Background: Legionella pneumophila is a leading cause of community- and hospital-acquired pneumonia (HAP/CAP), although the clinical and radiological features associated with infection remain incompletely defined. This study aimed to identify clinical, comorbidity-related, and chest computed tomography (CT) features associated with L. pneumophila pneumonia in hospitalized adults with community-acquired pneumonia (CAP). Methods: A retrospective case–control study was conducted at a tertiary-care university hospital in Italy between January 2019 and August 2025. Eighty patients positive for L. pneumophila were compared with 79 controls negative for L. pneumophila. Demographic, clinical, microbiological, and radiological data were collected, and factors independently associated with infection were evaluated using multivariable logistic regression analysis. Results: Patients with L. pneumophila infection exhibited a greater comorbidity burden, particularly heart failure, and were more frequently smokers. Bilateral lung involvement and hilar/mediastinal lymphadenopathy were significantly more common among Legionella-positive patients, whereas overall pulmonary complications and bilateral pleural effusion were more frequently observed in controls. Multivariable analysis identified comorbidity burden as an independent positive predictor of L. pneumophila infection, while intensive care unit admission, oxygen therapy, and pulmonary complication score were independently associated with a lower likelihood of infection. Conclusions: The integration of comorbidity assessment with readily available chest CT findings may help raise clinical suspicion of L. pneumophila pneumonia and support consideration of appropriate diagnostic testing.

Hemoptysis is a potentially life-threatening clinical emergency requiring rapid identification of the bleeding source to guide appropriate management. CT angiography is the primary imaging modality for evaluating hemoptysis, enabling characterization of underlying parenchymal disease, precise identification of arterial anatomy, and selection of candidates for endovascular intervention. This review describes the comprehensive spectrum of hemoptysis on CT angiography, including parenchymal abnormalities (e.g., tuberculosis and bronchiectasis), bronchial arterial anatomy, non-bronchial systemic and pulmonary arterial sources of hemorrhage, and vascular malformations. Careful evaluation of parenchymal disease, precise arterial source identification, and recognition of vascular pathology is crucial for optimizing diagnosis confirmation, risk stratification, and clinical decision-making. Embolization techniques, contraindications, and indications are also discussed.

We investigated the prevalence, clinical characteristics, and prognostic role of dilated cardiomyopathy (DCM) and non-dilated left ventricular cardiomyopathy (NDLVC) in patients with transfusion-dependent β-thalassemia (β-TDT). We retrospectively included 415 β-TDT patients who underwent cardiovascular magnetic resonance to quantify myocardial iron overload (MIO) and biventricular function parameters and to detect replacement myocardial fibrosis. Demographic and laboratory parameters were comparable among patients with no overt cardiomyopathy (NOCM; n = 294), DCM (n = 12), and NDLVC (n = 109), while cardiac size and systolic function were significantly different. Compared to NOCM patients, DCM and NDLVC patients had a higher prevalence of MIO and replacement myocardial fibrosis. During a mean follow-up of 57.03 ± 18.01 months, cardiac complications occurred in 32 (7.7%) patients: 15 heart failures, 15 supraventricular arrhythmias, and 2 pulmonary hypertensions. Compared to the NOCM group, both the NDLVC and the DCM groups were associated with a significantly increased risk of cardiac complications (hazard ratio = 4.26 and 8.81, respectively). In the multivariate analysis, the independent predictive factors were age, MIO, and the presence of DCM and NDLVC versus the NOCM phenotype. In β-TDT, the detection of NDLVC and DCM phenotypes may hold value in predicting cardiac outcomes.

Interstitial lung diseases (ILD) constitute a large and heterogeneous group of disorders affecting the lung parenchyma. While idiopathic pulmonary fibrosis (IPF), the most common type of ILD, is the prototype of progressive fibrosis, other forms, collectively termed "progressive pulmonary fibrosis" (PPF), can show a similar clinical course. Detecting chronic fibrosing ILD progression necessitates radiological evidence using high-resolution computed tomography (HRCT), which determines eligibility for treatment. However, assessing the extent of fibrosis and progression on HRCT images is difficult and lacks specific guidelines. Therefore, expert oversight and high-quality visual assessment/scoring of complex disease patterns is essential to monitor disease changes. Twelve Italian chest radiologists deliberated on the current state of quantifying lung fibrosis using existing literature to develop practice-oriented consensus statements to assist radiologists in visually assessing/scoring lung fibrosis on HRCT images in patients with PPF. The resulting statements cover three key areas: (1) technical requirements necessary for accurate HRCT image assessment; (2) an easy-to-use quantification protocol for routine clinical practice; and (3) a multiple specialist approach by combining radiological, clinical, and histopathological findings for the correct diagnosis, prompt detection of PPF, and timely start of antifibrotic treatment. In future, automated quantitative HRCT evaluation will lead to new clinical assessment tools.

BACKGROUND:Early diagnosis of idiopathic pulmonary fibrosis (IPF) is fundamental to slow disease progression; multidisciplinary teams (MDTs) play a central role in posing the final diagnosis of IPF, thus aiming to improve patient outcomes. However, the practical implementation of MDTs in clinical real-life settings may be hindered by the lack of local expertise or time constraints, with the diagnosis being made without the support of complementary professional health care figures. This study aims to evaluate the impact of MDT meetings on the latency between the symptom onset and the final diagnosis of IPF. METHODS:Patients referred to a regional center for IPF between January 2019 and August 2019 were included. The length of time to pose a definite diagnosis by means of MDT evaluation was compared with that of patients diagnosed elsewhere (no MDT evaluation) in an observational case-control investigation. RESULTS:Among 24 IPF patients, those evaluated by MDT (M/F: 14/2, age: 69.8±8.2 yrs) showed a time interval from the first outpatient visit to the definite diagnosis of 3±2.3 months; on the other hand, patients in the control group (M/F: 7/1, age: 76.9±7.7 yrs) showed a time interval of 12.8±9.4 months (P=0.02). The time elapsed between the onset of symptoms and the definite diagnosis was 11.1±5.3 months for patients evaluated within the MDT, compared to 33.8±21.5 months for the control group (P=0.02). CONCLUSIONS:These exploratory findings confirm the essential role of the MDT in the early diagnosis of IPF, thus discouraging the acquisition of diagnosis solely on individual basis. The current findings highlight the need for the implementation of MDTs in clinical practice to optimize patient care.

Considering the prevalence of ILA (3% in the current study) in asymptomatic adults and the association between ILA and lung function decline, early detection of ILAs through routine screenings could facilitate timely intervention and monitoring https://bit.ly/4ijguys.

Post-contrast acute kidney injury is defined as a nephropathy with an increase in serum creatinine of >0.3 mg/dL (or >26.5 μmol/L) or >1.5-times the baseline within 48–72 h of intravascular administration of a contrast medium. Patients with cancer have an increased risk of post-contrast acute kidney injury not only related to the frequent use of contrast medium for computed tomography scans but also to other factors, including the type of tumour, age, oncological therapies, use of other nephrotoxic agents and dehydration. Preventive strategies were developed and may be applied to different risk profiles. Patients at risk may be detected by recently published risk scores.

Background: We prospectively evaluated the predictive value of multiparametric cardiac magnetic resonance (CMR) for cardiovascular complications in non-transfusion-dependent β-thalassemia (β-NTDT) patients who started regular transfusions in late childhood/adulthood (neo β-TDT). Methods: We considered 180 patients (38.25 ± 11.24 years; 106 females). CMR was used to quantify cardiac iron overload, biventricular function, and atrial dimensions, and to detect left ventricular (LV) replacement fibrosis. Results: During a mean follow-up of 76.87 ± 41.60 months, 18 (10.0%) cardiovascular events were recorded: 2 heart failures, 13 arrhythmias (10 supraventricular), and 3 cases of pulmonary hypertension. Right ventricular (RV) end-diastolic volume index (EDVI), RV mass index (MI), LV replacement fibrosis, and right atrial (RA) area index emerged as significant univariate prognosticators of cardiovascular complications. The low number of events prevented us from performing a multivariable analysis including all univariable predictors simultaneously. Firstly, a multivariable analysis including the two RV size parameters (mass and volume) was carried out, and only the RV MI was proven to independently predict cardiovascular diseases. Then, a multivariable analysis, including RV MI, RA atrial area, and LV replacement fibrosis, was conducted. In this model, RV MI and LV replacement fibrosis emerged as independent predictors of cardiovascular outcomes (RV MI: hazard ratio (HR) = 1.18; LV replacement fibrosis: HR = 6.26). Conclusions: Our results highlight the importance of CMR in cardiovascular risk stratification.

e20036 Background: Lung cancerstill represents one of the most common and lethal diseases worldwide. There remains an unmet clinical need for the discovery of biomarkers to refine the management of patients with advanced non-small cell lung cancer (NSCLC). The combined evaluation of circulating cell-free DNA (cfDNA) and deep learning-based radiomic methods remains to be validated in the clinical setting. Methods: The RATIONALE study is a retro-prospective observational clinical trial consecutively enrolling treatment-naïve patients with advanced NSCLC who received standard first-line systemic treatments at Paolo Giaccone University Hospital, Palermo (Italy). Baseline and follow-up blood samples were collected according to computed tomography (CT) examinations performed using the same equipment (Siemens SOMATOM 128 slices), the same acquisition protocol, and the same contrast medium (Iomeron 400) every twelve weeks. All primary lung tumor internal regions of interest (ROIs) were segmented. Radiomic feature extraction was performed on the ROIs using Pyradiomics, an extension of the 3DSlicer. Circulating cfDNA was extracted from 1 ml of plasma using a QIAamp Circulating Nucleic Acid Kit (Qiagen) and quantified in terms of ng/μL using a QubitTM dsDNA HS Assay Kit (ThermoFisher Scientific). The diagnostic performance was evaluated using receiver operating characteristic (ROC) curves. Results: Between June 2021 and November 2023, fifty-five patients were included. Here we present the first results from the cohort of twenty patients undergoing first-line pembrolizumab-based treatments. Among the thirteen features extracted, the feature 'original_glcm_Id' evaluating the local image homogeneity emerged as statistically significant for differentiating adenocarcinoma and squamous cell carcinoma (sensitivity of 83.7%, specificity of 81.0%, accuracy of 82.8%; p < 0.001). When correlating cfDNA dynamics and radiologic response, out of the eight features examined, the feature 'first order_mean' measuring the average intensity of gray levels proved to be statistically significant (sensitivity of 86.0%, specificity of 87.7%, accuracy of 86.9%; p < 0.006). Finally, the feature 'size zone non-uniformity' measuring the variability of volumes in different gray level zones within the image showed a good performance in predicting overall survival (sensitivity of 65.8%, specificity of 100.0%, accuracy of 77.8%; p < 0.001). Conclusions: The preliminary results of this ongoing study suggest the combined evaluation of liquid biopsy and radiomic features for obtaining minimally invasive and cost-effective biomarkers in the first-line clinical setting of NSCLC undergoing first-line pembrolizumab.

Hypersensitivity reactions (HRs) to contrast media (CM) can be distinguished in immune-mediated (including allergic reactions) and non-immune-mediated reactions, even if clinical manifestations could be similar. Such manifestations range from mild skin eruptions to severe anaphylaxis, making it important for radiologists to know how to identify and manage them. A panel of experts from the Società Italiana di Radiologia Medica e Interventistica (SIRM) and the Società Italiana di Allergologia, Asma e Immunologia Clinica (SIAAIC) provided a consensus document on the management of patients who must undergo radiological investigations with CM. Consensus topics included: the risk stratification of patients, the identification of the culprit CM and of a safe alternative by an allergy workup, as well as the use of premedication and the correct procedure to safely perform an elective (i.e., scheduled) or urgent examination. The most important recommendations are: (1) in all patients, a thorough medical history must be taken by the prescribing physician and/or the radiologist to identify at-risk patients; (2) in patients with hypersensitivity reactions to CM, the radiologist must consider an alternative, non-contrast imaging study with a comparable diagnostic value, or prescribe a different investigation with another class of CM; (3) if such options are not feasible, the radiologist must address at-risk patients to a reference centre for an allergy evaluation; (4) if timely referral to an allergist is not viable, it is recommended to use a CM other than the responsible one, taking into account cross-reactivity patterns; in the case of patients with histories of severe reactions, the presence of an anesthesiologist is also recommended and a premedication is suggested.

IntroductionAcute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on clinical features and radiologic findings. One-third of patients with acute appendicitis present unusual symptoms. There are several circumstances that may cause misdiagnosis and unclear prognostic prediction. Among these, situs viscerum inversus totalis and midgut malrotation can be challenging scenarios, leading to a delay in treatment, especially when these conditions are unknown. We decided to carry on a systematic review of published cases of acute appendicitis in the context of anatomical anomalies.MethodsWe used the MESH terms "appendicitis" AND "situs inversus" AND/OR "gut malrotation" to search for titles and abstracts. Inclusion criteria were patients with clinical and/or radiological diagnosis of acute appendicitis, with conservative or surgical management and with preoperative/intraoperative findings of situs viscerum inversus or gut malrotation. Additionally, previous reviews were examined. Exclusion criteria of the studies were insufficient patient clinical and demographic data.ResultsWe included in this review 70 articles concerning 73 cases of acute appendicitis with anatomical anomaly. Patients were aged from 8 to 86 years (median: 27.0 years). 50 were male and 23 were female. 46 patients (63%) had situs viscerum inversus, 24 (33%) had midgut malrotation, 2 (2.7%) had Kartagener's syndrome, one of them (1.4%) had an undetermined anomaly In 61 patients the anatomical anomaly was unknown previously (83.6%), while 16,4% already were aware of their condition.ConclusionAcute appendicitis can occur in association of rare anatomical anomalies and in these cases diagnosis can be challenging. Situs viscerum inversus and midgut malrotation should always be considered in the differential diagnosis of a patient with left lower quadrant pain, especially in younger population. Besides clinical features, it is fundamental to implement the diagnostic progress with radiological examination. Laparoscopic approach is useful to identify and treat acute surgical emergency and it is also a diagnostic tool and can be tailored in order to offer the best exposition of the operatory field for each single case.

The incidence of non-uniform expansion in the context of the self-expandable transcatheter heart valve (THV) is little investigated, along with stent-frame decoupling, which is a form of stent adaptation, in which the lower part of the THV stent conforms to both the ellipticity of the left ventricle outflow tract and the native annulus while maintaining the higher part of the valve more circular. We analyzed post-implant multi-detector computed tomography scans in 50 patients. Prosthesis non-uniform expansion was assessed by computing the prosthesis eccentricity on 6 prespecified levels: (1) frame inflow, (2) native annulus, (3) leaflet inflow, (4) prosthesis waist, (5) leaflet outflow, and (6) frame outflow. Stent-frame decoupling was assessed by comparing the mean eccentricity on 6 different prosthesis levels. Implantation depth, leaflet expansion and alignment, and residual anatomic sinus area ratios were also calculated. Subclinical leaflet thrombosis was defined as hypoattenuated lesion of a meniscal shape. At a 12-month follow-up, non-uniform expansion was consistently detected at each valvular level. Highest eccentricity was measured at the native annulus level (eccentricity: 0.54 ±  0.12), while the lowest index at the frame outflow level (0.23 ± 0.11). Similar results were observed in the subgroup analyses of sizes 23, 26, 29, and 34. Eccentricity significantly decreased from the annulus level to the prosthesis frame outflow (p <0.001). Notably, the incidence of mild-to-severe subclinical leaflet thrombosis was relevant (16%). In conclusion, prosthesis non-uniform expansion and stent frame decoupling frequently occur after self-expandable THV replacement. The clinical and hemodynamic implications remain uncertain.

Topic: 27. Thalassemias Background: Hepatitis C virus (HCV) infection is associated with a number of important extrahepatic manifestations. Aims: The aim of this multicentric study was to prospectively assess the relationship between HCV infection and cardiovascular complications in patients with thalassemia major (TM). Methods: We considered 1057 TM patients (539 females; 29.79±10.08 years) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) project. Every 18±3 months the patients performed a Magnetic Resonance Imaging (MRI) scan for iron overload assessment by the T2* technique. Results: On the basis of the presence of HCV antibodies and RNA, a categorization in 4 groups was performed: negative patients (group 1a, N=460), patients who spontaneously cleared the virus in the first 6 months of infection (group 1b, N=242), patients who eradicated the virus after the treatment with antiviral therapy obtaining a sustained virological response (SVR) (group 2, N=102), and patients with chronic HCV infection (group 3, N=254). The absolute first MRI was the baseline for patients in groups 1a, 1b and 3 while for patients in group 2 the baseline was represented by the first MRI performed after the virus eradication. The follow-up date coincided with the date of the last available MRI. Mean age was significantly lower in group 1a than in all the other 3 groups and in both groups 1b and 3 than in group 2. Group 1a and 1b were considered as a unique group (group 1, no chronic HCV infection). A match 1:1 for age and sex with group 2 was performed. Forty-four (14.4%) patients had an active cardiovascular complication at the baseline: 10 heart failure (HF), 1 HF+hypokinetic arrhythmias, 3 HF+supraventricular arrhythmias, 3 myo/pericarditis, 24 supraverntricular arrhythmias, 1 ventricular and supraventricular arrhythmias, 2 ventricular arrhythmias. Frequency of cardiovascular complications was comparable among the three groups. Moreover, no difference was detected in hepatic and cardiac iron levels or biventricular function parameters. Only the 262 (85.6%) patients without an active cardiovascular complication were accounted for: 86 in group 1, 92 in group 2, and 84 in group 3. During a mean follow-up time of 65.18±39.46 months, 16 (6.1%) cardiovascular events were recorded: 5 HF, 10 supraventricular arrhythmias, and 1 ischemic stroke. Prevalence of cardiovascular diseases was 4.7% in group 1, 4.3% in group 2, and 9.5% in group 3. Mean time from the baseline MRI to the development of a cardiac complication was 40.95±24.77months. The chronic HCV group showed a significantly higher risk of cardiovascular complications than group 1 (HR=3.80, 95%CI=1.11-1.03; p=0.034). The Figure shows the Kaplan-Meier survival curve.Summary/Conclusion: In TM patients, chronic HCV infection is associated with a significantly higher risk of cardiovascular complications and should be analysed as a systemic disease. However, we failed to demonstrate a significant reduction in the risk for development of cardiovascular events following HCV clearance. This finding could be related to the fact that HCV infection, being involved in the development of cardiac fibrosis, could determine an irreversible damage. Keywords: beta thalassemia, Complications, Hepatitis C virus

Introduction: The aim of our study was to evaluate the feasibility of texture analysis of epicardial fat (EF) and thoracic subcutaneous fat (TSF) in patients undergoing cardiac CT (CCT). Materials and methods: We compared a consecutive population of 30 patients with BMI & LE;25 kg/m2 (Group A, 60.6 & PLUSMN; 13.7 years) with a control population of 30 patients with BMI >25 kg/m2 (Group B, 63.3 & PLUSMN; 11 years). A dedicated computer application for quantification of EF and a texture analysis application for the study of EF and TSF were employed. Results: The volume of EF was higher in group B (mean 116.1 cm3 vs. 86.3 cm3, p = 0.014), despite no differences were found neither in terms of mean density (-69.5 & PLUSMN; 5 HU vs. -68 & PLUSMN; 5 HU, p = 0.28), nor in terms of quartiles distribution (Q1, p = 0.83; Q2, p = 0.22, Q3, p = 0.83, Q4, p = 0.34). The discriminating parameters of the histogram class were mean (p = 0.02), 0,1st (p = 0.001), 10th (p = 0.002), and 50th percentiles (p = 0.02). DifVarnc was the discriminating parameter of the co-occurrence matrix class (p = 0.007). The TSF thickness was 15 & PLUSMN; 6 mm in group A and 19.5 & PLUSMN; 5 mm in group B (p = 0.003). The TSF had a mean density of -97 & PLUSMN; 19 HU in group A and -95.8 & PLUSMN; 19 HU in group B (p = 0.75). The discriminating parameters of texture analysis were 10th (p = 0.03), 50th (p = 0.01), 90th percentiles (p = 0.04), S(0,1)SumAverg (p = 0.02), S(1,-1)SumOfSqs (p = 0.02), S(3,0)Contrast (p = 0.03), S(3,0)SumAverg (p = 0.02), S(4,0)SumAverg (p = 0.04), Horzl_RLNonUni (p = 0.02), and Vertl_LngREmph (p = 0.0005). Conclusions: Texture analysis provides distinctive radiomic parameters of EF and TSF. EF and TSF had different radiomic features as the BMI varies.