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Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders

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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 June 2024) | Viewed by 15284

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Special Issue Editors

Dr. Francesco Fiz

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Guest Editor

Nuclear Medicine Unit, E.O. Ospedali Galliera, Genoa, Italy
Interests: nuclear medicine; radioisotope therapy; PET/CT; hematology; plaque imaging; image segmentation; texture analysis; radiomics
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Luca Viganò

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Guest Editor

Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
Interests: abdominal surgery; with specific interest in hepato-biliary surgery; with both traditional and minimally invasive approaches; intraoperative ultrasound

Special Issue Information

Dear Colleagues,

Gastrointestinal and hepato-bilio-pancreatic disorders, including benign and malignant oncological diseases, acute and chronic intestinal ailments, and exotoxin-related syndromes, can present a relevant diagnostic challenge. Issues in radiological diagnosis stem from complex anatomy of the abdominal region and difficult differential diagnosis among diseases at different prognoses and treatments but with a similar presentation at standard imaging modalities. In recent years, precision medicine approaches have gained traction but require accurate diagnostic pipelines. Tumor details, such as relationship with surrounding organs (namely the vessels), micrometastases, and residual disease after systemic therapy are crucial to planning an adequate treatment. Significant progress in imaging methods, such as imaging fusion, advanced segmentation, texture analysis, and artificial intelligence, have been recently reported and are the object of major research to extract as much information as possible from the available imaging data.

In this issue, we aim to gather the latest available evidence on any advanced and innovative imaging approach, aiming at diagnosis, staging or treatment guidance of gastrointestinal and hepato-bilio-pancreatic disorders. Manuscripts describing any types of imaging, i.e., US, CT, MRI, scintigraphy or PET can be submitted to this Special Issue.

We look forward to receiving your contributions.

Dr. Francesco Fiz
Prof. Dr. Luca Viganò
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.

Keywords

gastrointestinal and hepato-bilio-pancreatic disorders
benign and malignant oncological diseases
acute and chronic intestinal ailments
exotoxin-related syndromes
radiological diagnosis
abdominal region
precision medicine
imaging fusion
advanced segmentation
texture analysis
artificial intelligence
US, CT, MRI, scintigraphy or PET

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Published Papers (8 papers)

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Research

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16 pages, 4986 KiB

Open AccessArticle

Radiomic Gradient in Peritumoural Tissue of Liver Metastases: A Biomarker for Clinical Practice? Analysing Density, Entropy, and Uniformity Variations with Distance from the Tumour

by Francesco Fiz, Elisa Maria Ragaini, Sara Sirchia, Chiara Masala, Samuele Viganò, Marco Francone, Lara Cavinato, Ettore Lanzarone, Angela Ammirabile and Luca Viganò

Diagnostics 2024, 14(14), 1552; https://doi.org/10.3390/diagnostics14141552 - 18 Jul 2024

Cited by 1 | Viewed by 879

Abstract

The radiomic analysis of the tissue surrounding colorectal liver metastases (CRLM) enhances the prediction accuracy of pathology data and survival. We explored the variation of the textural features in the peritumoural tissue as the distance from CRLM increases. We considered patients with hypodense CRLMs >10 mm and high-quality computed tomography (CT). In the portal phase, we segmented (1) the tumour, (2) a series of concentric rims at a progressively increasing distance from CRLM (from one to ten millimetres), and (3) a cylinder of normal parenchyma (Liver-VOI). Sixty-three CRLMs in 51 patients were analysed. Median peritumoural HU values were similar to Liver-VOI, except for the first millimetre around the CRLM. Entropy progressively decreased (from 3.11 of CRLM to 2.54 of Liver-VOI), while uniformity increased (from 0.135 to 0.199, p < 0.001). At 10 mm from CRLM, entropy was similar to the Liver-VOI in 62% of cases and uniformity in 46%. In small CRLMs (≤30 mm) and responders to chemotherapy, normalisation of entropy and uniformity values occurred in a higher proportion of cases and at a shorter distance. The radiomic analysis of the parenchyma surrounding CRLMs unveiled a wide halo of progressively decreasing entropy and increasing uniformity despite a normal radiological aspect. Underlying pathology data should be investigated. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

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11 pages, 1541 KiB

Open AccessArticle

Rim Enhancement on Contrast-Enhanced CT as a Predictor of Prognosis in Patients with Pancreatic Ductal Adenocarcinoma

by Takeru Yamaguchi, Keitaro Sofue, Eisuke Ueshima, Naoki Sugiyama, Shinji Yabe, Yoshiko Ueno, Atsuhiro Masuda, Hirochika Toyama, Takayuki Kodama, Masato Komatsu, Masatoshi Hori and Takamichi Murakami

Diagnostics 2024, 14(8), 782; https://doi.org/10.3390/diagnostics14080782 - 9 Apr 2024

Viewed by 1548

Abstract

This study investigated the utility of imaging features, such as rim enhancement on contrast-enhanced CT (CECT), in predicting the prognosis of pancreatic ductal adenocarcinoma (PDAC). This retrospective study included 158 patients (84 men; mean age, 68 years) with pathologically confirmed PDAC. The following imaging features were evaluated on CECT by two radiologists: tumor size, tumor attenuation, and the presence of rim enhancement. Cox proportional hazards analysis was performed to identify the imaging and clinicopathological features for predicting disease-free survival (DFS) and overall survival (OS). Pathological features were compared with the presence of rim enhancement. Among the 158 patients, 106 (67%) underwent curative surgery (surgery group) and 52 (33%) received conservative treatment (non-surgery group). Rim enhancement was observed more frequently in the non-surgery group than in the surgery group (44% vs. 20%; p < 0.001). Rim enhancement showed significant associations with shorter DFS and OS in the surgery group (hazard ratios (HRs), 3.03 and 2.99; p < 0.001 and p = 0.003, respectively), whereas tumor size showed significant associations with shorter OS (HR per 1 mm increase, 1.08; p < 0.001). PDACs with rim enhancement showed significant associations with higher histological tumor grades (p < 0.001). PDAC with rim enhancement on CECT could predict poorer prognosis and more aggressive tumor grades. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

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11 pages, 5945 KiB

Open AccessArticle

Hyper Mucinous Proliferations in the Mucosa of Patients with Inflammatory Bowel Disease: Histological Lesions with a Real Potential for Neoplastic Evolution?

by Enrico Costantino Falco, Davide Giuseppe Ribaldone and Gabriella Canavese

Diagnostics 2024, 14(5), 499; https://doi.org/10.3390/diagnostics14050499 - 26 Feb 2024

Viewed by 1639

Abstract

Background and Aims: Mucin disfunction is a critical event in the pathogenesis of inflammatory bowel disease (IBD). Although hyper mucinous conditions have a still debated implication in the clinical evolution of this disorder, hyper mucinous villous proliferations were found to have a preneoplastic biologic potential. We studied morphologic and immunophenotypic characteristics of these lesions in ileocolonic resections for IBD to add evidence about the evolutive potential of these lesions in samples with well oriented wall structures. Methods: Morphologic characteristics of bowel samples from 20 patients resected for IBD and with raised lesions at gross examination were studied and sections from cases with hyper mucinous lesions were stained with the following antibodies: Ki 67, p21, and p27, which were employed to evaluate the characteristics of the proliferative and differentiative activity of the epithelial structures; mismatch repair proteins and p53 have been studied as proteins implicated in carcinogenesis in IBD-affected mucosa; mucins subtypes in hyper mucinous structures were evaluated with MUC-2 and MUC-6. The results in 11 cases of saplings were that they harbored hyper mucinous proliferations. The occurrence of hyper mucinous structures was not related to dysplastic lesions, pseudo pyloric metaplasia, subtype of disease, or activity. In only one of our cases, mild cytologic atypia in the proliferative compartment was detected. Proliferation markers (Ki 67, p53) were expressed in the proliferative compartments of mucosal crypts and antiproliferative proteins p21 and p27 were expressed in differentiated epithelium. MMR proteins expression was limited to the proliferative compartment of the hyper mucinous projections. Mucin subtypes distribution was regular in the epithelium of hyper mucinous proliferations. Conclusions: The present monocentric retrospective study was conducted on surgical samplings with well oriented crypts. Collected data show that hyper mucinous features are frequent occurrences in raised lesions in IBD patients. In hyper mucinous proliferations of the selected cases, the status of the proliferative cycle, the expression of the proteins most frequently involved in carcinogenetic pathways of mucosa affected by IBD, and the mucins subtypes expression have no evident anomalies. Findings are not consistent with the increased risk of neoplastic evolution observed in other studies; rather, they suggest a hyperplastic nature. However, the capacity of hyper mucinous raised lesions for neoplastic evolution should be ruled out with more extensive prospective studies to identify functional defects that could explain the hypothesized neoplastic potential. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

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12 pages, 4432 KiB

Open AccessArticle

Quantitative Edge Analysis of Pancreatic Margins in Patients with Chronic Pancreatitis: A Correlation with Exocrine Function

by Maria Chiara Ambrosetti, Annamaria Grecchi, Alberto Ambrosetti, Antonio Amodio, Giancarlo Mansueto, Stefania Montemezzi and Giulia A. Zamboni

Diagnostics 2023, 13(13), 2272; https://doi.org/10.3390/diagnostics13132272 - 5 Jul 2023

Cited by 2 | Viewed by 1264

Abstract

Background: Many efforts have been made to improve accuracy and sensitivity in diagnosing chronic pancreatitis (CP), obtaining quantitative assessments related to functional data. Our purpose was to correlate a computer-assisted analysis of pancreatic morphology, focusing on glandular margins, with exocrine function—measured by fecal elastase values—in chronic pancreatitis patients. Methods: We retrospectively reviewed chronic pancreatitis patients who underwent fecal elastase assessment and abdominal MRI in our institute within 1 year. We identified 123 patients divided into three groups based on the fecal elastase value: group A with fecal elastase > 200 μg/g; group B with fecal elastase between 100 and 200 μg/g; and group C with fecal elastase < 100 μg/g. Computer-assisted quantitative edge analysis of pancreatic margins was made on non-contrast-enhanced water-only Dixon T1-weighted images, obtaining the pancreatic margin score (PMS). PMS values were compared across groups using a Kruskal–Wallis test and the correlation between PMS and fecal elastase values was tested with the Spearman’s test. Results: A significant difference in PMS was observed between the three groups (p < 0.0001), with a significant correlation between PMS and elastase values (r = 0.6080). Conclusions: Quantitative edge analysis may stratify chronic pancreatitis patients according to the degree of exocrine insufficiency, potentially contributing to the morphological and functional staging of this pathology. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

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13 pages, 1397 KiB

Open AccessArticle

Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department

by Saowaluck Faikhongngoen, Boriboon Chenthanakij, Borwon Wittayachamnankul, Phichayut Phinyo and Wachira Wongtanasarasin

Diagnostics 2022, 12(9), 2246; https://doi.org/10.3390/diagnostics12092246 - 17 Sep 2022

Cited by 2 | Viewed by 3975

Abstract

We aim to develop a diagnostic score for acute cholecystitis that integrates symptoms, physical examinations, and laboratory data to help clinicians for timely detection and early treatment of this disease. We retrospectively collected data from our database from 2010 to 2020. Patients with acute abdominal pain who underwent an ultrasound or computed tomography (CT) scan at the emergency department (ED) were included. Cases were identified by pathological, CT, or ultrasound reports. Non-cases were those who did not fulfill any of these criteria. Multivariable regression analysis was conducted to identify predictors of acute cholecystitis. The model included 244 patients suspected of acute cholecystitis. Eighty-six patients (35.2%) were acute cholecystitis confirmed cases. Five final predictors remained within the reduced logistic model: age < 60, nausea and/or vomiting, right upper quadrant pain, positive Murphy’s sign, and AST ≥ two times upper limit of normal. A practical score diagnostic performance was AuROC 0.74 (95% CI, 0.67–0.81). Patients were categorized with a high probability of acute cholecystitis at score points of 9–12 with a positive likelihood ratio of 3.79 (95% CI, 1.68–8.94). ED Chole Score from these five predictors may aid in diagnosing acute cholecystitis at ED. Patients with an ED Chole Score >8 should be further investigated. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

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Review

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16 pages, 307 KiB

Open AccessReview

Application of Ultrasound Elastography in Assessing Portal Hypertension

by Man Zhang, Hongyu Jin, Jiazhi Cao, Ruyu Ren, Menglu Jia, Yi Yang, Xinyi Li, Ming Chen, Shen Li, Libin Huang and Wenwu Ling

Diagnostics 2022, 12(10), 2373; https://doi.org/10.3390/diagnostics12102373 - 29 Sep 2022

Cited by 2 | Viewed by 2280

Abstract

Portal hypertension is a common manifestation in late-to-end-stage liver diseases and can cause severe complications such as ascites, hepatic encephalopathy, etc. However, an early diagnosis of portal hypertension is often difficult as it can be asymptomatic. Though the gold standard to diagnose portal hypertension is hepatic vein catheterization, ultrasound elastography is regarded as a noninvasive alternative that can be used to accurately predict portal hypertension and a few further complications such as gastro-esophageal varices. Since ultrasound elastography is available in most medical centers, and is cheaper and noninvasive, studying its function in predicting portal hypertension is of paramount importance. Therefore, this review generalized the results of recently published articles in order to establish the indicators that were related to diagnostic and prediction efficiency. Our study found that various technologies of ultrasound elastography could be used to predict portal hypertension with satisfactory diagnostic sensitivity, specificity, accuracy, and AUC. Meanwhile, we also recognized similar diagnostic efficiency of ultrasound elastography in gastro-esophageal varices. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

Other

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20 pages, 6476 KiB

Open AccessSystematic Review

An Assessment of the Feasibility, Patient Acceptance, and Performance of Point-of-Care Transient Elastography for Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review and Meta-Analysis

by Taranika Sarkar Das, Xucong Meng, Mohamed Abdallah, Mohammad Bilal, Raiya Sarwar and Aasma Shaukat

Diagnostics 2024, 14(22), 2478; https://doi.org/10.3390/diagnostics14222478 - 6 Nov 2024

Viewed by 442

Abstract

Background: Vibration-Controlled Transient Elastography (VCTE) with FibroScan is a non-invasive, reliable diagnostic tool for Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD), enabling early detection and management to prevent severe liver diseases. VCTE’s ease and portability suit primary care, streamlining referrals, promoting lifestyle changes, reducing costs, and benefiting underserved communities. Methods: Studies on point-of-care VCTE were systematically reviewed, followed by meta-analysis using a random-effects model. Pooled proportions with 95% confidence intervals were reported, and heterogeneity was assessed using I2%. Results: A total of twenty studies from 14 countries, including 6159 patients, were analyzed, with three studies from France, two from the U.S., and four from China. The population had a slight male preponderance, with a mean age range of 35–73 years and a BMI range of 24.4–41.1%. The diagnostic accuracy for detecting any fibrosis (≥F1) was reported in four studies (n = 210) with an AUC of 0.74, sensitivity of 69.5%, and specificity of 70.6%. For significant fibrosis (≥F2), eight studies (n = 650) reported an AUC of 0.69, sensitivity of 81.7%, and specificity of 64.6%. Advanced fibrosis (≥F3) was evaluated in 10 studies (n = 619), with an AUC of 0.84, sensitivity of 88.1%, and specificity of 63.8%. Cirrhosis (F4) was assessed in nine studies (n = 533), with an AUC of 0.65, sensitivity of 87.5%, and specificity of 62.6%. Steatosis diagnoses across stages S1 to S3 showed increasing diagnostic accuracies, with AUCs of 0.85, 0.76, and 0.80, respectively. Probe type and BMI were significant covariates influencing diagnostic performance for both fibrosis and steatosis, while the percentage of male participants also showed significant associations. Conclusions: VCTE shows high diagnostic accuracy for fibrosis and steatosis in MASLD patients at the point of care. Future research should assess its implementation in fibroscan settings. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

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14 pages, 523 KiB

Open AccessSystematic Review

Percutanous Electrochemotherapy (ECT) in Primary and Secondary Liver Malignancies: A Systematic Review

by Vincenza Granata, Roberta Fusco, Valeria D’Alessio, Igino Simonetti, Francesca Grassi, Lucrezia Silvestro, Raffaele Palaia, Andrea Belli, Renato Patrone, Mauro Piccirillo and Francesco Izzo

Diagnostics 2023, 13(2), 209; https://doi.org/10.3390/diagnostics13020209 - 5 Jan 2023

Cited by 10 | Viewed by 1985

Abstract

The aim of the study was to analyse papers describing the use of Electrochemotherapy (ECT) in local treatment of primary and secondary liver tumours located at different sites and with different histologies. Other Local Ablative Therapies (LAT) are also discussed. Analyses of these papers demonstrate that ECT use is safe and effective in lesions of large size, independently of the histology of the treated lesions. ECT performed better than other thermal ablation techniques in lesions > 6 cm in size and can be safely used to treat lesions distant, close, or adjacent to vital structures. ECT spares vessel and bile ducts, is repeatable, and can be performed between chemotherapeutic cycles. ECT can fill the gap in local ablative therapies due to being lesions too large or localized in highly challenging anatomical sites. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Gastrointestinal and Hepato-Bilio-Pancreatic Disorders)

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