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| 1 | Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion显示文摘AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography(MDCT) as compared with conventional magnetic resonance imaging(MRI), in identifying mesorectal fascia(MRF) invasion in rectal cancer patients.METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner(ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 m As. Imaging data were reviewed as axial and as multiplanar reconstructions(MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images(DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed.RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91(41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged(45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value(PPV) 80.4%, negative predictive value(NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant(P = 0.02). CONCLUSION: New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications. | Davide Ippolito Silvia Girolama Drago Cammillo Talei Franzesi Davide Fior Sandro Sironi | 2016 | World Journal of Gastroenterology2016，22，20： | 7 |
| 2 | Combined value of apparent diffusion coefficient-standardized uptake value max in evaluation of post-treated locally advanced rectal cancer显示文摘AIM:To assess the clinical diagnostic value of functional imaging,combining quantitative parameters of apparent diffusion coefficient(ADC) and standardized uptake value(SUV)max,before and after chemo-radiation therapy,in prediction of tumor response of patients with rectal cancer,related to tumor regression grade at histology.METHODS:A total of 31 patients with biopsy proven diagnosis of rectal carcinoma were enrolled in our study.All patients underwent a whole body ^(18)FDG positron emission tomography(PET)/computed tomography(CT) scan and a pelvic magnetic resonance(MR)examination including diffusion weighted(DW) imaging for staging(PET1,RM1) and after completion(6.6 wk)of neoadjuvant treatment(PET2,RM2).Subsequently all patients underwent total mesorectal excision and the histological results were compared with imaging findings.The MR scanning,performed on 1.5 T magnet(Philips,Achieva),included T2-weighted multiplanar imaging and in addition DW images with b-value of 0 and 1000 mm^2/s.On PET/CT the SUVmax of the rectal lesion were calculated in PET1 and PET2.The percentage decrease of SUVmax(△SUV) and ADC(△ADC) values from baseline to presurgical scan were assessed and correlated with pathologic response classified as tumor regression grade(Mandard's criteria;TRG1 = complete regression,TRG5 = no regression).RESULTS:After completion of therapy,all the patients were submitted to surgery.According to the Mandard's criteria,22 tumors showed complete(TRG1) or subtotal regression(TRG2) and were classified as responders;9tumors were classified as non responders(TRG3,4 and5).Considering all patients the mean values of SUVmax in PET 1 was higher than the mean value of SUVmax in PET 2(P < 0.001),whereas the mean ADC values was lower in RM1 than RM2(P < 0.001),with a △SUV and △ADC respectively of 60.2%and 66.8%.The best predictors for TRG response were SUV2(threshold of4.4) and ADC2(1.29 × 10^(-3) mm^2/s) with high sensitivity and specificity.Combining in a single analysis both the obtained median value,the positive predictive value,in predicting the different group category response in related to TRG system,presented R^2 of 0.95.CONCLUSION:The functional imaging combining ADC and SUVmax in a single analysis permits to detect changes in cellular tissue structures useful for the assessment of tumour response after the neoadjuvant therapy in rectal cancer,increasing the sensitivity in correct depiction of treatment response than either method alone. | Davide Ippolito Davide Fior Chiara Trattenero Elena De Ponti Silvia Drago Luca Guerra Cammillo Talei Franzesi Sandro Sironi | 2015 | World Journal of Radiology2015，7，12： | 5 |
| 3 | Immune response evaluation criteria in solid tumors for assessment of atypical responses after immunotherapy显示文摘In 2017,immune response evaluation criteria in solid tumors(iRECIST)were introduced to validate radiologic and clinical interpretations and to better analyze tumor’s response to immunotherapy,considering the different time of following and response,between this new therapy compared to the standard one.However,even if the iRECIST are worldwide accepted,to date,different aspects should be better underlined and well reported,especially in clinical practice.Clinical experience has demonstrated that in a non-negligible percentage of patients,it is challenging to determine the correct category of response(stable disease,progression disease,partial or complete response),and consequently,to define which is the best management for those patients.Approaching radiological response in patients who underwent immunotherapy,a new uncommon kind of target lesions behavior was found.This phenomenon is mainly due to the different mechanisms of action of immunotherapeutic drug.Therefore,new groups of response have been described in clinical practice,defined as“atypical responses,”and categorized into three new groups:pseudoprogression,hyperprogression,and dissociated response.This review summarizes and reports these patterns,helping clinicians and radiologists get used to atypical responses,in order to identify patients that respond best to treatment. | Davide Ippolito Cesare Maino Maria Ragusi Marco Porta Davide Gandola Cammillo Talei Franzesi Teresa Paola Giandola Sandro Sironi | 2021 | World Journal of Clinical Oncology2021，12，5： | 3 |
| 4 | Role of dynamic perfusion magnetic resonance imaging in patients with local advanced rectal cancer显示文摘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 dynamiccontrast 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 1.5 T 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 responders;18 tumors(64%)were classified as non-responders(TRG3-5).Perfusion MRI parameters were significantly higher in the tumor tissue than in the healthy tissue in MR1(P<0.05).At baseline(MR1),no significant difference in perfusion parameters was found between responders and nonresponders.After chemo-radiation therapy,at MR2,responders showed significantly(P<0.05)lower perfusion values[RAE(%)54±20;RVE(%)73±24;RLE(%):82±29;ME(%):904±429]compared to non-responders[RAE(%):129±45;RVE(%):154±39;RLE(%):164±35;ME(%):1714±427].Moreover,in responders group perfusion values decreased significantly at MR2[RAE(%):54±20;RVE(%):73±24;RLE(%):82±29;ME(%):904±429]compared to the corresponding perfusion values at MR1[RAE(%):115±21;RVE(%):119±21;RLE(%):111±74;ME(%):1060±325];(P<0.05).Concerning the time-intensity curves,the AUC at MR2 showed significant difference(P=0.03)between responders and non-responders[AUC(mm2×10-3)121±50 vs 258±86],with lower AUC values of the tumor tissue in responders compared to nonresponders.In non-responders,there were no significant differences between perfusion values at MR1 and MR2.CONCLUSION Dynamic contrast perfusion-MRI analysis represents a complementary diagnostic tool for identifying vascularity characteristics of tumor tissue in local advanced rectal cancer,useful in the assessment of treatment response. | Davide Ippolito Silvia Girolama Drago Anna Pecorelli Cesare Maino Giulia Querques Ilaria Mariani Cammillo Talei Franzesi Sandro Sironi | 2020 | World Journal of Gastroenterology2020，26，20： | 3 |
| 5 | Low-dose computed tomography with 4th-generation iterative reconstruction algorithm in assessment of oncologic patients显示文摘AIM To compare radiation dose and image quality of lowdose computed tomography(CT) protocol combined with hybrid-iterative reconstruction algorithm with standarddose CT examinations for follow-up of oncologic patients. METHODS Fifty-one patients with known malignant diseases which underwent, during clinical follow-up, both standarddose and low-dose whole-body CT scans were enrolled. Low-dose CT was performed on 256-row scanner, with 120 kV and automated m A modulation, and iterative reconstruction algorithm. Standard-dose CT was performed on 16-rows scanner, with 120 kV, 200-400 m As(depending on patient weight). We evaluated density values and signal-to-noise ratio, along with image noise(SD), sharpness and diagnostic quality with 4-point scale.RESULTS Density values in liver, spleen and aorta were higher in lowdose images(liver 112.55 HU vs 103.90 HU, P < 0.001), as SD values in liver and spleen(liver 16.81 vs 14.41). Volumetric-Computed-Tomographic-Dose-Index(CTDIvol) and Dose-Length-Product(DLP) were significantly lower in low-dose CT as compared to standard-dose(DLP 1025.6 m Gy*cm vs 1429.2 m Gy*cm, P < 0.001) with overall dose reduction of 28.9%. Qualitative analysis did not reveal significant differences in image noise and diagnostic quality.CONCLUSION Automatic tube-current modulation combined with hybriditerative algorithm allows radiation dose reduction of 28.9% without loss of diagnostic quality, being useful in reducing dose exposure in oncologic patients. | Davide Ippolito Alessandra Silvia Casiraghi Cammillo Talei Franzesi Davide Fior Franca Meloni Sandro Sironi | 2017 | World Journal of Gastrointestinal Oncology2017，9，10： | 2 |
| 6 | Endometrial cancer: diagnostic value of quantitative measurements of microvascular changes with DCE-MR imaging显示文摘 | Davide Ippolito Orazio Minutolo Anna Cadonici Cammillo Talei Franzesi Pietro Bonaffini Patrizia Perego Sandro Sironi | 2014 | Magnetic Resonance Materials in Physics, Biology and Medicine2014，，6： | 1 |
| 7 | Relative volume measured with magnetic resonance imaging is an articular collapse predictor in hematological pediatric patients with femoral head osteonecrosis显示文摘AIM To assess the potential value of femoral head(FH) volume measurements to predict joint collapse, as compared to articular surface involvement, in posttreatment osteonecrosis(ON) in pediatric patients affected by lymphoproliferative diseases.METHODS Considering 114 young patients with lymphoproliferative diseases undergone a lower-limbs magnetic resonance imaging(MRI) examination between November 2006 and August 2012 for a suspected post-treatment ON, we finally considered a total of 13 cases(7 males, mean age 15.2 ± 4.8 years), which developed a FH ON lesions(n = 23). The MRI protocol included coronal short tau inversion recovery and T1-weighted sequences, from the hips to the ankles. During the follow-up(elapsed time: 9.2 ± 2 mo), 13/23 FH articular surface(FHS)developed articular deformity. The first MRI studies with diagnosis of ON were retrospectively analyzed, measuring FH volume(FHV), FHS, ON volume(ONV) and the articular surface involved by ON(ONS). The relative involvement of FHS, in terms of volume [relative volume(RV): ONV/FHV] and articular surface [relative surface(RS): ONS/FHS], was then calculated.RESULTS By using receiver operating characteristic curve analysis(threshold of 23% of volume involvement), RV predicted articular deformity in 13/13 FHS [sensitivity 100%, specificity 90%, accuracy 95%, positive predictive value(PPV) 93%, negative predictive value(NPV) 100%]. Considering a threshold of 50% of articular involvement, RS predicted articular deformity in 10/13 femoral heads(sensitivity 77%, specificity 100%, accuracy 87%, PPV 100%, NPV 77%).CONCLUSION RV might be a more reliable parameter than RS in predicting FH deformity and could represent a potential complementary diagnostic tool in the follow-up of femoral heads ON lesions. | Davide Ippolito Alessandro Masetto Cammillo Talei Franzesi Pietro A Bonaffini Alessandra Casiraghi Sandro Sironi | 2016 | World Journal of Radiology2016，8，8： | 0 |
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