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Objective: To assess whether different Gd-EOB-DTPA injection rates could influence the development of artifacts during the arterial phase of liver MRI studies. Materials and methods: All Gd-EOB-DTPA liver MRI studies performed for different clinical indications at a single tertiary referral center were retrospectively evaluated. Each examination was acquired on a 1.5 T scanner with T1 In- and Out-of-Phase, T2 with and without fat-saturation, DWI, and 3D-T1 fat-sat dynamic sequences. Patients were divided into two groups according to the injection rate (1 ml/s and 1.5 ml/s). A single radiologist recorded the presence or absence of artifacts during different acquisition phases, respectively: (1) all examination; (2) only during the arterial phase; (3) only during the portal-venous phase; (4) both in arterial and portal-venous phases. From a total of 748 MRI studies performed, 229 were excluded due to the presence of artifacts during the entire examination. The remaining 519 MRI studies were divided into two groups according to the injection rate. Results: The first group (flow rate = 1 ml/s) was composed by 312 (60.1%) patients and the second group (flow rate = 1.5 ml/s) by 207 (39.9%) patients. In the first group, 2 (0.6%) patients showed artifacts in all dynamic sequences; 13 (4%) only in the arterial phase, 16 (5%) only in the portal-venous phase, and 38 (12%) both in arterial and portal-venous phases; a total of 243 (78%) showed no artifacts. In the second group, 3 (1.5%) patients had artifacts in all dynamic sequences, 82 (40%) only in the arterial phase, 20 (10%) only in the portal-venous phase, and 53 (25%) both in arterial and portal-venous phases; a total of 49 (23.5%) showed no artifacts. A significant difference between the two groups regarding the absence of artifacts in all examination and the presence of artifacts only during the arterial phase was found (p < 0.001). Conclusion: The development of artifacts during the arterial

Objectives: To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging in the detection of prostate cancer, according to Prostate Imaging Reporting and Data System, and the usefulness of combining clinical parameters to improve patients’ risk assessment. Methods: Overall, 201 patients underwent multiparametric magnetic resonance imaging investigation with a 3-T magnet and a 32-channel body coil based on triplanar high-resolution T2-weighted, diffusion-weighted and T1-weighted dynamic contrast-enhanced imaging before, during and after intravenous administration of paramagnetic contrast agent. Random transrectal ultrasound-guided biopsy was carried out for all eligible patients. If a Prostate Imaging Reporting and Data System ≥3 lesion was present, a targeted biopsy with magnetic resonance imaging-transrectal ultrasound fusion-guided system was carried out. Results: Sensitivity, specificity, positive predictive value and negative predictive value of Prostate Imaging Reporting and Data System ≥3 lesions for the detection of prostate cancer were 65.1%, 54.9%, 43.1% and 75.0% respectively, with an accuracy of 64.2% (55.1–72.7%). At uni- and multivariate analysis, age ≥70 years and prostate-specific antigen density ≥0.15 ng/mL/mL were significantly associated with prostate cancer. A new risk model named “modified Prostate Imaging Reporting and Data System” was created considering age and prostate-specific antigen density in addition to the Prostate Imaging Reporting and Data System score showing an improved correlation with prostate cancer compared with the Prostate Imaging Reporting and Data System alone (area under curve 71.4%, 95% confidence interval 62.2–80.5 vs area under curve 62.6%, 95% confidence interval 52.1–73; P ≤ 0.0001). Conclusions: The accuracy of Prostate Imaging Reporting and Data System alone in the diagnosis of prostate cancer might be suboptimal, whereas a novel risk model based on the combination of multipar

Purpose: Imaging manifestations of hepatic lymphoma, both primary (PHL) and secondary (SHL), are extremely variable and non-specific, but some features are useful diagnostic clues in an appropriate clinical setting. Through a PubMed search, we found several published reviews focused on PHL and SHL diagnosis. However, to the best of our knowledge, few of them encompass a comprehensive analysis of all the diagnostic tools and relative radiological findings. The aim of this review is to provide a description of the radiological features of both PHL and SHL, by critically analyzing the available literature. Materials and methods: An extensive review of published literature along with a description of personal case series of both PHL and SHL has been conducted. Results: SHL can be easily diagnosed with imaging techniques, as it is usually associated with node disease. On the contrary the diagnosis can be a challenge in PHL, often mimicking HCC or liver metastasis of adenocarcinoma. In this context, multiparametric MRI plays a fundamental role in the differential diagnosis. Both for PHL and SHL, liver involvement presents as solitary or multiple lesions or as diffuse infiltrative disease. Conclusion: PHL and SHL may be correctly characterized using different radiological techniques. Both CT and MRI have showed a good correlation with histology, as they permit to distinguish between lymphomatous tissue, and necrotic and fibrotic areas.

BACKGROUND: The management of rectal cancer patients is mainly based on the use of the magnetic resonance imaging (MRI) technique as a diagnostic tool for both staging and restaging. After treatment, to date, the evaluation of complete response is based on the histopathology assessment by using different tumor regression grade (TRG) features (e.g., Dworak or Mandard classifications). While from the radiological point of view, the main attention for the prediction of a complete response after chemotherapy treatment focuses on MRI and the potential role of diffusion-weighted images and perfusion imaging represented by dynamic-contrast enhanced MRI. The main aim is to find a reliable tool to predict tumor response in comparison to histopathologic findings. AIM: To investigate the value of dynamic contrast-enhanced perfusion-MRI parameters in the evaluation of the healthy rectal wall and tumor response to chemo-radiation therapy in patients with local advanced rectal cancer with histopathologic correlation. METHODS: Twenty-eight patients with biopsy-proven rectal adenocarcinoma who underwent a dynamic contrast-enhanced MR study performed on a 1.5T MRI system (Achieva, Philips), before (MR1) and after chemoradiation therapy (MR2), were enrolled in this study. The protocol included T1 gadolinium enhanced THRIVE sequences acquired on axial planes. A dedicated workstation was used to generate color permeability maps. Region of interest was manually drawn on tumor tissue and normal rectal wall, hence the following parameters were calculated and statistically analyzed: Relative arterial enhancement (RAE), relative venous enhancement (RVE), relative late enhancement (RLE), maximum enhancement (ME), time to peak and area under the curve (AUC). Perfusion parameters were related to pathologic TRG (Mandard's criteria; TRG1 = complete regression, TRG5 = no regression). RESULTS: Ten tumors (36%) showed complete or subtotal regression (TRG1-2) at histology and classified as responder

Initial stages of Best vitelliform macular dystrophy (BVMD) and adult vitelliform macular dystrophy (AVMD) harbor similar blue autofluorescence (BAF) and optical coherence tomography (OCT) features. Nevertheless, BVMD is characterized by a worse final stage visual acuity (VA) and an earlier onset of critical VA loss. Currently, differential diagnosis requires an invasive and time-consuming process including genetic testing, electrooculography (EOG), full field electroretinogram (ERG), and visual field testing. The aim of our study was to automatically classify OCT and BAF images from stage II BVMD and AVMD eyes using a deep learning algorithm and to identify an image processing method to facilitate human-based clinical diagnosis based on non-invasive tests like BAF and OCT without the use of machine-learning technology. After the application of a customized image processing method, OCT images were characterized by a dark appearance of the vitelliform deposit in the case of BVMD and a lighter inhomogeneous appearance in the case of AVMD. By contrast, a customized method for processing of BAF images revealed that BVMD and AVMD were characterized respectively by the presence or absence of a hypo-autofluorescent region of retina encircling the central hyperautofluorescent foveal lesion. The human-based evaluation of both BAF and OCT images showed significantly higher correspondence to ground truth reference when performed on processed images. The deep learning classifiers based on BAF and OCT images showed around 90% accuracy of classification with both processed and unprocessed images, which was significantly higher than human performance on both processed and unprocessed images. The ability to differentiate between the two entities without recurring to invasive and expensive tests may offer a valuable clinical tool in the management of the two diseases.

Background/objectives: To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control). Methods: Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value <0.05 was considered significant. Results: A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65–0.80 and 0.61–0.75, respectively, p < 0.001 for both). Conclusion: This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.

Early diagnosis of HCC is of paramount importance in order to enable the application of curative treatments. Among these, radiofrequency ablation (RFA) is actually considered the most effective ablative therapy for early stage hepatocellular carcinoma (HCC) not suitable for surgery. On the other hand, transarterial chemoembolization (TACE) represents the standard of care for intermediate stage HCC and compensated liver function. Finally, sorafenib, an oral antiangiogenic targeted drug, is the only approved systemic therapy for advanced HCC with vascular invasion, extrahepatic spread, and well-preserved liver function. Beside traditional radiological techniques, new functional imaging tools have been introduced in order to provide not only morphological information but also quantitative functional data. In this review, we analyze perfusion-CT (pCT) from a technical point of view, describing the main different mathematical analytical models for the quantification of tissue perfusion from acquired CT raw data, the most commonly acquired perfusion parameters, and the technical parameters required to perform a standard pCT examination. Moreover, a systematic review of the literature was performed to assess the role of pCT as an emerging imaging biomarker for HCC diagnosis, response evaluation to RFA, TACE, and sorafenib, and we examine its challenges in HCC management.

Item does not contain fulltext, PURPOSE: To compare the effects of half-dose photodynamic therapy (PDT) and high-density subthreshold micropulse laser on choroidal dysfunction evaluated by degree and extent of hyperfluorescence on indocyanine green angiography (ICGA) in chronic central serous chorioretinopathy. METHODS: Data from the multicenter, randomized, controlled PLACE trial were used in this study. Hyperfluorescent and hypofluorescent areas on ICGA, their association with subretinal fluid and visual function were assessed. RESULTS: In total, 146 patients were included (72 in the PDT and 74 in the high-density subthreshold micropulse laser treatment arm). A significantly greater decrease in the size of hyperfluorescent areas on ICGA at first visit after treatment was seen after PDT compared with high-density subthreshold micropulse laser (mean, -1.41 ± 2.40 mm2 vs. -0.04 ± 0.73 mm2, respectively; P < 0.001). A reduction in the degree of hyperfluorescence on ICGA decreased the odds of having persistent subretinal fluid on optical coherence tomography at first visit after treatment (B = 0.295; P = 0.019). There were no significant differences in best-corrected visual acuity and retinal sensitivity between the subgroup with novel hypofluorescence (n = 20, 28%) on ICGA at first visit post PDT, compared with the subgroup without novel hypofluorescence on ICGA after PDT. CONCLUSION: Choroidal abnormalities in chronic central serous chorioretinopathy can be effectively treated by ICGA-guided half-dose PDT but not with high-density subthreshold micropulse laser application.

Purpose: To correctly define through Magnetic Resonance Imaging (MRI), diagnosis, staging and prognosis of the adductor longus (AL) acute lesions and to identify a correlation between Return to Play (RTP) and sport-related injury predisposing conditions and complications. Materials and methods: Twenty professional football players with acute groin pain and clinical suspicion of AL injury subsequent to sport's activity were evaluated. MRI examinations were performed by one and reviewed by other two radiologists with more than 10 years of experience. Lesions were stratified according to both Munich consensus statement and British Athletics Muscle Injury Classification (BAMIC). Patients were monitored until clinical recovery occurred. Results: According to the Munich consensus statement, 75% of lesions were defined as type 3 and 25%as type 4; while according to the BAMIC, 45% were considered as Grade 1, 20% as Grade 2, 10% as Grade 3, and 25% as Grade 4. RTP was 1–2 weeks for minor lesions (45%), 4–6 weeks for moderate lesions (30%), and more than 6 weeks for complete lesions (25%). Both BAMIC and Munich consensus significantly correlated with RTP (R = 0.958 and 0.974, respectively). The extent of gap was the only independent prognosticator of RTP always present in all three different models of multivariate analysis (p < 0.006, p < 0.002, and p < 0.001, respectively). Conclusions: MRI represents the gold standard imaging technique for the evaluation of AL due to its ability not only to recognize but also to classify acute lesions and define patient's prognosis. MRI is also useful to detect potential predisposing conditions and complications, which may correlate with RTP.

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PURPOSE: To establish a process to evaluate and standardize a state-of-the-art nomenclature for reporting neovascular age-related macular degeneration (AMD) data. DESIGN: Consensus meeting. PARTICIPANTS: An international panel of retina specialists, imaging and image reading center experts, and ocular pathologists. METHODS: During several meetings organized under the auspices of the Macula Society, an international study group discussed and codified a set nomenclature framework for classifying the subtypes of neovascular AMD and associated lesion components. MAIN OUTCOME MEASURES: A consensus classification of neovascular AMD. RESULTS: The study group created a standardized working definition of AMD. The components of neovascular AMD were defined and subclassified. Disease consequences of macular neovascularization were delineated. CONCLUSIONS: The framework of a consensus nomenclature system, a definition of AMD, and a delineation of the subtypes of neovascular AMD were developed. Establishing a uniform set of definitions will facilitate comparison of diverse patient groups and different studies. The framework presented is modified and updated readily, processes that are anticipated to occur on a periodic basis. The study group suggests that the consensus standards outlined in this article be used in future reported studies of neovascular AMD and clinical practice.

Objectives: To describe magnetic resonance imaging (MRI) characteristics of soleus muscle injuries in symptomatic professional football players stratified according to both the Munich consensus statement and the British Athletics Muscle Injury Classification (BAMIC), and to investigate the association between specific MRI features and the “return to play” (RTP). Materials and methods: Professional football players with an episode of acute posterior calf pain and impaired function, subsequent to sports activity, underwent ultrasound followed by MRI examination reviewed by two different radiologists with more than 10 years of experience in the musculoskeletal system. MRI features and RTP outcome were evaluated for all types of injuries. Results: During a 36-month period, a total of 20 professional football players were evaluated. According to the Munich consensus, 11 were type 3A, 8 were type 3B, and 1 was type 4, whereas according to the BAMIC, 11 lesions were considered grade 1, 4 grade 2, 4 grade 3, and 1 grade 4. RTP data were available for all patients (mean 3.3 ± 1.6 weeks). Both the Munich consensus and the BAMIC correlated with RTP (Spearman correlation = 0.982 and p < 0.0001 and 0.886 and p < 0.0001 respectively). Extension of edema was an independent prognostic factor for RTP in two different models of multivariate regression analysis (p = 0.044 model A; p = 0.031 model B). Conclusions: The Munich consensus and BAMIC grading systems are useful tools for defining the patient’s prognosis and proper rehabilitation time after injury. The MRI feature that we should carefully look for is the extension of edema, as it seems to significantly affect the RTP.