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Selective internal radiation therapy segmentectomy:A new minimally invasive curative option for primary liver malignancies?

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World Journal of Gastroenterology 2024年第18期30卷 2379-2386页

作者： Riccardo Inchingolo francesco cortese Antonio Rosario Pisani Fabrizio Acquafredda Roberto Calbi Riccardo Memeo Fotis Anagnostopoulos Stavros Spiliopoulos Unit of Interventional Radiology “F.Miulli”Regional General HospitalBari 70021Italy Interdisciplinary Department of Medicine Section of Nuclear MedicineUniversity of Bari“Aldo Moro”Bari 70121Italy Department of Radiology General Regional Hospital“F.Miulli”Acquaviva delle Fonti 70021Italy Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalBari 70021Italy The Second Radiology Department National and Kapodistrian University of AthensChaidari Athens 12461Greece

Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

关键词： Transarterial radioembolization Selective internal radiation therapy Radiation segmentectomy Hepatocellular carcinoma Primary liver malignancies Personalised dosimetry

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Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding:A useful predictor of positive angiographic findings

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World Journal of Radiology 2024年第5期16卷 115-127页

作者： Laura Maria Cacioppa Chiara Floridi Alessandra Bruno NicolòRossini Tommaso Valeri Alessandra Borgheresi Riccardo Inchingolo francesco cortese Giacomo Novelli Alessandro Felicioli Mario Torresi Pietro Boscarato Letizia Ottaviani Andrea Giovagnoni Division of Interventional Radiology Department of Radiological SciencesUniversity Politecnica Delle MarcheAncona 60126Italy Department of Clinical Special and Dental SciencesUniversity Politecnica Delle MarcheAncona 60126Italy Laura Maria Cacioppa and Chiara Floridi. Division of Radiology Department of Radiological SciencesUniversity Hospital"Azienda Ospedaliero Universitaria Delle Marche"Ancona 60126Italy Interventional Radiology Unit "F Miulli"Regional General HospitalAcquaviva delle Fonti 70021Italy Department of Radiology IRCCS INRCAAncona 60126Italy

BACKGROUND Gastrointestinal bleeding(GIB)is a severe and potentially life-threatening condition,especially in cases of delayed treatment.Computed tomography angiography(CTA)plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage.AIM To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings.METHODS In this retrospective single-centre study,35 patients(22 men;median age 69 years;range 16-92 years)admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled.Twenty-three(65.7%)patients underwent endoscopy before CTA.Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software.Bleeding rate was obtained from volume change between the two phases and standardised for unit time.Patients were divided into two groups,according to the angiographic signs and their concordance with CTA.RESULTS Upper bleeding accounted for 42.9%and lower GIB for 57.1%.Mean haemoglobin value at the admission was 7.7 g/dL.A concordance between positive CTA and direct angiographic bleeding signs was found in 19(54.3%)cases.Despite no significant differences in terms of bleeding volume in the arterial phase(0.55 mL vs 0.33 mL,P=0.35),a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography(2.06 mL vs 0.9 mL,P=0.02).In the latter patient group,a significant increase in bleeding rate was also detected(2.18 mL/min vs 0.19 mL/min,P=0.02).CONCLUSION In GIB of any origin,extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

关键词： Gastrointestinal haemorrhage Computed tomography angiography Volumetric analysis Computer-assisted image interpretation Therapeutic embolization Transcatheter arterial embolization

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Radiological findings in non-surgical recurrent hepatocellular carcinoma:From locoregional treatments to immunotherapy

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World Journal of Gastroenterology 2023年第11期29卷 1669-1684页

作者： Davide Ippolito Cesare Maino Marco Gatti Paolo Marra Riccardo Faletti francesco cortese Riccardo Inchingolo Sandro Sironi Department of Radiology IRCCS San Gerardo dei TintoriMonza 20900Italy School of Medicine and Surgery University of Milano-BicoccaMilano 20121Italy Department of Surgical Sciences University of TurinTurin 10126Italy Department of Diagnostic and Interventional Radiology Papa Giovanni ⅩⅩⅢ HospitalBergamo 24127Italy Interventional Radiology Unit “F.Miulli”Regional General HospitalBari 70121Italy

Since hepatocellular carcinoma(HCC)represents an important cause of mortality and morbidity all over the world.Currently,it is fundamental not only to achieve a curative treatment but also to manage in the best way any possible recurrence.Even if the latest update of the Barcelona Clinic Liver Cancer guidelines for HCC treatment has introduced new locoregional techniques and confirmed others as well-established clinical practices,there is still no consensus about the treatment of recurrent HCC(RHCC).Locoregional treatments and medical therapy represent two of the most widely accepted approaches for disease control,especially in the advanced stage of liver disease.Different medical treatments are now approved,and others are under investigation.On this basis,radiology plays a central role in the diagnosis of RHCC and the assessment of response to locoregional treatments and medical therapy for RHCC.This review summarized the actual clinical practice by underlining the importance of the radiological approach both in the diagnosis and treatment of RHCC.

关键词： Carcinoma Hepatocellular Liver Ablation Catheter Radio frequency ablation Ablation techniques Medication therapy management RECIST

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Percutaneous insertion of a novel dedicated metal stent to treat malignant hilar biliary obstruction

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World Journal of Gastrointestinal Oncology 2022年第9期14卷 1833-1843页

作者： francesco cortese Fabrizio Acquafredda Andrea Mardighian Maria Teresa Zurlo Valentina Ferraro Riccardo Memeo Stavros Spiliopoulos Riccardo Inchingolo Interventional Radiology Unit Miulli HospitalAcquaviva Delle Fonti 70124Italy Unit of Hepatobiliary Surgery Miulli hospitalAcquaviva Delle Fonti 70124Italy 2nd Radiology Department National and Kapodistrian University of AthensChaidari Athens 12461Greece

BACKGROUND Percutaneous bilateral biliary stenting is an established method for the management of unresectable malignant hilar biliary obstruction.AIM To evaluate the efficacy and safety of a novel uncovered biliary stent, specifically designed for hilar reconstruction.METHODS This, single-center, retrospective study included 18 patients(mean age 71 ± 11 years;61.1% male) undergoing percutaneous transhepatic Moving cell stent(MCS) placement for hilar reconstruction using the stent-in-stent technique for malignant biliary strictures, between November 2020 and July 2021. The Patients were diagnosed with cholangiocarcinoma(12/18;66.6%), gallbladder cancer(5/18;27.7%), and colorectal liver metastasis(1/18;5.5%). Primary endpoints were technical(appropriate stent placement) and clinical(relief from jaundice) success. Secondary endpoints included stent patency, overall survival, complication rates and stent-related complications.RESULTS The technical and clinical success rates were 100%(18/18 cases). According to Kaplan-Meier analysis, the estimated overall patient survival was 80.5% and 60.4% at 6 and 12 mo respectively, while stent patency was 90.9% and 68.2% at 6 mo and 12 mo respectively. The mean stent patency was 172.53 ± 56.20 d and median stent patency was 165 d(range 83-315). Laboratory tests for cholestasis significantly improved after procedure: mean total bilirubin decreased from 15.2 ± 6.0 mg/d L to 1.3 ± 0.4 mg/d L(P < 0.001);mean γGT decreased from 1389 ± 832 U/L to 114.6 ± 53.5 U/L(P < 0.001). One periprocedural complication was reported. Stent-related complications were observed in 5 patients(27.7%), including 1 occlusion(5.5%) and 1 stent migration(5.5 %).CONCLUSION Percutaneous hilar bifurcation biliary stenting with the MCS resulted in excellent clinical and technical success rates, with acceptable complication rates. Further studies are needed to confirm these initial positive results.

关键词： Malignant hilar biliary obstructions Hilar cholangiocarcinoma Self-expandable metallic stent Stent-in-stent technique Percutaneous approach Bilateral Y-stenting

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Radiomics in colorectal cancer patients

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World Journal of Gastroenterology 2023年第19期29卷 2888-2904页

作者： Riccardo Inchingolo Cesare Maino Roberto Cannella Federica Vernuccio francesco cortese Michele Dezio Antonio Rosario Pisani Teresa Giandola Marco Gatti Valentina Giannini Davide Ippolito Riccardo Faletti Unit of Interventional Radiology F.Miulli HospitalAcquaviva delle Fonti 70021Italy Department of Radiology Fondazione IRCCS San Gerardo dei TintoriMonza 20900Italy Department of Biomedicine Neuroscience and Advanced Diagnostics(BiND)University of PalermoPalermo 90127Italy Institute of Radiology University Hospital of PadovaPadova 35128Italy Interdisciplinary Department of Medicine Section of Nuclear MedicineUniversity of Bari“Aldo Moro”Bari 70121Italy Department of Surgical Sciences University of TurinTurin 10126Italy

The main therapeutic options for colorectal cancer are surgical resection and adjuvant chemotherapy in non-metastatic disease.However,the evaluation of the overall adjuvant chemotherapy benefit in patients with a high risk of recurrence is challenging.Radiological images can represent a source of data that can be analyzed by using automated computer-based techniques,working on numerical information coded within Digital Imaging and Communications in Medicine files:This image numerical analysis has been named“radiomics”.Radiomics allows the extraction of quantitative features from radiological images,mainly invisible to the naked eye,that can be further analyzed by artificial intelligence algorithms.Radiomics is expanding in oncology to either understand tumor biology or for the development of imaging biomarkers for diagnosis,staging,and prognosis,prediction of treatment response and diseases monitoring and surveillance.Several efforts have been made to develop radiomics signatures for colorectal cancer patient using computed tomography(CT)images with different aims:The preoperative prediction of lymph node metastasis,detecting BRAF and RAS gene mutations.Moreover,the use of delta-radiomics allows the analysis of variations of the radiomics parameters extracted from CT scans performed at different timepoints.Most published studies concerning radiomics and magnetic resonance imaging(MRI)mainly focused on the response of advanced tumors that under-went neoadjuvant therapy.Nodes status is the main determinant of adjuvant chemotherapy.Therefore,several radiomics model based on MRI,especially on T2-weighted images and ADC maps,for the preoperative prediction of nodes metastasis in rectal cancer has been developed.Current studies mostly focused on the applications of radiomics in positron emission tomogra-phy/CT for the prediction of survival after curative surgical resection and assessment of response following neoadjuvant chemoradiotherapy.Since colorectal liver metastases develop in about 25%of patients with colorecta

关键词： Colorectal cancer Radiomics Artificial intelligence Liver metastases Magnetic resonance imaging Computed tomography Positron emission tomography/computed tomography

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Liver metastases:The role of magnetic resonance imaging

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世界胃肠病学杂志:英文版 2023年第36期29卷 5180-5197页

作者： Cesare Maino Federica Vernuccio Roberto Cannella francesco cortese Paolo NiccolòFranco Clara Gaetani Valentina Giannini Riccardo Inchingolo Davide Ippolito Arianna Defeudis Giulia Pilato Davide Tore Riccardo Faletti Marco Gatti Department of Radiology Fondazione IRCCS San Gerardo dei TintoriMonza 20900Italy University Hospital of Padova Institute of RadiologyPadova 35128Italy Department of Biomedicine Neuroscience and Advanced Diagnostics(BiND)University of PalermoPalermo 90127Italy Unit of Interventional Radiology F Miulli HospitalAcquaviva delle Fonti 70021Italy Department of Surgical Sciences University of TurinTurin 10126Italy School of Medicine University of Milano BicoccaMilano 20100Italy

The liver is one of the organs most commonly involved in metastatic disease,especially due to its unique vascularization.It’s well known that liver metastases represent the most common hepatic malignant tumors.From a practical point of view,it’s of utmost importance to evaluate the presence of liver metastases when staging oncologic patients,to select the best treatment possible,and finally to predict the overall prognosis.In the past few years,imaging techniques have gained a central role in identifying liver metastases,thanks to ultrasonography,contrast-enhanced computed tomography(CT),and magnetic resonance imaging(MRI).All these techniques,especially CT and MRI,can be considered the noninvasive reference standard techniques for the assessment of liver involvement by metastases.On the other hand,the liver can be affected by different focal lesions,sometimes benign,and sometimes malignant.On these bases,radiologists should face the differential diagnosis between benign and secondary lesions to correctly allocate patients to the best management.Considering the above-mentioned principles,it’s extremely important to underline and refresh the broad spectrum of liver metastases features that can occur in everyday clinical practice.This review aims to summarize the most common imaging features of liver metastases,with a special focus on typical and atypical appearance,by using MRI.

关键词： Liver metastases Magnetic resonance imaging Gadolinium Gd-EOB-DTPA Gadoxetate disodium Liver specific contrast agents Hepatobiliary contrast agents

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RNAi mechanisms in Huntington’s disease therapy:siRNA versus shRNA

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Translational Neurodegeneration 2017年第1期6卷 300-309页

作者： Sebastian Aguiar Bram van der Gaag francesco Albert Bosco cortese Molecular Neuroscience Laboratory Swammerdam Institute for Life Sciences(SILS-CNS)University of AmsterdamAmsterdamNetherlands Fulbright Program US Department of State(IIE)New York CityNYUSA Department of Neurobiology Care Sciences and SocietyKarolinska InstituteStockholmSweden Biogerontology Research Foundation(BGRF) OxfordUK Department of Biomedical and Molecular Sciences Queen’s University School of MedicineQueen’s UniversityKingstonCanada

Huntington’s Disease(HD)is a genetically dominant trinucleotide repeat disorder resulting from CAG repeats within the Huntingtin(HTT)gene exceeding a normal range(>36 CAGs).Symptoms of the disease manifest in middle age and include chorea,dystonia,and cognitive decline.Typical latency from diagnosis to death is 20 years.There are currently no disease-modifying therapies available to HD patients.RNAi is a potentially curative therapy for HD.A popular line of research employs siRNA or antisense oligonucleotides(ASO)to knock down mutant Huntingtin mRNA(mHTT).Unfortunately,this modality requires repeated dosing,commonly exhibit off target effects(OTEs),and exert renal and hepatic toxicity.In contrast,a single AAV-mediated short-hairpin RNA(shRNA)dose can last years with low toxicity.In addition,we highlight research indicating that shRNA elicits fewer OTEs than siRNA when tested head-tohead.Despite this promise,shRNA therapy has been held back by difficulties controlling expression(oversaturating cells with toxic levels of RNA construct).In this review,we compare RNAi modalities for HD and propose novel methods of optimizing shRNA expression and on-target fidelity.

关键词： RNAi shRNA siRNA Huntington’s disease Off-target effects Huntingtin Silencing

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