OBJECTIVES:To assess the prevalence of aortitis and aortic dilation at diagnosis, estimate the progression of aortic diameter over time, and identify predictors of incident aortic dilation development in patients with newly diagnosed GCA. METHODS:We conducted a retrospective cohort study involving 157 patients with new-onset GCA from two European centres. All patients underwent baseline thoracic aortic imaging within 6 months of diagnosis and at least one follow-up imaging ≥6 months later. Outcomes included baseline aortic diameter, aortic expansion (cm2/year), and incident aortic dilation. Multivariable regression models were adjusted for sex and age. RESULTS:Aortitis was present in 60.4% of patients at baseline. Baseline aortic dilation was identified in 19.6% of patients, predominantly in the mid-ascending aorta. Aortitis was associated with larger aortic diameters and higher odds of baseline aortic dilation (adjusted odds ratio 2.3; 95% CI: 1.0, 5.1). Over a median follow-up of 30 months, incident aortic dilation developed in 9.8% of patients. Baseline aortic diameter was the strongest predictor of aortic expansion (β = 0.088; P = 0.006) and incident aortic dilation (adjusted hazard ratio 3.9; 95% CI: 2.0, 7.3). CONCLUSION:Aortic involvement is common at the time of GCA diagnosis, and baseline aortic diameter is the strongest predictor of future dilation in our cohort. These findings highlight the importance of early imaging assessment and longitudinal monitoring of aortic dimensions in patients with newly diagnosed GCA.

This retrospective study evaluated the applicability of radiomics analysis to mammographic images of patients with triple-negative breast cancer (TNBC) to identify features differentiating BRCA gene’s mutational status. The mammographic images of 52 patients histologically diagnosed with TNBC, (13 BRCA-mutated patients and 39 BRCA wild-type ones), were included and 53 tumor lesions were manually segmented in the mammographic projection where they were better demarcable. An additional elliptical ROI of standard size was drawn in the most homogeneous area of the contralateral healthy gland, using the analogue mammographic projection of the same date or, if not available, of the corresponding bilateral mammographic investigation closer to the time of diagnosis. Lesions consisted of 36 masses, 2 pathological microcalcifications, and 15 masses with microcalcifications. Radiomic features were extracted using Pyradiomics-3D. Preliminary analysis confirmed feasibility and showed differences in texture features, particularly GLCM SumEntropy, between BRCA-mutated and non-mutated patients. Moreover, the study enhanced the role of healthy glandular tissue in distinguishing the two groups, supporting and reinforcing previous MRI-based radiomics findings in the same population. The study concludes that radiomics analysis of diagnostic mammograms in TNBC patients is feasible and may help build predictive models to discriminate between BRCA mutated and non-mutated patients.

Abstract Objective This scoping review explores the potential role of cancer-staging chest CT scans in assessing cardiovascular (CV) risk in cancer patients. It aims to evaluate: (1) the correlation between non-gated chest CT and the conventional Agatston score from cardiac CT; (2) the association between coronary calcium scores from non-gated chest CT and CV risk in non-oncological patients; (3) the link between coronary calcium assessed by non-gated chest CT and CV events or endothelial damage in cancer patients. Methods Three different searches were performed on PubMed, according to the three steps described above. Both original articles and systematic reviews were included. Results Many studies in the literature have found a strong correlation between coronary calcium scores from non-gated chest CTs and the conventional Agatston scores from gated cardiac CTs. Various methodologies, including Agatston scoring, ordinal scoring, and the “extent” and “length” methods, have been successfully adapted for use with non-gated chest CTs. Studies show that non-gated scans, even those using iodinated contrast, can accurately assess coronary calcification and predict CV risk, with correlations as high as r = 0.94 when compared to cardiac CTs. In oncological settings, studies demonstrated a significant link between coronary calcium levels on non-gated chest CTs and higher CV risk, including MACE and overall mortality. Conclusions Radiological assessment of coronary calcium on non-gated CT scans shows potential for improving CV risk prediction. Critical relevance statement Non-gated chest CT scans can detect endothelial damage in cancer patients, highlighting the need for standardized radiological practices to assess CV risks during routine oncological follow-up, thereby enhancing radiology’s role in comprehensive cancer care. Key Points Cancer therapies improve outcomes but increase cardiovascular risk, requiring balanced management. Coronary calcification on non-gated CT correlates with Agatston scores, predicting cardiovascular risk. Routinely performed CTs predict cardiovascular risk, optimizing the management of cancer patients. Graphical Abstract

Increased CT-derived fat tissue radiodensity has been indicated as a poor prognostic factor in oncological settings, although the reasons are not clear. One hypothesis is that increased radiodensity may reflect the loss of fat droplets within adipocytes, being a proxy of recent weight loss. This study aims to test this hypothesis by evaluating the association between longitudinal variations in fat tissue radiodensity and area in a cohort of COVID-19 patients. Baseline and 2–3-month follow-up chest CT scans of severe COVID-19 pneumonia survivors were retrospectively reviewed to measure subcutaneous, visceral, and intermuscular adipose tissue (SAT, VAT, and IMAT) areas and densities at the T7–T8 vertebrae, and longitudinal variations were computed for each variable. The associations between each compartment area and radiodensity variations (standardized values) were evaluated in univariate linear models and models adjusted by age and sex. A total of 196 COVID-19 survivors with suitable baseline and follow-up CT scans were included (mean age 65 ± 11 years, 62 (31.6%) females, 25% with diabetes and 2.6% with morbid obesity). Longitudinal variation in SAT area was inversely associated with longitudinal variation in SAT radiodensity in univariate models (coeff −0.91, 95%CI = −1.70/−0.12, p = 0.02) and after adjustment by age and sex (coeff −0.89, 95%CI = −1.7/−0.09, p = 0.03). The effect was similar and stronger for IMAT (coeff −2.1, 95%CI = −3.06/−1.19, p < 0.01 in adjusted models), and absent for VAT. Longitudinal variations in subcutaneous and intermuscular adipose tissue areas and densities are inversely associated. Higher adipose tissue radiodensity may be due to decrease in fat area (i.e., weight loss), explaining the poor prognostic effect found in cancer patients.

OBJECTIVES:To assess the maintenance of efficacy of one year of tocilizumab (TCZ) monotherapy after its discontinuation in large vessel-GCA (LV-GCA). METHODS:17 patients with active LV-GCA were previously treated with 3 boluses of intravenous methylprednisone and weekly subcutaneous TCZ in monotherapy for 52 weeks. Patients in relapse-free clinical remission at week 52 discontinued TCZ and entered part two, which was a 26-week observational follow-up period. PET/CT was performed in all patients at the end of the 26-week observational period (week 78). End points were the variation in PET vascular activity score (PETVAS) at week 78 compared with baseline and with week 52, and the proportion of patients with relapse-free clinical remission at week 78 and at the end of the follow-up. RESULTS:Compared with baseline, a significant reduction in PETVAS was observed at week 78, mean (95% CI) change -6.6 (-9.5 to -3.7). However, compared with week 52, PETVAS significantly increase 6 months after TCZ discontinuation (week 78), mean (95% CI) change 4.6 (0.7-8.5). The proportion of patients with relapse-free clinical remission at weeks 78 and at the end of the follow-up (median time from TCZ discontinuation 148 weeks) was 11/17 (65%, 95% CI 38-86) and 8/17 (47%, 95% CI 23-72), respectively. Age and sex-adjusted HR (95% CI) for each unit increase of PETVAS indicating subsequent relapse was 1.36 (0.92-2.00). CONCLUSIONS:One year of TCZ monotherapy was effective in maintaining drug-free clinical remission in LV-GCA. Changes in PETVAS early after TCZ discontinuation may predict subsequent relapses. TRIAL REGISTRATION:ClinicalTrials.gov, http://clinicaltrials.gov, NCT05394909.

The first part of this review highlighted the evolving landscape of atherosclerosis, noting emerging cardiometabolic risk factors, the growing impact of exposomes, and social determinants of health. The prominent role of atherosclerosis in the bidirectional relationship between cardiovascular disease and cancer was also discussed. In this second part, we examine the complex interplay between multimorbid cardio-oncologic patients, cardiometabolic risk factors, and the harmful environments that lend a “syndemic” nature to these chronic diseases. We summarize management strategies targeting disordered cardiometabolic factors to mitigate cardiovascular disease and explore molecular mechanisms enabling more tailored therapies. Importantly, we emphasize the early interception of atherosclerosis through multifactorial interventions that detect subclinical signs (via biomarkers and imaging) to treat modifiable risk factors and prevent clinical events. A concerted preventive effort—referred to by some as a “preventome”—is essential to reduce the burden of atherosclerosis-driven chronic diseases, shifting from mere chronic disease management to the proactive promotion of “chronic health.”

The AI case malignancy score (AI-CMS) represents the AI algorithm’s confidence (from 0 to 100

Background: Metabolic syndrome (MetS) is a common comorbidity associated with hypertension that occurs more often in primary aldosteronism (PA). Our work aims to investigate the prevalence of MetS and its determinants in unilateral PA and bilateral PA, as confirmed by adrenal venous sampling (AVS). Methods: This was a retrospective, cross-sectional study. We investigated metabolic indicators in 160 cases of PA, categorized by AVS—82 with unilateral PA and 78 with bilateral PA. A control group of 80 non-PA patients with essential hypertension, matched for age and sex, was also included. Results: Unilateral PA had a higher aldosterone–renin ratio and lower serum potassium levels than bilateral PA. Nevertheless, bilateral PA exhibited a higher prevalence of MetS (41% vs. 30.5%; p = 0.001), obesity, BMI, LDL hypercholesterolemia, and hypertriglyceridemia than unilateral PA. Conclusions: Bilateral PA presents a greater incidence of MetS than unilateral PA, in spite of the latter showing a higher aldosterone–renin ratio and lower serum potassium levels. The results suggest that the mechanisms underlying MetS may differ between unilateral and bilateral PA.

IntroductionGiant Cell Arteritis (GCA) is the most common vasculitis in the elderly, characterized by granulomatous infiltration of immune cells in medium and large arteries. A therapeutic protocol that combines ultra-short glucocorticoids (GC) followed by tocilizumab (TCZ) monotherapy has been proven effective in GCA patients with extracranial large vessel involvement (LV-GCA). However, its effects on circulating immune cells are unknown. The aim of this study was to deepen the understanding of the immunological mechanisms behind this treatment regimen in patients with LV-GCA.Methods15 patients with active LV-GCA were included in this study. Blood samples were collected at baseline, after 3 days of GC treatment, at weeks 24 and 52 during TCZ monotherapy, and at week 78 after the suspension of TCZ. Peripheral blood mononuclear cells were isolated from blood samples. The percentages of lymphocyte and monocyte subsets and the expression of the monocyte markers CCR2, CX3CR1, and HLA-DR were analyzed by flow cytometry. Paired Student’s t-test and mixed-effects analysis were used for the comparison between and among groups, respectively.ResultsGC boluses increased the percentages of B lymphocytes and classical monocytes while decreased those of CD4+ T lymphocytes and intermediate and non-classical monocytes. Moreover, GC boluses increased CCR2 and decreased HLA-DR and CX3CR1 expression by monocytes. TCZ induced a reduction in CCR2 expression versus baseline in classical and intermediate monocytes. Patients with higher reduction in CCR2 expression in intermediate monocytes at 24 weeks and 52 weeks versus baseline showed signs of disease activity at 78 weeks.ConclusionGC boluses modified the relative percentages of lymphocyte and monocyte subsets and modified the expression levels of CCR2, CX3CR1, and HLA-DR in monocytes. These changes may contribute to the anti-inflammatory effects of GCs. TCZ monotherapy had more limited effects. Changes in CCR2 expression by intermediate monocytes might have a prognostic value in LVV.

OBJECTIVES:The objectives of this study were to investigate the role of total inflammation vascular volume (TIVV), a novel quantitative parameter obtained from 18-fluorodeoxyglucose (18F-FDG) PET/CT, in assessing disease activity and predicting relapses and aortic dilatation in patients with large-vessel (LV)-GCA. METHODS:This retrospective analysis included PET/CT scans from the TOPAZIO study. Patients with active LV-GCA were enrolled and treated with tocilizumab monotherapy for 52 weeks, preceded by three boluses of i.v. methylprednisone. PET/CT scans were performed at baseline and at weeks 24, 52 and 78. TIVV was calculated using a semiautomatic approach, while total inflammation glycolytic volume (TIGV) was obtained by multiplying TIVV by the mean standardized uptake value (SUVmean). Visual assessment was performed, and PET vascular activity score (PETVAS) and total vascular score (TVS) were calculated. RESULTS:Eighteen patients with a total of 61 PET scans were included. TIVV and TIGV were strongly associated with active disease, with odds ratios (ORs) of 4.74 (95% CI 1.23-18.2) and 5.45 (95% CI 1.36-21.8), respectively, whereas PETVAS and TVS showed moderate associations (OR 2.16; 95% CI 0.87-5.33 and 1.86; 95% CI 0.76-4.52, respectively). Over a median follow-up of 117 weeks, 10 events occurred. The Cox proportional hazard model showed strong associations of TIVV and TIGV with time to relapse or aortic dilatation, with hazard ratios (HRs) of 2.50 (95% CI 1.07-5.84) and 2.23 (95% CI 1.04-4.82), respectively. PETVAS and TVS exhibited a weaker association with prognosis. CONCLUSION:TIVV and TIGV showed superior diagnostic and prognostic performance compared with conventional PET parameters, underscoring the importance of inflammation volume in evaluating disease activity in LV-GCA. TRIAL REGISTRATION:ClinicalTrials.gov, http://clinicaltrials.gov, NCT05394909.

We aimed to identify cytokines whose concentrations are related to lung damage, radiomic features, and clinical outcomes in COVID-19 patients. Two hundred twenty-six patients with SARS-CoV-2 infection and chest computed tomography (CT) images were enrolled. CCL18, CHI3L1/YKL-40, GAL3, ANG2, IP-10, IL-10, TNFα, IL-6, soluble gp130, soluble IL-6R were quantified in plasma samples using Luminex assays. The Mann–Whitney U test, the Kruskal–Wallis test, correlation and regression analyses were performed. Mediation analyses were used to investigate the possible causal relationships between cytokines, lung damage, and outcomes. AVIEW lung cancer screening software, pyradiomics, and XGBoost classifier were used for radiomic feature analyses. CCL18, CHI3L1, and ANG2 systemic levels mainly reflected the extent of lung injury. Increased levels of every cytokine, but particularly of IL-6, were associated with the three outcomes: hospitalization, mechanical ventilation, and death. Soluble IL-6R showed a slight protective effect on death. The effect of age on COVID-19 outcomes was partially mediated by cytokine levels, while CT scores considerably mediated the effect of cytokine levels on outcomes. Radiomic-feature-based models confirmed the association between lung imaging characteristics and CCL18 and CHI3L1. Data suggest a causal link between cytokines (risk factor), lung damage (mediator), and COVID-19 outcomes.

Background: Temporal artery biopsy (TAB) still represents the gold standard for giant cell arteritis (GCA) diagnosis. The eosinophilic infiltrate at TAB has been described in 8% of 274 TAB with transmural inflammation[1]. Whether it is part of the GCA spectrum or indicate other conditions is still controversial. Objectives: The aim of our study was to describe the clinical findings, disease course and treatment response of GCA patients with transmural eosinophilic infiltration at TAB. Methods: All biopsies with evidence of transmural inflammation obtained between January 1986 and December 2013 at the IRCCS in Reggio Emilia, Italy were reviewed by a single pathologist. The eosinophilic infiltrate was defined by ≥ 20 eosinophils/high-power-field (hpf) and was categorized according to the severity (mild ≥20 and <40/hpf, moderate ≥40 and <60/hpf, and severe ≥60/hpf). Patients with histological evidence of eosinophilic infiltration were compared with patients without for demographic, clinical and histological features. To compare the presence of eosinophil-related manifestations (namely asthma, allergic rhinitis, and nasal polyposis), patients with eosinophilic infiltrate were matched 1:2 for age, sex, and duration of follow-up (±5 years) with patients without. Results: 254 TAB were included, 22 (8.7%) showed evidence of eosinophilic infiltrate. GCA patients with eosinophilic infiltration were more likely females (p = 0.055). At diagnosis, they presented more frequently cranial symptoms (p = 0.052), particularly headache (p = 0.005), and systemic manifestations (p = 0.016). They also showed higher C-reactive protein levels at diagnosis (p = 0.001) (Table 1). Regarding histological lesions, a severe transmural inflammation, laminar necrosis, and intraluminal acute thrombosis were more frequently observed in patients with eosinophilic infiltration (p = 0.066, p < 0.001, and p = 0.010, respectively). Almost no differences were observed in the two groups regarding frequencies of relapses, long-term remission, duration of glucocorticoid therapy and its cumulative dose. When the 22 patients were matched with 44 without eosinophilic infiltrate, no differences in the eosinophil levels or in the development of eosinophil-related manifestations were detected. Furthermore, no patient developed signs of systemic necrotizing vasculitis during follow up. Conclusion: Patients with transmural eosinophilic infiltration represent a subset of GCA patients with cranial manifestations and more severe inflammation, both at clinical and histological levels. REFERENCES: [1]Cavazza A,et al. Am J Surg Pathol. 2014 Oct;38(10):1360-70. doi: 10.1097/PAS.0000000000000244Table 1. Demographic and clinical features at diagnosis of patient with eosinophilic infiltrate compared with those without. Acknowledgements: NIL. Disclosure of Interests: None declared.

Objectives: To assess the effectiveness and safety of the 26-week tapering regimen of glucocorticoids (GC) used in the GiACTA trial in a prospective cohort of treatment-naive, biopsy-proven GCA patients. Methods: Patients with a new diagnosis of biopsy-proven GCA enrolled in the GC arm of the START project (molecular stratification of patients with GCA to tailor GC and tocilizumab therapy) were included. All patients were treated with the 26-week taper regimen of GC used in the GiACTA trial. The primary endpoint was the rate of relapse-free remission at week 52. The secondary endpoints were the proportion of patients with incident aortic damage, cumulative GC doses and GC-related adverse events (AE).Results: 22 patients were included between December 2018 and February 2022. At week 52, 10 patients (45 %, 95 % CI 24-68) were in relapse-free remission. After a median (IQR) follow-up of 35 (22-40) months, 7 patients (32 %, 95 % CI 14-55) were in relapse-free remission. 18 patients with baseline large-vessel imaging underwent CT angiography at the end of the follow-up. No patients had evidence of new aortic dilation, significant progression of aortic damage or large vessel stenosis. 15/22 patients (68 %) had at least one relapse during follow-up. No patients developed visual or cerebrovascular manifestations during relapses. 15/22 (68 %) patients had at least one GC-related AE.Conclusions: A 26 week taper regimen of GC was effective and safe in inducing and maintaining remission in a sizeable proportion of newly diagnosed GCA patients. However, the frequency of GC-related adverse events was high.

This retrospective study aimed to compare the average glandular dose (AGD) per acquisition in breast biopsies guided by contrast-enhanced mammography (CEM), conventional stereotactic breast biopsy (SBB), and digital breast tomosynthesis (DBT). The study also investigated the influence of compressed breast thickness (CBT) and density on AGD. Furthermore, the study aimed to estimate the AGD per procedure for each guidance modality. The study included 163 female patients (mean age 57 ± 10 years) who underwent mammography-guided biopsies using SBB (9

AimsTumour necrosis and/or increased mitoses define high‐grade papillary thyroid carcinoma (PTC). It is unclear whether angioinvasion is prognostic for PTC. Cut‐offs at five or more mitoses/2 mm2 and four or more angioinvasive foci have been empirically defined based upon data from all forms of aggressive non‐anaplastic thyroid carcinomas. Performance of tumour necrosis, mitoses and vascular invasion in predicting distant metastases when specifically applied to PTC is undefined.MethodsWe analysed 50 consecutive PTC cases with distant metastases (DM‐PTC): 16 synchronous and 34 metachronous. A total of 108 non‐metastatic PTC (N‐DM‐PTC, 15.0‐year median follow‐up) were used as controls. Invasive encapsulated follicular variant PTC was excluded. Necrosis, mitoses and angioinvasion were quantified. Receiver operating characteristics (ROC) and area under the curve (AUC) analyses determined best sensitivity and specificity cut‐offs predictive of distant metastases.ResultsMetastases correlated with necrosis (any extent = 43.8% all DM‐PTC, 53.1% metachronous DM‐PTC versus 5% N‐DM‐PTC; P < 0.001), mitoses (P < 0.001) and angioinvasion (P < 0.001). Mitoses at five or more per 2 mm2 was the best cut‐off correlating with distant metastases: sensitivity/specificity 42.9%/97.2% all DM‐PTC (AUC = 0.78), 18.8%/97.2% synchronous DM‐PTC (AUC = 0.63), 54.6%/97.2% metachronous DM‐PTC (AUC = 0.85). Angioinvasive foci at five or more was the best cut‐off correlating with distant metastases: sensitivity/specificity 36.2%/91.7% all DM‐PTC (AUC = 0.75), 25%/91.7% synchronous DM‐PTC (AUC = 0.79) and 41.9%/91.7% metachronous DM‐PTC (AUC = 0.73). Positive/negative predictive values (PPV/NPV) were: necrosis 22.6%/98.2%; five or more mitoses 32.3%/98.2%; five or more angioinvasive foci 11.8%/97.9%. After multivariable analysis, only necrosis and mitotic activity remained associated with DM‐PTC.ConclusionOur data strongly support PTC grading, statistically validating World Health Organisation (WHO) criteria to identify poor prognosis PTC. Angioinvasion is not an independent predictor of DM‐PTC.

BACKGROUND:Transperitoneal laparoscopic adrenalectomy (TLA) is the most frequently chosen approach in adrenal surgery. At present, impact of obesity on patient outcomes following adrenal surgery is frequently under discussion. We intended to offer updated evidence thanks to a comparison between intraoperative and perioperative outcomes in non-obese and obese patients, who underwent TLA for benign or malignant adrenal diseases. METHODS:Our systematic review made use of Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Articles of interest turned out from a search with PubMed/MEDLINE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials-CENTRAL), Web of Science (Science and Social Science Citation Index), and Scopus databases. We evaluated two groups of outcomes: intraoperative (operative time, intraoperative complications rate, estimated blood loss (EBL), transfusion rate, conversion to open surgery rate) and postoperative (overall postoperative complications rate, major postoperative complications rate, length of hospital stay). RevMan (Computer program) Version 5.4 was used to perform the meta-analysis. The heterogeneity of the included studies in the meta-analysis was assessed by using the I2 statist. RESULTS:The 8 included comparative studies (1,646 patients: 995 non-obese versus 651 obese) had a time frame of approximately 30 years (1994-2020) and an observational nature. Meta-analysis showed no differences in terms of operative time, intraoperative complications rate, EBL, transfusion rate, conversion to open surgery rate, overall postoperative complications rate, major (Clavien-Dindo ≥ III) postoperative complications rate, length of hospital stay between non-obese and obese populations. CONCLUSIONS:We can say that obesity does not impact TLA safety and effectiveness. Due to biases among meta-analyzed studies (small overall sample size and small number of events analyzed, in particular), careful interpretation is needed to interpret our results. Additional randomized, possibly multi-center trials may contribute to confirm our results.