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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 27576

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Special Issue Editors

Dr. Valerio Nardone

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Guest Editor

Department of Precision Oncology, University of Campania “L. Vanvitelli”, Naples, Italy
Interests: radiotherapy; radiomics; texture analysis; nsclc

Dr. Alfonso Reginelli

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Guest Editor

Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80125 Naples, Italy
Interests: magnetic resonance; oncologic radiology; abdominal radiology; bone metastases; lung cancer; breast cancer; colo-rectal cancer; whole-body diffusion-weighted imaging; whole-body MRI; contrast media; computed tomography
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Special Issue Information

Dear Colleagues,

In the last decade, the definition of precision medicine has seen raised interest, thanks to the huge advances in technologies and knowledge of both the human body and diseases.

Precision medicine represents an opportunity to provide far more tailored treatments, taking into consideration that particular attributes and characteristics are unique for patients.

In oncology, this concept is known as precision oncology, defined as the molecular profiling of tumors to identify targetable alterations, and is rapidly developing and has entered the mainstream of clinical practice.

In the fields of imaging, that involve both radiology and radiation oncology, the corresponding concept is represented by the image-guided precision medicine, defined as the use of any form of medical imaging to plan, perform, and evaluate procedures and interventions.

The cross-sectional digital imaging modalities magnetic resonance imaging (MRI) and computed tomography (CT) are the most commonly used modalities of image-guided therapy. These procedures are also supported by ultrasound, angiography, surgical navigation equipment, tracking tools, and integration software.

At the same time, recent developments in radiotherapy with the incorporation of intensity-modulated radiotherapy, molecular imaging-guided radiotherapy, adaptive radiotherapy, and proton therapy have always included image-guided approaches in the workflow.

Last (but not least), radiomics can also be included in this context, as a method that extracts a large number of features from medical images using data-characterisation algorithms, with the aim of uncovering tumoral patterns and characteristics that cannot be appreciated by the naked eye.

For this Special Issue, we welcome basic translational and clinical research papers, cancer biomarkers, professional opinions, and reviews in the broad field of image-guided cancer diagnosis and therapy in the following categories:

CNS
Head and neck
Breast
Hematology
Upper GI (oesophagus, stomach, pancreas, liver)
Lung
Gynaecological (endometrium, cervix, vagina, vulva)
Lower GI (colon, rectum, anus)
Non-prostate urology-
Prostate
Sarcoma
Skin cancer/malignant melanoma
Palliation
Pediatric tumours
Elderly Oncology

Dr. Valerio Nardone
Dr. Alfonso Reginelli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (9 papers)

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Research

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10 pages, 942 KiB

Open AccessArticle

Role of Cardiac Biomarkers in Non-Small Cell Lung Cancer Patients

by Valerio Nardone, Alfonso Reginelli, Giuseppina De Marco, Giovanni Natale, Vittorio Patanè, Marco De Chiara, Mauro Buono, Gaetano Maria Russo, Riccardo Monti, Giovanni Balestrucci, Maria Salvarezza, Gaetano Di Guida, Emma D’Ippolito, Angelo Sangiovanni, Roberta Grassi, Ida D’Onofrio, Maria Paola Belfiore, Giovanni Cimmino, Carminia Maria Della Corte, Giovanni Vicidomini, Alfonso Fiorelli, Antonio Gambardella, Floriana Morgillo and Salvatore Cappabianca Show full author list Hide full author list

Diagnostics 2023, 13(3), 400; https://doi.org/10.3390/diagnostics13030400 - 22 Jan 2023

Cited by 2 | Viewed by 2245

Abstract

Treatment-induced cardiac toxicity represents an important issue in non-small cell lung cancer (NSCLC) patients, and no biomarkers are currently available in clinical practice. A novel and easy-to-calculate marker is the quantitative analysis of calcium plaque in the coronary, calculated on CT. It is called the Agatston score (or CAD score). At the same time, other potential predictors include cardiac ultrasonography and anamnesis of the patients. Our work aimed to correlate cardiac biomarkers with overall survival (OS) in NSCLC patients. We retrospectively analyzed patients with NSCLC discussed in the Multidisciplinary Tumor Board of our Institute for the present analysis between January 2018 and July 2022. Inclusion criteria were the availability of basal CT imaging of the thorax, cardiac ultrasonography with the calculation of ejection fraction (EF), and complete anamnesis, including assessment of co-pathologies and pharmacological drugs. The clinical data of the patients were retrospectively collected, and the CAD scores was calculated on a CT scan. All of these parameters were correlated with overall survival (OS) with univariate analysis (Kaplan–Meier analysis) and multivariate analysis (Cox regression analysis). Following the above-mentioned inclusion criteria, 173 patients were included in the present analysis. Of those, 120 patients died in the follow-up period (69.6%), and the median overall survival (OS) was 28 months (mean 47.2 months, 95% CI, 36–57 months). In univariate analysis, several parameters that significantly correlated with lower OS were the stage (p < 0.001), the CAD grading (p < 0.001), history of ischemic heart disease (p: 0.034), use of beta blocker drugs (p: 0.036), and cardiac ejection fraction (p: 0.005). In multivariate analysis, the only parameters that remained significant were as follows: CAD score (p: 0.014, OR 1.56, 95% CI: 1.04–1.83), stage (p: 0.016, OR: 1.26, 95% CI: 1.05–1.53), and cardiac ejection fraction (p: 0.011, OR 0.46, 95% CI: 0.25–0.84). Both CAD score and ejection fraction are correlated with survival in NSCLC patients at all stages of the disease. Independently from the treatment choice, a cardiological evaluation is mandatory for patients with NSCLC. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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15 pages, 1675 KiB

Open AccessArticle

Differentiating False Positive Lesions from Clinically Significant Cancer and Normal Prostate Tissue Using VERDICT MRI and Other Diffusion Models

by Snigdha Sen, Vanya Valindria, Paddy J. Slator, Hayley Pye, Alistair Grey, Alex Freeman, Caroline Moore, Hayley Whitaker, Shonit Punwani, Saurabh Singh and Eleftheria Panagiotaki

Diagnostics 2022, 12(7), 1631; https://doi.org/10.3390/diagnostics12071631 - 5 Jul 2022

Cited by 7 | Viewed by 3311

Abstract

False positives on multiparametric MRIs (mp-MRIs) result in many unnecessary invasive biopsies in men with clinically insignificant diseases. This study investigated whether quantitative diffusion MRI could differentiate between false positives, true positives and normal tissue non-invasively. Thirty-eight patients underwent mp-MRI and Vascular, Extracellular and Restricted Diffusion for Cytometry in Tumors (VERDICT) MRI, followed by transperineal biopsy. The patients were categorized into two groups following biopsy: (1) significant cancer—true positive, 19 patients; (2) atrophy/inflammation/high-grade prostatic intraepithelial neoplasia (PIN)—false positive, 19 patients. The clinical apparent diffusion coefficient (ADC) values were obtained, and the intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI) and VERDICT models were fitted via deep learning. Significant differences (p < 0.05) between true positive and false positive lesions were found in ADC, IVIM perfusion fraction (f) and diffusivity (D), DKI diffusivity (D_K) (p < 0.0001) and kurtosis (K) and VERDICT intracellular volume fraction (f_IC), extracellular–extravascular volume fraction (f_EES) and diffusivity (d_EES) values. Significant differences between false positives and normal tissue were found for the VERDICT f_IC (p = 0.004) and IVIM D. These results demonstrate that model-based diffusion MRI could reduce unnecessary biopsies occurring due to false positive prostate lesions and shows promising sensitivity to benign diseases. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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9 pages, 986 KiB

Open AccessArticle

Tissue Fraction Correction and Visual Analysis Increase Diagnostic Sensitivity in Predicting Malignancy of Ground-Glass Nodules on [¹⁸F]FDG PET/CT: A Bicenter Retrospective Study

by Yun Hye Song, Jung Won Moon, Yoo Na Kim, Ji Young Woo, Hye Joo Son, Suk Hyun Lee and Hee Sung Hwang

Diagnostics 2022, 12(5), 1292; https://doi.org/10.3390/diagnostics12051292 - 23 May 2022

Cited by 3 | Viewed by 1953

Abstract

We investigated the role of [¹⁸F]FDG positron emission tomography/computed tomography (PET/CT) in evaluating ground-glass nodules (GGNs) by visual analysis and tissue fraction correction. A total of 40 pathologically confirmed ≥1 cm GGNs were evaluated visually and semiquantitatively. [¹⁸F]FDG uptake of GGN distinct from background lung activity was considered positive in visual analysis. In semiquantitative analysis, we performed tissue fraction correction for the maximum standardized uptake value (SUV_max) of GGN. Of the 40 GGNs, 25 (63%) were adenocarcinomas, 9 (23%) were minimally invasive adenocarcinomas (MIAs), and 6 (15%) were adenocarcinomas in situ (AIS). On visual analysis, adenocarcinoma showed the highest positivity rate among the three pathological groups (88%, 44%, and 17%, respectively). Both SUV_max and tissue-fraction–corrected SUV_max (SUV_maxTF) were in the order of adenocarcinoma > MIA > AIS (p = 0.033 and 0.018, respectively). SUV_maxTF was significantly higher than SUV_max before correction (2.4 [1.9–3.0] vs. 1.3 [0.8–1.8], p < 0.001). When using a cutoff value of 2.5, the positivity rate of GGNs was significantly higher in SUV_maxTF than in SUV_max (50% vs. 5%, p < 0.001). The diagnostic sensitivity of [¹⁸F]FDG PET/CT in predicting the malignancy of lung GGN was improved by tissue fraction correction and visual analysis. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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10 pages, 1336 KiB

Open AccessArticle

Percutaneous Thermal Ablation Therapy of Hepatocellular Carcinoma (HCC): Microwave Ablation (MWA) versus Laser-Induced Thermotherapy (LITT)

by Hamzah Adwan, Thomas J. Vogl, Ümniye Balaban and Nour-Eldin Abdelrehim Nour-Eldin

Diagnostics 2022, 12(3), 564; https://doi.org/10.3390/diagnostics12030564 - 23 Feb 2022

Cited by 11 | Viewed by 2759

Abstract

The purpose of this study is to compare the efficacy and safety of microwave ablation (MWA) versus laser-induced thermotherapy (LITT) as a local treatment for hepatocellular carcinoma (HCC,) with regard to therapy response, survival rates, and complication rates as measurable outcomes. This retrospective study included 250 patients (52 females and 198 males; mean age: 66 ± 10 years) with 435 tumors that were treated by MWA and 53 patients (12 females and 41 males; mean age: 67.5 ± 8 years) with 75 tumors that were treated by LITT. Tumor response was evaluated using CEMRI (contrast-enhanced magnetic resonance imaging). Overall, 445 MWA sessions and 76 LITT sessions were performed. The rate of local tumor progression (LTP) and the rate of intrahepatic distant recurrence (IDR) were 6% (15/250) and 46% (115/250) in the MWA-group and 3.8% (2/53) and 64.2% (34/53) in the LITT-group, respectively. The 1-, 3-, and 5-year overall survival (OS) rates calculated from the date of diagnosis were 94.3%, 65.4%, and 49.1% in the MWA-group and 96.2%, 54.7%, and 30.2% in the LITT-group, respectively (p-value: 0.002). The 1-, 2-, and 3-year disease-free survival (DFS) rates were 45.9%, 30.6%, and 24.8% in the MWA-group and 54.7%, 30.2%, and 17% in the LITT-group, respectively (p-value: 0.719). Initial complete ablation rate was 97.7% (425/435) in the MWA-group and 98.7% (74/75) in the LITT-group (p-value > 0.99). The overall complication rate was 2.9% (13/445) in the MWA-group and 7.9% (6/76) in the LITT-group (p-value: 0.045). Based on the results, MWA and LITT thermal ablation techniques are well-tolerated, effective, and safe for the local treatment of HCC. However, MWA is recommended over LITT for the treatment of HCC, since the patients in the MWA-group had higher survival rates. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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Review

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19 pages, 15748 KiB

Open AccessReview

Management of Non-Melanoma Skin Cancer: Radiologists Challenging and Risk Assessment

by Gaetano Maria Russo, Anna Russo, Fabrizio Urraro, Fabrizio Cioce, Luigi Gallo, Maria Paola Belfiore, Angelo Sangiovanni, Stefania Napolitano, Teresa Troiani, Pasquale Verolino, Antonello Sica, Gabriella Brancaccio, Giulia Briatico, Valerio Nardone and Alfonso Reginelli

Diagnostics 2023, 13(4), 793; https://doi.org/10.3390/diagnostics13040793 - 20 Feb 2023

Cited by 5 | Viewed by 2540

Abstract

Basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma are the three main types of nonmelanoma skin cancers and their rates of occurrence and mortality have been steadily rising over the past few decades. For radiologists, it is still difficult to treat patients with advanced nonmelanoma skin cancer. Nonmelanoma skin cancer patients would benefit greatly from an improved diagnostic imaging-based risk stratification and staging method that takes into account patient characteristics. The risk is especially elevated among those who previously received systemic treatment or phototherapy. Systemic treatments, including biologic therapies and methotrexate (MTX), are effective in managing immune-mediated diseases; however, they may increase susceptibility to NMSC due to immunosuppression or other factors. Risk stratification and staging tools are crucial in treatment planning and prognostic evaluation. PET/CT appears more sensitive and superior to CT and MRI for nodal and distant metastasis as well as in surveillance after surgery. The patient treatment response improved with advent and utilization of immunotherapy and different immune-specific criteria are established to standardized evaluation criteria of clinical trials but none of them have been utilized routinely with immunotherapy. The advent of immunotherapy has also arisen new critical issues for radiologists, such as atypical response pattern, pseudo-progression, as well as immune-related adverse events that require early identification to optimize and improve patient prognosis and management. It is important for radiologists to have knowledge of the radiologic features site of the tumor, clinical stage, histological subtype, and any high-risk features to assess immunotherapy treatment response and immune-related adverse events. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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34 pages, 13835 KiB

Open AccessReview

Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors

by Arian Mansur, Tushar Garg, Apurva Shrigiriwar, Vahid Etezadi, Christos Georgiades, Peiman Habibollahi, Timothy C. Huber, Juan C. Camacho, Sherif G. Nour, Alan Alper Sag, John David Prologo and Nariman Nezami

Diagnostics 2022, 12(6), 1300; https://doi.org/10.3390/diagnostics12061300 - 24 May 2022

Cited by 16 | Viewed by 4767

Abstract

Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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18 pages, 1484 KiB

Open AccessReview

Role of Combined ⁶⁸Ga DOTA-Peptides and ¹⁸F FDG PET/CT in the Evaluation of Gastroenteropancreatic Neuroendocrine Neoplasms

by Chalermrat Kaewput and Sobhan Vinjamuri

Diagnostics 2022, 12(2), 280; https://doi.org/10.3390/diagnostics12020280 - 22 Jan 2022

Cited by 12 | Viewed by 5098

Abstract

This review article summarizes the role of combined ⁶⁸Ga DOTA-peptides and ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the evaluation of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). Patients with GEP-NENs can initially present themselves to a gastroenterologist or endocrinologist rather than cancer specialist; hence, it is vital for a wider group of clinicians to be familiar with the range of tests available for the evaluation of these patients. The role of PET scanning by using ⁶⁸Ga DOTA-peptides has a high sensitivity in the diagnosis of GEP-NENs and to guide patient selection for treatment with somatostatin analogues (SSA) and/or peptide receptor radionuclide therapy (PRRT). The loss of somatostatin receptor (SSTR) expression was found to be associated with an increased glucose metabolism in cells. However, the routine use of SSTR targeted radiotracers in combination with ¹⁸F-FDG to evaluate glucose utilization in GEP-NENs is still debatable. In our opinion, in patients with NENs, ¹⁸F-FDG PET should be performed in the case of a negative or slightly positive ⁶⁸Ga DOTA-peptides PET scan for assessing the dedifferentiation status, to guide correct therapeutic strategy and to evaluate the prognosis. The approach of combined receptor and metabolic imaging can improve diagnostic accuracy, especially considering the heterogeneity of these lesions. Therefore, ⁶⁸Ga DOTA-peptides and ¹⁸F-FDG PET should be considered complementary in patients with GEP-NENs. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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Other

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3 pages, 1060 KiB

Open AccessInteresting Images

Unexpected Movement of the Esophagus across the Aorta

by Hyun Ho Choi, Soo-Yoon Sung and Yoon Ho Ko

Diagnostics 2022, 12(7), 1758; https://doi.org/10.3390/diagnostics12071758 - 20 Jul 2022

Cited by 1 | Viewed by 1559

Abstract

Tumor regression throughout treatment would induce organ movement, but little is known of this in the esophagus. To achieve successful tumor regression, radiation therapy requires several weeks of radiation to be delivered accurately to the tumor. Usually, a 5–10 mm margin is allowed for set-up error and internal organ motion. Our case exhibited an unexpectedly large movement of the esophagus across the aorta with tumor regression that extended outside the margin and thus outside the radiotherapy field. These movements may affect subsequent invasive procedures or treatment during cancer therapy. After the unexpected large movement of the esophagus due to tumor regression, we revised the radiotherapy plan to reflect the new esophageal position. This implied that regular imaging and close monitoring are required during treatment of esophageal cancer. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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3 pages, 5659 KiB

Open AccessInteresting Images

A Rare Case of Radiation-Induced Liver Disease in Treated Abdominal Lymphoma Showing High [¹⁸F]FDG Avidity and Low EOB Uptake Proportional to the Irradiation Dose

by Aya Usami, Kota Yokoyama, Junichi Tsuchiya, Yoshihiro Umezawa, Kazuma Toda, Ukihide Tateishi and Ryoichi Yoshimura

Diagnostics 2022, 12(2), 504; https://doi.org/10.3390/diagnostics12020504 - 16 Feb 2022

Viewed by 2163

Abstract

A 44-year-old woman presented with high [¹⁸F]FDG uptake liver lesion after six courses of R-CHOP and radiotherapy for abdominal DLBCL, which was misdiagnosed as a hepatic invasion. EOB–MRI showed slight T2 hyperintensity, low-intensity DWI, and decreased EOB uptake in the hepatocellular phase. Compared with the pretreatment planning CT, the liver lesion coincided with the area of >40.5 Gy, resulting in the diagnosis of RILD. At the follow-up [¹⁸F]FDG PET/CT 7 months after irradiation, the abnormal liver uptake disappeared. Comparing [¹⁸F]FDG PET/CT, EOB–MRI, and planning CT can lead to the correct diagnosis of RILD and avoid unnecessary biopsies and treatment changes. Full article

(This article belongs to the Special Issue Image-Guided Cancer Diagnosis and Therapy)

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