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Liver volumetry:Is imaging reliable?Personal experience and review of the literature

World Journal of Radiology 2014年第4期6卷 62-71页

作者： Mirko D'Onofrio Riccardo De Robertis emanuele demozzi Stefano Crosara Stefano Canestrini Roberto Pozzi Mucelli Department of Radiology G.B. Rossi HospitalUniversity of Verona

The amount of the future liver remnant volume is fun-damental for hepato-biliary surgery, representing animportant potential risk-factor for the development ofpost-hepatectomy liver failure. Despite this, there isno uniform consensus about the amount of hepaticparenchyma that can be safely resected, nor about themodality that should be chosen for this evaluation. Thepre-operative evaluation of hepatic volume, along witha precise identification of vascular and biliar anatomyand variants, are therefore necessary to reduce surgi-cal complications, especially for extensive resections.Some studies have tried to validate imaging methods[ultrasound, computed tomography(CT), magneticresonance imaging] for the assessment of liver volume,but there is no clear evidence about the most accuratemethod for this evaluation. Furthermore, this volumet-ric evaluation seems to have a certain degree of error,tending to overestimate the actual hepatic volume,therefore some conversion factors, which should givea more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communica-tions in medicine images with their own personal com-puter, but very few studies have provided a validation of these methods. Moreover, while the pre-transplanta-tion volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is dis-cussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.

关键词： Liver Hepatectomy Ultrasound Computed tomography Magnetic resonance imaging

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Noninvasive diagnosis of cirrhosis:A review of different imaging modalities

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World Journal of Gastroenterology 2014年第23期20卷 7231-7241页

作者： Riccardo De Robertis Mirko D'Onofrio emanuele demozzi Stefano Crosara Stefano Canestrini Roberto Pozzi Mucelli Department of Radiology G.B.Rossi HospitalUniversity of Verona37134 VeronaItaly

Progressive hepatic fibrosis can lead to cirrhosis,so its early detection is fundamental.Staging fibrosis is also critical for prognosis and management.The gold standard for these aims is liver biopsy,but it has several drawbacks,as it is invasive,expensive,has poor acceptance,is prone to inter observer variability and sampling errors,has poor repeatability,and has a risk of complications and mortality.Therefore,non-invasive imaging tests have been developed.This review mainly focuses on the role of transient elastography,acoustic radiation force impulse imaging,and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis.

关键词： Liver Cirrhosis Elastography Acoustic radiation fo

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Autoimmune pancreatitis:Multimodality non-invasive imaging diagnosis

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World Journal of Gastroenterology 2014年第45期20卷 16881-16890页

作者： Stefano Crosara Mirko D'Onofrio Riccardo De Robertis emanuele demozzi Stefano Canestrini Giulia Zamboni Roberto Pozzi Mucelli Department of Radiology University Hospital GB Rossi University of Verona

Autoimmune pancreatitis(AIP)is characterized by obstructive jaundice,a dramatic clinical response to steroids and pathologically by a lymphoplasmacytic infiltrate,with or without a pancreatic mass.Type 1AIP is the pancreatic manifestation of an Ig G4-related systemic disease and is characterized by elevated Ig G4serum levels,infiltration of Ig G4-positive plasma cells and extrapancreatic lesions.Type 2 AIP usually has none or very few Ig G4-positive plasma cells,no serum Ig G4 elevation and appears to be a pancreas-specific disorder without extrapancreatic involvement.AIP is diagnosed in approximately 2%-6%of patients that undergo pancreatic resection for suspected pancreatic cancer.There are three patterns of autoimmune pancreatitis:diffuse disease is the most common type,with a diffuse,"sausage-like"pancreatic enlargement with sharp margins and loss of the lobular contours;focal disease is less common and manifests as a focal mass,often within the pancreatic head,mimicking a pancreatic malignancy.Multifocal involvement can also occur.In this paper we describe the features of AIP at ultrasonography,computed tomography,magnetic resonanceand positron emission tomography/computed tomography imaging,focusing on diagnosis and differential diagnosis with pancreatic ductal adenocarcinoma.It is of utmost importance to make an early correct differential diagnosis between these two diseases in order to identify the optimal therapeutic strategy and to avoid unnecessary laparotomy or pancreatic resection in AIP patients.Non-invasive imaging plays also an important role in therapy monitoring,in follow-up and in early identification of disease recurrence.

关键词： Autoimmune pancreatitis Pancreatic imag-ing Ultras

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Acoustic radiation force impulse of the liver

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World Journal of Gastroenterology 2013年第30期19卷 4841-4849页

作者： Mirko D'Onofrio Stefano Crosara Riccardo De Robertis Stefano Canestrini emanuele demozzi Anna Gallotti Roberto Pozzi Mucelli Department of Radiology University Hospital G.B.RossiUniversity of Verona37134 VeronaItaly Department of Radiology Policlinico San Matteo27100 PaviaItaly

Acoustic radiation force impulse(ARFI)imaging is a new and promising ultrasound-based diagnostic technique that,evaluating the wave propagation speed,allows the assessment of the tissue stiffness.ARFI is implemented in the ultrasound scanner.By short-duration acoustic radiation forces(less than 1 ms),localized displacements are generated in a selected region of interest not requiring any external compression so reducing the operator dependency.The generated wave scan provides qualitative or quantitative(wave velocity values)responses.Several non-invasive methods for assessing the staging of fibrosis are used,in order to avoid liver biopsy.Liver function tests and transient elastography are non-invasive,sensitive and accurate tools for the assessment of liver fibrosis and for the discrimination between cirrhotic and non-cirrhotic liver.Many published studies analyse ARFI performance and feasibility in studying diffuse liver diseases and compare them to other diagnostic imaging modalities such as conventional ultrasonography and transient elastography.Solid focal liver lesions,both benign and malignant,are common findings during abdominal examinations.The accurate characterization and differential diagnosis are important aims of all the imaging modalities available today.Only few papers describe the application of ARFI technology in the study of solid focal liver lesions,with different results.In the present study,the existing literature,to the best of our knowledge,about ARFI application on diffuse and focal liver pathology has been evaluated and results and statistical analyses have been compared,bringing to the conclusion that ARFI can be used in the study of the liver with similar accuracy as transient elastography in diagnosing significant fibrosis or cirrhosis and has got some advantages in respect to transient elastography since it does not require separate equipment,better displays anatomical structures and measurements can be successfully carried out almost in every patient.

关键词： Acoustic radiation force impulse imaging Sonoelastography Diffuse liver pathology Focal liver lesion

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Prognostication and response assessment in liver and pancreatic tumors:The new imaging

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World Journal of Gastroenterology 2015年第22期21卷 6794-6808页

作者： Riccardo De Robertis Paolo Tinazzi Martini emanuele demozzi Gino Puntel Silvia Ortolani Sara Cingarlini Andrea Ruzzenente Alfredo Guglielmi Giampaolo Tortora Claudio Bassi Paolo Pederzoli Mirko D'Onofrio Department of Radiology Verona Comprehensive Cancer Network G.B. Rossi Hospital University of Verona Department of Radiology Casa di Cura Pederzoli Department of Oncology Verona Comprehensive Cancer Network G.B.Rossi Hospital University of Verona Department of Hepato-Biliary Surgery Verona Comprehensive Cancer NetworkG.B. Rossi Hospital University of Verona Department of Pancreatic Surgery Verona Comprehensive Cancer Network G.B. Rossi Hospital University of Verona Department of Pancreatic Surgery Casa di Cura Pederzoli

Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations.Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography(PET)CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging,therefore these techniques could be used also for posttreatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart frommolecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations,prognostic stratification and post-treatment monitoring.

关键词： Diffusion magnetic resonance imaging Perfusion imaging Hepatocellular carcinoma Liverneoplasms Pancreatic neoplasms

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Diffusion-weighted imaging of pancreatic cancer

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World Journal of Radiology 2015年第10期7卷 319-328页

作者： Riccardo De Robertis Paolo Tinazzi Martini emanuele demozzi Flavia Dal Corso Claudio Bassi Paolo Pederzoli Mirko D'Onofrio Department of Radiology Verona Comprehensive Cancer Network Department of RadiologyG.B.Rossi Hospital-University of Verona Verona Comprehensive Cancer Network-Department of Pancreatic Surgery G.B.Rossi Hospital-University of Verona Department of Pancreatic Surgery

Magnetic resonance imaging(MRI) is a reliable and accurate imaging method for the evaluation of patients with pancreatic ductal adenocarcinoma(PDAC). Diffusion-weighted imaging(DWI) is a relatively recent technological improvement that expanded MRI capabilities, having brought functional aspects into conventional morphologic MRI evaluation. DWI can depict the random diffusion of water molecules within tissues(the so-called Brownian motions). Modifications of water diffusion induced by different factors acting on the extracellular and intracellular spaces, as increased cell density, edema, fibrosis, or altered functionality of cell membranes, can be detected using this MR sequence. The intravoxel incoherent motion(IVIM) model is an advanced DWI technique that consent a separate quantitative evaluation of all the microscopic random motions that contribute to DWI, which are essentially represented by molecular diffusion and blood microcirculation(perfusion). Technological improvements have made possible the routine use of DWI during abdominal MRI study. Several authors have reported that the addition of DWI sequence can be of value for the evaluation of patients with PDAC, especially improving the staging; nevertheless, it is still unclear whether and how DWI could be helpful for identification, characterization, prognostic stratification and follow-up during treatment. The aim of this paper is to review up-to-date literature data regarding the applications of DWI and IVIM to PDACs.

关键词： Pancreas Pancreatic neoplasms Pancreatic ductal ca

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Carbon sequestration in a bamboo plantation:a case study in a Mediterranean area

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Journal of Forestry Research 2024年第3期35卷 231-238页

作者： Tommaso Chiti emanuele Blasi Maria Vincenza Chiriaco Department for Innovation in Biological Agro-Food and Forest Systems(DIBAF)University of TusciaVia San C.De Lellis snc01100 ViterboItaly Foundation Euro-Mediterranean Center on Climate Change(CMCC) Division on Climate Change Impacts on AgricultureForests and Ecosystem Services(IAFES)Via Garbini5101100 ViterboItaly

In the Mediterranean region,despite bamboo being an alien species that can seriously alter plant and ani-mal biocoenosis,the area occupied by bamboo plantations continues to increase,especially for the purpose to seques-ter carbon(C).However,the C dynamics in the soil-plant system when bamboo is grown outside its native area are poorly understood.Here we investigated the C mitigation potential of the fast-growing Moso bamboo(Phyllostachys edulis)introduced in Italy for climate-change mitigation.We analyzed aboveground(AGB)and belowground(as root/shoot ratio)biomass,litter and soil organic C(SOC)at O-15-and 15-30-cm depths in a 4-year-old bamboo plantation in comparison with the former annual cropland on which the bamboo was established.To have an idea of the maximum C stored at an ecosystem level,a natural forest adjacent the two sites was also considered.In the plantation,C accumulation as AGB was stimulated,with 14.8±3.1 Mg C ha^(-1) stored in 3 years;because thinning was done to remove culms from the first year,the mean sequestration rate was 4.9 Mg C ha^(-1) a^(-1).The sequestration rates were high but comparable to other fast-growing tree species in Italy(e.g.,Pinus nigra).SOC was significantly higher in the bamboo plantation than in the cropland only at the 0-15 cm depth,but SOC stock did not differ.Possibly 4 years were not enough time for a clear increase in SOC,or the high nutrient uptake by bamboos might have depleted the soil nutrients,thus inhibiting the soil organic matter formation by bacteria.In comparison,the natural forest had significantly higher C levels in all the pools.For C dynamics at an ecosystem level,the bamboo plantation on the former annual cropland led to substantial C removal from the atmosphere(about 12 Mg C ha^(-1) a^(-1)).However,despite the promising C sequestration rates by bamboo,its introduction should be carefully considered due to potential ecological problems caused by this species in overexploited environments such as the Mediterranean area.

关键词： Carbon sequestration Climate change mitigation Mediterranean area Moso bamboo Soil organic carbon

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A randomized,controlled,open label non-inferiority trial of intravenous ferric carboxymaltose versus iron sucrose in patients with iron deficiency anemia in China

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Frontiers of Medicine 2024年第1期18卷 98-108页

作者： Jie Jin Zhihua Ran emanuele Noseda Bernard Roubert Matthieu Marty Anna Mezzacasa Udo Michael Göring The First Affiliated Hospital Zhejiang University College of MedicineHangzhou310058China Renji Hospital Shanghai Jiao Tong University School of MedicineShanghai200025China Vifor Pharma Glattbrugg8152Switzerland

Iron deficiency(ID)and ID anemia(IDA)pose significant public health concerns in China.Although iron sucrose(IS)treatment is well-established in the country,ferric carboxymaltose(FCM)offers the advantage of higher doses and fewer infusions.This open label,randomized,controlled,non-inferiority trial was conducted at multiple sites in China to compare the outcomes of FCM(maximum of 2 doses,500 or 1000 mg iron)and IS(up to 11 infusions,200 mg iron)treatments in subjects with IDA.The primary endpoint was the achievement of hemoglobin(Hb)response(an increase of⩾2 g/dL from baseline)within 8 weeks,whereas secondary endpoints included changes in Hb,transferrin saturation,and serum ferritin levels.Among the 371 randomized subjects,a similar percentage of subjects treated with FCM and IS achieved Hb-response(FCM 99.4%,IS 98.3%),thereby confirming the non-inferiority of FCM compared with IS(difference 1.12(−2.15,4.71;95%confidence interval(CI))).Furthermore,a significantly higher proportion of FCM-treated subjects achieved early Hb-response at Week 2(FCM 85.2%,IS 73.2%;difference 12.1(3.31,20.65;95%CI)).Additionally,the increase in TSAT and serum ferritin levels from baseline was significantly greater at all time points for FCM-treated subjects.The safety profiles of FCM and IS were comparable,with the exception of transient hypophosphatemia and pyrexia,which are consistent with FCM’s known safety profile.In conclusion,FCM proves to be an efficacious treatment for IDA,providing faster Hb-response and correction of ID with fewer administrations than IS.

关键词： iron deficiency anemia intravenous iron ferric carboxymaltose iron sucrose Hb response early response

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Stem cell technology for antitumor drug loading and delivery in oncology

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Oncology Research 2024年第3期32卷 433-437页

作者： FRANCESCO PETRELLA ENRICO MARIO CASSINA LIDIA LIBRETTI emanuele PIRONDINI FEDERICO RAVEGLIA ANTONIO TUORO Department of Thoracic Surgery Fondazione IRCCSS an Gerardo dei TintoriMonza20900Italy

The main aim of antineoplastic treatment is to maximize patient benefit by augmenting the drug accumulation within affected organs and tissues,thus incrementing drug effects and,at the same time,reducing the damage of non-involved tissues to cytotoxic agents.Mesenchymal stromal cells(MSC)represent a group of undifferentiated multipotent cells presenting wide self-renewal features and the capacity to differentiate into an assortment of mesenchymal family cells.During the last year,they have been proposed as natural carriers for the selective release of antitumor drugs to malignant cll,s thus optimizing cytotoxic action on cancer cll,while significantly reducing adverse side efect on healthy cells.MSC chemotherapeutic drug loading and delivery is an encouraging new area of cell therapy for several tumors,especially for those with unsatisfactory prognosis and limited treatment options available.Although some experim ental models have been sucesfuly developed,phase I dinical studies are needed to confirm this potential application of cell therapy,in particular in the case of primary and secondary lung cancers.

关键词： Mesenchymal stromal cell Drug loading Drug delivery Mesothelioma Melanoma Glioblastoma Pancreatic ductal adenocarcinoma Multiple myeloma

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Interplay between metabolic dysfunction-associated fatty liver disease and renal function: An intriguing pediatric perspective

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World Journal of Gastroenterology 2024年第15期30卷 2081-2086页

作者： Michele Nardolillo Fabiola Rescigno Mario Bartiromo Dario Piatto Stefano Guarino Pierluigi Marzuillo emanuele Miraglia del Giudice Anna Di Sessa Department of Woman Child and of General and Specialized SurgeryUniversitàdegli Studi della Campania“Luigi Vanvitelli”Naples 80138Italy

Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since childhood.More recently,this term has been further replaced with metabolic associated steatotic liver disease.It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments.However,comparable pediatric data remain limited.Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.

关键词： Metabolic(dysfunction)associated fatty liver disease Renal Function Children Obesity

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