Background: Neonatal aortic coarctation (CoA) remains difficult to diagnose before hemodynamic deterioration occurs after ductal closure. Pulse wave velocity (PWV) may reflect functional vascular alterations associated with CoA. Methods: A simplified hemodynamic mathematical model describing pulse wave propagation across aortic coarctation has been developed. The model is based on conservation of energy principles and incorporates simplified assumptions regarding arterial compliance to relate PWV changes to systolic–diastolic pressure. Results: The model suggests a nonlinear relationship between PWV reduction distal to the coarctation and pressure excursion damping. Specifically, a twofold PWV reduction corresponds theoretically to an approximately fourfold reduction in systolic–diastolic pressure variation. The derived relationships were shown to be conceptually consistent with the Moens–Korteweg formulation and Laplace law. Conclusions: This theoretical framework supports the physiological plausibility of combining PWV assessment with pressure-gradient evaluation in neonatal CoA screening. Future studies are required to validate the model in clinical settings and define diagnostic thresholds.

This study investigated whether radiomic features extracted from [18F]FDG-PET scans acquired before and two weeks after neoadjuvant treatment, and their variation, provided prognostic parameters in locally advanced cervical cancer (LACC) patients treated with neoadjuvant chemo-radiotherapy (CRT) followed by radical surgery. We retrospectively included LACC patients referred to our Institution from 2010 to 2016. [18F]FDG-PET/CT was performed before neoadjuvant CRT (baseline) and two weeks after the start of treatment (early). Radiomic features were extracted after semi-automatic delineation of the primary tumour, on baseline and early PET images. Delta radiomics were calculated as the relative differences between baseline and early features. We performed 5-fold cross-validation stratified for recurrence and cancer-specific death, integrating dimensionality reduction of the radiomic features and variable hunting with importance within the folds. After supervised feature selection, radiomic models with the best-performing features for each timepoint, as well as clinical models and combined clinico-radiomic models, were built. Model performances are presented as C-indices, for prediction of recurrence/progression (disease-free survival, DFS) and cancer-specific death (overall survival, OS). 95 patients were included. With a median follow-up of 76.0 months (95

Minimally invasive surgery typically requires the use of small instruments that are easily manipulated and have various functions. Our goal is to create, develop, and ultimately obtain a prototype for a novel surgical suction-irrigation device that includes coagulation and neuromuscular stimulation capabilities. The need to achieve accurate hemostasis, particularly during deep pelvic dissection while maintaining suction-irrigation capabilities, served as a valuable motivation for the development of this device. Neurostimulation is necessary in various anatomical contexts, in addition to its coagulation function. Several prototypes were built with exterior diameters ranging from 8 to 5 mm. A series of tests were conducted on pork steaks, and a pathological investigation was carried out using hematoxylin–eosin staining to assess the extent of coagulation. Manual tests demonstrated excellent agility and a high level of effectiveness. The two functions, coagulation and neurostimulation, aid the surgeon in reducing blood loss and accurately pinpointing nerve locations. Hence, this novel prototype has the potential to stimulate the creation of additional equipment that could prove highly valuable in pelvic radical surgery and neuropelveology, where the need for accurate hemostasis and the identification of nerve landmarks are of utmost significance.

Introduction: The term theragnostic refers to the combination of a predictive imaging biomarker with a therapeutic agent. The promising application of prostate-specific membrane antigen (PSMA)-based radiopharmaceuticals in the imaging and treatment of prostate cancer (PCa) patients opens the way to investigate a possible role of PSMA-based radiopharmaceuticals in cancers beyond the prostate. Therefore, the aim of this review was to evaluate the role of 177Lu-PSMA radioligand therapy (RLT) in malignancies other than prostate cancer by evaluating preclinical, clinical studies, and ongoing clinical trials. Methods: An extensive literature search was performed in three different databases using different combinations of the following terms: “Lu-PSMA”, “177Lu-PSMA”, “preclinical”, “mouse”, “salivary gland cancer”, “breast cancer”, “glioblastoma”, “solid tumour”, “renal cell carcinoma”, “HCC”, “thyroid”, “salivary”, “radioligand therapy”, and “lutetium-177”. The search had no beginning date limit and was updated to April 2024. Only articles written in English were included in this review. Results: A total of four preclinical studies were selected (breast cancer model n = 3/4). PSMA-RLT significantly reduced cell viability and had anti-angiogenic effects, especially under hypoxic conditions, which increase PSMA binding and uptake. Considering the clinical studies (n = 8), the complexity of evaluating PSMA-RLT in cancers other than prostate cancer was clearly revealed, since in most of the presented cases a sufficient tumour radiation dose was not achieved. However, encouraging results can be found in some types of diseases, such as thyroid cancer. Some clinical trials are still ongoing, and results from prospective larger cohorts of patients are awaited. Conclusions: The need for larger patient cohorts and more RLT cycles administered underscores the need for further comprehensive studies. Given the very preliminary results of both preclinical and clinical studies, ongoing clinical trials in the near future may provide stronger evidence of both the safety and therapeutic efficacy of PSMA-RLT in malignancies other than prostate cancer.

This study investigated whether radiomic features extracted from pretreatment [18F]FDG PET could improve the prediction of both histopathologic tumor response and survival in patients with locally advanced cervical cancer (LACC) treated with neoadjuvant chemoradiotherapy followed by surgery compared with conventional PET parameters and histopathologic features. Methods: The medical records of all consecutive patients with LACC referred between July 2010 and July 2016 were reviewed. [18F]FDG PET/CT was performed before neoadjuvant chemoradiotherapy. Radiomic features were extracted from the primary tumor volumes delineated semiautomatically on the PET images and reduced by factor analysis. A receiver-operating-characteristic analysis was performed, and conventional and radiomic features were dichotomized with Liu's method according to pathologic response (pR) and cancer-specific death. According to the study protocol, only areas under the curve of more than 0.70 were selected for further analysis, including logistic regression analysis for response prediction and Cox regression analysis for survival prediction. Results: A total of 195 patients fulfilled the inclusion criteria. At pathologic evaluation after surgery, 131 patients (67.2%) had no or microscopic (≤3 mm) residual tumor (pR0 or pR1, respectively); 64 patients (32.8%) had macroscopic residual tumor (>3 mm, pR2). With a median follow-up of 76.0 mo (95% CI, 70.7-78.7 mo), 31.3% of patients had recurrence or progression and 20.0% died of the disease. Among conventional PET parameters, SUVmean significantly differed between pathologic responders and nonresponders. Among radiomic features, 1 shape and 3 textural features significantly differed between pathologic responders and nonresponders. Three radiomic features significantly differed between presence and absence of recurrence or progression and between presence and absence of cancer-specific death. Areas under the curve were less than 0.70 for all parameters; thus, univariate and multivariate regression analyses were not performed. Conclusion: In a large series of patients with LACC treated with neoadjuvant chemoradiotherapy followed by surgery, PET radiomic features could not predict histopathologic tumor response and survival. It is crucial to further explore the biologic mechanism underlying imaging-derived parameters and plan a large, prospective, multicenter study with standardized protocols for all phases of the process of radiomic analysis to validate radiomics before its use in clinical routine.

Sentinel node biopsy (SNB) is a minimally invasive technique for assessing the nodal involvement in some gynecological cancers. This technique is safe and feasible in early stages of cervical and vulvar cancers, while is still matter of controversy in early endometrial, vaginal and ovarian cancers. It is indicated for squamous cell carcinoma of vulva with T < 4 cm, > 1 mm depth of invasion and cN0. In cervical cancer, it is advised in stages IA1 with lymphovascular invasion to IB2. In endometrial cancer, it may be considered in patients with apparent uterine-confined disease and cN0 or no obvious extra-uterine disease at exploration or even in high-risk histologies. Preoperative lymphoscintigraphy and SPECT/CT images are crucial to mapping the lymphatic drainage of gynecologic cancers for planning a tailored surgery. Indocyanine green-99mTc-nanocolloid has been recently used in vulvar and cervical cancers with good results, but remains to be confirmed in further studies. Intraoperatively, the handheld gamma probe may be supplemented with the use of a portable gamma camera or an intraoperative freehand SPECT. The ultra-staging should be performed in negative sentinel nodes at hematoxylin and eosin analysis for detecting micro-metastatic disease. Finally, SNB should be done in institutions with expertise in this procedure.

Background: 18-FDG PET/CT is a functional imaging method which allows to identify inflammation of vessel walls. The use of PET in large vessels vasculitis(LVV) at disease onset and during follow up is still debate either to confirm clinical remission either to drive the therapy choice. American Society of Nuclear Cardiology (ASNC) recently advanced recommendations aimed to standardize the application of PET in LVV(1). Objectives: The aim of our study was to assess the clinical role of PET performed in patients affected by LVV at the diagnosis and during the follow up. Methods: We retrospectively evaluated PET/CT of 49 patients affected by clinically active LVV according to LVV visual grading (LVG, grading 0-3) and measured the standardized uptake value(SUV) of large vessels. 38 (77,6%) patients were affected by Giant Cells Arteritis and 11(22,4%) by Takayasu Arteritis. 32(65.3%) patients repeated the imaging after a mean follow-up of 11.5±5.4 months. All baseline (T0) and follow up (T1) clinical data of disease activity were collected. Patients were treated according to EULAR LVV management recommendations(2). T0 PET/CT study was performed in patients with a clinically active disease defined by suggestive symptoms/signs and/or high inflammatory markers. The mean disease duration before T1 PET/CT examination was 4 months. T0 PET was performed in 25/49 patients(52%) at the diagnosis of LVV, whereas in 24/49(48%) patients with already diagnosed but active LVV disease. Results: Baseline PET was positive in 21 patients(42.9%). According to ASNC recommendations, 19 patients (38.8%) presented a LVG=3, 2(4.0%) a LVG=2, 6(12.2%) LVG=1 and 22 (44.9%) LVG=0. Patients performing PET at disease onset(75%) had higher LVG score than patients performing PET during the disease course (25%),p=0,002. At T0, aortic, carotid, axillary and subclavian SUV did not correlate with inflammatory markers. Follow up PET/CT studies were performed in 32 patients, 13 (40.6%) with a clinically active disease despite therapy, while 19(59.4%) in clinical remission. Follow up PET was still positive in 8 patients (25%) with a LVG=3, 10 (31.2%) patients presented LVG=1 and 14 (43.8%) LVG=0. T1 PET/CT study showed a significant reduction of SUV values in descending aorta, left and right subclavian arteries, and left and right axillary arteries when compared with first PET/CT study. According to LVG, 12 patients with active PET/CT study at T0 (19 pts) presented a reduction of LVG from score 2 and 3 to grade 1 or 0 (64.2%) at second PET/CT study. Only 3 patients presented an increased LVG score at T1, while in the other 17 patients T1 PET confirmed the previous score. No significant difference was found between LVG scores according with clinical characteristics, but among 8 patients presenting an active T1 PET, 4(50%) were in clinical remission. Conclusion: The use of ASNC recommendations for FDG PET/CT in LVV enables to confirm a metabolically active disease in 40% of patients and in 75% of patients at disease onset, suggesting that post-posing the exam could lead to underrate the real extension of disease. Our data, even if limited, suggest that PET/CT could be crucial in management of patients in clinical remission, detecting patients with still metabolically active LVV. Further prospective studies are necessary to evaluate the role of PET/CT in driving therapeutic strategies. References: [1]Slart R et all - Eur J Nucl Med Mol Imaging, 2018 [2]Hellmich et all – Ann Rheum Dis 2018 Disclosure of Interests: Laura Gigante: None declared, Dario Bruno: None declared, Vanessa Feudo: None declared, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Lucia Leccisotti: None declared, Alessia Musto: None declared, Pier Giacomo Cerasuolo: None declared, Angelo Zoli: None declared, Alessandro Giordano: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

A 42-year-old woman presented with a ten-day history of dysphagia, slight chest pain and occasional vomiting. With the performance of thoracic and abdominal enhanced computed tomography (CT) and upper gastrointestinal contrast, once esophageal cancer was suspected. Significant activity mass in esophagus and mediastinal lymph nodes could be found on the imaging of 18F-FDG PET/CT, which also supported malignancy. However, The biopsies of the mid-esophagus were negative for malignancy. Then a video-assisted thoracic surgery (VATS) for mediastinal lymph node biopsy was taken and esophageal tuberculosis was diagnosed by histopathologic examination. This rare case reminds us of esophageal tuberculosis as a possible differential diagnosis in esophageal mass with enlarged lymph nodes.

This mini-review aims to qualitatively analyze the diagnostic performance of FDG PET in patients with diagnosis or suspected large vessel vasculitis (LVV). The future perspectives of PET in this field are also described. A comprehensive computer literature search of case–control studies published in PubMed/MEDLINE database in the last 10 years and regarding the diagnostic performance of FDG PET in LVV was carried out. Patient preparation, FDG PET image acquisition, and interpretation criteria were analyzed with respect to the recent joint procedural recommendations in LVV. We have summarized the methodological aspects and the diagnostic performances of FDG PET in detecting LVV considering 15 articles published in the literature. The data confirm the good diagnostic performance of FDG PET in this setting, using both visual and semiquantitative analysis. However, some heterogeneity has been found in several methodological aspects, as well as in the results of the included studies. Overall, FDG PET has a good diagnostic performance for the detection of active disease in LVV. Future prospective studies, more consistent with the joint procedural recommendations in LVV, are needed to support the use of standardized procedures and reproducible criteria for defining the presence of LVV with FDG PET/CT. Hybrid imaging and novel radiopharmaceuticals, more specific than FDG, are the future of PET in this field.

Background: Global cardiovascular adaptation of normal healthy term newborns is rarely studied from a multiorgan and hematological point of view. Aims: To evaluate comprehensive neonatal cardiovascular adaptation during the first days of life with echocardiography and renal-cerebral echo color-Doppler and to correlate it with hematocrit (Ht) changes. Study design: A prospective observational study was conducted on 35 healthy term neonates with a mean ± SD gestational age and birth weight of 39.5 ± 1.1 weeks and 3,400 ± 330 g, respectively. All infants underwent serial echocardiograms at 15 ± 4 hours (day 1) and 72 ± 4 hours (day 3) of age. At the same time, cerebral and renal Doppler parameters were acquired and Ht was sampled. Results: The weight and Ht declined by 220 g (189-251) and 8.1% (6.7-9.5), respectively. Systolic and diastolic diameters of the right ventricle and diastolic left ventricle posterior wall thickness showed a reduction, while the diastolic diameter of the left ventricle showed a small increase. The Doppler cardiac evaluation showed an increase in the mitral E/A ratio and pulmonary acceleration time, a reduction of late transmitral flow peak velocity, aortic peak systolic velocity (PSV), aortic peak systolic pressure gradient, aortic velocity-time integral, aortic mean pressure gradient and pulmonary mean acceleration. We also found a reduction of cerebral resistance parameters and an increase in PSV, end-diastolic velocity, and time-averaged velocity. Other measured parameters remained unchanged. Conclusion: Systemic cardiovascular evaluation about changes in Ht is an essential approach to study newborns, especially during the first days of life when Ht shows a significant decrease. Knowledge of the laws of physics related to the effect of Ht changes on vascular parameters is another important factor in understanding the pathophysiology of neonatal disease states. Further studies are useful to help physicians make evidence-based decisions in the management of newborns in Neonatal Intensive Care Units (NICUs).

Positron emission tomography-computed tomography (PET-CT) is a nuclear medicine imaging technique widely used in oncology, cardiology and neurology where it’is becoming of great interest especially because of its role in the diagnosis and differential diagnosis between several pathological conditions involving the nervous system. In neurodegenerative diseases, the most used PET-CT radiopharmaceuticals are 18Fluoro-Fluorodeoxyglucose (18FFDG), a glucose analogue that is able to identify abnormalities of cerebral glucose metabolism, and amyloid-tracers (11C-PiB, 18F-Florbetapir, 18F-Flutemetamol, 18F-Florbetaben) that are able to detect presence of amyloid plaques. Depending on the specific characteristic of tracers and patient’s disease, the examination has dedicated appropriate indications that are illustrated in this article. PET-CT, with its several tracers, is an accurate tool in evaluating neurodegenerative diseases. 18F-FDG is considered a hallmark of the stage of the disease. Glucose hypometabolism in specific cerebral areas allows distinguishing different degenerative diseases. Amyloid tracers are considered the hallmark of the state of the disease. The uptake of PET-amyloids tracers reflects the cortical regional density of amyloid plaques.