Pre-TAVI imaging: an Italian survey by the CT PRotocol optimization (CT-PRO) group.

PURPOSE: The purpose of this survey was to evaluate the current state-of-art of pre-TAVI imaging in a large radiological professional community. METHODS: Between December 2022 and January 2023 all members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited by the CT PRotocol Optimization group (CT-PRO group) to complete an online 24-item questionnaire about pre-TAVI imaging. RESULTS: 557 SIRM members participated in the survey. The greatest part of respondents were consultant radiologists employed in public hospitals and 84% claimed to routinely perform pre-TAVI imaging at their institutions. The most widespread acquisition protocol consisted of an ECG-gated CT angiography (CTA) scan of the aortic root and heart followed by a non-ECG-synchronized CTA of the thorax, abdomen, and pelvis. Contrast agent administration was generally tailored on the patient's body weight with a preference for using high concentration contrast media. The reports were commonly written by radiologists with expertise in cardiovascular imaging, and included all the measurements suggested by current guidelines for adequate pre-procedural planning. About 60% of the subjects affirmed that the Heart Team is present at their institutions, however only 7% of the respondents regularly attended the multidisciplinary meetings. CONCLUSIONS: This survey defines the current pre-TAVI imaging practice in a large radiological professional community. Interestingly, despite the majority of radiologists follow the current guidelines regarding acquisition and reporting of pre-TAVI imaging studies, there is still a noteworthy absence from multidisciplinary meetings and from the Heart Team.

Prostate Imaging for Local Recurrence Reporting and Data System for Biparametric Magnetic Resonance Imaging: A Proposal.

We investigated a novel dedicated Prostate Imaging for Local Recurrence Reporting and Data System (PI-RRADS) in biochemical recurrence after radiotherapy (RT) and rad- ical prostatectomy (RP) evaluating biparametric magnetic resonance imaging (bpMRI) exams, at 3T MRI of 55 patients. Associating bpMRI and biochemical recurrence data, we calculated bpMRI diagnostic accuracy. Four probability categories, from 1 (very low) to 4 (very high), were distinguished. In 20 patients with radiotherapy, 25% and 75% of lesions were reported as PI-RRADS 3, and 4, respectively. In 35 patients with radi- cal prostatectomy, 7.7% of lesions were included in PI-RRADS 1-2, whereas 40.4% and 51.9% in PI-RRADS 3 and 4 categories, respectively. Excellent agreement and significant correlation between bpMRI and biochemical recurrence were found. BpMRI showed sensitivity, specificity, positive predictive value, negative predictive value, false-posi- tive value, false-negative value, and total diagnostic accuracy of 96.15%, 86.7%, 97.4 %, 81.25%, 13.3%, 3.8% and 94.6%, respectively. BpMRI-based PI-RRADS allows the detection and localization local recurrence in biochemical recurrence after RT and RP contributing in clinical management and treatment.

S-PI-RADS and PI-RRADS for Biparametric MRI in the Detection of Prostate Cancer and Post-treatment Local Recurrence.

The application of biparametric magnetic resonance imaging (bpMRI) [T2-weighted (T2W) and diffusion weighted imaging (DWI)/apparent diffusion coefficient (ADC)] using dedicated structured methods, such as Simplified Prostate Imaging Reporting and Data System (S-PI-RADS) for the detection, categorization, and management of prostate cancer (PCa) is reported. Also, Prostate Imaging Reporting for Local Recurrence and Data System (PI-RRADS) for the detection and assessment of the probability of local recurrence after radiotherapy (RT) or radical prostatectomy (RP) in patients with biochemical recurrence (BCR) is proposed. Both S-PI-RADS and PI-RRADS assign to DWI/ADC a main role for the above purpose. S-PI-RADS identifies four categories and, on the basis of the qualitative and quantitative analysis of the restricted diffusion on ADC map and lesion volume, distinguishes two categories of lesions: category 3 (moderately homogeneous hypointense on ADC map) and category 4 (markedly homogeneous or inhomogeneous hypointense on ADC map). Ιn category 3, two subcategories (3a: volume <0.5 cm3 and 3b: volume ≥0.5 cm3) suggesting clinical management. PI-RRADS distinguishes four assessment categories and suggests the stratification of the probability (ranging from very low for category 1 to very high for category 4) of local disease recurrence. In clinical practice, S-PI-RADS and PI-RRADS, based on bpMRI represent a potential valid approach that may facilitates the detection and management of PCa and for detecting local recurrence after treatment improving communication with other professionals.

Lesion Volume in a Bi- or Multivariate Prediction Model for the Management of PI-RADS v2.1 Score 3 Category Lesions.

OBJECTIVE: This study aimed at improving the discrimination of Prostate Imaging - Reporting and Data System version 2.1 (PI-RADS v2.1) score 3 suspicious prostate cancer lesions using lesion volume evaluation. MATERIAL AND METHODS: Two hundred five PI-RADS v2.1 score 3 lesions were submitted to transperineal MRI/TRUS fusion-targeted biopsy. The lesion volumes were estimated on diffusion-weighted imaging sequence and distributed in PI-RADS 3a (LV < 0.5 mL) and PI-RADS 3b (LV ≥ 0.5 mL) subcategories, using a 0.5 mL cutoff value. Data were retrospectively matched with histopathological findings from the biopsy. Assuming that lesions with LV < or ≥ 0.5 mL were respectively not eligible (benign and indolent PCa lesions) or eligible for biopsy (significant PCa lesions), the diagnostic accuracy of lesion volume in determining clinically significant PCa at biopsy was evaluated using a bi- or multivariate model. RESULTS: About 55.1% and 44.9% of lesions were distributed in subcategories 3a and 3b, respectively. The overall PI-RADS score 3 detection rate was 273%. 3.5% (1.95% of total), and 25% (11.7% of total) significant PCa were found in PI-RADS 3a and 3b subcategory, respectively. The method showed 85.2% sensitivity, 61.2% specificity, 25% positive predictive value, and 96.5% negative predictive value and avoided 55.1% of unnecessary biopsies. The diagnostic accuracy in determining significant PCa at biopsy was 73.2% or 86.5% depending on whether lesion volume was used alone or in combination with prostate volume and patient age in a multivariate model. CONCLUSION: 0.5 mL lesion volume cutoff value significantly discriminates fusion-targeted biopsy need in PI-RADS v2.1 score 3 lesions and its diagnostic accuracy improves when it combines with prostate volume and age in a multivariate model.

Pulmonary interstitial emphysema and complications: incidence and CT findings in COVID-19.

Background and Objectives: There are scant data available in the published literature providing chest computed tomography (CT) findings on pulmonary interstitial emphysema (PIE), complications and associated parenchymal abnormalities. We report the incidence of PIE and complications by chest CT in patients with COVID-19. Methods: We retrospective analyzed 897 chest CT scans performed with 64-slice CT scanners during the COVID-19 pandemic period from March 2020 to September 2021. Two radiologists and two physicians in training in diagnostic radiology, independently and in consensus, assessed PIE as air within the perilobular (low-attenuation area) and perivascular interstitium such as its complications, parenchymal anomalies and pleural effusion; in addition, the complications of PIE, parenchymal anomalies and pleural effusion were evaluated. Descriptive statistics were used to summarize the data, and the results were expressed as counts and percentages. Results: PIE was revealed in 25 out of 897 patients (2.8%) and associated with pneumomediastinum, subcutaneous emphysema, and pneumothorax in 25 (100%), 16 (64%), and 7 (28%), patients, respectively. Out of 25 patients, 24 patients had ground-glass opacity (GGO), 23 patients had crazy paving, 22 patients had consolidation and 2 patients had pleural effusion. Eighteen out of 25 patients had noninvasive ventilation before CT scan, initially treated with continuous positive airway pressure (positive end expiratory pressure [PEEP] of 10 cmH2O) and subsequently with bilevel positive airway pressure (range PEEP of 8-12 cmH2O). The remaining seven patients had invasive mechanical ventilation via orotracheal intubation (pressure plateau at approximately 25 cmH2O). Six out of 25 (24%) patients died. Conclusion: Chest CT allows the detection of complications associated with PIE and parenchyma abnormalities. The timely detection of PIE and minimal pneumomediastinum could aid the optimization of ventilation modalities and parameters based on patients clinical status therefore potentially reducing complications.

Assessment of Stability of MIMU Probes to Skin-Marker-Based Anatomical Reference Frames During Locomotion Tasks: Effect of Different Locations on the Lower Limb.

Soft tissue artefacts (STAs) undermine the validity of skin-mounted approaches to measure skeletal kinematics. Magneto-inertial measurement units (MIMU) gained popularity due to their low cost and ease of use. Although the reliability of different protocols for marker-based joint kinematics estimation has been widely reported, there are still no indications on where to place MIMU to minimize STA. This study aims to find the most stable positions for MIMU placement, among four positions on the thigh, four on the shank, and three on the foot. Stability was investigated by measuring MIMU movements against an anatomical reference frame, defined according to a standard marker-based approach. To this aim, markers were attached both on the case of each MIMU (technical frame) and on bony landmarks (anatomical frame). For each MIMU, the nine angles between each versor of the technical frame with each versor of the corresponding anatomical frame were computed. The maximum standard deviation of these angles was assumed as the instability index of MIMU-body coupling. Six healthy subjects were asked to perform barefoot gait, step negotiation, and sit-to-stand. Results showed that (1) in the thigh, the frontal position was the most stable in all tasks, especially in gait; (2) in the shank, the proximal position is the least stable, (3) lateral or medial calcaneus and foot dorsum positions showed equivalent stability performances. Further studies should be done before generalizing these conclusions to different motor tasks and MIMU-body fixation methods. The above results are of interest for both MIMU-based gait analysis and rehabilitation approaches using wearable sensors-based biofeedback.

Gait regularity assessed by wearable sensors: Comparison between accelerometer and gyroscope data for different sensor locations and walking speeds in healthy subjects.

Inertial measurement units (IMU), including accelerometers and gyroscopes, can support the assessment of gait regularity, relevant for an effective walking. Gait regularity is typically quantified by an autocorrelation analysis of trunk/pelvis accelerations. A methodological upgrade fosters a multi-sensor approach including upper and lower limbs. Very few studies dealt with gait regularity using gyroscope data and no comparison between the two inertial sensors has been published. Therefore, this study compares gait regularity assessment by autocorrelation analyses performed on accelerometer and gyroscope data simultaneously acquired. Twenty-five adult healthy subjects walked steady-state on treadmill at three speeds (3.6, 5.0, 6.4 km/h), with rest between. Four IMUs were firmly attached on the trunk, pelvis, wrist and ankle. The autocorrelation method was applied to time-windows of the signal vector magnitude and resulted, on average for each trial, in its regularity index (RI) and periodicity index (PI), i.e. the stride time. Results showed that both sensors identified the same PI (Spearman correlation coefficient = 0.999), and evidenced that, for matched sensor locations and gait speeds, the accelerometer-based RI was larger/equal to the gyroscope-based RI on 86.3% of all conditions (overall median of gyroscope-to-accelerometer RI ratio was 91.1%). The two sensors gave always statistically different RI, with the exception of the ankle at the lowest speed and wrist at higher speeds. Such results help remove potential confounders from analyses performed with different sensors and support the use of accelerometers for gait regularity assessment, not excluding that gyroscopes may be more suitable for other human movements.

Effects of Gait Strategy and Speed on Regularity of Locomotion Assessed in Healthy Subjects Using a Multi-Sensor Method.

The regularity of pseudo-periodic human movements, including locomotion, can be assessed by autocorrelation analysis of measurements using inertial sensors. Though sensors are generally placed on the trunk or pelvis, movement regularity can be assessed at any body location. Pathological factors are expected to reduce regularity either globally or on specific anatomical subparts. However, other non-pathological factors, including gait strategy (walking and running) and speed, modulate locomotion regularity, thus potentially confounding the identification of the pathological factor. The present study's objectives were (1) to define a multi-sensor method based on the autocorrelation analysis of the acceleration module (norm of the acceleration vector) to quantify regularity; (2) to conduct an experimental study on healthy adult subjects to quantify the effect on movement regularity of gait strategy (walking and running at the same velocity), gait speed (four speeds, lower three for walking, upper two for running), and sensor location (on four different body parts). Twenty-five healthy adults participated and four triaxial accelerometers were located on the seventh cervical vertebra (C7), pelvis, wrist, and ankle. The results showed that increasing velocity was associated with increasing regularity only for walking, while no difference in regularity was observed between walking and running. Regularity was generally highest at C7 and ankle, and lowest at the wrist. These data confirm and complement previous literature on regularity assessed on the trunk, and will support future analyses on individuals or groups with specific pathologies affecting locomotor functions.

Performance comparison between wrist and chest actigraphy in combination with heart rate variability for sleep classification.

The concurrent usage of actigraphy and heart rate variability (HRV) for sleep efficiency quantification is still matter of investigation. This study compared chest (CACT) and wrist (WACT) actigraphy (actigraphs positioned on chest and wrist, respectively) in combination with HRV for automatic sleep vs wake classification. Accelerometer and ECG signals were collected during polysomnographic studies (PSGs) including 18 individuals (25-53 years old) with no previous history of sleep disorders. Then, an experienced neurologist performed sleep staging on PSG data. Eleven features from HRV and accelerometry were extracted from series of different lengths. A support vector machine (SVM) was used to automatically distinguish sleep and wake. We found 7 min as the optimal signal length for classification, while maximizing specificity (wake detection). CACT and WACT provided similar accuracies (78% chest vs 77% wrist), larger than what yielded by HRV alone (66%). The addition of HRV to CACT reduced slightly the accuracy, while improving specificity (from 33% to 51%, p < 0.05). On the contrary, the concurrent usage of HRV and WACT did not provide statistically significant improvements over WACT. Then, a subset of features (3 from HRV + 1 from actigraphy) was selected by reducing redundancy using a strategy based on Spearman's correlation and area under the ROC curve. The usage of the reduced set of features and SVM classifier gave only slightly reduced classification performances, which did not differ from the full sets of features. The study opens interesting possibilities in the design of wearable devices for long-term monitoring of sleep at home.

Middle ear metastasis from dormant breast cancer as the initial sign of disseminated disease 20 years after quadrantectomy.

We describe an unusual case of breast cancer metastatic to the middle ear in a 71-year-old woman. The metastasis was the initial sign of disseminated disease 20 years after the patient had undergone a quadrantectomy for her primary disease. Computed tomography (CT) demonstrated the presence of an intratympanic mass with a soft-tissue density that was suggestive of chronic inflammation. The patient underwent a canal-wall-down tympanoplasty. When a brownish mass was found around the ossicles, a mastoidectomy with posterior tympanotomy was carried out. However, exposure of the tumor was insufficient, and therefore the posterior wall of the ear canal had to be removed en bloc. Some tumor was left on the round window membrane so that we would not leave the patient with a total hearing loss. Our case highlights the limitations of CT and magnetic resonance imaging in differentiating inflammatory and neoplastic lesions.

Long-term follow-up of atherosclerotic renovascular disease. Beneficial effect of ACE inhibition.

BACKGROUND: Patients with atherosclerotic renovascular disease (ARVD) are almost invariably treated by revascularization. However, the long-term outcomes of this approach on survival and progression to renal failure have not been investigated and have not been compared with that of a purely medical treatment. The aim of this observational study was to investigate factors affecting long-term (over 5 years) outcome, survival and renal function of patients with ARVD treated invasively or medically. METHODS: ARVD was demonstrated angiographically in 195 patients who were consecutively enrolled into a follow-up study. Patient age was 65.6+/-11.2 years, serum creatinine was 1.74+/-1.22 mg/dl and renal artery lumen narrowing was 73.5+/-17.5%. A revascularization was performed in 136 patients, whereas 54 subjects having comparable characteristics were maintained on a medical treatment throughout the study; five patients were lost during follow-up. RESULTS: The main follow-up was 54.4+/-40.4 months. The assessment of cardiovascular survival and renal survival at the end of follow-up revealed 46 cardiovascular deaths, 20 patients with end-stage renal disease (ESRD) and 41 patients with an increase in serum creatinine of over one-third. The multivariate analysis showed that renal revascularization did not affect mortality or renal survival compared with medical treatment. Revascularization produced slightly lower increases in serum creatinine and a better control of blood pressure. A longer survival was associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) (P = 0.002) in both revascularized and medically treated patients. The only significant predictor of ESRD was an abnormal baseline serum creatinine. CONCLUSIONS: On long-term follow-up, ARVD was associated with a poor prognosis due to a high cardiovascular mortality and a high rate of ESRD. In our non-randomized study, revascularization was not a major advantage over medical treatment in terms of mortality or renal survival. The use of ACEIs was associated with improved survival.

Percutaneous treatment of carotid stenosis with protection system: preliminary experience.

PURPOSE: To assess the feasibility, safety, and efficacy of carotid artery stenting with filter device. MATERIALS AND METHODS: Between May 2001 and July 2002, a total of 96 consecutive patients (100 lesions) who presented with symptomatic >70% diameter stenosis, asymptomatic >90% diameter stenosis or post-endarterectomy as well as post-radiotherapy hemodynamically significant stenosis underwent carotid artery stenting with filter protection at our institute. The mean age of the patients was 72 (range 51-91). There were 22 female (23%), and 74 male (77%). Of the 96 patients, 62 patients (65%) did not filled the NASCET surgical criteria and 24 (26%) were classified as ASA 4. All the patients underwent pretreatment with antiplatelet agents. All procedures were performed with a standardized monitoring system by a multidisciplinary team. Filtration system for cerebral protection was consistently used. Outcome measures were procedural atheroembolic events, including all-stroke and death rates up to 30 days. RESULTS: A protection system type "TRAP" (Microvena, Italy) or a protection system type "EPIFILTER" (Boston Scientific, USA) were employed in 28% and 67% of cases, respectively. In the remaining 5% it was not possible to cross the stenosis with the filter. The stent placement was achieved in 95 of the procedures (95%). In 86% of cases a primary stenting technique was performed, with balloon pre-dilation of the lesion and subsequent stent advancement through the stenosis accounting for 9% of cases. At the time of protection system removal, 21 filter (21%) showed presence of macroscopic particles. We recorded 8 (8%) homolateral neurological events: two major strokes, one minor stroke and five TIAs (all the patients with TIA fully recovered within 2 hours). General complications (5%) included one lesion of the median nerve, two groin haematomas (one with disability for the patient, and one requiring surgery), one myocardial infarct and one lower limb ischaemia requiring surgical intervention. All major complications (4%) (two major strokes, one myocardial infarct and one lesion of the median nerve) occurred within the first 31 cases, the 69 following procedures not showing any neurological or non-neurological major events. At 30 days all patient were still alive. CONCLUSIONS: Filter protection during carotid artery stenting seems technically feasible as well as reasonably safe and effective. The EPIFILTER system turned out to be of easier employment due to its "monorail" system and because it does not usually need a catheter of dedicated recovery. Further studies in larger groups of patients are required to best characterize criteria guiding the choice for the right protection system.