1,721,032 research outputs found
Performance of texture analysis in predicting tumoral response to neoadjuvant chemoradiotherapy in rectal cancer patients studied with 3T MR
Full text linkPurpose: To determine the performance of texture analysis (TA) in the prediction of tumoral response in Colon rectal Cancer (CRC) Patients. Material and methods: We prospectively enrolled 40 consecutive CRC patients, who underwent pre-treatment and post-treatment 3T MRI. A region of interest was drawn manually around the tumour on Unenhanced axial obliqueT2-weighted images and analysed using TA (TexRAD), evaluating first order statistical texture parameters (Skewness, Kurtosis). After CRT, all patients underwent complete surgical resection and the surgical specimen served as the gold standard. Moreover, receiver operating characteristic (ROC) curve analysis was performed to assess the discriminatory power of each quantitative parameter to predict complete response. Artificial Intelligence software (Weka) was used to evaluate the impact of machine learning algorithms on texture parameters in rectal cancer aimed to combine all texture parameters in order to improve diagnostic accuracy. Results: Entropy, Kurtosis and MPP showed significant differences before and after CRT in CR’s; PR/NR Entropy and Skewness showed significant differences before and after CRT (all p<0.05). Absolute changes among different texture parameters in CR and PR/NR patients before and after CRT showed significant differences in Entropy, Kurtosis and MPP (0.31±0.35, in CR, -0.02 ± 1.28 in PR/NR, (p=0.04); 1.87 ± 2.19, in CR, -0.06 ± 3.78 in PR/NR(p=0.0005); (107.91 ± 274.40, in CR, -28.33 ± 202.91 in PR/NR, (p=0.004), respectively). Kurtosis and Entropy seem to be the texture parameters able to predict CR. ROC curves showed the optimal cutoff value for pretreatment kurtosis, the best paremter, ≤ 3.29, resulting a sensitivity and specificity for pCR prediction of 81.5% and 61.5%, respectively. A decisional map was defined combining all texture parameters. Conclusion: TA from T2w images can potentially have an important role as imaging biomarkers of tumoral response to neoadjuvant CRT in rectal cancer. Machine learning software can be apply in this setting to combined efficiently all texture parameters in order to improve diagnostic accuracy
Indwelling biliary stent during Endoscopic Ultrasound-Guided Tissue Acquisition of pancreatic masses: Not necessarily a problem
No full textIn this issue of Journal of Clinical Ultrasound: Sonography and other Imaging Techniques, an interesting original research article by Constantinescu et al. addresses the impact of biliary stenting in EUS-TA in patients affected by pancreatic cancer, assessing and comparing the accuracy of sampling pancreatic malignant tissue by means of EUS-TA in patients who underwent prior ERCP with biliary stenting and patients in whom ERCP was not performed. A total of 243 patients with pancreatic cancer who underwent ERCP and EUS-TA, either with Fine-Needle Aspiration (FNA) or Fine-Needle Biopsy (FNB), were retrospectively evaluated
Endoscopic Ultrasound-Guided Antegrade Stenting as an Effective Alternative to Endoscopic Retrograde Colangio-Pancreatography-Based Biliary Drainage in the Management of Extra-Hepatic Malignant Biliary Obstruction: Current Perspectives and Limitations
No full textTrans-papillary biliary stenting under Endoscopic Retrograde Colangio-Pancreatography (ERCP) is the standard of care for the management of malignant biliary obstruction, providing biliary decompression and symptomatic relief. However, the success rate is reported to be hindered in up to 10% of cases, typically due to difficult selective biliary cannulation, surgically altered anatomy, gastro-duodenal obstruction, or duodenal stenosis. In such cases, surgical by-pass and Percutaneous Trans-Hepatic Biliary Drainage (PTBD) represent the conventional alternative rescue approaches. Nevertheless, these procedures are associated with high morbidity and a significantly reduced quality of life during the post-operative period. Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) has recently been developed and reported as a novel reliable alternative biliary drainage procedure for cases in which ERCP is unsuccessful. In several EUS-BD techniques, EUS-Guided Antegrade Stenting (EUS-AGS) has been proposed as a useful approach
Role of magnetic resonance cholangiopancreatography in choledocholithiasis
No full textIn this very interesting study, the authors compared the diagnostic accuracy of ultrasonography (US) with magnetic resonance cholangiopancreatography (MRCP) for the evaluation of choledocholithiasis. The authors retrospectively selected 243 patients suspected for choledocholithiasis who underwent both US and MRCP within 1 month, then they compared common bile duct measurements, false positive and false negative percentages in common bile duct stone detection. The
authors concluded that US is ideal as the first step in the diagnostic algorithm for choledocholithiasis. Diagnostic accuracy was high, in line
with previously published paper (AUC = 0.727; 95% CI, 0.603–0.852).
However, due to the high percentage of false negatives (16%), if patients have elevated liver enzymes or a high risk of CBD stones, MRCP is recommended. This paper underlines the role of US as first step in patients with suspected biliary stones, strengthen its importance in this clinical scenario. On the other hand, the role of MRCP deserves a more comprehensive evaluatio
ESR essentials: imaging in colorectal cancer-practice recommendations by ESGAR
Full text linkColorectal cancer (CRC) is a significant global health concern. Diagnostic imaging, using different modalities, has a pivotal role in CRC, from early detection (i.e., screening) to follow-up. The role of imaging in CRC screening depends on each country's approach: if an organized screening program is in place, the role of CT colonography (CTC) is limited to the study of either individuals with a positive stool test unwilling/unable to undergo colonoscopy (CC) or in patients with incomplete CC. Although CC is the most common modality to diagnose CRC, CRC can be also incidentally detected during a routine abdominal imaging examination or at the emergency room in patients presenting with intestinal occlusion/subocclusion or perforation. Staging is a crucial aspect of CRC management, guiding treatment decisions and providing valuable prognostic information. An accurate local staging is mandatory in both rectal and colon cancer to drive the appropriate therapeutic workflow. Important limitations of US, CT, and MR in N-staging can be partially solved by FDG PET/CT. Distant staging is usually managed by CT, with MR and FDG PET/CT which can be used as problem-solving techniques. Follow-up is performed according to the general recommendations of the oncological societies.Clinical relevance statement It is essential to summarize each phase of colorectal cancer workup, differentiating the management for colon and rectal cancer supported by the main international guidelines and literature data, with the aim to inform the community on the best practice imaging in colorectal cancer
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