Current status of magnetic resonance imaging radiomics in hepatocellular carcinoma:A quantitative review with Radiomics Quality Score

BACKGROUND Radiomics is a promising tool that may increase the value of magnetic resonance imaging(MRI)for different tasks related to the management of patients with hepatocellular carcinoma(HCC).However,its implementation in clinical practice is still far,with many issues related to the methodological quality of radiomic studies.AIM To systematically review the current status of MRI radiomic studies concerning HCC using the Radiomics Quality Score(RQS).METHODS A systematic literature search of PubMed,Google Scholar,and Web of Science databases was performed to identify original articles focusing on the use of MRI radiomics for HCC management published between 2017 and 2023.The methodological quality of radiomic studies was assessed using the RQS tool.Spearman’s correlation(ρ)analysis was performed to explore if RQS was correlated with journal metrics and characteristics of the studies.The level of statistical significance was set at P<0.05.RESULTS One hundred and twenty-seven articles were included,of which 43 focused on HCC prognosis,39 on prediction of pathological findings,16 on prediction of the expression of molecular markers outcomes,18 had a diagnostic purpose,and 11 had multiple purposes.The mean RQS was 8±6.22,and the corresponding percentage was 24.15%±15.25%(ranging from 0.0% to 58.33%).RQS was positively correlated with journal impact factor(IF;ρ=0.36,P=2.98×10^(-5)),5-years IF(ρ=0.33,P=1.56×10^(-4)),number of patients included in the study(ρ=0.51,P<9.37×10^(-10))and number of radiomics features extracted in the study(ρ=0.59,P<4.59×10^(-13)),and time of publication(ρ=-0.23,P<0.0072).CONCLUSION Although MRI radiomics in HCC represents a promising tool to develop adequate personalized treatment as a noninvasive approach in HCC patients,our study revealed that studies in this field still lack the quality required to allow its introduction into clinical practice.

Impact of radiogenomics in esophageal cancer on clinical outcomes: A pilot study

BACKGROUND Esophageal cancer(ESCA)is the sixth most common malignancy in the world,and its incidence is rapidly increasing.Recently,several microRNAs(miRNAs)and messenger RNA(mRNA)targets were evaluated as potential biomarkers and regulators of epigenetic mechanisms involved in early diagnosis.In addition,computed tomography(CT)radiomic studies on ESCA improved the early stage identification and the prediction of response to treatment.Radiogenomics provides clinically useful prognostic predictions by linking molecular characteristics such as gene mutations and gene expression patterns of malignant tumors with medical images and could provide more opportunities in the management of patients with ESCA.AIM To explore the combination of CT radiomic features and molecular targets associated with clinical outcomes for characterization of ESCA patients.METHODS Of 15 patients with diagnosed ESCA were included in this study and their CT imaging and transcriptomic data were extracted from The Cancer Imaging Archive and gene expression data from The Cancer Genome Atlas,respectively.Cancer stage,history of significant alcohol consumption and body mass index(BMI)were considered as clinical outcomes.Radiomic analysis was performed on CT images acquired after injection of contrast medium.In total,1302 radiomics features were extracted from three-dimensional regions of interest by using PyRadiomics.Feature selection was performed using a correlation filter based on Spearman’s correlation(ρ)and Wilcoxon-rank sum test respect to clinical outcomes.Radiogenomic analysis involvedρanalysis between radiomic features associated with clinical outcomes and transcriptomic signatures consisting of eight N6-methyladenosine RNA methylation regulators and five up-regulated miRNA.The significance level was set at P<0.05.RESULTS Of 25,five and 29 radiomic features survived after feature selection,considering stage,alcohol history and BMI as clinical outcomes,respectively.Radiogenomic analysis with stage as clinical outcome revealed that six of the eight mRNA regulators and two of the five up-regulated miRNA were significantly correlated with ten and three of the 25 selected radiomic features,respectively(-0.61<ρ<-0.60 and 0.53<ρ<0.69,P<0.05).Assuming alcohol history as clinical outcome,no correlation was found between the five selected radiomic features and mRNA regulators,while a significant correlation was found between one radiomic feature and three up-regulated miRNAs(ρ=-0.56,ρ=-0.64 andρ=0.61,P<0.05).Radiogenomic analysis with BMI as clinical outcome revealed that four mRNA regulators and one up-regulated miRNA were significantly correlated with 10 and two radiomic features,respectively(-0.67<ρ<-0.54 and 0.53<ρ<0.71,P<0.05).CONCLUSION Our study revealed interesting relationships between the expression of eight N6-methyladenosine RNA regulators,as well as five up-regulated miRNAs,and CT radiomic features associated with clinical outcomes of ESCA patients.

Compromised nutritional status in patients with end-stage liver disease:Role of gut microbiota

Background: Patients with end-stage liver disease(ESLD) have a compromised nutritional status because of the liver crucial role in regulating metabolic homeostasis and energy balance.Data sources: A systematic review of literature based on extensive relevant articles published from 2001 to 2017 in English in Pub Med database was performed by searching keywords such as liver disease, nonalcoholic liver disease, alcoholic liver disease, malnutrition, epigenetics, gut microbiota, and probiotics.Results: Liver transplantation would be one eligible therapy for ESLD patients, even if, the clinical outcome is negatively influenced by malnutrition and/or infections. The malnutrition is a condition of nutrient imbalance with a high incidence in ESLD patients. An accurate evaluation of nutritional status could be fundamental for reducing complications and prolonging the survival of ESLD patients including those undergoing liver transplantation. In addition, the interaction among nutrients, diet and genes via epigenetics has emerged as a potential target to reduce the morbidity and mortality in ESLD patients. The malnutrition induces changes in gut microbiota causing dysbiosis with a probable translocation of bacteria and/or pathogen-derived factors from the intestine to the liver. Gut microbiota contribute to the progression of chronic liver diseases as well as hepatocellular carcinoma. The administration of probiotics modulating gut microbiota could improve all chronic liver diseases.Conclusions: This review provides an update on malnutrition status linked to epigenetics and the potential benefit of some probiotics on the management of ESLD patients. In support of this view and to reveal the constant and growing interest in this field, some clinical trials are reported.

Cardiac hybrid imaging: novel tracers for novel targets

Non-invasive cardiac imaging has explored enormous advances in the last few decades.In particular,hybrid imaging represents the fusion of information from multiple imaging modalities,allowing to provide a more comprehensive dataset compared to traditional imaging techniques in patients with cardiovascular diseases.The complementary anatomical,functional and molecular information provided by hybrid systems are able to simplify the evaluation procedure of various pathologies in a routine clinical setting.The diagnostic capability of hybrid imaging modalities can be further enhanced by introducing novel and specific imaging biomarkers.The aim of this review is to cover the most recent advancements in radiotracers development for SPECT/CT,PET/CT,and PET/MRI for cardiovascular diseases.

Digital liver biopsy:Bio-imaging of fatty liver for translational and clinical research

The rapidly growing field of functional, molecular and structural bio-imaging is providing an extraordinary new opportunity to overcome the limits of invasive liver biopsy and introduce a "digital biopsy" for in vivo study of liver pathophysiology. To foster the application of bio-imaging in clinical and translational research, there is a need to standardize the methods of both acquisition and the storage of the bio-images of the liver. It can be hoped that the combination of digital, liquid and histologic liver biopsies will provide an innovative synergistic tri-dimensional approach to identifying new aetiologies, diagnostic and prognostic biomarkers and therapeutic targets for the optimization of personalized therapy of liver diseases and liver cancer. A group of experts of different disciplines(Special Interest Group for Personalized Hepatology of the Italian Association for the Study of the Liver, Institute for Biostructures and Bio-imaging of the National Research Council and Bio-banking and Biomolecular Resources Research Infrastructure) discussed criteria, methods and guidelines for facilitating the requisite application of data collection. This manuscript provides a multi-Author review of the issue with special focus on fatty liver.

Relationship between Mutations in DNA Sequences Loci Coding Pre-miRNAs and Genes Related to Biogenesis of SncRNAs with MiRNA Expression in Endometrial Carcinoma Tissues

Endometrial cancer （EC） is the most common and lethal gynaecological cancer type in Europe and in North America. Frequently EC arises more in the corpus proper and manifests as round, polypoid expansile masses, but it may also originate in the lower uterine segment or spread in endometrium with necrosis and hemorrhage. The analysis was performed using a custom panel containing all DNA sequences loci coding pre-miRNAs and genes related to biogenesis and regulation of sncRNAs in normal and tumor tissues extracted from 6 unrelated patients with endometrial carcinoma. The identified variations were correlated with mature miRNAs differentially expressed in the same normal and tumor endometrial tissues. The comparison analysis confirmed the high degree of cellular and genetic intratumoral heterogeneity with a temporal and spatial miRNA expression distribution in association with genomic variants identified. The classification of specific DNA mutations, onto the loci identified, should be suitable to characterize possible instability genome regions and help classification of tumors to ameliorate the clinical management of patients affected by endometrial carcinoma.