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Objective: The aim of our study is to correlate the CT adipose tissue distribution and recurrence risk of Prostatic Cancer (PCa) after Radical Prostatectomy (RP). Furthermore, we evaluated the association of adipose tissue and PCa aggressiveness., Materials and Methods: We identified two groups of patients based on presence (group A) and absence (group B or control group) of Bio-chemical Recurrence (BCR) after RP. A semi-automatic function able to recognize the typical attenuation values of adipose tissue was used for sub-cutaneous (SCAT), visceral (VAT), total (TAT) and periprostatic (PPAT) adipose tissues. For both groups of patients, a descriptive analysis of continuous variables and categorical variables was performed., Results: After comparing between groups, a statistically significant difference was found for VAT (p<0.001) and for VAT/TAT ratio (p=0.013). No statistically significant correlation was found for PPAT and SCAT, even if higher values were found in patients with high grade tumors., Conclusion: This study confirms visceral adipose tissue as a quantitative imaging parameter related to oncological risk of PCa recurrence development, and the role of abdominal fat distribution measured with CT before RP as an important tool to predict the PCa recurrence risk, particularly in patients with high grade tumors., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Assess multiparametric-MRI (mp-MRI) diagnostic accuracy in the detection of local recurrence of Prostate Cancer (PCa) after Radical Prostatectomy (PR) and before Radiation Therapy (RT)., Materials and Methods: A total of 188 patients underwent 1.5-T mp-MRI after RP before RT. Patients were divided into two groups: with biochemical recurrence (group A) and without but with high risk of local recurrence (group B). Continuous variables were compared between two groups using T-Student; categoric variables were analyzed using Pearson chi-square. ROC analysis was performed considering PSA before RT, ISUP, pT and pN as grouping variables., Results: PCa recurrence (reduction of PSA levels after RT) was 89.8% in the group A and 80.3% in the group B. Comparing patients with and without PCa recurrence, there was a significant difference in PSA values before RT for group A and for PSA values before RT and after RT for group B. In group A, there was a significant correlation between PSA before RT and diameter of recurrence and between PSA before RT and time spent before recurrence. The mp-MRI diagnostic accuracy in detecting PCa local recurrence after RP is of 62.2% in group A and 38% in group B. DWI is the most specific MRI-sequence and DCE the most sensitive. For PSA = 0.5 ng/ml, the AUC decreases while sensitivity and accuracy increase for each MRI-sequence. For PSA = 0.9 ng/ml, DCE-AUC increases significantly., Conclusion: mp-MRI should always be performed before RT when a recurrence is suspected. New scenarios can be opened considering the role of DWI for PSA ≤ 0.5 ng/ml., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The aim of the present study was to assess the temperature map and its reproducibility while applying two different MWA systems (915 MHz vs 2.45 GHz) in ex vivo porcine livers., Materials and Methods: Fifteen fresh pig livers were treated using the two antennae at three different settings: treatment time of 10 min and power of 45 W for both systems; 4 min and 100 W for the 2.45 GHz system. Trends of temperature were recorded during all procedures by means of fiber optic-based probes located at five fixed distances from the antenna, ranging between 10 mm and 30 mm. Each trial was repeated twice to assess the reproducibility of temperature distribution., Results: Temperature as function of distance from the antenna can be modeled by a decreasing exponential trend. At the same settings, temperature obtained with the 2.45 GHz system was higher than that obtained with the 915 MHz thus resulting into a wider area of ablation (diameter 17 mm vs 15 mm). Both systems showed good reproducibility in terms of temperature distribution (root mean squared difference for both systems ranged between 2.8 °C and 3.4 °C)., Conclusions: When both MWA systems are applied, a decreasing exponential model can predict the temperature map. The 2.45 GHz antenna causes higher temperatures as compared to the 915 MHz thus, resulting into larger areas of ablation. Both systems showed good reproducibility although better results were achieved with the 2.45 GHz antenna., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Bone metastases can be treated by interventional radiologists with a minimally invasive approach. Such treatments are performed percutaneously under radiological imaging guidance. Different interventional techniques can be applied with curative or palliative intent depending on lesions and patients' status. In the whole, available interventional techniques are distinguished into "ablative" and "consolidative". Ablative techniques achieve bone tumor necrosis by dramatically increasing or decreasing intra-tumoral temperature. This option can be performed in order to alleviate pain or to eradicate the lesion. On the other hand, consolidative techniques aim at obtaining bone defect reinforcement mainly to alleviate pain and prevent pathological fractures. We herein present evidence supporting the application of each different interventional technique, as well as common strategies followed by interventional radiologists while approaching bone metastases., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: This study was undertaken to clinically validate the accuracy of a semiautomated software tool for analysing the enhancement curve in focal malignant bone lesions., Materials and Methods: Twenty-three patients affected by cancer with malignant focal bone lesions underwent dynamic gadolinium-enhanced magnetic resonance (MR) imaging using the following protocol: T1-weighted turbo spin-echo sequences (time to repeat [TR] 600 ms, time to echo [TE] 8.6 ms, field of view [FOV] 40x40 cm) before and after intravenous injection of gadolinium-containing contrast agent. Image postprocessing was performed using the software DyCoH. Each region of interest (5x5 pixels), drawn to include the area of the lesion with the highest values of the area under the curve map, was analysed to obtain time-intensity curves and relative perfusion parameters: time to peak (TTP), peak intensity (PI), slope (60-s slope), intensity at 60 s after contrast agent injection (60-s I) and final intensity (FI)., Results: Data were obtained by analysing 86 malignant lesions and 86 apparently normal bone regions. PI, 60-s slope, 60-s I and FI were significantly different between neoplastic and apparently normal (p<0.001) samples. Sensitivity, specificity and accuracy were, respectively, 94%, 93% and 94% at a PI threshold of 100 (signal-to-noise ratio), with positive and negative predictive values of 93% and 94%. At a threshold value of 0.85 for 60-s slope, sensitivity and specificity values were both 91%., Conclusions: The semiautomated technique we report appears to be accurate for identifying neoplastic tissue and for mapping perfusion parameters, with the added value of a consistent measurement of perfusion parameters on colour-coded maps.

Background: Hepatic intra-arterial chemotherapy (HIAC) leads to a higher response rate than systemic administration in untreated patients with liver metastases from colorectal cancer (CRC). The aim of this study was to evaluate the activity and safety of giving HIAC through a percutaneous catheter in pre-treated patients., Patients and Methods: Forty-five CRC patients with liver-only or liver-dominant metastases, resistant or refractory to previous systemic therapy, were treated using a temporary trans-subclavian catheter. A 3-day chemotherapy regimen of daily 5-fluorouracil (5-FU) 1000 mg/m2/day + heparin 5000 IU/day given as a 24-hour continuous infusion, and twice daily bolus injections of cisplatin (CDDP) 10 mg/m2 and mitomycin C (MMC) 2 mg/m2, was administered every six weeks., Results: One hundred and seventeen courses were administered to 45 patients (a median of three per patient: range 1-5). Of the 44 patients evaluable for response, 16 (35%) had a partial response, 15 (33%) stable disease and 12 (26%) progressive disease. Eleven of the 16 responding patients had been refractory to a previous 5-FU-based systemic therapy. The most relevant grade 3-4 toxicities included neutropenia (22%) and thrombocytopenia (15%). Gastro-duodenal ulcers occurred in nine patients. Catheter displacement was recorded during 22 out of 117 (18%) courses., Conclusion: HIAC with 5-FU, CDDP and MMC given through a temporary percutaneous catheter is safe and active in pretreated patients with metastatic CRC. Iatrogenic gastroduodenal ulcers are a serious but manageable complication.

Introduction: This study will report our experience on positioning of totally implanted venous catheter system (port-a-cath) as compared to ultrasound guidance versus blind technique., Materials and Methods: From July 1996 to November 1999 in the vascular suite of the Europen Institute of Oncology, 427 port-a-cath were implanted in patients with neoplastic disease. All devices were implanted through the subclavian vein. 198 with ultrasound guided puncture and 229 following anatomical landmarks. All patients underwent a close and specific clinical and instrumental follow-up to evaluate possible complications., Results: Use of Ultrasound (US) in subclavian vein catheterization has reduced the number of puncture attempts, with a better patient complicance, allowing a faster procedure and reducing peri-procedural complications. Ultrasound technique has shown reduction in early complications. In fact in our experience we had no pneumothorax events by using ultrasound guidance, versus 11 events with blind technique. US has shown no reduction in late complications: 3 thrombosis versus 6 thrombosis with US guidance, and 3 fractured and embolized catheter versus 2 cases. Fibrin-cuff percentage was the same in the two groups with only 1 case, as the dislocation of the catheter tip in the jugular vein with 2 cases in both groups. Moreover US let us to avoid the arterial puncture and to perform a more peripheral puncture of the subclavian vein, reducing the risk of 'pinch-off' phenomenon and of haematoma, with no cases reported under US guidance versus 1 case respectively in direct vein puncture., Conclusions: US guided puncture of subclavian vein for the implantation of venous catheter system is faster by reducing procedure time, it is easier for the operator and safer for the patient than blind technique by exposing anatomical structures. Morevover US guidance reduces early complications and limits costs.

A proper preoperative staging of rectal tumors is important for correct treatment planning. We included in our study 23 patients with rectal carcinoma in order to evaluate the diagnostic accuracy of endorectal MRI. This technique enabled us to show neoplasms as a hyperintense lesion as compared to the muscolaris. To better delineate the renal dimensions of the neoplasms and reduce chemical shift artifact we performed T2 weighted TSE sequences with and without fat suppression. The diagnostic accuracy in the evaluation of T and N factors as compared to surgery was respectively 78.2% and 78.9%. The major problem has been a slight tendency to overstage parietal infiltration and lymphnodal involvement. Endorectal MRI allows us to obtain an excellent anatomic detail of the three rectal wall layers and a very high spatial resolution which might make this technique the examination of choice in the evaluation of rectal carcinoma.

Our study was aimed at investigating the role of MR-cholangiography (MRC) in the examination of patients treated with biliary-enteric anastomosis. MRC was performed in 15 patients (8 men and 7 women, mean age: 64.7 years) operated on for biliary-enteric anastomoses (13 hepaticojejunostomies and 2 choledochoduodenostomies) whose symptoms were as follows: persistent jaundice in 4 patients; cholangitis and abnormal liver function tests in 2 patients; associated transient jaundice, epigastric pain, abnormal liver function tests in 2 patients. The remaining 7 patients were asymptomatic and examined during their follow-up. MRC was performed with a non-breath-hold, fat-suppressed 3D turbo spin echo sequence (TR = 3000 msec, TE = 700 msec, ETL = 128) with an acquisition time ranging 4 min 24 sec to 5 min 48 sec. Six patients were subsequently submitted to Percutaneous Transhepatic Cholangiography (PTC) to confirm the diagnosis and to perform a therapeutical procedure. Two patients, submitted to choledochoduodenostomy were examined with ERCP. The remaining seven patients, examined during their surgical follow-up and who presented no major symptoms or dilation of the bile ducts, were not submitted to any invasive procedure. Image quality was graded as good to fair in 12/15 cases (80%) and poor in 3/15 cases (20%). The degree of bile ducts dilation was correctly assessed with complete inter observer agreement in 8/8 patients. MRCP correctly showed: bile ducts irregularities in 2 of 4 patients with cholangitis (k = 0.59), anastomosis stenosis in 8 of 8 patients (k = 0.86), and 5-15 mm stones in 5 of 5 patients (k = 0.95). In conclusion, MRCP is a safe, noninvasive technique in the study of biliary-enteric anastomoses with high accuracy in assessing the cause of jaundice. MRCP images can be used as a guide for subsequent interventional procedures. Its main disadvantages are the lack of functional information and the high cost which limits its its use to the screening of symptomatic patients.

This work was aimed at investigating the diagnostic accuracy of Magnetic Resonance Angiography (MRA) in the study of the portal vein in liver transplant recipients. Ten patients (7 men and 3 women; mean age: 45 years) were examined 7-180 days after transplantation. The indications to liver transplant follow: post-infective active chronic hepatitis (4 patients), post-alcoholic chronic hepatitis (2 patients), HCC (2 patients), sclerosing cholangitis (1 patient) and primary biliary cirrhosis (1 patient). MRA images were acquired with the 2D TOF technique (TR 50 ms, TE 6.9 ms; FA 30 degrees, 40 slices; 6-mm thickness with 1-mm overlapping; 2 averages; 7.06 TA; matrix: 192 x 256). Axial scans were reconstructed with the MIP technique. Phase contrast sequences with retrospective cardiac triggering were also acquired for flow quantitation (TR/TE/FA: 26/9.3/20 degrees; FOV 150; matrix: 96 x 128; 4 averages, VENC = 20 cm/s). MRA yielded good quality images of the anatomy of the main portal vein and of the bifurcation in all cases, while a signal loss was observed in the peripheral branches. In all cases, the anastomosis could be studied at the portal vein. On MIP reconstructed images, the anastomosis appeared as a relative stenosis (4), while on 2D images it appeared as a small hypodense area on the vessel margin, because of the slight paramagnetic effect of the vascular suture. No thrombi were depicted in any patient and flow was hepatopetal in all cases. In conclusion, MRA is a useful tool for portal system studies in liver transplant recipients, because it permits the panoramic depiction of the portal system and the quantitation of flow (10).

The contribution of biomedical sciences to the scientific breakthroughs in the last years has benefitted also by experiments on animals. As for diagnostic imaging, the use of new contrast media for angiography, CT and MRI makes it necessary, according to the law, to perform preliminary animal studies to test efficacy, pharmacokinetics and pharmacodynamics of the contrast agents. Experimental animal studies of clinically well-established contrast agents are also justified by the need to implement new imaging modalities. The close relationship between medical research and animal experimentation has awakened public opinion, as well as the researchers themselves, to the ethical and legal problems related to animal testing. This paper reports on the regulations which are currently in use in this field.