We compared three customized nnU-Net models (A: baseline two-dimensional (2D); B: 2D + region-growing; C: three-dimensional (3D) + region-growing) for automated detection and blood clot volume (BCV) quantification of acute pulmonary embolism (PE) on computed tomography pulmonary angiography (CTPA), and to explore the association between BCV and clinical outcome. We retrospectively screened 9,715 CTPA examinations (2015‒2024) to develop a dataset of 874 PE-positive and 339 PE-negative cases. A stratified subset (n = 437) with manually refined ground-truth segmentations was used for model training and internal validation. Region-growing in Models B and C included a 5-voxel negative buffer. Internal testing was performed on 776 cases (Humanitas dataset). External testing was performed on the public RSPECT-RSNA dataset. Performance metrics included accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) at zero-clot and for optimized BCV threshold. Correlations between BCV, survival, and major adverse cardiovascular events (MACE) were analyzed. Model C achieved the highest AUROC on external testing (0.868), outperforming Model A (0.843) and Model B (0.846). On internal testing at ROC-optimized threshold, Model C showed the highest accuracy (85.5

BACKGROUND:The aim of this study was to retrospectively evaluate technical efficacy and safety of radiofrequency ablation (RFA) of renal tumors using a novel RF system. METHODS:Eighty-two patients with 85 renal tumors (renal cell, papillary and chromophobe carcinomas, oncocytomas and lymphoma) considered unsuitable for surgery by the local Multidisciplinary Board were enrolled for RFA. Tumor location was exophytic in 49.4% of patients, endophytic in 36.5% and central in 14.1%, and tumor size was below 3 cm in 68/85 (80%) cases and between 3.1 and 4.3 cm in the remaining 17 (20%). A new high-power RF system with a maximum power of 370W, a pulsing algorithm for automated control of energy deposition and internally-cooled electrode tip up to 5 cm long was used. Technical success and technique efficacy (also related to size and location of tumors), and safety were evaluated. The follow-up period ranged from 12 to 26 months. RESULTS:The ablation time was much shorter than with conventional RF systems, ranging between 12 and 15 minutes. At the immediate post-procedural assessment, the technical success was 100%. At the first follow-up evaluation, at two months, primary technique efficacy was achieved in 80/85 (94.1%) cases, without significant differences according to tumor location and size. The 5 partially ablated tumors were successfully retreated and the secondary technique efficacy at 12 months was 100%. Considering only the subgroup of the 45 patients with cyto-histologically proven RCC, the primary technique efficacy was 88.9% (40/45 cases) and the secondary was 100%. Significant complications, CIRSE grade 3, occurred in 3/90 (3.3%) procedures, but only one required treatment (transarterial embolization), while minor complications, all spontaneously remitting, occurred in 27/90 procedures. RFA performed with this new technology proved to be fast, effective and safe, and was associated with shorter procedure times and very few major complications, thus reducing or bridging the gap with MWA and CA. CONCLUSIONS:RFA performed with this new modality resulted safe and effective and it is associated with short procedural times. The automatic energy-delivery controlled system might overcome limitations due to long procedural times and heat-sink effect in RFA.

Surgery with perioperative chemotherapy offers a potentially curative treatment for colorectal liver metastases (CRLM). Selection of candidates for resection relies on survival prediction, but available prognostic factors have limited reliability. This study evaluated the potential of preoperative CT-based radiomics to predict overall survival, focusing on the impact of the CT–surgery interval and peritumoral tissue analysis. All consecutive patients undergoing resection for CRLM (2010–2020) with contrast-enhanced CT performed ≤ 60 days before surgery and at least one CRLM ≥ 10 mm were considered. Manual tumor segmentation (Tumor-VOI) and automatic 5-mm peritumoral expansion (Margin-VOI) were performed on portal phase images. From each VOI, 110 IBSI-compliant radiomic features were extracted. Three prediction models were developed: Clinical, Clinical+Tumor-radiomics, Clinical+Tumor/Margin-radiomics. Features selection was performed using Boruta algorithm, followed by Random Forest classification with 10-fold cross-validation. Model performance was evaluated in the entire cohort and in patients with CT-surgery interval ≤ 30 days. 306 patients were included (mean age 63 years; 187 men). Five-year survival was 40.9

PURPOSE:To systematically describe the observed safety and pain outcomes of genicular artery embolization (GAE) for symptomatic knee osteoarthritis (KOA), compare embolic agent classes, and critically appraise the methodological quality of available evidence, including sham-controlled randomized controlled trial (RCT) design. METHODS:Adults with radiographic KOA who underwent transcatheter GAE and reported ≥ 1 patient-reported outcome measure were eligible. The primary outcome was VAS pain reduction at 12 months. Secondary outcomes included WOMAC and KOOS scores, technical success, and adverse events. Random-effects meta-analysis with REML estimation was used; prediction intervals were computed. Pre-specified subgroup analysis compared imipenem/cilastatin versus permanent microspheres. RESULTS:22 studies (3 RCTs, 19 single-arm or comparative cohorts) comprising 633 patients and 719 knees were included. Pooled within-group VAS WMD at 12 months: -39.6 mm (95% CI, -47.1 to - 32.1; 95% prediction interval [PI], -58.4 to - 20.8; I2 = 76%; p < 0.001). IPM/CS and permanent microspheres produced equivalent observed outcomes (between-subgroup p = 0.73). Technical success: 98.7%. Pooled minor adverse event rate: 18.3%. RCT-pooled between-group SMD versus sham: -0.23 (95% CI, -0.71 to + 0.25; p = 0.34; I2 = 38%). CONCLUSIONS:GAE is consistently associated with large within-group pain reductions; however, these pre-post estimates are descriptive and do not establish procedure-specific causal efficacy. Three sham-controlled RCTs did not demonstrate significant between-group benefit, representing the highest-quality evidence currently available. Embolic agent class does not significantly influence pain-reduction outcomes; however, safety profiles are not equivalent-focal asymptomatic osteonecrosis was reported exclusively with permanent microspheres, warranting prospective imaging surveillance and explicit patient counseling. Adequately powered RCTs with pharmacologically inert controls, standardized technique protocols, and systematic safety imaging are required before definitive conclusions can be drawn.

Introduction: Small Bowel Obstruction (SBO) accounts for 15% of emergency department (ED) admissions. While conservative management is recommended, surgery becomes necessary when strangulation is suspected. Identifying which patients need surgery remains a challenge, as traditional imaging lacks sufficient sensitivity and specificity. This study aimed to explore radiomic features to identify potential predictors of strangulation. Methods: This retrospective study included patients admitted to a tertiary referral hospital ED between 2019 and 2023, diagnosed with Adhesion Small Bowel Obstruction (aSBO) via contrast-enhanced abdominal CT scans. Two patient groups were examined: those who underwent surgery with bowel resection and ischemic changes confirmed histologically (operative management—OM) and those successfully treated with conservative management (CM). All CT scans were reviewed blindly by a general surgeon and an experienced radiologist. Pre-obstructive loop segmentation was performed using 3D Slicer software, with slice-by-slice contouring of intestinal borders on images of suspected strangulated bowel. Radiomic features were extracted, followed by univariate and multivariate regression analysis. Results: A total of 55 patients were included: 27 CM and 28 OM. Significant differences emerged in GLCM (Gray Level Co-occurrence Matrix), GLDM (Gray Level Dependence Matrix), GLRLM (Gray Level Run Length Matrix), and GLSZM (Gray Level Size Zone Matrix), particularly involving entropy and uniformity. These metrics reflect subtle variations in gray levels not visible to the naked eye. Conclusions: Differences in entropy, uniformity, and energy align with imaging and histopathological findings, supporting the development of radiomic models and future AI-based prediction tools.

Background and Aims:Cholangiocarcinoma (CCA) displays remarkable anatomical and histological heterogeneity. Besides diagnosis confirmation, histology currently does not have a major role in the management of CCA. We aimed to study the clinical relevance of histological heterogeneity of CCA and putative tissue biomarkers by creating a multicentric digitalized European CCA Histology Registry.Approach and Results:Nine referral centers, participating in the International Cholangiocarcinoma Clinical Registry, shared samples and data from 293 patients. Histological and immunohistochemistry stains (n=10) were performed. Computed tomography (CT) scans (n=112 cases) were analyzed by morphological and radiomics techniques. A selection of cases (n=18) was processed for spatial transcriptomics analysis. No significant differences in 5-year overall survival (OS) were found in perihilar CCA versus intrahepatic (i) CCA, and in small bile duct (SBD) versus large bile duct (LBD) iCCA. When cases were classified by Periodic acid of Schiff (PAS) positivity (mucin content), PASHIGH LBD iCCA showed a significantly worse 5-year OS compared to PASLOW iCCA. Multivariate Cox regression identified PASHIGH LBD iCCA phenotype as an independent predictor of worse OS. PASHIGH LBD iCCA subtype showed specific molecular characteristics at spatial transcriptomics and immunohistochemistry; CT scans and serology could distinguish PASHIGH LBD iCCA phenotype with excellent accuracy.Conclusions:Our data underline the importance of identifying morphological subclasses with a significant prevalence in CCA as a tool for risk stratification and prognosis. The European CCA Histology Registry represents a valuable platform for integrating digital pathology with clinical, radiological, and molecular information as a framework for digital twin advancement.

AbstractBackgroundDespite guideline recommendations, few institutions have implemented clinical pathways that incorporate frailty into routine decision‐making for patients undergoing radical cystectomy (RC). This paper presents an integrated clinical pathway designed to address the needs of frail patients undergoing RC. The purpose of the study is to determine whether a multifaceted prevention programme that tailors interventions to the syndromic components of frailty can improve postoperative morbidity and recovery time for patients. New insights will be gained into how to optimize the physical and mental status and quality of life of patients before and after surgery, up to 1 year later.Study designThe Global RAdical Cystectomy Evaluation and Management (GRACEM) study is a prospective, observational, single‐centre, 2‐year cohort study. Patient enrolment began on 27 April 2023, and results are pending.EndpointsThe primary endpoints are postoperative morbidity and the in‐hospital postoperative care burden. Postoperative morbidity is measured by the number of early (up to 1 month) and late (over 1 month and up to 12 months) complications, graded by severity according to the Clavien–Dindo classification. In‐hospital postoperative care burden is measured by the number and duration of key care processes as recorded by the Care Process Monitoring Chart, a tool developed for this study. Secondary endpoints are changes in frailty and health‐related quality of life (HRQoL) from pre‐intervention to planned follow‐up up to 1 year. Frailty is assessed with the Functional Limitations and Geriatric Syndromes Frailty Questionnaire (FLIGS‐FQ), another ad hoc tool. HRQoL is assessed using the EQ‐5D‐5L questionnaire combined with the cystectomy‐specific FACT‐Bl‐cys index from the first month of follow‐up.Patients and methodsThe GRACEM study includes patients with non‐metastatic, histologically confirmed, muscle‐infiltrating bladder cancer who underwent RC surgery with curative intent. This study is unique in that the GRACEM Core Team shares decision‐making throughout the pathway, from before the intervention to the end of the patient's follow‐up. The pathway involves the patient, family members and community services.

RATIONALE AND OBJECTIVES:Deep learning (DL)-based methods show promise in detecting pulmonary embolism (PE) on CT pulmonary angiography (CTPA), potentially improving diagnostic accuracy and workflow efficiency. This meta-analysis aimed to (1) determine pooled performance estimates of DL algorithms for PE detection; and (2) compare the diagnostic efficacy of convolutional neural network (CNN)- versus U-Net-based architectures. MATERIALS AND METHODS:Following PRISMA guidelines, we searched PubMed and EMBASE through April 15, 2025 for English-language studies (2010-2025) reporting DL models for PE detection with extractable 2 × 2 data or performance metrics. True/false positives and negatives were reconstructed when necessary under an assumed 50 % PE prevalence (with 0.5 continuity correction). We approximated AUROC as the mean of sensitivity and specificity if not directly reported. Sensitivity, specificity, accuracy, PPV and NPV were pooled using a DerSimonian-Laird random-effects model with Freeman-Tukey transformation; AUROC values were combined via a fixed-effect inverse-variance approach. Heterogeneity was assessed by Cochran's Q and I2. Subgroup analyses contrasted CNN versus U-Net models. RESULTS:Twenty-four studies (n = 22,984 patients) met inclusion criteria. Pooled estimates were: AUROC 0.895 (95 % CI: 0.874-0.917), sensitivity 0.894 (0.856-0.923), specificity 0.871 (0.831-0.903), accuracy 0.857 (0.833-0.882), PPV 0.832 (0.794-0.869) and NPV 0.902 (0.874-0.929). Between-study heterogeneity was high (I2 ≈ 97 % for sensitivity/specificity). U-Net models exhibited higher sensitivity (0.899 vs 0.893) and CNN models higher specificity (0.926 vs 0.900); subgroup Q-tests confirmed significant differences for both sensitivity (p = 0.0002) and specificity (p < 0.001). CONCLUSIONS:DL algorithms demonstrate high diagnostic accuracy for PE detection on CTPA, with complementary strengths: U-Net architectures excel in true-positive identification, whereas CNNs yield fewer false positives. However, marked heterogeneity underscores the need for standardized, prospective validation before routine clinical implementation.

Background: Emergency laparotomy (EL) is related to a high risk of morbidity and mortality. Sarcopenia (low skeletal muscle mass) and myosteatosis (poor muscle quality) have emerged as prognostic indicators in various clinical contexts. This study evaluated the impact of these conditions on postoperative outcomes in patients undergoing EL for abdominal emergencies. Methods: A retrospective analysis was conducted on 242 patients who underwent EL between January 2016 and December 2023. Skeletal muscle index (SMI) and muscle radiation attenuation (MRA) were measured using CT imaging at the L3 level. Sarcopenia was defined as SMI ≤ 41.6 cm2/m2 for men and ≤ 32 cm2/m2 for women. Myosteatosis was defined as MRA ≤ 29.3 HU for men and ≤ 22 HU for women. Outcomes included 30-day mortality, hospital length of stay (h-LOS), severe complications (Clavien-Dindo ≥ 3), and Intensive Care Unit (ICU) admission. Results: Of the 242 patients (median age: 70; 51.2% men), 42.6% were sarcopenic and 78.1% had myosteatosis. Sarcopenia was not significantly associated with any postoperative outcomes. Conversely, myosteatosis was significantly associated with longer h-LOS (17 vs. 8 days; p < 0.001), higher rates of severe complications (37.1% vs. 22.7%; p = 0.048), and ICU admission (48.2% vs. 28.3%; p = 0.010), but not with 30-day mortality. Multivariate analysis confirmed myosteatosis as an independent predictor of prolonged hospital stay (HR 0.59, 95% CI: 0.42–0.84 p = 0.003). Conclusions: Myosteatosis, rather than sarcopenia, is associated with worse postoperative outcomes following EL for abdominal emergencies. Including myosteatosis in preoperative risk assessments may improve the identification of high-risk patients and guide perioperative management.

This retrospective study aimed to confirm the safety and long-term efficacy of a single-session combined treatment approach with transcatheter arterial embolization (TAE) and microwave ablation (MWA) for inoperable small—to intermediate-sized hepatocellular carcinomas (HCC), focusing on their combined benefits for improving local control. All consecutive patients with up to 2 small-to-intermediate HCC lesions (≤ 5 cm) treated with a combined single-session MWA-TAE approach were enrolled between April 2020 and October 2023. All procedures were performed in two stages: TAE and MWA. Clinical and radiological follow-up was performed 3, 6, and 12 months after treatment. In the 21 enrolled patients (15 males, mean age 75.9 years), post-procedural contrast-enhanced CT scans confirmed a satisfactory ablation zone in all patients (100

OBJECTIVES:CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, and DL algorithms are being developed to manage the increase in demand. The nnU-Net is a new auto-adaptive DL framework that minimizes manual tuning, making it easier to develop effective algorithms for medical imaging even without specific expertise. This study assesses the performance of a locally developed nnU-Net algorithm on the RSPECT dataset for PE detection, clot volume measurement, and correlation with right ventricle overload. MATERIALS & METHODS:User input was limited to segmentation using 3DSlicer. We worked with the RSPECT dataset and trained an algorithm from 205 PE and 340 negatives. The test dataset comprised 6573 exams. Performance was tested against PE characteristics, such as central, non-central, and RV overload. Blood clot volume (BCV) was extracted from each exam. We employed ROC curves and logistic regression for statistical validation. RESULTS:Negative studies had a median BCV of 1 μL, which increased to 345 μL in PE-positive cases and 7,378 μL in central PEs. Statistical analysis confirmed a significant BCV correlation with PE presence, central PE, and increased RV/LV ratio (p < 0.0001). The model's AUC for PE detection was 0.865, with an 83 % accuracy at a 55 μL threshold. Central PE detection AUC was 0.937 with 91 % accuracy at 850 μL. The RV overload AUC stood at 0.848 with 79 % accuracy. CONCLUSION:The nnU-Net algorithm demonstrated accurate PE detection, particularly for central PE. BCV is an accurate metric for automated severity stratification and case prioritization. CLINICAL RELEVANCE STATEMENT:The nnU-Net framework can be utilized to create a dependable DL for detecting PE. It offers a user-friendly approach to those lacking expertise in AI and rapidly extracts the Blood Clot Volume, a metric that can evaluate the PE's severity.

INTRODUCTION:Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT. EVIDENCE ACQUISITION:Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach. EVIDENCE SYNTHESIS:Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I2=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I2=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I2=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I2=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I2=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I2=0%). Certainty of evidence ranged from low to very low. CONCLUSIONS:UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.

This case report describes the successful angiographic treatment of a bronchial to pulmonary artery fistula in a 43-year-old male with a history of right testicular cancer. The patient was found to have a pulmonary vascular anomaly during preoperative evaluation for an abdominal hernia repair. Imaging confirmed a bronchial to pulmonary artery fistula, which was effectively managed through selective embolization using arterial and venous catheters.

BACKGROUND:Lung cancer screening with low-dose helical computed tomography (LDCT) reduces mortality in high-risk subjects. Cigarette smoking is linked to up to 90% of lung cancer deaths. Even more so, it is a key risk factor for many other cancers and cardiovascular and pulmonary diseases. The Smokers health Multiple ACtions (SMAC-1) trial aimed to demonstrate the feasibility and effectiveness of an integrated program based on the early detection of smoking-related thoraco-cardiovascular diseases in high-risk subjects, combined with primary prevention. A new multi-component screening design was utilized to strengthen the framework on conventional lung cancer screening programs. We report here the study design and the results from our baseline round, focusing on oncological findings. METHODS:High-risk subjects were defined as being >55 years of age and active smokers or formers who had quit within 15 years (>30 pack/y). A PLCOm2012 threshold >2% was chosen. Subject outreach was streamlined through media campaign and general practitioners' engagement. Eligible subjects, upon written informed consent, underwent a psychology consultation, blood sample collection, self-evaluation questionnaire, spirometry, and LDCT scan. Blood samples were analyzed for pentraxin-3 protein levels, interleukins, microRNA, and circulating tumor cells. Cardiovascular risk assessment and coronary artery calcium (CAC) scoring were performed. Direct and indirect costs were analyzed focusing on the incremental cost-effectiveness ratio per quality-adjusted life years gained in different scenarios. Personalized screening time-intervals were determined using the "Maisonneuve risk re-calculation model", and a threshold <0.6% was chosen for the biennial round. RESULTS:In total, 3228 subjects were willing to be enrolled. Out of 1654 eligible subjects, 1112 participated. The mean age was 64 years (M/F 62/38%), with a mean PLCOm2012 of 5.6%. Former and active smokers represented 23% and 77% of the subjects, respectively. At least one nodule was identified in 348 subjects. LDCTs showed no clinically significant findings in 762 subjects (69%); thus, they were referred for annual/biennial LDCTs based on the Maisonneuve risk (mean value = 0.44%). Lung nodule active surveillance was indicated for 122 subjects (11%). Forty-four subjects with baseline suspicious nodules underwent a PET-FDG and twenty-seven a CT-guided lung biopsy. Finally, a total of 32 cancers were diagnosed, of which 30 were lung cancers (2.7%) and 2 were extrapulmonary cancers (malignant pleural mesothelioma and thymoma). Finally, 25 subjects underwent lung surgery (2.25%). Importantly, there were zero false positives and two false negatives with CT-guided biopsy, of which the patients were operated on with no stage shift. The final pathology included lung adenocarcinomas (69%), squamous cell carcinomas (10%), and others (21%). Pathological staging showed 14 stage I (47%) and 16 stage II-IV (53%) cancers. CONCLUSIONS:LDCTs continue to confirm their efficacy in safely detecting early-stage lung cancer in high-risk subjects, with a negligible risk of false-positive results. Re-calculating the risk of developing lung cancer after baseline LDCTs with the Maisonneuve model allows us to optimize time intervals to subsequent screening. The Smokers health Multiple ACtions (SMAC-1) trial offers solid support for policy assessments by policymakers. We trust that this will help in developing guidelines for the large-scale implementation of lung cancer screening, paving the way for better outcomes for lung cancer patients.

This study investigated the long-term efficacy of n-butyl-2-cyanoacrylate-metacryloxysulpholane (NBCA-MS) for varicocele embolization (VE) without using a microcatheter. A retrospective study was conducted on male patients who underwent VE with NBCA-MS for grade III-IV varicocele between January 2016 and December 2022. Patients were categorized by the catheter type used. Telephone interviews assessed long-term effectiveness, focusing on relapse, re-treatment and spermiogram improvements. Of 185 patients, 102 completed the phone interview (median age 25 years, median follow-up 4.1 years). Sixty-six procedures were performed with only an HH1 catheter (Group A, 65

This record contains raw data related to article “Percutaneous Computed Tomography (CT)-Guided Localization with Indocyanine Green for the Thoracoscopic Resection of Small Pulmonary Nodules" Abstract Background: The identification of small lung nodules is challenging during mini-invasive thoracic surgery. Unable to palpate them directly, surgeons have developed several methods to preoperatively localize pulmonary nodules, including the computed tomography-guided positioning of coils or metallic landmarks (hook wire) or bronchoscopic marking. Methods: We present a series of patients scheduled for the video-assisted thoracoscopic sublobar resection of small pulmonary nodules, in which we performed preoperative percutaneous computed tomography (CT)-guided nodule localization through the injection of a mixture of indocyanine green and human albumin. Results: A total of 40 patients underwent a preoperative CT-guided injection of indocyanine green followed by VATS resection within 24 h. Patients tolerated the procedure well, no pain medication was administrated, and no complications were observed during the marking procedure. All pulmonary nodules were easily detected and successfully resected. Conclusion: the near-infrared dye marking solution of indocyanine green (ICG) with diluted human albumin was safe, effective, and easy to perform. The ICG solution has the potential to facilitate the accurate localization and resection of pulmonary nodules during VATS surgery, avoiding the risk of marker displacement/migration.

This study aimed to identify the radiological CT findings that are significantly correlated with the outcome of conservative management with oral water-soluble contrast medium in patients presenting with Adhesive Small Bowel Obstruction (ASBO) to the Emergency Room. In this retrospective single-center study, we considered all consecutive patients admitted to the ER from February 2019 to February 2023 for ASBO with an available contrast-enhanced CT scan performed at diagnosis and treated with conservative management. The investigated CT findings were type and location of transition zone, ASBO degree, fat notch sign, beak sign, small bowel feces sign, presence of peritoneal free fluid and pneumatosis intestinalis. Radiological parameters were analyzed using univariable and multivariable logistic regression to test the significant association between the CT parameters and the target. Among the 106 included patients (median age 74.5 years), conservative treatment was effective in 59 (55.7

Introduction The standard treatment of colorectal liver metastases (CRLM) is surgery with perioperative chemotherapy. A tumor response to systemic therapy confirmed at pathology examination is the strongest predictor of survival, but it cannot be adequately predicted in the preoperative setting. This bi-institutional retrospective study investigates whether CT-based radiomics of CRLM and peritumoral tissue provides a reliable non-invasive estimation of the pathological tumor response to chemotherapy. Methods All consecutive patients undergoing liver resection for CRLM at the two institutions were considered. Only patients with a radiological partial response or stable disease at chemotherapy and with a preoperative/post-chemotherapy CT performed <60 days before surgery were included. The pathological response was evaluated according to the tumor regression grade (TRG). The tumor (Tumor-VOI) was manually segmented on the portal phase of the CT and a 5-mm ring of peritumoral tissue was automatically generated (Margin-VOI). The predictive models underwent internal validation. Results Overall, 222 patients were included; 64 had a pathological response (29%, TRG1-3). Two-third of patients displaying a radiological response (111/170) did not have a pathological one (TRG4-5). For TRG1-3 prediction, the clinical model performed fairly (Accuracy=0.725, validation-AUC=0.717 95%CI=0.652-0.788). Radiomics improved the results: the model combining the clinical data and Tumor-VOI features had Accuracy=0.743 and validation-AUC=0.729 (95%CI=0.665-0.798); the full model (clinical/Tumor-VOI/Margin-VOI) achieved Accuracy=0.820 and validation-AUC=0.768 (95%CI=0.707-0.826). Conclusion CT-based radiomics of CRLM allows an insightful non-invasive assessment of TRG. The combined analysis of the tumor and peritumoral tissue improves the prediction. In association with clinical data, the radiomic indices outperform standard radiological and clinical evaluation.

The objective of this study is to assess the potential cost-effectiveness of a population-based lung cancer screening program targeting high-risk prior and current heavy smokers (≥20 pack-years) aged between 55 and 74 years, in Italy.