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Murphy DJ, Mayoral M, Larici AR, Ginsberg MS, Cicchetti G, Fintelmann FJ, Marom EM, Truong MT, Gill RR. Imaging Follow-Up of Nonsurgical Therapies for Lung Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:409-424. [PMID: 37095669 PMCID: PMC11037936 DOI: 10.2214/ajr.23.29104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Lung cancer continues to be the most common cause of cancer-related death worldwide. In the past decade, with the implementation of lung cancer screening programs and advances in surgical and nonsurgical therapies, the survival of patients with lung cancer has increased, as has the number of imaging studies that these patients undergo. However, most patients with lung cancer do not undergo surgical re-section, because they have comorbid disease or lung cancer in an advanced stage at diagnosis. Nonsurgical therapies have continued to evolve with a growing range of systemic and targeted therapies, and there has been an associated evolution in the imaging findings encountered at follow-up examinations after such therapies (e.g., with respect to posttreatment changes, treatment complications, and recurrent tumor). This AJR Expert Panel Narrative Review describes the current status of nonsurgical therapies for lung cancer and their expected and unexpected imaging manifestations. The goal is to provide guidance to radiologists regarding imaging assessment after such therapies, focusing mainly on non-small cell lung cancer. Covered therapies include systemic therapy (conventional chemotherapy, targeted therapy, and immunotherapy), radiotherapy, and thermal ablation.
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Martini K, Larici AR, Revel MP, Ghaye B, Sverzellati N, Parkar AP, Snoeckx A, Screaton N, Biederer J, Prosch H, Silva M, Brady A, Gleeson F, Frauenfelder T. COVID-19 pneumonia imaging follow-up: when and how? A proposition from ESTI and ESR. Eur Radiol 2022; 32:2639-2649. [PMID: 34713328 PMCID: PMC8553396 DOI: 10.1007/s00330-021-08317-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 12/26/2022]
Abstract
This document from the European Society of Thoracic Imaging (ESTI) and the European Society of Radiology (ESR) discusses the role of imaging in the long-term follow-up of COVID-19 patients, to define which patients may benefit from imaging, and what imaging modalities and protocols should be used. Insights into imaging features encountered on computed tomography (CT) scans and potential pitfalls are discussed and possible areas for future review and research are also included. KEY POINTS: • Post-COVID-19 pneumonia changes are mainly consistent with prior organizing pneumonia and are likely to disappear within 12 months of recovery from the acute infection in the majority of patients. • At present, with the longest series of follow-up examinations reported not exceeding 12 months, the development of persistent or progressive fibrosis in at least some individuals cannot yet be excluded. • Residual ground glass opacification may be associated with persisting bronchial dilatation and distortion, and might be termed "fibrotic-like changes" probably consistent with prior organizing pneumonia.
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Passiglia F, Cinquini M, Bertolaccini L, Del Re M, Facchinetti F, Ferrara R, Franchina T, Larici AR, Malapelle U, Menis J, Passaro A, Pilotto S, Ramella S, Rossi G, Trisolini R, Novello S. Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis. J Clin Oncol 2021; 39:2574-2585. [PMID: 34236916 DOI: 10.1200/jco.20.02574] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS. MATERIALS AND METHODS Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach. RESULTS Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer-related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer-related mortality by sex revealed nonsignificant differences between men and women (P = .21; I-squared = 33.6%). CONCLUSION Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide.
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Neri E, Coppola F, Larici AR, Sverzellati N, Mazzei MA, Sacco P, Dalpiaz G, Feragalli B, Miele V, Grassi R. Structured reporting of chest CT in COVID-19 pneumonia: a consensus proposal. Insights Imaging 2020; 11:92. [PMID: 32785803 PMCID: PMC7422456 DOI: 10.1186/s13244-020-00901-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The need of a standardized reporting scheme and language, in imaging of COVID-19 pneumonia, has been welcomed by major scientific societies. The aim of the study was to build the reporting scheme of chest CT in COVID-19 pneumonia. METHODS A team of experts, of the Italian Society of Medical and Interventional Radiology (SIRM), has been recruited to compose a consensus panel. They used a modified Delphi process to build a reporting scheme and expressed a level of agreement for each section of the report. To measure the internal consistency of the panelist ratings for each section of the report, a quality analysis based on the average inter-item correlation was performed with Cronbach's alpha (Cα) correlation coefficient. RESULTS The overall mean score of the experts and the sum of score were 3.1 (std.dev. ± 0.11) and 122 in the second round, and improved to 3.75 (std.dev. ± 0.40) and 154 in the third round. The Cronbach's alpha (Cα) correlation coefficient was 0.741 (acceptable) in the second round and improved to 0.789 in the third round. The final report was built in the management of radiology report template (MRRT) and includes n = 4 items in the procedure information, n = 5 items in the clinical information, n = 16 in the findings, and n = 3 in the impression, with overall 28 items. CONCLUSIONS The proposed structured report could be of help both for expert radiologists and for the less experienced who are faced with the management of these patients. The structured report is conceived as a guideline, to recommend the key items/findings of chest CT in COVID-19 pneumonia.
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Moro F, Buonsenso D, Moruzzi MC, Inchingolo R, Smargiassi A, Demi L, Larici AR, Scambia G, Lanzone A, Testa AC. How to perform lung ultrasound in pregnant women with suspected COVID-19. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:593-598. [PMID: 32207208 DOI: 10.1002/uog.22028] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 05/02/2023]
Abstract
Under certain circumstances, such as during the current COVID-19 outbreak, pregnant women can be a target for respiratory infection, and lung examination may be required as part of their clinical evaluation, ideally while avoiding exposure to radiation. We propose a practical approach for obstetricians/gynecologists to perform lung ultrasound examination, discussing potential applications, semiology and practical aspects, which could be of particular importance in emergency situations, such as the current pandemic infection of COVID-19. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Iezzi R, Larici AR, Posa A, Carchesio F, Congedo MT, Tagliaferri L, Cassano A, D'argento E, Mantini G, Rodolfino E, Margaritora S, Bria E, Tortora G, Valentini V, Manfredi R. Percutaneous radiofrequency ablation using internally cooled wet electrodes for the treatment of patients with lung tumors. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2019; 23:6554-6561. [PMID: 31378896 DOI: 10.26355/eurrev_201908_18541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the safety and feasibility of computed tomography-guided radiofrequency ablation (CT-guided RFA) in unresectable lung neoplasms, using a new 15G monopolar internally cooled wet electrode. PATIENTS AND METHODS 15 consecutive patients with lung neoplasms (< 4 cm), both primary and secondary, unsuitable for or refusing surgery, underwent percutaneous CT-guided RFA using a 15G electrode with a 3-cm exposed tip. The prevalence and grade of adverse events and technical success were evaluated, as well as the extension of the ablation zone, the complete response rates, and the time to progression, determined at CT examination performed 1, 6, and 12 months after the procedure. RESULTS A total of 22 lung neoplasms were treated (mean diameter: 28 mm; range: 20-39 mm). Technical success was obtained in all patients, without major complications or intraprocedural deaths. Mild or moderate pneumothorax was registered in 46.7% of patients, while a perilesional hemorrhage was observed in 5/15 cases. During the follow-up period, a complete response was obtained in 19 out of 22 lesions (86.4%) with three partial response, two of them successfully retreated with the same technique. CONCLUSIONS Percutaneous RFA using a 15G internally cooled wet electrode is a safe and feasible treatment for unresectable lung neoplasms, with high complete response rates.
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Larici AR, Glaudemans AW, Del Ciello A, Slart RH, Calandriello L, Gheysens O. Radiological and nuclear medicine imaging of sarcoidosis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2017; 62:14-33. [PMID: 29190998 DOI: 10.23736/s1824-4785.17.03046-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sarcoidosis is a multisystem chronic inflammatory disease of unknown etiology characterized by widespread growth of non-caseating granulomas. The diagnosis of sarcoidosis is based on clinical and imaging presentation, histologic confirmation and the absence of alternative diseases. Radiology and Nuclear Medicine play an essential role in the diagnostic work-up of patients with sarcoidosis to assess disease extent and activity. In addition, imaging modalities have shown their potential in managing these patients in terms of treatment response and prognostic assessment. Sarcoidosis has a predilection for chest involvement, showing typical and atypical manifestations in the lungs, airways and hilar/mediastinal lymph nodes. Chest radiography (X-ray) still plays an important role in suggesting diagnosis for cases with typical presentation of sarcoidosis, while computed tomography (CT) has higher accuracy in detecting early stage disease and in narrowing differential diagnosis, particularly in atypical manifestations. For extrathoracic involvement, both CT and MR (magnetic resonance) have comparable performance even though MR is the modality of choice for assessing neurosarcoidosis and cardiac sarcoidosis. In the last decades positron emission tomography/CT (PET/CT) has demonstrated an increasing and relevant value in assessing disease extent and activity, treatment planning and therapy response, with a crucial role in the management of cardiac sarcoidosis. In this article, an overview of the possible imaging manifestations of thoracic and extrathoracic sarcoidosis and current concepts on staging, response assessment and prognosis is provided. Finally, the potential applications of non-FDG radiotracers is briefly discussed.
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Larici AR, Storto ML, Torge M, Mereu M, Molinari F, Maggi F, Bonomo L. Automated volumetry of pulmonary nodules on multidetector CT: influence of slice thickness, reconstruction algorithm and tube current. Preliminary results. Radiol Med 2008; 113:29-42. [PMID: 18338125 DOI: 10.1007/s11547-008-0231-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 05/29/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the influence of slice thickness, reconstruction algorithm and tube current (mA) on the performance of a software package in determining the volume of solid pulmonary nodules on multidetector-row computed tomography (MDCT). MATERIALS AND METHODS A chest phantom containing artificial solid nodules with known volume was imaged with two MDCT scans at 100 and 40 mAs (200 mA and 80 mA, 0.5-s rotation time), respectively. Data were reconstructed with slice thicknesses of 1.25 and 2.5 mm and five different algorithms. The volumes of three nodules (juxtavascular, intraparenchymal, juxtapleural) were calculated using three-dimensional (3D) volumetric software. Differences between estimated and real volume were reported for each nodule and reconstruction set. RESULTS The software segmented all nodules on 1.25-mm-thick reconstructions, independently from the mAs. It did not segment the juxtapleural nodule on 2.5-mm-thick reconstructions at 40 mAs. Mean values of the differences, which better approximated the real volume of the nodules, were obtained with high-spatial-resolution algorithms on both 100 and 40 mAs images at 1.25-mm slice thickness. CONCLUSIONS Slice thickness, reconstruction algorithm and tube current can affect the 3D volume measurement of solid nodules. The best performance of the software, on both 100 and 40 mAs images, was observed with a slice thickness of 1.25 mm and high-spatial-resolution algorithms.
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Larici AR, Gotway MB, Litt HI, Reddy GP, Webb WR, Gotway CA, Dawn SK, Marder SR, Storto ML. Helical CT with sagittal and coronal reconstructions: accuracy for detection of diaphragmatic injury. AJR Am J Roentgenol 2002; 179:451-7. [PMID: 12130450 DOI: 10.2214/ajr.179.2.1790451] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objectives of our study were to determine the accuracy of single-detector helical CT (including coronal and sagittal reconstructions) for the diagnosis of traumatic diaphragmatic injury, establish measurements for the thickness of the normal diaphragmatic crus, and describe an additional sign of diaphragmatic injury: active arterial extravasation of contrast material at the level of the diaphragm. MATERIALS AND METHODS The CT scans of 25 patients with surgically proven diaphragmatic injury and 22 patients with surgically confirmed uninjured diaphragms were blindly reviewed by five thoracic radiologists. Sagittal and coronal reconstructions were performed for 20 of the 25 patients with a proven diaphragmatic injury and for all the patients without a diaphragmatic injury. Scans were evaluated for findings suggestive of diaphragmatic injury and for associated injuries. Reviewers scored the usefulness of the reconstructed images for establishing the final diagnosis. Measurements of the right and left crura were performed to establish a threshold measurement that would enable radiologists to discriminate between a normal diaphragm and an injured diaphragm. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of helical CT were 84%, 77%, 81%, 81%, and 83%, respectively. Scans showing active arterial extravasation of contrast material enabled reviewers to correctly identify diaphragmatic injury in two patients. Reconstructed images confirmed the correct diagnosis in three patients but supported an incorrect diagnosis in two. The mean thickness of the diaphragmatic crura (right and left) was not significantly greater in patients with an injured diaphragm than in those with an uninjured diaphragm. CONCLUSION Helical CT shows good sensitivity, specificity, and accuracy for the diagnosis of diaphragmatic injury. Coronal and sagittal reconstructions are of limited use in establishing or refuting this diagnosis. Active arterial extravasation of contrast material near the diaphragm should raise suspicion for injury. Crus measurements cannot be used to reliably distinguish between injured and uninjured diaphragms.
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Tartaro A, Larici AR, Antonucci D, Merlino B, Colosimo C, Bonomo L. [Optimization and diagnostic accuracy of computerized tomography with tridimensional spiral technique in the study of craniostenosis]. LA RADIOLOGIA MEDICA 1998; 96:10-7. [PMID: 9819612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Conventional Computed Tomography (CT) with three-dimensional (3D) reconstructions is considered the most complete and accurate imaging modality to diagnose craniosynostosis. However, the introduction of Spiral CT (SCT) opened new possibilities for 3D studies of the skull in pediatric patients with craniosynostosis. The purpose of our study is two fold: first, to optimize the scanning and imaging parameters to obtain diagnostic images in a single spiral scan; second, to assess the diagnostic accuracy of such images in the identification of normal and abnormal cranial vault sutures. MATERIAL AND METHODS Seventy-eight pediatric patients (age range: 1-35 months; mean: 11.8 months) with craniosynostosis were submitted to SCT of the head. The images were acquired with the following parameters: 3- and 5-mm nominal slice thickness, 5-6 mm/s table feed (pitch 1-2), 165 mAs and 120 kV. Two different algorithms and increases were used for image reconstructions. A first set of images was reconstructed with 2-mm increases and a soft tissue algorithm: these images were used for brain studies and for 3D reconstructions. A second set of slices was reconstructed with 5-mm increases and a bone algorithm to visualize the sutures of the axial plane. The 3D images were processed with the Shaded Surface Display software with threshold values ranging 120-150 HU. All images were acquired with a single spiral scan lasting less than 30 seconds. Two blinded radiologists analyzed the 3D and the planar images independently to evaluate the course and depth of each cranial suture. The sensitivity, specificity and diagnostic accuracy of both 3D and planar SCT images were evaluated. The frequency of artifacts (the Lego effect, boiled egg, pseudoforamina, movement, and chainsaw artifacts) and their influence on the final diagnosis were studied on 3D SCT images. RESULTS The diagnostic accuracy rates of 3D SCT images, by suture, were: sagittal 90.7%, metopic 100%, left lamboid 90.9%, right lamboid 93.9%, left coronal 85.7%, right coronal 91.1%. The diagnostic accuracy rates of the axial images, by suture, were: sagittal 90.7%, metopic 95.5%, left lamboid 86.4%, right lamboid 90.9%, left coronal 83.7%, right coronal 91.1%. The interobserver agreement on 3D images was: sagittal 91.1%, metopic 100%, left lamboid 88.9%, right lamboid 91.1%, left coronal 88.9%, right coronal 84.4%. The Lego effect artifact was the most frequent one (82%) and affected image evaluation in 6.3% of cases. CONCLUSIONS Our results prove that 3D SCT is a very accurate technique for identifying normal and abnormal sutures and presents many advantages over conventional 3D CT in the examination of pediatric patients with craniosynostosis. The quality of 3D SCT images was adequate and the artifacts did not affect the final diagnostic yield significantly.
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