission to the intensive care unit, need for invasive mechanical ventilation, use of vasopressors or in-hospital mortality. In total 326 consecutive patients were included in the analysis (mean age 66.7 ± 15.3 years, 52.1% male) of whom 85 (26.1%) experienced clinical deterioration. In the multivariable regression analysis prior myocardial infarction (OR = 2.81, 95% CI = 1.12–7.04, p = 0.027), immunodeficiency (OR = 2.08, 95% CI = 1.02–4.25, p = 0.043), C-reactive protein (OR = 1.73, 95% CI = 1.32–2.33, p &lt, 0.001) and AI-based COVID-19 severity score (OR = 1.08, 95% CI = 1.02–1.15, p = 0.013) appeared to be independent predictors of clinical deterioration. Personalized probability values were determined. AI-based COVID-19 severity score assessed at hospital admission can provide additional information about the prognosis of COVID-19, possibly serving as a useful tool for individualized risk-stratification.

PURPOSE Our study aimed to evaluate the technical success rate, interobserver reproducibility, and accuracy of shearwave elastography (SWE) in the staging of hepatitis C virus (HCV)-associated liver fibrosis. METHODS A total of 10 healthy controls and 49 patients with chronic liver disease were enrolled prospectively. Two examiners performed point shearwave elastography (pSWE) and two-dimensional shearwave elastography (2D-SWE) measurements with an RS85A ultrasound scanner using the S-Shearwave application (Samsung Medison, Hongcheon, Korea). The performance of S-Shearwave in the staging (METAVIR F0-F4) of liver fibrosis was compared with prior transient elastography (TE) with receiver operating characteristic (ROC) curve analysis. RESULTS The interobserver reproducibility was excellent with pSWE (ICC = 0.92, 95% CI: 0.86-0.95, P < .001). A very good agreement was found between pSWE and TE measurements (ICC =0.85, 95% CI: 0.78-0.89, P

Background CT texture analysis (CTTA) has been successfully used to assess tissue heterogeneity in multiple diseases. The purpose of this work is to demonstrate the value of three-dimensional CTTA in the evaluation of diffuse liver disease. We aimed to develop CTTA based prediction models, which can be used for staging of fibrosis in different anatomic liver segments irrespective of variations in scanning parameters. Methods We retrospectively collected CT scans of thirty-two chronic hepatitis patients with liver fibrosis. The CT examinations were performed on either a 16- or a 64-slice scanner. Altogether 354 anatomic liver segments were manually highlighted on portal venous phase images, and 1117 three-dimensional texture parameters were calculated from each segment. The segments were divided between groups of low-grade and high-grade fibrosis using shear-wave elastography. The highly-correlated features (Pearson r > 0.95) were filtered out, and the remaining 453 features were normalized and used in a classification with k-means and hierarchical cluster analysis. The segments were split between the train and test sets in equal proportion (analysis I) or based on the scanner type (analysis II) into 64-slice train 16-slice validation cohorts for machine learning classification, and a subset of highly prognostic features was selected with recursive feature elimination. Results A classification with k-means and hierarchical cluster analysis divided segments into four main clusters. The average CT density was significantly higher in cluster-4 (110 HU ± SD = 10.1HU) compared to the other clusters (c1: 96.1 HU ± SD = 11.3HU; p Conclusions In conclusion, CTTA-based models can be successfully applied to differentiate high-grade from low-grade fibrosis irrespective of the imaging platform. Thus, CTTA may be useful in the non-invasive prognostication of patients with chronic liver disease.

To disentangle genetic and environmental influences on the development of femoral plaques using a population of adult twins. To evaluate the potential role of shared genetic and environmental factors in the co-occurrence of femoral and carotid plaques. The sample included 566 twins belonging to 164 monozygotic (MZ) and 119 dizygotic (DZ) twin pairs, who underwent peripheral arterial assessment by B-mode ultrasound in different centers. The variance in femoral plaques onset was due to genetic factors and the remaining 50% was explained by common (15%) and unique (35%) environmental factors. Findings on sidedness and number of femoral plaques indicated that also these traits were mainly under genetic control. No effect of common environment was found on plaques composition, and variability of this trait was explained by genetics (64%) and unique environment (36%). Covariation between the liabilities to carotid and femoral plaques was mainly attributed to shared genes (77%), with the remaining 23% explained by individual-specific environmental factors shared by the two districts. Inter-individual differences in plaque onset as well as in their number, sidedness and composition are mainly genetic in origin. The results on the cooccurrence of carotid and femoral plaque underline the genetic role in atherogenesis.

Poster: "ECR 2016 / C-2137 / Vertebral artery diameter and flow: nature or nurture " by: " A. D. Tarnoki 1, D. L. Tarnoki1, L. Littvay1, P. Lucatelli2, C. Fagnani2, C. Baracchini3, G. Pucci4, G. Schillaci4, M. A. Stazi2; 1Budapest/HU, 2Rome/IT, 3Padua/IT, 4Terni/IT"

Background We aimed at evaluating the impact of genetic and environmental factors on longitudinal changes in aortic pulse wave velocity (aPWV) and aortic augmentation index (aAIx). Method Three hundred and sixty-eight Italian and Hungarian adult twins (214 monozygotic, 154 dizygotic) underwent repeated evaluations of aPWV and aAIx (TensioMed Arteriograph). Within-individual/cross-wave, cross-twin/within-wave and cross-twin/cross-wave correlations were calculated; bivariate Cholesky models were fitted to calculate additive genetic (A), shared environmental (C) and unique environmental (E) components. Results For both aPWV and aAIx, cross-twin correlations in monozygotic pairs (r between 0.35 and 0.56) were all significant and always higher than in dizygotic pairs, both at wave 1 and at wave 2. Heritability and unshared environmental proportion of variance at each wave were substantially time-invariant for aPWV (heritability 0.51, 95% CI 0.36-0.63 at wave 1; 0.49, 95% CI 0.34-0.62 at wave 2), whereas for aAIx, we observed a diminished genetic effect (heritability 0.57, 95% CI 0.45-0.67 at wave 1; 0.37, 95% CI 0.21-0.51 at wave 2). Overlapping genetic factors explained a high proportion (0.88, 95% CI 0.61-1.00) of longitudinal covariance for aPWV, and had a relatively lower impact on aAIx (0.55, 95% CI 0.35-0.70). Genetic correlations of aPWV (r = 0.64, 95% CI 0.42-0.85) and aAIx (r = 0.70, 95% CI 0.52-0.87) between waves were lower than 1, suggesting a potential contribution of novel genetic variance on arterial stiffening. Conclusion Changes in aPWV and aAIx over time are largely genetically determined. Our results might stimulate further studies on genetic and epigenetic factors influencing the process of vascular ageing.

Introduction: Idiopathic pulmonary fibrosis (IPF) is one of the most common interstitial lung diseases characteristed by worsening dyspnea, decline in forced vital capacity (FVC) and transfer factor of the lung for carbone monoxide (TLco). Whilst new therapies are being explored there is no validated systematic tool for measuring and monitoring health related quality of life (QoL) in IPF patients. Objective: To evaluate the relationship between QoL and clinical features of IPF patients. Methods: Data of 54 IPF patients (43% males; mean age 65,3 ±10,5 years) were reviewed retrospectively between 2013 and 2016. All patients underwent detailed pulmonological examinations including lung function tests, 6 minute walk test (6MWT), blood gas analysis, fluoroscopy to assess diaphragm movement and high resolution tomography (HRCT). The participants completed EuroQol five-dimensional test and Visual analog scale (VAS). Results: All of lung volumes were below normal volumes: FVC: 69.3±20.0%ref, total lung capacity (TLC): 66.4±28.2%ref, TLco: 65.9±21.3%ref. The main complaints were cough (70.4%) and dyspnea (64.8%). QoL values were below normal values: VAS: 57.6±18.2%, EuroQol: 0.6±0.3. Positive correlation was found between QoL and FVC (r=0.4, p Conclusion: The QoL of patients with IPF is strongly related to their FVC, TLco, the maximum of diaphragm motion by fluoroscopy, and inhaled lung volume define by HRCT. The most significant correlation was found between QoL, diaphragm mobility and resting dyspnoe.

Background The measurement of femoral intima-media thickness (IMT) is underutilized in the clinical practice, although it is a surrogate marker of cardiovascular disease. Materials and methods 388 Hungarian and Italian twins (121 monozygotic, 73 dizygotic pairs) underwent bilateral B-mode sonography of femoral arteries. IMT was measured by semiautomated software, where available, or by calipers. Results Within-pair correlation in monozygotic twins was higher than in dizygotics for each parameter. Age-, sex- and country-adjusted genetic effect accounted for 43.9% (95% confidence interval, CI 21.3%–65.2%) and 47.2% (95% CI, 31.4%–62.6%) of the variance of common and superficial femoral artery IMT, respectively, and unshared environmental effect for 56.1% (95% CI 34.6%–78.5%) and 52.8% (95% CI, 37.2%–68.5%). These results did not change significantly after correcting for body mass index or central systolic blood pressure. Conclusions Genetic factors have a moderate role in the determination of common and superficial femoral IMT; however, the influence of environmental (lifestyle) factors remains still relevant. Environmental factors may have a role in influencing the genetic predisposition for femoral vascular hypertrophy.

In contrast with the carotid arteries, the vertebral arteries (VAs) show considerable variation in length, caliber, and vessel course. This study investigated whether the variation in diameter and flow characteristics of the VAs might be inherited.A total of 172 Italian twins from Padua, Perugia, and Terni (54 monozygotic, 32 dizygotic) recruited from the Italian Twin Registry underwent B-mode and pulsed-wave Doppler ultrasound assessment of their VAs. VA diameters, peak systolic velocity (PSV) and end diastolic velocity (EDV) were assessed at the level of a horizontal V2 segment. Univariate quantitative genetic modeling was performed.Fourteen percent of the sample had VA hypoplasia. Within pair correlation in monozygotic twins was higher than in dizygotics (.552 vs. .229) for VA diameter. Age- and sex-adjusted genetic effect, under the most parsimonious model, accounted for 54.7% (95% CI: 42.2-69.1%) of the variance of VA diameter, and unshared environmental effect for 45.3% (95% CI: 30.9-57.8%). No heritability was found for the PSV of VA, but shared (34.1%; 95% CI: 16.7-53.7%) and unshared (65.9%; 95% CI: 45.9-83.1%) environmental factors determined the variance. EDV of VA is moderately genetically influenced (42.4%; 95% CI: 16.1-64.9%) and also determined by the unshared environment (57.6%; 95% CI: 34.7-83.7%).The diameter of the VAs is moderately genetically determined. Different factors influence the PSV and EDV of VAs, which may highlight the complex hemodynamic background of VA flow and help to understand the vertebral flow anomalies found by ultrasound.

Background Transitional cell carcinoma (TCC) may mimic renal cell carcinoma (RCC) when it develops in a similar location, therefore, differentiation with imaging techniques might be challenging. Preoperative differentiation may have a significant role indicating the type of surgical treatment (nephrectomy vs. ureteronephrectomy). Purpose To retrospectively analyze the differences in the contrast enhancement of TCC and RCC. Material and Methods Images of 20 RCC and 12 TCC (mean ages, 62.3 ± 14.1 and 67.4 ± 12.0 years, respectively) were analyzed from patients who underwent multiphase computed tomography (CT) examinations following 1.5 mL/kg non-ionic contrast agent administration. Unenhanced corticomedullary (30–45 s), nephrographic (70–90 s), and excretory (300–480 s) phases were imaged. The attenuation characteristics of RCC and TCC were compared to the attenuation of the normal renal cortex. Results Significant differences were found in the attenuation ratios between RCC or TCC in the corticomedullary ( P = 0.040) and nephrographic ( P = 0.004) phases using three regions of interest (ROIs) of 10 mm2 size. If measuring ROIs comprising the complete tumor lesion instead of three small ROIs, no significant difference was observed in the attenuation ratios between RCC in TCC in any phases. Conclusion Our study reports significant attenuation differences between RCC and TCC in the corticomedullary and nephrographic phases by multiphase CT. The findings underscore the importance of multiphase CT in the differentiation of these two different entities. Using multiple small (three) ROIs is more accurate than measuring the whole tumor attenuation.

PURPOSE Conventional clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) have different behavioral characteristics and clinical management strategies (nephrectomy vs. nephron-sparing surgery). Our aim was to retrospectively evaluate the contrast enhancement pattern of ccRCC and pRCC and evaluate its possible diagnostic role for preoperative differentiation using a standardized protocol. MATERIALS AND METHODS Quadriphasic multidetector computed tomography (CT) images (unenhanced, corticomedullary, nephrographic, and excretory phases) of 19 patients with 20 ccRCC and 14 patients with 15 pRCC lesions (mean ages, 62.3±14.1 and 61.4±13.7 years, respectively) were reviewed retrospectively. The attenuation characteristics were compared with the attenuation of the normal renal cortex using either multiple 10 mm2 regions of interest or whole tumor attenuation measurements. The degree of contrast enhancement was also compared. RESULTS Univariate analysis revealed that ccRCC lesions showed higher mean attenuation values on the corticomedullary and nephrographic phases compared with pRCC masses (P < 0.05) using both measurement techniques. CONCLUSION The findings underscore the importance of multiphase CT in the differentiation of these two subtypes of RCC using standard assessment techniques. The measurement of the degree of enhancement on contrast-enhanced multidetector CT may be a simple and useful method to radiologically differentiate between the two histological types of RCC.

Femoral atherosclerosis, a major cause of peripheral artery disease, has been associated with higher cardiovascular risk in lower extremity peripheral arterial disease patients. The purpose of our study was to assess the effects of the heritable components of atherosclerotic plaque formation in the femoral artery. 161 Hungarian and Italian twin pairs (n = 322, 75 Hungarian and 86 Italian pairs from Padua, Perugia and Terni; 83 monozygotic /MZ/, 78 dizygotic /DZ/; mean age 50 ± 13 years) recruited from the Hungarian and Italian Twin Registries underwent B-mode sonography of bilateral common and superficial femoral arteries (CFA, SFA). Concordance rates between members of the MZ and DZ pairs were calculated, and compared by Chi-square test. Rough heritability was analysed by Falconer formula. Plaques were identified in 24% and 6% of patients in CFA and SFA, respectively. Significantly higher concordance rate was found in MZ twins compared to DZ pairs regarding the presence of plaques in CFA (rMZ = 0.869 vs. rDZ = 0.696) and SFA (rMZ = 0.622 vs. rDZ = 0.403) on left or right side, which indicated a 34% and 44% rough heritability, respectively. Femoral atherosclerotic plaque formation in CFA and SFA is moderately genetically determined. Further studies should elucidate whether offsprings of families at high risk for femoral atherosclerosis may benefit from early ultrasound screening.