Abstract Background Our purpose was to evaluate the correlations between right ventricular (RV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in patients with tetralogy of Fallot (ToF) scheduled for pulmonary valve replacement (PVR) and post-PVR functional data. Methods We retrospectively reviewed ToF patients scheduled for PVR who underwent two CMR examinations at our institution, one before the procedure (CMR-0), including contrast-enhanced sequences, and one after the procedure (CMR-1). Functional left and RV data were obtained by segmenting short-axis stacks on both CMR examinations, and normalised variations were calculated by dividing differences between CMR-1 and CMR-0 by the intercurring time interval, whereas the RV scar burden was assessed on CMR-0 LGE sequences both semiquantitatively and quantitatively. Data were reported as median and interquartile range, differences were appraised with the Mann–Whitney U test, while correlations were assessed with Spearman’s ρ. Results Fifteen patients with a median age of 25 years (16–29), including 9 (60%) males, with a median time interval between CMR-0 and CMR-1 of 17 months (12–23), were retrospectively reviewed. The semiquantitative LGE score at CMR-0 was 7 (6–9), and LGE volume was 4.49 mL (3.70–5.78), covering 5.63% (4.92–7.00) of the RV. RV LGE score showed a moderate positive correlation with the normalised variation of RV stroke volume (ρ = 0.662, p = 0.007) and a borderline moderate positive correlation with the normalised variation of RV end-diastolic indexed volume (ρ = 0.513, p = 0.050). Conclusions The assessment of RV LGE before PVR may provide insights on post-PVR functional data, potentially facilitating a patient-tailored treatment pathway.

Giulia Lastella,1 Andrea Esposito,2 Alice Scarabelli,3 Guido Giovanni Plensich,3 Elvira Stellato,3 Emanuele Avola,3 Caterina Giannitto,4 Massimo Castellani,5 Marco Cuzzocrea,6 Luca Bonomo,7 Gianpaolo Carrafiello5 1Unit of Radiology, Ospedale Città di Sesto San Giovanni, ASST Nord Milano, Sesto San Giovanni, Italy; 2Unit of Radiology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio, Italy; 3Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy; 4Unit of Radiology, Istituto Clinico Humanitas, Rozzano, Italy; 5Unit of Nuclear Medicine, IRCCS Fondazione Cà Granda, Maggiore Policlinico Hospital, Milan, Italy; 6Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 7Clinica di Radiologia, Ente Ospedaliero Cantonale, Lugano, SwitzerlandCorrespondence: Andrea Esposito, Unit of Radiology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio, Italy, Tel +393475476654, Email andrea_esposito@asst-bgovest.itPurpose: To compare the diagnostic performance of lung perfusion colormaps derived from computed tomography pulmonary angiography (cmCTPA) by novel semi-automatic post-processing software, with lung perfusion scintigraphy (LPS), for detection of lung perfusion defects (LPDs) in pulmonary embolism (PE).Patients and Methods: Consecutive patients from January 2016 to April 2020 who underwent both computed tomography pulmonary angiography (CTPA) and LPS within 7 days of each other, to rule out PE, were retrospectively enrolled. cmCTPA images were obtained from CTPA images using semi-automatic post-processing software (Pulmonary Artery Analysis, Intellispace Portal Release 11, Philips). The diagnosis of LPD was assessed on LPS images by two nuclear medicine physicians in consensus; CTPA and cmCTPA images were evaluated by two radiologists in consensus, blind to the LPS results. The spatial location of the LPD was assessed according to Boyden’s nomenclature. Agreement between LPS and cmCTPA in the diagnosis of LPD was tested using Cohen’s kappa.Results: Fifty-three patients were enrolled. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of cmCTPA were, respectively, 100%, 40%, 73%, and 100%; disease prevalence was 67%, accuracy was 77%, and positive and negative likelihood ratios were 1.67 and 0, respectively. An almost perfect agreement was found between cmCPTA and LPS in 13 segments (72%) and a substantial agreement was found in the remaining five segments (28%).Conclusion: cmCTPA, owing to its NPV (100%) and its overall high agreement in the number and location of LPDs compared to LPS, may have an upcoming role in the evaluation of lung perfusion in PE.Keywords: nuclear medicine, pulmonary embolism, perfusion imaging, computed tomography angiography, image processing, computer-assisted

1Unit of Radiology, Ospedale Città di Sesto San Giovanni, ASST Nord Milano, Sesto San Giovanni, Italy; 2Unit of Radiology, Ospedale Treviglio-Caravaggio, ASST Bergamo Ovest, Treviglio, Italy; 3Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy; 4Unit of Radiology, Istituto Clinico Humanitas, Rozzano, Italy; 5Unit of Nuclear Medicine, IRCCS Fondazione Cà Granda, Maggiore Policlinico Hospital, Milan, Italy; 6Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 7Clinica di Radiologia, Ente Ospedaliero Cantonale, Lugano, Switzerland

Objectives To evaluate the quality of the reports of loco-regional staging computed tomography (CT) or magnetic resonance imaging (MRI) in head and neck (H&N) cancer. Methods Consecutive reports of staging CT and MRI of all H&N cancer cases from 2018 to 2020 were collected. We created lists of quality indicators for tumor (T) for each district and for node (N). We marked these as 0 or 1 in the report calculating a report score (RS) and a maximum sum (MS) of each list. Two radiologists and two otolaryngologists in consensus classified reports as low quality (LQ) if the RS fell in the percentage range 0-59% of MS and as high quality (HQ) if it fell in the range 60-100%, annotating technique and district. We evaluated the distribution of reports in these categories. Results Two hundred thirty-seven reports (97 CT and 140 MRI) of 95 oral cavity, 52 laryngeal, 47 oropharyngeal, 19 hypo-pharyngeal, 14 parotid, and 10 nasopharyngeal cancers were included. Sixty-six percent of all the reports were LQ for T, 66% out of all the MRI reports, and 65% out of all CT reports were LQ. Eight-five percent of reports were HQ for N, 85% out of all the MRI reports, and 82% out of all CT reports were HQ. Reports of oral cavity, oro-nasopharynx, and parotid were LQ, respectively, in 76%, 73%, 100% and 92 out of cases. Conclusion Reports of staging CT/MRI in H&N cancer were LQ for T description and HQ for N description.

epatocellular carcinoma (HCC) metastasizes mainly in the liver through portal vein, only few patients report metastases in distant organs and bone is considered a rare site of HCC metastases.We report the case of a man with HCC, who presented with chronic right hindfoot pain, in which bone scintigraphy and computed tomography (CT) revealed a rare secondary calcaneus localization.Case description.A 58-year-old man with multi-treated HCC, during a hepatological followup, complained of chronic right hindfoot pain, unresponsive to analgesic therapy.The bone scintigraphy shows focal hypercaptations in the right calcaneus and, less evidently, in the right tibia.CT showed multiple focal solid enhancing nodules in the tibial bone marrow, and a 3,5-cm solid enhancing nodule in the calcaneal body, with cortical interruption and invasion of adjacent soft tissues.HCC calcaneal metastasis was confirmed through a biopsy.Conclusion.In a patient with HCC and chronic hindfoot pain, with increase of alphafetoprotein levels, the possibility of a distant metastasis should be taken in account, as in our case, even though it is a rare cause.

Purpose: To determine the performance of a chest radiograph (CXR) severity scoring system combined with clinical and laboratory data in predicting the outcome of COVID-19 patients Materials and Methods: We retrospectively enrolled 301 patients who had reverse transcriptase-polymerase chain reaction (RT-PCR) positive results for COVID-19 CXRs, clinical and laboratory data were collected A CXR severity scoring system based on a qualitative evaluation by two expert thoracic radiologists was defined Based on the clinical outcome, the patients were divided into two classes: moderate/mild (patients who did not die or were not intubated) and severe (patients who were intubated and/or died) ROC curve analysis was applied to identify the cut-off point maximizing the Youden index in the prediction of the outcome Clinical and laboratory data were analyzed through Boruta and Random Forest classifiers Results: The agreement between the two radiologist scores was substantial (kappa = 0 76) A radiological score ≥ 9 predicted a severe class: sensitivity = 0 67, specificity = 0 58, accuracy = 0 61, PPV = 0 40, NPV = 0 81, F1 score = 0 50, AUC = 0 65 Such performance was improved to sensitivity = 0 80, specificity = 0 86, accuracy = 0 84, PPV = 0 73, NPV = 0 90, F1 score = 0 76, AUC= 0 82, combining two clinical variables (oxygen saturation [SpO2]), the ratio of arterial oxygen partial pressure to fractional inspired oxygen [P/F ratio] and three laboratory test results (C-reactive protein, lymphocytes [%], hemoglobin) Conclusion: Our CXR severity score assigned by the two radiologists, who read the CXRs combined with some specific clinical data and laboratory results, has the potential role in predicting the outcome of COVID-19 patients

Dataset from the article Monti CB, Secchi F, Capra D, Guarnieri G, Lastella G, Barbaro U, Carminati M, Sardanelli F. Right ventricular strain in repaired Tetralogy of Fallot with regards to pulmonary valve replacement. Eur J Radiol. 2020 Oct;131:109235. doi: 10.1016/j.ejrad.2020.109235. Epub 2020 Aug 28. PMID: 32919263. Abstract Purpose: To assess right ventricular (RV) myocardial strain both globally and segmentally through feature-tracking cardiac magnetic resonance (CMR) in patients with Tetralogy of Fallot (ToF), with regards to pulmonary valve replacement (PVR). Methods: After Ethics Committee approval, we retrospectively included 46 consecutive ToF patients who had two CMR examinations performed at our institution between March 2014 and June 2019. We divided patients into those who had not undergone PVR between the two CMR examinations (Group-0), and those who had (Group-1). Ventricular volumes were quantified on cine sequences, and strain was calculated through feature-tracking, using the previously traced segmentations. RV longitudinal and radial strain were assessed both globally and separately for the septum and free wall. Variations were normalized for intercurrent years, differences were appraised with t-tests or Mann-Whitney U. Results: 30 patients belonged to Group-0 and 16 to Group-1. Median age was 22 years (interquartile range [IQR] 17-29 years) in Group-0, and 21 years (IQR 16-29 years) in Group-1. No significant differences were reported in RV strain between groups (p ≥ 0.254) except for RV septal radial strain, significantly higher (p = 0.010) in Group-0 (24.2 %, IQR 10.1-52.4 %) than in Group-1 (6.0 %, IQR -3.3-23.3 %) at the second CMR. Both global and segmental RV strains decreased over time in both groups, and yearly variations did not differ significantly (p ≥ 0.081) between groups. Conclusions: While PVR performed at the appropriate timing eases the burden on the RV allowing for a reduction in volumes, RV strain seems to continuously deteriorate as in patients who do not undergo PVR.

1Radiology Department, Foundation IRCCS Ospedale Maggiore Policlinico Hospital, Milan, 20122, Italy; 2Anacleto Lab, Computer Science Department, University of Milan, Milan, 20133, Italy; 3Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, 20122, Italy; 4Accident and Emergency Department, Foundation IRCCS Ospedale Maggiore Policlinico Hospital, Milan, 20122, Italy; 5Radiology Department, Humanitas Research Hospital, Milan, 20013, Italy; 6KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, 94035, USA; 7Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA; 8The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA; 9Institute for Systems Genomics, University of Connecticut, Farmington, CT, 06030, USA Purpose: To determine the performance of a chest radiograph (CXR) severity scoring system combined with clinical and laboratory data in predicting the outcome of COVID-19 patients. Materials and Methods: We retrospectively enrolled 301 patients who had reverse transcriptase-polymerase chain reaction (RT-PCR) positive results for COVID-19. CXRs, clinical and laboratory data were collected. A CXR severity scoring system based on a qualitative evaluation by two expert thoracic radiologists was defined. Based on the clinical outcome, the patients were divided into two classes: moderate/mild (patients who did not die or were not intubated) and severe (patients who were intubated and/or died). ROC curve analysis was applied to identify the cut-off point maximizing the Youden index in the prediction of the outcome. Clinical and laboratory data were analyzed through Boruta and Random Forest classifiers. Results: The agreement between the two radiologist scores was substantial (kappa = 0.76). A radiological score ≥9 predicted a severe class: sensitivity = 0.67, specificity = 0.58, accuracy = 0.61, PPV = 0.40, NPV = 0.81, F1 score = 0.50, AUC = 0.65. Such performance was improved to sensitivity = 0.80, specificity = 0.86, accuracy = 0.84, PPV = 0.73, NPV = 0.90, F1 score = 0.76, AUC= 0.82, combining two clinical variables (oxygen saturation [SpO2]), the ratio of arterial oxygen partial pressure to fractional inspired oxygen [P/F ratio] and three laboratory test results (C-reactive protein, lymphocytes [%], hemoglobin). Conclusion: Our CXR severity score assigned by the two radiologists, who read the CXRs combined with some specific clinical data and laboratory results, has the potential role in predicting the outcome of COVID-19 patients.

Purpose: The aim of this study is to review the literature concerning myocardial late gadolinium enhancement (LGE) with cardiac magnetic resonance in patients with Tetralogy of Fallot (ToF), with regards to its prevalence, characteristics and clinical relevance. Methods: We performed a systematic search, aiming to retrieve original articles that evaluated LGE in ToF, running a search string on MEDLINE and EMBASE in November 2019 and November 2020. Papers were then selected by two independent, blinded readers based on title and abstract, and then on full-text reading, and articles which did not include LGE evaluation were excluded. From each included paper two readers extracted descriptive data concerning technical parameters of LGE acquisition, LGE description and clinical significance. Results: 18 articles were eventually included in our review. The included studies observed that a higher amount of right ventricular LGE relates with higher right ventricular volumes, lower ejection fraction and a higher pulmonary regurgitant fraction, thus acting as a marker of progressive impairment of myocardial function. Moreover, LGE in ToF patients correlated with the onset of arrhythmias, and with serum biomarkers indicative of myocardial stress and fibrosis. Conclusions: LGE could be used in the follow-up repaired ToF patients as its appraisal can provide information concerning cardiac dysfunction. Moreover, it may be ideal to aim towards a common framework for standardizing assessment and quantification of LGE in ToF patients.

Rhabdomyosarcoma is one of the most common tumors in the pediatric age, but perineal localization is very rare, with a poor prognosis due to late diagnosis. Magnetic resonance (MR) is a non-invasive technique that is very useful in the evaluation of local infiltration and can facilitate the diagnosis. In this article, we present a case of perineal rhabdomyosarcoma diagnosed with pelvic MR, with simultaneous presence of multiple synchronous metastases.

Purpose: To assess right ventricular (RV) myocardial strain both globally and segmentally through featuretracking cardiac magnetic resonance (CMR) in patients with Tetralogy of Fallot (ToF), with regards to pulmonary valve replacement (PVR). Methods: After Ethics Committee approval, we retrospectively included 46 consecutive ToF patients who had two CMR examinations performed at our institution between March 2014 and June 2019. We divided patients into those who had not undergone PVR between the two CMR examinations (Group-0), and those who had (Group-1). Ventricular volumes were quantified on cine sequences, and strain was calculated through feature-tracking, using the previously traced segmentations. RV longitudinal and radial strain were assessed both globally and separately for the septum and free wall. Variations were normalized for intercurrent years, differences were appraised with t-tests or Mann-Whitney U. Results: 30 patients belonged to Group-0 and 16 to Group-1. Median age was 22 years (interquartile range [IQR] 17-29 years) in Group-0, and 21 years (IQR 16-29 years) in Group-1. No significant differences were reported in RV strain between groups (p >= 0.254) except for RV septal radial strain, significantly higher (p = 0.010) in Group-0 (24.2 %, IQR 10.1-52.4 %) than in Group-1 (6.0 %, IQR -3.3-23.3 %) at the second CMR. Both global and segmental RV strains decreased over time in both groups, and yearly variations did not differ significantly (p >= 0.081) between groups. Conclusions: While PVR performed at the appropriate timing eases the burden on the RV allowing for a reduction in volumes, RV strain seems to continuously deteriorate as in patients who do not undergo PVR.

Aims: Carotid intima-media thickness (CIMT) is used increasingly as an imaging biomarker of cardiovascular risk (CVR). Our aim was to compare semiautomatic CIMT (sCIMT) versus manual CIMT (mCIMT) for reproducibility and prediction of CVR.Materials and methods: Two independent readers measured sCIMT and mCIMT on previously acquired images of the right common carotid artery of 200 consecutive patients. Measurements were performed twice, four weeks apart; sCIMT was reported along with an image quality index (IQI) provided by the software. CVR stratification was compared for thresholds established by mCIMT studies, adapted for sCIMT according to a regression model.Results: sCIMT (median 0.67 mm, interquartile range [IQR] 0.57‒0.76 mm) was significantly lower (p<0.001) than mCIMT (median 0.76 mm, IQR 0.63‒0.84 mm; ρ=0.832, p<0.001, slope 0.714, intercept 0.124). Overall, intra-reader reproducibility was 76% for sCIMT and 83% for mCIMT (p=0.002), inter-reader reproducibility 75% and 76%, respectively (p=0.316). In 129 cases with IQI≥0.65, reproducibility was significantly higher (p≤0.004) for sCIMT than for mCIMT (intra-reader 85% versus 83%, inter-reader 80% versus 77%,). The agreement between sCIMT and mCIMT for CVR stratification was fair both overall (κ=0.270) and for IQI≥0.65 (κ=0.345), crude concordance being 79% and 88%, respectively.Conclusions: Reproducibility of sCIMT was not higher than mCIMT overall but sCIMT was significantly more reproducible than mCIMT for high-IQI cases. sCIMT cannot be used for CVR stratification due to fair concordance with mCIMT, even for high IQI. More research is required to improve image quality and define sCIMT-based thresholds for stratification of CVR.

PURPOSE:The aim of this paper was to compare the open 1-T (O-1T) versus the closed 1.5-T (C-1.5T) cardiac magnetic resonance (MR). PATIENTS/METHODS:The MR examinations of two concurrent cohorts (each including 100 subjects) of patients with suspected or known cardiac disease were reviewed. Such examinations were obtained using O-1T or C-1.5T MRI. The bright-blood cine, T1-weighted (T1), T2-weighed short-tau inversion recovery (T2-STIR), late gadolinium enhancement (LGE) sequences were performed. Signal-to-noise ratio of blood (SNRb) or myocardium (SNRm), and contrast-to-noise ratio of myocardium (CNRm) were calculated. Subjective image quality (SIQ) of each sequence was graded as 0 = poor, 1 = intermediate, or 2 = optimal. Each examination was considered as diagnostic when the report answered the clinical question. RESULTS:C-1.5T was better than O-1T on cine for SNRb(median 172 versus 452), SNRm(71 versus 160) and CNRm (107 versus 265) and on T2-STIR for SNRb(10 versus 29), SNRm(74 versus 261) and CNRm(-67 versus -233)(P < 0.001). On LGE, SNRm was higher with O-1T than for C-1.5T (312 versus 79, P < 0.001) while CNR was lower (158 versus 389; P < 0.001). No significant differences were found for SNRb on LGE and both SNRm and CNRm on T1 (P ≥ 0.215). SIQ of O-1T was not significantly different from that of C-1.5T for both R1 and R2 for cine, T1, and LGE (P ≥ 0.157); for T2-STIR, SIQ of O-1T was significantly lower (P = 0.003). R1-R2 concordance was almost perfect (κ = 0.816-0.894), and all examinations were diagnostic. CONCLUSION:Even though quantitative measurements mostly favored C-1.5T, the SIQ of O-1T was not significantly different for any sequence, with the only exception of T2-STIR.

The importance of childhood and adolescence for bone development and mineral accrual is increasingly accepted, cleading to a need of suitable methods for monitoring bone health even in pediatric setting. Among the several different imaging methods available for clinical measurement of bone mineral density (BMD) in children, dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly used due to its reproducibility, negligible radiation dose and reliable pediatric reference data. Nevertheless, DXA in children has some technical specific features that should be known by those physicians who interpret and report this examination. We provide recommendations for optimal DXA scan reporting in pediatric setting, including indications, skeletal sites to be examined, parameters to be measured, timing of follow-up BMD measurements. Adequate report and analysis of DXA examinations are essential to prevent over- and underdiagnosis of bone mineral impairment in pediatric patients. In conclusion, a complete and exhaustive DXA report in children and adolescents is mandatory for an accurate diagnosis and a precise monitoring of pediatric bone status.

•DXA is the gold standard technique for bone mass measurement in pediatric patients.•Common pediatric DXA examination sites are lumbar spine and “total body less head”.•Proximal femur scan is usually not indicated in pediatric patients.•Bone mineral apparent density (BMAD) is the most accurate DXA value in pediatric patients.•Pediatric DXA scan should be performed only when the results can influence patient’s management.

Poster: ECR 2018 / C-0129 / Pediatric Dual-Energy X-Ray Absorptiometry In Clinical Practice: how to report it by: G. Lastella 1, C. Messina2, S. M. E. sorce2, G. Guglielmi3, F. M. Ulivieri2; 1milano/IT, 2Milan/IT, 3Andria/IT

Poster: ECR 2018 / C-2665 / Reproducibility of the automatic calculation of average intima-media thickness (IMT), in the carotids' ultrasound study: preliminary results by: G. Lastella 1, F. Wiedenmann1, M. Ali2, F. Secchi2, G. Di Leo2, F. Sardanelli1; 1Milan/IT, 2San Donato Milanese/IT