| 1. |
- Pozzi Mucelli, Raffaella M., et al.
(författare)
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Branch-duct intraductal papillary mucinous neoplasm (IPMN) : Are cyst volumetry and other novel imaging features able to improve malignancy prediction compared to well-established resection criteria?
- 2022
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Ingår i: European Radiology. - : Springer Science+Business Media B.V.. - 0938-7994 .- 1432-1084. ; 32:8, s. 5144-5155
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Current guidelines base the management of intraductal papillary mucinous neoplasms (IPMN) on several well-established resection criteria (RC), including cyst size. However, malignancy may occur in small cysts. Since branch-duct (BD) IPMN are not perfect spheres, volumetric and morphologic analysis might better correlate with mucin production and grade of dysplasia. Nonetheless, their role in malignancy (high-grade dysplasia/invasive cancer) prediction has been poorly investigated. Previous studies evaluating RC also included patients with solid-mass-forming pancreatic cancer (PC), which may affect the RC yield. This study aimed to assess the role of volume, morphology, and other well-established RC in malignancy prediction in patients with BD- and mixed-type IPMN after excluding solid masses.Methods: Retrospective ethical review-board-approved study of 106 patients (2008–2019) with histopathological diagnosis of BD- and mixed-type IPMN (without solid masses) and preoperative MRI available. Standard imaging and clinical features were collected, and the novel imaging features cyst-volume and elongation value [EV = 1 − (width/length)] calculated on T2-weighted images. Logistic regression analysis was performed. Statistical significance set at two-tails, p < 0.05.Results: Neither volume (odds ratio (OR) = 1.01, 95% CI: 0.99–1.02, p = 0.12) nor EV (OR = 0.38, 95% CI: 0.02–5.93, p = 0.49) was associated with malignancy. Contrast-enhancing mural nodules (MN), main pancreatic duct (MPD) ≥ 5 mm, and elevated carbohydrate antigen (CA) 19-9 serum levels (> 37 μmol/L) were associated with malignancy (MN OR: 4.32, 95% CI: 1.18–15.76, p = 0.02; MPD ≥ 5 mm OR: 4.2, 95% CI: 1.34–13.1, p = 0.01; CA19-9 OR: 6.72; 95% CI: 1.89 – 23.89, p = 0.003).Conclusions: Volume and elongation value cannot predict malignancy in BD- and/or mixed-type IPMN. Mural nodules, MPD ≥ 5 mm and elevated CA19-9 serum levels are associated with higher malignancy risk even after the exclusion of solid masses. Key Points: • Novel and well-established resection criteria for IPMN have been evaluated after excluding solid masses. • BD-IPMN volume and elongation value cannot predict malignancy. • Main pancreatic duct ≥ 5 mm, mural nodules, and elevated carbohydrate antigen 19-9 levels are associated with malignancy.
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| 2. |
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| 3. |
- Grigoriadis, Aristeidis, et al.
(författare)
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Development of a prognostic MRCP-score (DiStrict) for individuals with large-duct primary sclerosing cholangitis
- 2022
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Ingår i: JHEP Reports. - : Elsevier. - 2589-5559. ; 4:12
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis and follow-up of individuals with primary sclerosing cholangitis (PSC). The aim of our study is to develop an MRCP-score based on chol-angiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC.Methods: The score (DiStrict score) was developed based on the extent and severity of cholangiographic changes of intra-hepatic and extrahepatic bile ducts (range 0-8) on 3D-MRCP. In this retrospective, multicentre study, three pairs of radiol-ogists with different levels of expertise from three tertiary centres applied the score independently. MRCP examinations of 220 consecutive individuals with PSC from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Inter-reader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell's C-statistic was calculated.Results: Forty patients developed outcomes (liver transplantation or liver-related death). Inter-reader agreement between experienced radiologists was good (ICC 0.82; 95% CI 0.74-0.87, and ICC 0.81; 95% CI 0.70-0.87, respectively) and better than the agreement for the pair of experienced/less-experienced radiologists (ICC 0.48; 95% CI 0.05-0.72). Agreement between radiologists from the three centres was good (ICC 0.76; 95% CI 0.57-0.89). Intrareader agreement was good to excellent (ICC 0.85-0.93). Harrell's C was 0.78. Patients with a DiStrict score of 5-8 had 8.2-fold higher risk (hazard ratio 8.2; 95% CI 2.97-22.65) of developing outcomes, and significantly worse survival (p <0.001), compared to those with a DiStrict score of 1-4.Conclusions: The novel DiStrict score is reproducible and strongly associated with outcomes, indicating its prognostic value for individuals with PSC in clinical practice.Impact and implications: The diagnosis of primary sclerosing cholangitis (PSC) is based on magnetic resonance chol-angiopancreatography (MRCP). However, the role of MRCP in the prognostication of PSC is still unclear. We developed a novel, simple, and reproducible risk-score, based on MRCP findings, that showed a strong association with prognosis in individuals with PSC (DiStrict score). This score can be easily used in clinical practice and thus has the potential to be useful in clinical trials and in patient counselling and management.
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| 4. |
- Grigoriadis, Aristeidis, et al.
(författare)
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Development of a prognostic MRCP score (DiStrict) for patients with large-duct primary sclerosing cholangitis
- 2022
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Ingår i: JHEP Reports. - : Elsevier BV. - 2589-5559. ; 4:12
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Tidskriftsartikel (refereegranskat)abstract
- Background and AimsMRCP is used for diagnosis and follow-up of patients with primary sclerosing cholangitis (PSC). Interest in the prognostic value of MRCP is increasing. The aim of our study is to develop an MRCP-score based on cholangiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC.MethodsThe score (DiStrict-score) was developed based on the extent and severity of cholangiographic changes of intrahepatic and extrahepatic bile ducts (range 0–8) on 3D-MRCP. In this retrospective, ethics review board approved, multicentre study, three pairs of radiologists with different levels of expertise from three tertiary centres applied the score independently. MRCP- examinations of 220 consecutive PSC-patients from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Interreader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell´s C-statistic was calculated.Results40 patients developed outcomes (liver transplantation or liver-related death). Interreader agreement between experienced radiologists was good (ICC=0.82; 95%CI:0.74–0.87, and ICC=0.81; 95%CI:0.70–0.87, respectively) and better than the agreement for the pair of experienced/less experienced radiologist (ICC=0.48; 95%CI:0.05–0.72). Agreement between radiologists from the three centres was good (ICC=0.76; 95%CI:0.57–0.89). Intrareader agreement was good to excellent (ICC=0.85–0.93). Harrell´s C was 0.78. Patients with DiStrict-score of 5 – 8 had 8.2 times higher risk (HR=8.2; 95%CI:2.97–22.65) for developing outcomes, and significantly worse survival (P ConclusionsThe novel DiStrict-score is reproducible and strongly associated with outcomes, indicating its value for PSC-patient prognoses in clinical practice.Lay summaryDiagnosis of primary sclerosing cholangitis (PSC) is based on magnetic resonance cholangiopancreatography (MRCP). However, the role of MRCP in the prognosis of PSC is still unclear. We developed a novel, simple, and reproducible risk-score, based on MRCP findings, that showed a strong association with PSC patient prognoses (DiStrict score). This score can be easily used in clinical practice and thus has the potential to be useful in clinical trials and in patient counselling and management.
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| 5. |
- Holm, Jon, et al.
(författare)
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Low tube voltage CT for improved detection of pancreatic cancer : detection threshold for small, simulated lesions
- 2012
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Ingår i: BMC Medical Imaging. - : Springer Science and Business Media LLC. - 1471-2342. ; 12, s. 20-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Pancreatic ductal adenocarcinoma is associated with dismal prognosis. The detection of small pancreatic tumors which are still resectable is still a challenging problem.The aim of this study was to investigate the effect of decreasing the tube voltage from 120 to 80 kV on the detection of pancreatic tumors.METHODS:Three scanning protocols was used; one using the standard tube voltage (120 kV) and current (160 mA) and two using 80 kV but with different tube currents (500 and 675 mA) to achieve equivalent dose (15 mGy) and noise (15 HU) as that of the standard protocol.Tumors were simulated into collected CT phantom images. The attenuation in normal parenchyma at 120 kV was set at 130 HU, as measured previously in clinical examinations, and the tumor attenuation was assumed to differ 20 HU and was set at 110HU. By scanning and measuring of iodine solution with different concentrations the corresponding tumor and parenchyma attenuation at 80 kV was found to be 185 and 219 HU, respectively.To objectively evaluate the differences between the three protocols, a multi-reader multi-case receiver operating characteristic study was conducted, using three readers and 100 cases, each containing 0-3 lesions.RESULTS:The highest reader averaged figure-of-merit (FOM) was achieved for 80 kV and 675 mA (FOM=0,850), and the lowest for 120 kV (FOM=0,709). There was a significant difference between the three protocols (p<0,0001), when making an analysis of variance (ANOVA). Post-hoc analysis (students t-test) shows that there was a significant difference between 120 and 80 kV, but not between the two levels of tube currents at 80 kV.CONCLUSION:We conclude that when decreasing the tube voltage there is a significant improvement in tumor conspicuity.
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| 6. |
- Kartalis, Nikolaos
(författare)
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Optimized MRI methods for simplified oncological imaging in pancreas and liver
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Recent technological advances within the fields of Abdominal Imaging have revolutionised oncological imaging. In the investigation of the solid organs in the upper abdomen, extensive examinations are used in order to obtain accurate information. To improve the early detection of still curable pathological changes, novel methods that are faster, easier and still as highly accurate as the ones currently used, are warranted; in that way, the needs for higher efficiency in the modern multidisciplinary environment can be met in a cost-effective manner. The overall purpose of this thesis was to develop and optimise MRI methods for the simplified oncological imaging evaluation of two important patient groups: a. those with pancreatic cancer, by applying diffusion-weighted (DW) MRI (studies I and II), and b. those with colorectal cancer liver metastases (CRLM), by using a novel, manganese-based, orally administered MRI contrast agent (CMC-001) (studies III and IV). In study I, the accuracy of DW MRI was evaluated and compared with a conventional comprehensive MRI (MRI-c) protocol in 36 patients with pancreatic lesions (12 malignant and 24 benign) and 39 without lesions. The results showed that DW MRI has an accuracy that is similarly high to that of MRIc for the detection of pancreatic cancer. In study II, three different DW MRI techniques (respiratory-triggered, free-breathing, and breath-hold) were compared regarding image quality, signal intensity and ADC measurement in 15 patients with proven pancreatic cancer. The results showed superiority of the respiratory-triggered technique in both analyses for demonstrating pancreatic cancer. In study III, the sensitivity of MRI to detect CRLM after ingestion of a full-dose of CMC-001 was compared with that of a comprehensive intravenous gadobenate dimeglumine protocol as well as their safety profile and patient acceptability were compared in 20 patients suspected of having 1-6 such lesions. The results showed that CMC-001 and the intravenous gadobenate dimeglumine had similar sensitivities; no safety issues were raised for neither contrast agent but CMC-001 had higher rates of gastrointestinal adverse events. In study IV, the efficacy of three different doses of the contrast agent CMC-001 (corresponding to 1/2,1/4 and 1/8 of the full dose) as well as its safety profile and patient acceptability were evaluated in 32 healthy volunteers. The results showed that ½ dose of CMC-001 had higher efficiency and still acceptable adverse drug reactions/adverse events. In conclusion of studies I and II, DW MRI is as sensitive as the comprehensive MRI protocol in detecting pancreatic cancer and for that, the respiratory-triggering seems the optimal technique. In conclusion of studies III and IV, the sensitivity of the full dose of oral CMC-001 is as high as the intravenous gadobenate dimeglumine protocol but half-dose of this agent should be preferred due to higher patient acceptability.
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| 7. |
- Kartalis, Nikolaos, et al.
(författare)
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Recent developments in imaging of pancreatic neuroendocrine tumors
- 2015
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Ingår i: Annals of Gastroenterology. - 1108-7471 .- 1792-7463. ; 28:2, s. 193-202
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic neuroendocrine tumors (PNETs) are very rare, accounting for 1-2% of all pancreatic neoplasms. They are classified into functioning and non-functioning and their behavior varies widely from benign to highly malignant. For their investigation, a variety of anatomical and functional imaging methods are available. Anatomical methods include computed tomography (CT), magnetic resonance imaging, and ultrasonography. Functional methods include scintigraphy and positron emission tomography (PET). A combination of anatomical and morphological methods results in the so-called hybrid imaging, such as PET/CT. We herein discuss the currently available imaging modalities for the investigation of PNETs and, more specifically, their applications in tumor detection and staging as well as in choice of therapy, imaging follow up and prediction of response, with emphasis on the recent developments.
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| 8. |
- Kourie, Mourad, et al.
(författare)
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Autoimmune Pancreatitis Type 1 with Biliary, Nasal, Testicular, and Pulmonary Involvement: A Case Report and a Systematic Review
- 2023
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 12:19
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition associated with fibroinflammatory lesions that can occur at almost any anatomical site. It often presents as a multiorgan disease that may mimic malignancy, infection, or other immune-mediated conditions. Autoimmune pancreatitis (AIP) type 1 is the most prominent manifestation of IgG4-RD in the digestive tract, with common extra-pancreatic inflammation. We present the first patient with AIP and involvement of the testicles and nasal cavity. Patient and methods: A case of a patient with AIP type 1 and other organ involvement (bile ducts, testicles, nasal polyps, and lungs) is described. Additionally, a systematic review of AIP type 1 with testicular and nasal involvement was conducted. Results: The systematic review found two cases of AIP type 1 with testicular involvement and 143 cases with AIP type 1 with nasal cavity involvement. None of them had both testicular and nasal involvement. Conclusions: This is the first case of AIP type 1 with other organ involvement, including testicular and nasal involvement, to be described. The number of patients with nasal and testicular involvement described in the literature is low. Creating awareness of this rare clinical condition is necessary, especially due to the very effective available treatment with corticosteroids and rituximab.
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| 9. |
- Tesi, Bianca, et al.
(författare)
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Successful Hematopoietic Stem Cell Transplantation in a Patient with LPS-Responsive Beige-Like Anchor (LRBA) Gene Mutation
- 2016
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Ingår i: Journal of Clinical Immunology. - : Springer Science and Business Media LLC. - 0271-9142 .- 1573-2592. ; 36:5, s. 480-489
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Autosomal recessive mutations in LRBA, encoding for LPS-responsive beige-like anchor protein, were described in patients with a common variable immunodeficiency (CVID)-like disease characterized by hypogammaglobulinemia, autoimmune cytopenias, and enteropathy. Here, we detail the clinical, immunological, and genetic features of a patient with severe autoimmune manifestations. Methods: Whole exome sequencing was performed to establish a molecular diagnosis. Evaluation of lymphocyte subsets was performed for immunological characterization. Medical files were reviewed to collect clinical and immunological data. Results: A 7-year-old boy, born to consanguineous parents, presented with autoimmune hemolytic anemia, hepatosplenomegaly, autoimmune thyroiditis, and severe autoimmune gastrointestinal manifestations. Immunological investigations revealed low immunoglobulin levels and low numbers of B and NK cells. Treatment included immunoglobulin replacement and immunosuppressive therapy. Seven years after disease onset, the patient developed severe neurological symptoms resembling acute disseminated encephalomyelitis, prompting allogeneic hematopoietic stem cell transplantation (HSCT) with the HLA-identical mother as donor. Whole exome sequencing of the patient uncovered a homozygous 1 bp deletion in LRBA (c.7162delA:p.T2388Pfs*7). Importantly, during 2 years of follow-up post-HSCT, marked clinical improvement and recovery of immune function was observed. Conclusions: Our data suggest a beneficial effect of HSCT in patients with LRBA deficiency.
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