riccardo inchingolo

RESEARCH, TEACHING, or OTHER INTERESTS

Radiology, Nuclear Medicine and imaging

Scopus Publications

Non-invasive imaging biomarkers in chronic liver disease
Cesare Maino, Federica Vernuccio, Roberto Cannella, Laura Cristoferi, Paolo Niccolò Franco, Marco Carbone, Francesco Cortese, Riccardo Faletti, Elisabetta De Bernardi, Riccardo Inchingolo,et al.
Elsevier BV



Inferior Vena Cava Filter in Cancer-Associated Thrombosis: A Vade Mecum for the Treating Physicians: A Narrative Review
Agnese Maria Fioretti, Daniele La Forgia, Pietro Scicchitano, Natale Daniele Brunetti, Riccardo Inchingolo, Carlo Gabriele Tocchetti, and Stefano Oliva
MDPI AG
Cancer is a remarkable prothrombotic disease, and cancer-associated thrombosis acts as a dreadful omen for poor prognosis. The cornerstone of venous thromboembolism therapy is anticoagulation; however, in patients with venous thromboembolism who are not suitable for anticoagulation (contraindication, failure, or complication), the inferior vena cava filter appears a valuable option in the therapeutic arsenal. The recently heightened trend of steady rise in filter placement mirrors the spread of retrievable devices, together with improvements in physicians’ insertion ability, medico-legal issue, and novel and fewer thrombogenic materials. Nevertheless, the exact role of the inferior vena cava filter in cancer has yet to be endorsed due to a dearth of robust evidence. Indeed, data that support the inferior vena cava filter are weak and even controversial, resulting in discrepancies in the interpretation and application of guidelines in daily practice. In this narrative review, we aim at clarifying the state of the art on inferior vena cava filter use in malignancies. Furthermore, we provide a feasible, conclusive 4-step algorithm for the treating physicians in order to offer a practical strategy to successfully employ the inferior vena cava filter as a priceless device in the current armamentarium against cancer.


Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function?
Chiara Floridi, Laura Maria Cacioppa, Nicolò Rossini, Marco Macchini, Alessandra Bruno, Andrea Agostini, Valeria Consoli, Riccardo Inchingolo, Fabrizio Acquafredda, Daniele Nicolini,et al.
Springer Science and Business Media LLC
Abstract Purpose Microwave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described. Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function. Materials and methods All 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated. Results A total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate. Conclusion MWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.


Machine learning for predicting liver and/or lung metastasis in colorectal cancer: A retrospective study based on the SEER database
Zhentian Guo, Zongming Zhang, Limin Liu, Yue Zhao, Zhuo Liu, Chong Zhang, Hui Qi, Jinqiu Feng, Chunmin Yang, Weiping Tai,et al.
Elsevier BV



Robotic Major Hepatectomy in Elderly Patient
Antonella Delvecchio, Maria Conticchio, Riccardo Inchingolo, Francesca Ratti, Paolo Magistri, Andrea Belli, Graziano Ceccarelli, Francesco Izzo, Marcello Giuseppe Spampinato, Nicola De’ Angelis,et al.
MDPI AG
Background: the role of minimally invasive liver surgery has been progressively developed, with the practice increasing in safety and feasibility also with respect to major liver resections. The aim of this study was to analyze the feasibility and safety of major liver resection in elderly patients. Methods: data from a multicentric retrospective database including 1070 consecutive robotic liver resections in nine European hospital centers were analyzed. Among these, 131 were major liver resections. Patients were also divided in two groups (<65 years old and ≥65 years old) and perioperative data were compared between the two groups. Results: a total of 131 patients were included in the study. Operative time was 332 ± 125 min. Postoperative overall complications occurred in 27.1% of patients. Severe complications (Clavien Dindo ≥ 3) were 9.9%. Hospital stay was 6.6 ± 5.3 days. Patients were divided into two groups based on their age: 75 patients < 65 years old and 56 patients ≥ 65 years old. Prolonged pain, lung infection, intensive care stay, and 90-day readmission were worse in the elderly group. The two groups were matched for ASA and Charlson comorbidity score and, after statistical adjustment, postoperative data were similar between two groups. Conclusions: robotic major liver resection in elderly patients was associated with satisfying short-term outcomes.


Selective internal radiation therapy segmentectomy: A new minimally invasive curative option for primary liver malignancies?
Riccardo Inchingolo, Francesco Cortese, Antonio Rosario Pisani, Fabrizio Acquafredda, Roberto Calbi, Riccardo Memeo, Fotis Anagnostopoulos, and Stavros Spiliopoulos
Baishideng Publishing Group Inc.
Transarterial radioembolization or selective internal radiation therapy (SIRT) has emerged as a minimally invasive approach for the treatment of tumors. This percutaneous technique involves the local, intra-arterial delivery of radioactive microspheres directly into the tumor. Historically employed as a palliative measure for liver malignancies, SIRT has gained traction over the past decade as a potential curative option, mirroring the increasing role of radiation segmentectomy. The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods, particularly well-suited for patients where surgical resection or ablation is not feasible. Radiation segmentectomy is a more selective approach, aiming to deliver high-dose radiation to one to three specific hepatic segments, while minimizing damage to surrounding healthy tissue. Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.


Intra-patient and inter-observer image quality analysis in liver MRI study with gadoxetic acid using two different multi-arterial phase techniques
Francesca Castagnoli, Riccardo Faletti, Riccardo Inchingolo, Alberta Villanacci, Valeria Ruggeri, Domenico Zacà, Dow-Mu Koh, and Luigi Grazioli
Oxford University Press (OUP)
Abstract Purpose To evaluate intra-patient and interobserver agreement in patients who underwent liver MRI with gadoxetic acid using two different multi-arterial phase (AP) techniques. Methods A total of 154 prospectively enrolled patients underwent clinical gadoxetic acid-enhanced liver MRI twice within 12 months, using two different multi-arterial algorithms: CAIPIRINHA-VIBE and TWIST-VIBE. For every patient, breath-holding time, body mass index, sex, age were recorded. The phase without contrast media and the APs were independently evaluated by two radiologists who quantified Gibbs artefacts, noise, respiratory motion artefacts, and general image quality. Presence or absence of Gibbs artefacts and noise was compared by the McNemar’s test. Respiratory motion artefacts and image quality scores were compared using Wilcoxon signed rank test. Interobserver agreement was assessed by Cohen kappa statistics. Results Compared with TWIST-VIBE, CAIPIRINHA-VIBE images had better scores for every parameter except higher noise score. Triple APs were always acquired with TWIST-VIBE but failed in 37% using CAIPIRINHA-VIBE: 11% have only one AP, 26% have two. Breath-holding time was the only parameter that influenced the success of multi-arterial techniques. TWIST-VIBE images had worst score for Gibbs and respiratory motion artefacts but lower noise score. Conclusion CAIPIRINHA-VIBE images were always diagnostic, but with a failure of triple-AP in 37%. TWIST-VIBE was successful in obtaining three APs in all patients. Breath-holding time is the only parameter which can influence the preliminary choice between CAIPIRINHA-VIBE and TWIST-VIBE algorithm. Advances in knowledge If the patient is expected to perform good breath-holds, TWIST-VIBE is preferable; otherwise, CAIPIRINHA-VIBE is more appropriate.


Development and validation of a chromatin regulator signature for predicting prognosis hepatocellular carcinoma patient
Jiazhen Mao, Fei Song, Yu Zhang, Yifan Li, Riccardo Inchingolo, Aman Chauhan, Yutaka Midorikawa, Zhong Chen, and Weidong Tang
AME Publishing Company
Background Hepatocellular carcinoma (HCC) is a malignancy with a bleak prognosis. Although emerging research increasingly supports the involvement of chromatin regulators (CRs) in cancer development, CRs in HCC patients have not received proportionate attention. This study aimed to investigate the role and prognostic significance of CRs in HCC patients, providing new insights for clinical diagnosis and treatment strategies. Methods We analyzed 424 samples in The Cancer Genome Atlas-Liver hepatocellular carcinoma (TCGA-LIHC) data to identify key CR genes associated with HCC prognosis by differential expression and univariate Cox regression analyses. LASSO-multivariate Cox regression method was used for construction of a prognostic signature and development of a CR-related prognosis model. The prognosis capacity of the model was evaluated via Kaplan-Meier method. Relationship between the model and tumor microenvironment (TME) was evaluated. Additionally, clinical variables and the model were incorporated to create a nomogram. The role of the prognostic gene MRG-binding protein (MRGBP) in HCC was elucidated by immunohistochemistry and semiquantitative analysis. Results A risk score model, comprising B-lymphoma Mo-MLV insertion region 1 (BMI1), chromobox 2 (CBX2), and MRGBP, was constructed. The area under the curve (AUC) of the CR-based signature is 0.698 (P<0.05), exhibiting robust predictive power. Functional and pathway analyses illuminated the biological relevance of these genes. Immune microenvironment analysis suggested potential implications for immunotherapy. Drug sensitivity analysis identified agents for targeted treatment. Clinical samples show that MRGBP is highly expressed in HCC tissues. Conclusions This CR-based signature shows promise as a valuable prognostic tool for HCC patients. It demonstrates predictive capabilities, independence from other clinical factors, and potential clinical applicability. In addition, we need more experiments to validate our findings. These findings offer insights into HCC prognosis and treatment, with implications for personalized medicine and improved patient outcomes.


Radiomics and liver: Where we are and where we are headed?
Cesare Maino, Federica Vernuccio, Roberto Cannella, Paolo Niccolò Franco, Valentina Giannini, Michele Dezio, Antonio Rosario Pisani, Antonino Andrea Blandino, Riccardo Faletti, Elisabetta De Bernardi,et al.
Elsevier BV



Peri-operative score for elderly patients with resectable hepatocellular carcinoma
Maria Conticchio, Riccardo Inchingolo, Antonella Delvecchio, Francesca Ratti, Maximiliano Gelli, Massimiliano Ferdinando Anelli, Alexis Laurent, Giulio Cesare Vitali, Paolo Magistri, Giacomo Assirati,et al.
Baishideng Publishing Group Inc.
BACKGROUND Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality. AIM To identify new perioperative risk factors that could be associated with higher 90- and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score. METHODS A multicentric, retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC; several independent variables correlated with death from all causes at 90 and 180 d were studied. The coefficients of Cox regression proportional-hazards model for six-month mortality were rounded to the nearest integer to assign risk factors' weights and derive the scoring algorithm. RESULTS Multivariate analysis found variables (American Society of Anesthesiology score, high rate of comorbidities, Mayo end stage liver disease score and size of biggest lesion) that had independent correlations with increased 90- and 180-d mortality. A clinical risk score was developed with survival profiles. CONCLUSION This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.


2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery
Nicola de’Angelis, Carlo Alberto Schena, Francesco Marchegiani, Elisa Reitano, Belinda De Simone, Geoffrey Yuet Mun Wong, Aleix Martínez-Pérez, Fikri M. Abu-Zidan, Vanni Agnoletti, Filippo Aisoni,et al.
Springer Science and Business Media LLC
AbstractIatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.


Detection and management of bile duct injury during cholecystectomy
Francesco MARCHEGIANI, Maria CONTICCHIO, Alizée ZADOROZNYJ, Riccardo INCHINGOLO, Riccardo MEMEO, and Nicola DE’ANGELIS
Edizioni Minerva Medica
INTRODUCTION Cholecystectomy represents one of the most performed surgical procedures. Bile duct injuries (BDIs) are a dangerous complication of this intervention. With the advent of the laparoscopy, the rate of BDIs showed a growing trend that was partially justified by the learning curve of this technique. EVIDENCE ACQUISITION A literature search was conducted on Embase, Medline, and Cochrane databases to identify studies published up to October 2022 that analyzed the intraoperative detection and management of BDIs diagnosed during cholecystectomy. EVIDENCE SYNTHESIS According to the literature, approximately 25% of BDIs is diagnosed during the laparoscopic cholecystectomy. In the clinical suspicion of BDI, an intraoperative cholangiography is performed to confirm it. Complimentary technology, such as near-infrared cholangiography, can be also adopted. Intraoperative ultrasound represents a useful tool to furtherly define the biliary and the vascular anatomy. The proper classification of the type of BDI allows to identify the correct treatment. When a good expertise in hepato-pancreato-biliary surgery is available, a direct repair is performed with good outcomes both in case of simple and complex lesions. When the local resources are limited or there is a lack of dedicated surgical experience, patient referral to a reference center shows better outcomes. In particular, complex vasculo-biliary injuries require a highly specialized treatment. The key elements to transfer the patients are a good documentation of the injury, a proper drainage of the abdomen, and an antibiotic therapy. CONCLUSIONS BDI management requires a proper diagnostic process and prompt treatment to reduce the morbidity and mortality of this feared complication occurring during cholecystectomy.


Liver resection versus radiofrequency ablation in octogenarian patients for hepatocellular carcinoma: a propensity score multicenter analysis
Rosalinda Filippo, Maria Conticchio, Francesca Ratti, Riccardo Inchingolo, Maximiliano Gelli, Ferdinando Massimiliano Anelli, Alexis Laurent, Giulio Cesare Vitali, Paolo Magistri, Giacomo Assirati,et al.
Springer Science and Business Media LLC



Radiological findings in non-surgical recurrent hepatocellular carcinoma: From locoregional treatments to immunotherapy
Davide Ippolito, Cesare Maino, Marco Gatti, Paolo Marra, Riccardo Faletti, Francesco Cortese, Riccardo Inchingolo, and Sandro Sironi
Baishideng Publishing Group Inc.
Since hepatocellular carcinoma (HCC) represents an important cause of mortality and morbidity all over the world. Currently, it is fundamental not only to achieve a curative treatment but also to manage in the best way any possible recurrence. Even if the latest update of the Barcelona Clinic Liver Cancer guidelines for HCC treatment has introduced new locoregional techniques and confirmed others as well-established clinical practices, there is still no consensus about the treatment of recurrent HCC (RHCC). Locoregional treatments and medical therapy represent two of the most widely accepted approaches for disease control, especially in the advanced stage of liver disease. Different medical treatments are now approved, and others are under investigation. On this basis, radiology plays a central role in the diagnosis of RHCC and the assessment of response to locoregional treatments and medical therapy for RHCC. This review summarized the actual clinical practice by underlining the importance of the radiological approach both in the diagnosis and treatment of RHCC.


Liver involvement in patients with COVID-19 infection: A comprehensive overview of diagnostic imaging features
Davide Ippolito, Cesare Maino, Federica Vernuccio, Roberto Cannella, Riccardo Inchingolo, Michele Dezio, Riccardo Faletti, Pietro Andrea Bonaffini, Marco Gatti, and Sandro Sironi
Baishideng Publishing Group Inc.
During the first wave of the pandemic, coronavirus disease 2019 (COVID-19) infection has been considered mainly as a pulmonary infection. However, different clinical and radiological manifestations were observed over time, including involvement of abdominal organs. Nowadays, the liver is considered one of the main affected abdominal organs. Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs. After clinical assessment, radiology plays a key role in the evaluation of liver involvement. Ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) may be used to evaluate liver involvement. US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection, in particular liver steatosis and portal-vein thrombosis. CT and MRI are used as second- and third-line techniques, respectively, considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization. This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage.


Irreversible electroporation for the management of pancreatic cancer: Current data and future directions
Stavros Spiliopoulos, Lazaros Reppas, Dimitrios Filippiadis, Antonella Delvecchio, Maria Conticchio, Riccardo Memeo, and Riccardo Inchingolo
Baishideng Publishing Group Inc.
Pancreatic cancer is currently the seventh leading cause of cancer death (4.5% of all cancer deaths) while 80%-90% of the patients suffer from unresectable disease at the time of diagnosis. Prognosis remains poor, with a mean survival up to 15 mo following systemic chemotherapy. Loco-regional thermal ablative techniques are rarely implemented due to the increased risk of thermal injury to the adjacent structures, which can lead to severe adverse events. Irreversible electroporation, a promising novel non-thermal ablative modality, has been recently introduced in clinical practice for the management of inoperable pancreatic cancer as a safer and more effective loco-regional treatment option. Experimental and initial clinical data are optimistic. This review will focus on the basic principles of IRE technology, currently available data, and future directions.


Multimodal Management of Colorectal Liver Metastases: State of the Art
Elisabetta Filoni, Vittoria Musci, Alessia Di Rito, Riccardo Inchingolo, Riccardo Memeo, and Francesco Mannavola
Frontiers Media SA
Liver is the most common site of colorectal cancer (CRC) metastases. Treatment of CRC liver metastases (CRLM) includes different strategies, prevalently based on the clinical and oncological intent. Valid approaches in liver-limited or liver-prevalent disease include surgery, percutaneous ablative procedures (radiofrequency ablation, microwave ablation), intra-arterial perfusional techniques (chemo-embolization, radio-embolization) as well as stereotactic radiotherapy. Systemic treatments, including chemotherapy, immunotherapy and other biological agents, are the only options for patients with no chance of locoregional approaches. The use of chemotherapy in other settings, such as neoadjuvant, adjuvant or conversion therapy of CRLM, is commonly accepted in the clinical practice, although data from several clinical trials have been mostly inconclusive. The optimal integration of all these strategies, when applicable and clinically indicated, should be ever considered in patients affected by CRLM based on clinical evidence and multidisciplinary experience. Here we revised in detail all the possible therapeutic approaches of CRLM focusing on the current evidences, the studies still in progress and the often contradictory data.


Abelacimab in Cancer-Associated Thrombosis: The Right Drug at the Right Time for the Right Purpose. A Comprehensive Review
Agnese Maria Fioretti, Tiziana Leopizzi, Daniele La Forgia, Raffaele De Luca, Donato Oreste, Riccardo Inchingolo, Pietro Scicchitano, and Stefano Oliva
IMR Press



Liver metastases: The role of magnetic resonance imaging
Cesare Maino, Federica Vernuccio, Roberto Cannella, Francesco Cortese, Paolo Niccolò Franco, Clara Gaetani, Valentina Giannini, Riccardo Inchingolo, Davide Ippolito, Arianna Defeudis,et al.
Baishideng Publishing Group Inc.
The liver is one of the organs most commonly involved in metastatic disease, especially due to its unique vascularization. It’s well known that liver metastases represent the most common hepatic malignant tumors. From a practical point of view, it’s of utmost importance to evaluate the presence of liver metastases when staging oncologic patients, to select the best treatment possible, and finally to predict the overall prognosis. In the past few years, imaging techniques have gained a central role in identifying liver metastases, thanks to ultrasonography, contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). All these techniques, especially CT and MRI, can be considered the non-invasive reference standard techniques for the assessment of liver involvement by metastases. On the other hand, the liver can be affected by different focal lesions, sometimes benign, and sometimes malignant. On these bases, radiologists should face the differential diagnosis between benign and secondary lesions to correctly allocate patients to the best management. Considering the above-mentioned principles, it’s extremely important to underline and refresh the broad spectrum of liver metastases features that can occur in everyday clinical practice. This review aims to summarize the most common imaging features of liver metastases, with a special focus on typical and atypical appearance, by using MRI.


Radiomics in colorectal cancer patients
Riccardo Inchingolo, Cesare Maino, Roberto Cannella, Federica Vernuccio, Francesco Cortese, Michele Dezio, Antonio Rosario Pisani, Teresa Giandola, Marco Gatti, Valentina Giannini,et al.
Baishideng Publishing Group Inc.
The main therapeutic options for colorectal cancer are surgical resection and adjuvant chemotherapy in non-metastatic disease. However, the evaluation of the overall adjuvant chemotherapy benefit in patients with a high risk of recurrence is challenging. Radiological images can represent a source of data that can be analyzed by using automated computer-based techniques, working on numerical information coded within Digital Imaging and Communications in Medicine files: This image numerical analysis has been named “radiomics”. Radiomics allows the extraction of quantitative features from radiological images, mainly invisible to the naked eye, that can be further analyzed by artificial intelligence algorithms. Radiomics is expanding in oncology to either understand tumor biology or for the development of imaging biomarkers for diagnosis, staging, and prognosis, prediction of treatment response and diseases monitoring and surveillance. Several efforts have been made to develop radiomics signatures for colorectal cancer patient using computed tomography (CT) images with different aims: The preoperative prediction of lymph node metastasis, detecting BRAF and RAS gene mutations. Moreover, the use of delta-radiomics allows the analysis of variations of the radiomics parameters extracted from CT scans performed at different timepoints. Most published studies concerning radiomics and magnetic resonance imaging (MRI) mainly focused on the response of advanced tumors that underwent neoadjuvant therapy. Nodes status is the main determinant of adjuvant chemotherapy. Therefore, several radiomics model based on MRI, especially on T2-weighted images and ADC maps, for the preoperative prediction of nodes metastasis in rectal cancer has been developed. Current studies mostly focused on the applications of radiomics in positron emission tomography/CT for the prediction of survival after curative surgical resection and assessment of response following neoadjuvant chemoradiotherapy. Since colorectal liver metastases develop in about 25% of patients with colorectal carcinoma, the main diagnostic tasks of radiomics should be the detection of synchronous and metachronous lesions. Radiomics could be an additional tool in clinical setting, especially in identifying patients with high-risk disease. Nevertheless, radiomics has numerous shortcomings that make daily use extremely difficult. Further studies are needed to assess performance of radiomics in stratifying patients with high-risk disease.


Computed tomography fluoroscopy-guided percutaneous biopsy of pulmonary nodules ≤ 10 mm: retrospective analysis of procedures performed during the COVID-19 pandemic
Thiago Franchi Nunes, Riccardo Inchingolo, Cristina Faria Kikuti, Bernardo Bacelar de Faria, Cezar Augusto Vendas Galhardo, João Ricardo Filgueiras Tognini, Edson Marchiori, and Bruno Hochhegger
FapUNIFESP (SciELO)
Abstract Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured &lt; 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.


Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Case Report and Literature Review of 890 Patients Affected by Uncommon Primary Liver Tumor Presentation
Maria Conticchio, Nicola Maggialetti, Marco Rescigno, Maria Chiara Brunese, Roberto Vaschetti, Riccardo Inchingolo, Roberto Calbi, Valentina Ferraro, Michele Tedeschi, Maria Rita Fantozzi,et al.
MDPI AG
Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47-year-old male patient admitted to the University Hospital of Bari with abdominal pain. Blood tests revealed the presence of an untreated hepatitis B virus infection (HBV), with normal liver function and without jaundice. Abdominal ultrasonography revealed a cirrhotic liver with a segmental dilatation of the third bile duct segment, confirmed by a CT scan and liver MRI, which also identified a heterologous mass. No other focal hepatic lesions were identified. A percutaneous ultrasound-guided needle biopsy was then performed, detecting a moderately differentiated HCC. Finally, the patient underwent a third hepatic segmentectomy, and the histopathological analysis confirmed the endobiliary localization of HCC. Subsequently, the patient experienced a nodular recurrence in the fourth hepatic segment, which was treated with ultrasound-guided percutaneous radiofrequency ablation (RFA). This case shows that HCC with BDTT can mimic different types of tumors. It also indicates the value of an early multidisciplinary patient assessment to obtain an accurate diagnosis of HCC with BDTT, which may have prognostic value that has not been recognized until now.


Liver magnetic resonance imaging for evaluation of response to treatment after stereotactic body radiation therapy of hepatocellular carcinoma
Alessandro Serafini, Valeria Ruggeri, Riccardo Inchingolo, Marco Gatti, Alessia Guarneri, Cesare Maino, Davide Ippolito, Luigi Grazioli, Umberto Ricardi, and Riccardo Faletti
Baishideng Publishing Group Inc.
BACKGROUND Although stereotactic body radiation therapy (SBRT) is increasingly used, its application has not yet been regulated by the main international guidelines, leaving the decision to multidisciplinary teams. AIM To assess magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) treated with SBRT, highlighting the efficacy of the treatment and the main aspects of the lesion before and after the procedure. METHODS As part of a retrospective study, 49 patients who underwent SBRT for HCC between January 2013 and November 2019 were recruited. Each patient underwent a pre-treatment MRI examination with a hepatospecific contrast agent and a similar follow-up examination within 6 mo of therapy. In addition, 22 patients underwent a second follow-up examination after the first 6 mo. The following characteristics were analysed: Features analysed compared to pre-treatment MRI examination, presence or absence of infield and outfield progression, ring-like enhancement, signal hyperintensity in T2-weighted sequences in the perilesional parenchyma, capsular retraction, and "band" signal hypointensity in T1-weighted gradient echo fat saturated sequences obtained during hepatobiliary excretion. RESULTS Signal hyperintensity in the T2-weighted sequences showed a statistically significant reduction in the number of lesions at the post-SBRT first control (P = 0.0006). Signal hyperintensity in diffusion-weighted imaging-weighted sequences was decreased at MRI first control (P < 0.0001). A statistically significant increase of apparent diffusion coefficient values from a median of 1.01 to 1.38 at the first post-control was found (P < 0.0001). Capsular retraction was increased at the late evaluation (P = 0.006). Band-like signal hypointensity in the hepatobiliary phase was present in 94% at the late control (P = 0.006). The study of the risk of outfield progression vs infield progression revealed a hazard ratio of 9. CONCLUSION The efficacy of SBRT should be evaluated not in the first 6 mo, but at least 9 mo post-SBRT, when infield progression persists at very low rates while the risk of outfield progression increases significantly.


Percutaneous insertion of a novel dedicated metal stent to treat malignant hilar biliary obstruction
Francesco Cortese, Fabrizio Acquafredda, Andrea Mardighian, Maria Teresa Zurlo, Valentina Ferraro, Riccardo Memeo, Stavros Spiliopoulos, and Riccardo Inchingolo
Baishideng Publishing Group Inc.
BACKGROUND Percutaneous bilateral biliary stenting is an established method for the management of unresectable malignant hilar biliary obstruction. AIM To evaluate the efficacy and safety of a novel uncovered biliary stent, specifically designed for hilar reconstruction. METHODS This, single-center, retrospective study included 18 patients (mean age 71 ± 11 years; 61.1% male) undergoing percutaneous transhepatic Moving cell stent (MCS) placement for hilar reconstruction using the stent-in-stent technique for malignant biliary strictures, between November 2020 and July 2021. The Patients were diagnosed with cholangiocarcinoma (12/18; 66.6%), gallbladder cancer (5/18; 27.7%), and colorectal liver metastasis (1/18; 5.5%). Primary endpoints were technical (appropriate stent placement) and clinical (relief from jaundice) success. Secondary endpoints included stent patency, overall survival, complication rates and stent-related complications. RESULTS The technical and clinical success rates were 100% (18/18 cases). According to Kaplan-Meier analysis, the estimated overall patient survival was 80.5% and 60.4% at 6 and 12 mo respectively, while stent patency was 90.9% and 68.2% at 6 mo and 12 mo respectively. The mean stent patency was 172.53 ± 56.20 d and median stent patency was 165 d (range 83-315). Laboratory tests for cholestasis significantly improved after procedure: mean total bilirubin decreased from 15.2 ± 6.0 mg/dL to 1.3 ± 0.4 mg/dL (P < 0.001); mean γGT decreased from 1389 ± 832 U/L to 114.6 ± 53.5 U/L (P < 0.001). One periprocedural complication was reported. Stent-related complications were observed in 5 patients (27.7%), including 1 occlusion (5.5%) and 1 stent migration (5.5 %). CONCLUSION Percutaneous hilar bifurcation biliary stenting with the MCS resulted in excellent clinical and technical success rates, with acceptable complication rates. Further studies are needed to confirm these initial positive results.


Role of gadoxetic acid-enhanced liver magnetic resonance imaging in the evaluation of hepatocellular carcinoma after locoregional treatment
Marco Gatti, Cesare Maino, Fatemeh Darvizeh, Alessandro Serafini, Eleonora Tricarico, Alessia Guarneri, Riccardo Inchingolo, Davide Ippolito, Umberto Ricardi, Paolo Fonio,et al.
Baishideng Publishing Group Inc.
Locoregional treatments, as alternatives to surgery, play a key role in the management of hepatocellular carcinoma (HCC). Liver magnetic resonance imaging (MRI) enables a multiparametric assessment, going beyond the traditional dynamic computed tomography approach. Moreover, the use of hepatobiliary agents can improve diagnostic accuracy and are becoming important in the diagnosis and follow-up of HCC. However, the main challenge is to quickly identify classical responses to loco-regional treatments in order to determine the most suitable management strategy for each patient. The aim of this review is to provide a summary of the most common and uncommon liver MRI findings in patients who underwent loco-regional treatments for HCC, with a special focus on ablative therapies (radiofrequency, microwaves and cryoablation), trans-arterial chemoembolization, trans-arterial radio-embolization and stereotactic ablative radiotherapy techniques, considering the usefulness of gadoxetate disodium (Gd-EOB-DTPA) contrast agent.