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Introduzione e scopo dello studio: È stato condotto uno studio prospettico per analizzare la dose efficace e le capacità diagnostiche della Tomografia Computerizzata (TC) 320-strati rispetto all’angiografia coronarica invasiva (ICA) in pazienti con sospetta CAD. Materiali e metodi: Lo studio è stato disegnato in modo prospettico attraverso la valutazione, mediante TC 320-strati, di stenosi coronariche responsabili di ostruzioni ≥ 50% del diametro del vaso, utilizzando come standard di riferimento l’analisi quantitativa da parte dell’ICA. Il gruppo di studio finale annoverava 118 pazienti (78 uomini e 40 donne, età media: 61±10 anni, range: 40-80 anni). Le immagini sono state eseguite mediante TC 320-strati con detettori da 0.5 mm, tempo di rotazione del gantry pari a 350 ms e fino a 16 cm di copertura lungo l’asse Z (Aquilion ONE, Toshiba Medical Systems, Otawara, Japan). La valutazione delle stenosi è stata eseguita da due operatori, non a conoscenza dei risultati dell’ICA, tramite l’utilizzo di un’appropriata workstation (Vitrea2 FX, Vital Images, Plymouth, Minnesota) che ha permesso la creazione automatica di ricostruzioni curve multiplanari lungo le arterie coronarie L’angiografia coronarica invasiva è stata considerata metodica gold-standard di riferimento. La valutazione delle coronarie è stata effettuata tramite approccio trans-femorale entro 1 settimana dalla TC Risultati: La dose efficace di radiazione è stata minore per la TC 320-strati rispetto alla ICA (3.1 ± 2.3 vs 6.5 ± 4.2 mSv; P 50% del lume del vaso è stata effettuata l’analisi per paziente, per vaso e per segmento coronarico. Nell’analisi per paziente, sensibilità e specificità della TC erano rispettivamente del 98% e 91%; Nell’analisi per singolo vaso, sensibilità e specificità erano del 93% e 95%. Nell’analisi per segmento, sensibilità e specificità si attestavano rispettivamente al 91% e 99% . Conclusioni: Lo studio dimostra come la TC 320-strati possa essere paragonata con successo alla coronarografia invasiva nella reale pratica clinica, dal momento che fornisce un’accuratezza diagnostica simile nella diagnosi di CAD provvedendo al contempo ad una drastica riduzione della dose efficace di radiazione. Infatti, con una dose media di 3 mSv, la TC 320-strati riduce l’esposizione alle radiazioni, se messa a confronto con i vecchi sistemi di TC coronarica che utilizzavano approcci convenzionali per le acquisizioni elicoidali (in studi precedenti è stata riportata una dose media pari a 12-15 mSv).

ObjectivesThis study examined the utility of 3-dimensional right atrial volume index (3D-RAVi), combined with 2-dimensional echocardiographic (2DE) parameters, for the identification of elevated right atrial pressure (RAP) in patients with heart failure.BackgroundAccurate noninvasive determination of RAP is clinically important for the management of patients with heart failure. Although 2DE methods have been used to noninvasively estimate RAP, the accuracy of these parameters has limitations when estimating RAP in an individual patient. Three-dimensional echocardiography (3DE) provides tomographic imaging of right atrial volume that may be helpful in refining the noninvasive assessment of hemodynamics in patients with heart failure.Methods2DE and 3DE studies were examined in 40 initial patients who were admitted for acutely decompensated heart failure. Simultaneous pulmonary artery catheter monitoring was performed. The relationship between echocardiographic parameters and RAP was examined in this derivation group. The findings from the derivation group were then prospectively tested in a validation group of 40 additional patients.ResultsMean RAP was 11 ± 5 mm Hg (range 2 to 22 mm Hg). 3D-RAVi correlated with RAP (r = 0.51, p < 0.001), whereas 2-dimensional right atrial volume index did not. Inferior vena cava (IVC) diameter ≥2 cm and IVC respirophasic collapse 10 mm Hg. The value of 3D-RAVi ≥35 ml/m2, combined with IVC measures, for predicting RAP >10 mm Hg was prospectively tested in the validation group. 3D-RAVi ≥35 ml/m2 in combination with IVC ≥2 cm had a high accuracy (88%) for identifying RAP >10 mm Hg and had a higher accuracy than the combination of IVC ≥2 cm and IVC collapse

Objective The aim of this study was to investigate the incidence of stoma recurrence and the therapeutic strategy outcomes in relation to survival that have been adopted over the past few decades using a monoclonal antibody, specifically nivolumab. Methods This study included a total of 487 patients diagnosed with laryngeal carcinoma undergoing either a laryngectomy or salvage surgery after conservative interventions at the ENT Unit of Federico II University in Naples, Italy, between 2011 and 2021. Following a minimum 2.5-year follow-up and a maximum 21-year follow-up, the results revealed that only 38 patients suffered a stomal recurrence. Results Despite various adopted treatment strategies, the literature reports lower patient survival rates. Following a total laryngectomy, stomal recurrence represents a therapeutic management challenge due to a poor prognosis for nearly every treated case. According to the literature, in fact, despite a low incidence (ie, 0.8–31.3%), the overall mortality rate increases from 77% to 100% after three years. Nevertheless, introducing immunotherapy into cancer treatment has resulted in an observable revolution in the treatment of different types of cancers over the years. Conclusion In light of recorded data on survival following the use of the nivolumab, the case presented in this study allows a new perspective of successfully treating recurrences of squamous carcinoma of the head and neck.

Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajectory based approaches allowed a greater awareness about the entire left ventricle or left atrium revolution and on their deficiencies that take place in presence of hypertrophic cardiomyopathy. However, surprisingly, the concomitant function of the two left heart chambers has not been analyzed for their geometrical/mechanical relationship. For the first time we study here, by acquiring left ventricle and left atrial geometries on the same heartbeat, the trajectory attributes of the entire left heart treated as a whole shape and the shape covariation of its two subunits. We contrasted healthy subjects with patients affected by hypertrophic cardiomyopathy. We found impaired left heart trajectory mainly in terms of orientation and size. More importantly, we found profound differences in the direction of morphological covariation of left ventricle and left atrium. These findings open to new perspectives in pathophysiological evaluation of different diseases by allowing the appreciation of concomitant functioning of both left heart whole geometry and of its two chambers.

Statistical Shape Analysis, that includes classic Geometric Morphometrics (GM), is often based on landmarks and frequently used to describe shape and shapes changes in biological studies. In this context changes in shape are typically analyzed separately from changes in size measured, in most cases, with centroid size (CS) [1]. Changes in shape are projected in a common linear space: the tangent space to the consensus and decomposed in affine and non affine components. The non affine component can be in turn de-composed in a series of local deformations (partial warps). This approach relies on the assumption that shapes are limitedly scattered in the shape space. In these conditions the difference between centroid size and m-volume is barely appreciable. In medical image, and in general in soft tissues, bodies can undergo very large deformations, involving also large changes in size strictly coupled with the change in shape from mechanical point of view. The cardiac example, analyzed in the present paper, shows changes in volume that can reach the 60% when comparing systole and diastole, coupled with severe longitudinal, radial and torsional strains. Because ventricle’s volume, together with its pressure, is one of the most important descriptors of the pumping heart function, it is natural considering the size change as volumes change. In fact, when dealing with such large size differences, CS and volume behave differently. In the last years the emerging disciplines of Diffeomorphometry and the related Functional Anatomy apply to replace classic GM through the use of diffeomorphisms, more suitable to describe soft tissues changes [2, 3]. On the other hand, these descriptions are very sophisticated but ignore some synthetic properties of the decomposition of deformation in some significant aspects. The goal of the present work is to show that standard GM tools (landmarks, Thin Plate Spline, and related decomposition of the deformation) can be generalized to better describe the very large deformations of biological tissues, without losing a synthetic description. In particular, the classical decomposition of the tangent space to the shape space in affine and non affine components [4] is enriched to include also the change in size, in such a way to give a complete description of the tangent space to the size-and-shape space. The proposed generalization is formulated by means of a new Riemannian metric describing the change in size as change in volume rather than change in CS. This lead to a redefinition of some aspect of the Kendalls size-and-shape space without abandoning Kendalls original formulation. This new formulation is discussed by analyzing 3D heart ventricular shapes coming from 3D Speckle Tracking Echocardiography. We evaluate the performances of different methods in recognizing Control (healthy) subjects from patients affected by Hypertrophic Cardiomyopathy.

The analysis of full Left Atrium (LA) deformation and whole LA deformational trajectory in time has been poorly investigated and, to the best of our knowledge, seldom discussed in patients with Hypertrophic Cardiomyopathy. Therefore, we considered 22 patients with Hypertrophic Cardiomyopathy (HCM) and 46 healthy subjects, investigated them by three–dimensional Speckle Tracking Echocardiography, and studied the derived landmark clouds via Geometric Morphometrics with Parallel Transport. Trajectory shape and trajectory size were different in Controls versus HCM and their classification powers had high AUC (Area Under the Receiving Operator Characteristic Curve) and accuracy. The two trajectories were much different at the transition between LA conduit and booster pump functions. Full shape and deformation analyses with trajectory analysis enabled a straightforward perception of pathophysiological consequences of HCM condition on LA functioning. It might be worthwhile to apply these techniques to look for novel pathophysiological approaches that may better define atrio–ventricular interaction.

We present a procedure that detects myocardial infarction by analyzing left ventricular shapes recorded at end-diastole and end-systole, involving both shape and statistical analyses. In the framework of Geometric Morphometrics, we use Generalized Procrustes Analysis, and optionally an Euclidean Parallel Transport, followed by Principal Components Analysis to analyze the shapes. We then test the performances of different classification methods on the dataset. Among the different datasets and classification methods used, we found that the best classification performance is given by the following workflow: full shape epicardium+endocardium analyzed in the Shape Space i.e. by scaling shapes at unit size; successive Parallel Transport centered toward the Grand Mean, in order to detect pure deformations; final statistical analysis via Support Vector Machine with radial basis Gaussian function. Healthy individuals show both a stronger contraction and a shape difference in systole with respect to pathological subjects. Moreover, endocardium clearly presents a larger deformation when contrasted with epicardium. Eventually, the solution for the blind test dataset is given. When using Support Vector Machine for learning from the whole training dataset and for successively classifying the 200 blind test dataset, we obtained 96 subjects classified as normal and 104 classified as pathological. After the disclosure of the blind dataset this resulted in 95i¾?% of total accurracy with sensitivity at 97i¾?% and specificity at 93i¾?%.

The assessment of left ventricular shape changes during cardiac revolution may be a new step in clinical cardiology to ease early diagnosis and treatment. To quantify these changes, only point registration was adopted and neither Generalized Procrustes Analysis nor Principal Component Analysis were applied as we did previously to study a group of healthy subjects. Here, we extend to patients affected by hypertrophic cardiomyopathy the original approach and preliminarily include genotype positive/phenotype negative individuals to explore the potential that incumbent pathology might also be detected. Using 3D Speckle Tracking Echocardiography, we recorded left ventricular shape of 48 healthy subjects, 24 patients affected by hypertrophic cardiomyopathy and 3 genotype positive/phenotype negative individuals. We then applied Generalized Procrustes Analysis and Principal Component Analysis and inter-individual differences were cleaned by Parallel Transport performed on the tangent space, along the horizontal geodesic, between the per-subject consensuses and the grand mean. Endocardial and epicardial layers were evaluated separately, different from many ecocardiographic applications. Under a common Principal Component Analysis, we then evaluated left ventricle morphological changes (at both layers) explained by first Principal Component scores. Trajectories’ shape and orientation were investigated and contrasted. Logistic regression and Receiver Operating Characteristic curves were used to compare these morphometric indicators with traditional 3D Speckle Tracking Echocardiography global parameters. Geometric morphometrics indicators performed better than 3D Speckle Tracking Echocardiography global parameters in recognizing pathology both in systole and diastole. Genotype positive/phenotype negative individuals clustered with patients affected by hypertrophic cardiomyopathy during diastole, suggesting that incumbent pathology may indeed be foreseen by these methods. Left ventricle deformation in patients affected by hypertrophic cardiomyopathy compared to healthy subjects may be assessed by modern shape analysis better than by traditional 3D Speckle Tracking Echocardiography global parameters. Hypertrophic cardiomyopathy pathophysiology was unveiled in a new manner whereby also diastolic phase abnormalities are evident which is more difficult to investigate by traditional ecocardiographic techniques.