In the last decade tyrosine kinase inhibitors (TKIs) have been employed for a wide range of hematological and solid tumors and today they represent a valid therapeutic option for different neoplasms. Among them, both sorafenib and lenvatinib were approved for the treatment of radioactive iodine (RAI) refractory differentiated thyroid carcinoma (DTC). Unfortunately, in some cases the efficacy of TKIs is limited by the onset of drug resistance after the initial response. Areas covered: We report the case of a patient with a RAI refractory advanced DTC, treated with lenvatinib after surgery, multiple RAI administrations, traditional chemotherapy, and sorafenib. During treatment with lenvatinib, a noticeable response was detected by sequential computed tomography scans but, after 27 months, tumor progression became evident and led to lenvatinib interruption. In absence of any active treatment, a further disease progression was documented, and lenvatinib was re-administered obtaining a new objective response. Starting from this case report, we review available reports about the rechallenge with TKIs in solid tumors, discussing the possible mechanisms underlying the efficacy of this approach. Expert commentary: Rechallenge with TKIs in solid tumors could be a therapeutic option in subjects with advanced and metastatic DTC who experience a progressive disease after initial response to lenvatinib.

This was a prospective, multicenter study designed to evaluate the utility of MDCT in the diagnosis of coronary artery disease (CAD) in patients scheduled for elective coronary angiography (CA) using different MDCT systems from different manufacturers. Twenty national sites prospectively enrolled 367 patients between July 2004 and June 2006. Computed tomography (CT) was performed using a standardized/optimized scan protocol for each type of MDCT system (> or =16 slices) and compared with quantitative CA performed within 2 weeks of MDCT. A total of 284 patients (81%) were studied by 16-slice MDCT systems, while 66 patients (19%) by 64-slice MDCT scanners. The primary analysis was on-site/off-site evaluation of the negative predictive value (NPV) on a per-patient basis. Secondary analyses included on-site evaluation on a per-artery and per-segment basis. On-site evaluation included 327 patients (CAD prevalence 58%). NPV, positive predictive value (PPV), sensitivity, specificity, and diagnostic accuracy (DA) were 0.91 (95% CI 0.85-0.95), 0.91 (95% CI 0.86-0.95), 0.94 (95% CI 0.89-0.97), 0.88 (95% CI 0.81-0.93), and 0.91 (95% CI 0.88-0.94), respectively. Off-site analysis included 295 patients (CAD prevalence 56%). NPV, PPV, sensitivity, specificity, and DA were 0.73 (95% CI 0.65-0.79), 0.93 (95% CI 0.87-0.97), 0.73 (95% CI 0.65-0.79), 0.93 (95% CI 0.87-0.97), and 0.82 (95% CI 0.77-0.86), respectively. The results of this study demonstrate the utility of MDCT in excluding significant CAD even when conducted by centers with varying degrees of expertise and using different MDCT machines.

The purpose of this study was to evaluate the consequences of different choices of acquisition parameters on the actual image noise and on the patient dose with an automatic tube current modulation system. The CT investigated was a GE Lightspeed 16-slice and an anthropomorphic phantom was used to simulate the patient. Several acquisitions were made varying noise index (NI), kilovoltage and pitch values. Tube current values were compared for the different acquisitions. Patient dose was evaluated in terms of volumetric computed tomography dose index (CTDI(vol)) and also as effective dose. The noise actually present in the images was analyzed by a region of interest analysis considering representatively phantom sections in the regions of the shoulders, of the lungs and of the abdomen. The obtained results generally evidenced a good agreement between the noise index and the measured noise for the abdomen sections, whereas for the shoulders and the lungs sections the measured noise was respectively greater and lower of the NI. Varying the kV the automatic current modulation system provided images with a substantially constancy of the actual noise and of the patient dose. An increase of the pitch generally decreased the patient dose, whereas the noise was slightly greater for the lowest pitch and almost constant for the other pitch values. This study outlines some important relationships between an automatic tube current modulation system and other CT acquisition parameters, providing useful informations for the choice requested by radiologists in the task of optimization of the CT acquisition protocols. Unless there are other considerations in place, pixel pitches below 1.375 should be avoided, and kVp settings can be changed with no real impact on dose or image noise.

Tube thoracostomy is usually the first step to treat several thoracic/pleural conditions such as pneumothorax, pleural effusions, haemothorax, haemo-pneumothorax and empyema. Today, a wide range of drains is available, ranging from small to large bore ones. Indications for an appropriate selection remains yet matter of debate, especially regarding the use of small bore catheters. Through this paper, we aimed to retrace the improvements of drains through the years and to review the current clinical indications for chest drain placement in pleural/thoracic diseases, comparing the effectiveness of small-bore drains vs. large-bore ones.

Our data confirm lenvatinib efficacy in patients with advanced thyroid cancer, despite an important toxic profile.

No abstract

The vascularization of the short rectal stump is generally well represented even after total mesorectal excision.

Adaptive statistical iterative reconstruction-V is a new iterative reconstruction technique that has the potential to provide image quality equal to or greater than ASIR, with a dose reduction around 40%.